NR 224: Fundamentals Exam 2 (Ch. 45 Urinary Elimination) Flashcards
Anuria
failure of the kidneys to produce urine
Potter 1045
Bacteremia
bacteria in the bloodstream
Potter 1046
Bacteriuria
bacteria in the urine
Potter 1046
Catheterization
introduction of a catheter into a body cavity or organ to inject or remove fluid
(Potter 1061)
Cystitis
irritated bladder caused by frequent & urgency of needing to void
(Potter 1047)
Diuresis
increased rate of formation & excretion or urine
Potter 1045
Dysuria
painful urination resulting from bacterial infection of the bladder & obstructive conditions of the urethra
(Potter 1047)
Erythropoietin
a hormone secreted by the kidneys that increases the rate of production of RBCs in response to decrease of O2 levels in the tissues
(Potter 1043)
Hematuria
Abnormal presence of blood in the urine
Potter 1047
Hyperactive/Overactive Bladder
common bladder complaint that occurs more frequently with aging & includes the symptoms of urgency, frequency, nocturia, urge incontinence
(Potter 1047)
Meatus
(Potter 1051)
Micturition
Urination; act of passing or expelling urine voluntarily through the urethra
(Potter 1044)
Nephron
functional unit of the kidneys, forms the urine
Potter 1043
Nephrostomy
procedure where a tube is place directly into the renal pelvis
(Potter 1047)
Nocturia
urination at night; can be a symptom of renal disease or may occur in persons who drink excessive amounts of fluids before bedtime
(Potter 1045)
Nocturnal Enuresis
nighttime voiding without awakening (bedwetting)
Potter 1049
Oliguria
decreased of urine output despite of normal intake
Potter 1045
Overflow Incontinence
bladder is overly full & bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine
(Potter 1044)
Pelvic Floor Exercises (Kegel Exercises)
(Potter 1066)
Polyuria
An excessive output of urine
Potter 1045
Proteinuria
presence of large protein in the urine (sign of glomerular injury)
(Potter 1043)
Pyelonephritis
(Potter 1047)
Reflex Incontinence
damage to the spinal cord above the sacral region -> loss of voluntary control of urination while reflex pathway is intact but no sensation of needing to void
(Potter 1044)
Renal Calculus
an obstruction within a ureter (ex: kidney stone), results in strong peristaltic wave that attempt to move the obstruction into the bladder
(Potter 1044)
Renal Replacement Therapy
treatments for those with uremic syndromes
Potter 1045
Renin
proteolytic enzyme produced by & store in the juxtaglomerular apparatus that surrounds each arteriole as it enters a glomerulus. The enzyme affects the BP by catalyzing the change of angiotensinogen to angiotensin (strong repressor).
(Potter 1043)
Residual Urine
volume of urine remaining in the bladder after a normal voiding; the bladder normally is almost completely empty after micturition
(Potter 1046)
Specific Gravity
(Potter 1053)
Stoma
artificially created opening between a body cavity & the surface of the body (ex: colostomy formed from a portion of the colon pulled thru the abdominal wall)
(Potter 1046)
Uremic Syndrome
an increase in nitrogenous wastes in the blood, marked fluid & electrolyte abnormalities, NV, HA, coma, and convulsions
(Potter 1045)
Urge Incontinence
(Potter 1047)
Urinalysis
(Potter 1053)
Urinary Diversion
(Potter 1046)
Urinary Frequency
(Potter 1049)
Urinary Incontinence
a type of urinary incontinence that results from sudden, involuntary contraction of the muscles of the urinary bladder, resulting in an urge to urinate
(Potter 1047)
Urinary Retention
retention of urine in the bladder; condition frequently caused by a temporary loss of muscle function
(Potter 1046)
Urosepsis
organisms in the bloodstream
Potter 1046
Ureters
tubular structures that enter the urinary bladder
Potter
Factors Influencing Urination
Disease Conditions, Sociocultural Factors, Psychological Factors, Fluid Balance, Surgical Procedures, Medications, & Diagnostic Examination
Alterations in Urinary Elimination
Urinary Retention, UTIs, Urinary Incontinence, & Urinary Diversions
Factors in a patient’s history that normally affect urination:
age, environmental factors, medication history, psychological factors, muscle tones, fluid balance, current surgical or diagnostic procedures, presence of disease conditions
Primary structures that need to be assess due to severity of urinary elimination problems:
skin and mucosal membranes, kidneys, bladder, & urethral meatus
(Table 45-1) Common Types of Urinary Alterations
Urgency, Dysuria, Frequency, Hesitancy, Polyuria, Oliguria, Nocturia, Dribbling, Incontinence, Hematuria, Retention, Residual Urine
Assessment of Urine involves
measuring patient’s fluid Intake/Output & observing characteristics of the urine
Characteristics of Urine
color, clarity, & odor
Types of Urine Tests
Urinalysis, Specific Gravity, Urine Culture
What are the common symptoms to urinary disturbances?
frequency, urgency, dysuria, polyuria, oliguria, incontinence, & difficulty in starting the urinary stream
When collected properly, a clean-voided urine specimen does not contain:
bacteria from the urethral meatus
Incontinence is classified as
functional, overflow, stress, urge, or total
Increases diluted urine formation that reduces the risk of urinary tract infections results an ______ fluid intake
increased
an indwelling urinary catheter that remains in the bladder for an extended period makes:
the risk for infection greater
a female patient reports that she is experiencing burning on urination, frequency, & urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The Probable cause of these symptoms & findings is:
cystitis
A male patient returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the patient to void?
suggest he stand at the bedside
Elimination changes that results from inability of the bladder to empty properly may cause what?
incontinence, frequency, urgency, urinary retention, & UTI
An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to:
have him practice Crede’s method
Since removal of the patient’s Foley catheter, the patient has voided 50 to 100mL every 2 to 3 hours. Which action should the nurse take first?
check for bladder distention
To minimize the patient experiencing nocturia, the nurse would teach him or her to:
limit fluids before bedtime
A patient with a Foley catheter carries the collection bag at waist level when ambulation. The nurse tells the patient that he or she is at risk for:
Infection & Reflux of urine
The patient is incontinent, & a condom catheter is placed. The nurse should take which action?
assess the patient for skin irritation
After a transurethral prostatectomy a patient returns to his room with a triple-lumen indwelling catheter & continuous bladder irrigation. The irrigation is normal saline at 150mL/hr. The nurse empties the drainage bag for a total of 2520mL after an 8-hour period. How much of the total is urine output?
1320mL
The nurse is planning to remove a Foley catheter at 1300. The nurse would check if the patient has voided by:
1700
The patient is to have an intravenous pyelogram (IVP). What should you do for this procedure?
Note any allergies & encourage fluids after the procedure.
The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to:
use Crede’s method
The patient states that she “loses urine” every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. The nurse recognizes the need for further teaching when the patient states:
“I drink two glasses of wine with dinner.”
The nurse notes that the patient’s Foley catheter bag has been empty for 4 hours. The priority action would be to:
check for kinks in the tubing
Renal Calculi
calcium stones in the renal pelvis
urinary elimination depends on the functions of the:
kidneys, ureters, bladder & urethra
Process of urinary elimination
kidneys remove wastes from blood to form urine -> ureters transport urine from kidneys to bladder -> bladder holds urine -> urine leaves the body thru the urethra
where are the kidneys located?
they lie on either side of the vertebral column behind the peritoneum & against the deep muscles of the back
The kidney is compose of what structures?
glomerulus, Bowman’s capsule, proximal convoluted tubule, loop of Henle, distal tubule & collecting duct
what is the normal adult urine output average?
1200-1500 mL/day
an output
possible circulatory, blood volume, or renal alterations
ischemia
decreased blood supply
angiotensinogen
a substance synthesized by the liver
In what organ is angiotensin 1 converted to angiotensin 2?
lungs
Angiotensin 2 causes
vasoconstriction & stimulates aldosterone release from the adrenal cortex
aldosterone causes _____ of water, which _______ blood volume
retention; increases
The kidneys produces what other two hormones that helps maintain renal blood flow thru vasodilation & these mechanisms increases _______ & _________.
prostaglandin E2 & prostacyclin; arterial blood pressure & renal blood flow
Bladder
hollow, distensible, muscular organ (detrusor muscle) that stores & excretes urine
trigone
a smooth triangular area on the inner surface of the bladder located at the base of the bladder
What are the brain structures that influence bladder functioning?
cerebral cortex, thalamus, hypothalamus, & brainstem
bladder capacity generally ranges from?
600-1000mL of urine
a normal adult normally void how often?
q 2-4h
Causes of overflow incontinence
head injury, spinal injury, multiple sclerosis, diabetes, trauma to the urinary system & postanesthesia sedative/hypnotics, tricyclics & analgesia
Hyperreflexia
a life - threatening problem affecting the HR & BP
What causes Hyperreflexia
overly full bladder
Disease Conditions: Prerenal
decreased blood flow to & thru the kidney
Disease Conditions: Renal
disease conditions of the renal tissue
Disease Conditions: Postrenal
obstruction in the lower urinary tract that prevents urine flow from the kidneys
Conditions of the lower urinary tract includes
narrowing of the urethra, altered innervation of the bladder, or weakened pelvic and/or perineal muscles
_______ & _________ (ex: multiple sclerosis) causes changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions
diabetes mellitus & neuromuscular diseases
Older men with benign prostatic hyperplasia (BPH) are at risk for
urinary retention & incontinence
what are the 2 methods of renal placement?
dialysis & organ transplantation
What are the 2 forms of dialysis?
peritoneal dialysis & hemodialysis
Forms of dialysis: Peritoneal dialysis-
is an indirect method of cleaning the blood of waste products using osmosis
& diffusion, with the peritoneum functioning as a semipermeable membrane
Forms of dialysis: Hemodialysis-
requires a machine equipped with a semipermeable filtering membrane (artificial kidney) that removes accumulated waste products & excess fluids from the blood
Organ transplantation
is the replacement of a patient’s diseased kidney with a healthy one from a living or cadaver donor of compatible blood & tissue type
(Box 45-1) What are some indications for Dialysis?
renal failure that can no longer be controlled by conservative management, worsening or uremic syndrome, & severe electrolyte and/or fluid abnormalities (ex: hyperkalemia & pulmonary edema)
A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is:
Cystitis (cloudy urine due to bacterial and white cells)
A male patient returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the patient to void?
suggest he stand at the bedside
Elimination changes that result from inability of the bladder to empty properly may cause:
Incontinence, Frequency, Urgency, Urinary Retention, & UTI
An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to:
Initiate Kegel exercises
Since removal of the patient’s Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first?
check for bladder distention
To minimize the patient experiencing nocturia, the nurse would teach him or her to:
limit fluids before bedtime
A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is at risk for:
Infection & Reflux of urine
The patient is incontinent, and a condom catheter is placed. The nurse should take which action?
assess the patient for skin irritation
The nurse directs the NAP to remove a Foley catheter at 1300. The nurse would check if the patient has voided by:
1700 (q4h)
The postoperative patient has difficulty voiding after surgery and is feeling “uncomfortable” in the lower abdomen. Which action should the nurse implement first?
turn on the bathroom faucet as he tries to void
The patient is to have an intravenous pyelogram (IVP). What is done during the procedure?
note any allergies & encourage fluids after the procedure
The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to:
use Credes’s method
The patient states that she “loses urine” every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. The nurse recognizes the need for further teaching when the patient states:
“I drink 2 glasses of wine with dinner.”
The nurse notes that the patient’s Foley catheter bag has been empty for 4 hours. The priority action would be to:
check for kinks in the tubing
