NSG352 Urinary Elimination Flashcards
1
Q
Ureters structure
A
- Smooth muscle
- Serves as passageway for urine flow from kidneys –> bladder
- Contains valves that prevent reflux of urine from bladder –> kidney
2
Q
What type of muscle is the bladder made of? Where is it found in women/men?
A
- Smooth muscle
- In front of uterus/vagina in women
- In front of rectum/above prostate in men
3
Q
- Function of the urethra
- Length of the urethra (male vs female)
- What type of muscle is the urethra made of?
A
- Exit pathway for urine
- Women: 1-2 inches
- Men: 8 inches
- External sphincter made of muscle that relaxes to release urine
4
Q
What are the two functions of the urinary tract?
A
Urine formation/excretion
5
Q
Describe the process of urine formation
A
- Filtration: begins at glomerulus, renal arteries bring blood flow to the glomerulus of each nephron. That fluid is then filtered from the flomerulus into Bowmans capsule & is called the glomerular filtrate
- Reabsorption: the tubule actively/passively reabsorbs substances that the body wants to retain (water, glucose, amino acids, K+, Na+, Cl-, and bicarbonate. 99% is reabsorbed, the other 1% is unabsorbed and formed as urine.
- Secretion: the tubules secrete some substances to rid them from the body (hydrogen, potassium ions, ammonia, creatinine, urinc acid, and other metabolites)
6
Q
When does urine excretion occur?
A
When 250-400 mL of urine stretches/distends the bladder muscle
7
Q
Urine excretion involves __________ involvement; an involuntary reflex. How could this cause issues with excretion?
A
- Sacral spinal cord involvement
- If a patient has a spinal cord injury, they could have an issue with involuntarily excreting urine
8
Q
Adults need a minimum of how many mL/hr of output? What if it is below this number?
A
- 30 mL/hr
- Could show kidney damage
9
Q
Characteristics of Urine
A
- Volume
- Color
- Clarity
- Odor
- pH
- Specific Gravity (1.010-1.025)
- Protein, glucose, and ketone bodies (dont want)
- Red/white blood cells, casts, crystals, and bacteria (dont want)
10
Q
How does fluid intake affect urinary elimination? What hormone controls volume?
A
- Increased intake = increased output
- Volume hormonally controlled by ADH secreted by the posterior pituitary
11
Q
How does loss of body fluid affect urinary elimination?
A
- With large volume loss, the kidneys increase reabsorption of water from the glomerular filtrate to maintain proper osmolarity in ECF
- Increased loss of body fluids can consist of: vomiting, diarrhea, excessive diaphoresis/wound drainage/extensive burns or blood loss
12
Q
How does diet affect urinary elimination?
A
- Foods high in water content will increase urine output
- Salty food without increase in water intake will decrease urine output
- Consumption of alcohol/caffine irritate the bladder & contain a diuretic which can result in increased urine output
13
Q
How does a persons body position affect urinary elimination?
A
- Sitting for women
- Standing for men
- Inability to maintain that position can result in an inability to void/empty the bladder completely
14
Q
How does cognition affect urinary elimination?
A
- Influences urinary continence
- Includes: stroke, dementia, and brain tumors that reduce ability to percieve bladder fullness
- Medications/illnesses that cause confusion can influence urinary continence
15
Q
What psychological factors affect urinary elimination?
A
- Hearing/thinking about voiding can cause you to void
- Stress/anxiety can cause an increased need to void/urinary retention
16
Q
What causes urinary obstruction? How does an obstruction of urine flow affect urinary elimination?
A
- Tumors/renal stones can obstruct outflow of urine
- When urine is produced & cannot be released from the kidneys can result in kidney distension AKA hydronephrosis
- Urinary stasis allows stagnant urine an opportunity for microorganism growth
17
Q
How do infections of the urinary tract affect urinary elimination?
A
- UTI caused by microorganisms from the GI tract (E.coli, Klebsiella and Proteus)
- Women more prone than men because of their shortened urethra
- Patients with indwelling catheters are at high risk of CAUTI
18
Q
How does hypotension affect urinary elimination?
A
- Inadequate circulating volume/heart’s ability to adequately pump blood
- Shunting (kidneys not considered necessary)
19
Q
How does a neurologic injury affect urinary elimination?
A
- Can lead to incontinence
- Neurogenic bladder can cause OAB or underactive bladder
20
Q
What causes the muscles of the urinary tract to weaken? How does this affect urinary elimination?
A
- Can weaken due to obesity, multiple pregnancies, menopausal atrophy and chronic constipation
- Continuous bladder draining with an indwelling catheter can cause decreased muscle tone due to the prevention of bladder stretching
21
Q
How can pregnancy affect urinary elimination?
A
- Increasing size/weight causes pressure on the bladder
- Can create need to frequently empty the bladder but also obstruction of urinary flow causing incomplete emptying of bladder
- Pregnancy hormones also create changed to the urinary tract and increase risk of UTI
22
Q
How can surgery affect urinary elimination?
A
- Should be able to void after 8 hours
- Causes include volume deficiency after surgery, stress (triggers ADH), position restrictions (bedrest), anesthesia, spinal/regional nerve blocks, impact/trauma of urinary system structures depending on surgery
23
Q
How can medications affect urinary elimination?
A
- Diuretics: increase urine output through reabsorption of sodium/water in the tubules of the nephron
- Cholinergics: stimulate contraction of the detrusor muscle, may be given to promote voiding
- Oxybutynin/tolerodine: used to treat urinary urgency/frequency (OAB)
- Tricyclics/antihistamines: risk urinary retention due to anticholinergic effects, caution in elderly
- Opiods: decrease GFR and sensation of bladder fullness
- Some medications cause urine color changes
24
Q
What is dysuria? What may it be associated with?
A
- Painful voiding
- UTI, bladder inflammation, trauma to urethra
25
What is polyuria? What can it be caused by?
* Formation/excretion of excessive amounts of urine (more than 2500-3500 mL in 24 hrs
* Untreated diabetes insipidous
* Hyperglycemia
* Comsumption of diuretics (caffine/alcohol)
26
What is oliguria? What is is caused by?
* Formation/excretion of decreased amounts of urine (less than 500 mL in 24 hrs)
* Fluid volume deficit
* Excessive loss of body fluids
* Renal disease
27
What is anuria? What is the cause?
* formation/excretion of less than 100mL every 24 hrs
* When the kidneys approach complete failure
28
What is urgency? What is the cause?
* Subjective feeling of being unable to delay voiding when it contains 250-400 mL of urine
* Inflammation/infection
* Incomlete urethral sphincter
* Weakened perineal muscles
* Psychological stress
29
What is frequency? What is the cause?
* Voiding at frequent intervals less than 250 mL of urine
* Increased intake
* Infection
* Pressure on bladder
30
Frequency can be combined with __________
Urgency (OAB)
31
What is nocturia? What is the cause?
* Voiding during normal sleeping hours
* Consuming too much fluid, alcohol, or caffine too close to bedtime
* Positioning while sleeping (increases blood flow to kidneys which increases GFR and urine output)
32
What patients may experiene nocturia?
Heart failure patients
33
What is hematuria? What is the cause?
* Blood in the urine either visible (gross) or invisible (occult)
* Infection
* Tumors
* Kidney stones
* Poisoning/trauma
34
What is pyuria?
* Urine containing pus containing microorganisms/WBCs
* Causes cloudy color/unpleasant odor
35
What is urinary retention? What is the cause?
* Inability to empty bladder
* Loss of sensation of bladder fullness
* Inability to relax the bladder neck/external sphincter
36
What complication does urinary retention create?
Continuous bladder distension which can cause loss of bladder tone, hydronephrosis and bladder stasis
37
Bladder stasis can cause an increased risk for ____ and ____
UTI and Kidney Stones
38
What is urinary incontinence? What is the cause?
| List the types of incontinence
* Involuntary loss of urine from the bladder
* Stress incontinence: increased abdominal pressure (sneezing, coughing)
* Urge incontinence: random involuntary urination after a strong urge to void
* Reflex incontinence: casued by a spinal cord injury, occuring at regular intervals
* Functional incontinence: inability to reach the bathroom in time to void
* Total incontinence: continuous, involuntary, unpredictable loss of urine from a nondistended bladder
39
What is enuresis? What is it also referred to at night time?
* involuntary voiding when no underlying reason after the age of 4-5 years old
* Bedwetting
40
What is urinary diversion? What is is this procedure performed?
* A surgical procedure in which the normal pathway of urine elimination is altered
* Can be associated with bladder cancer or surgical removal (cystectomy)
* The ureters are implanted into the distal segment of the small intestine (ileum) and is brought out of the abdomen creating a stoma (ileostomy)
41
Describe ways to promote healthy urination
* Promote scheduled voiding
* Pelvic floor exercises for women (keegal)
* Promote fluid intake avoiding caffine/alcohol
* Practice hand hygeine, cleaning front to back, and voiding after intercourse to prevent a UTI
* Prevent constipation
42
Describe the problems associated with urinary incontinence
* Increased risk of skin breakdown
* Ammonia (a metabolite of urine) irritates the skin
* Constant moisture/soaking contributes to maceration
* Constant moisture increases the risk for pressure injuries
43
What are some ways to manage incontinence?
* Absorbent products
* External male catheter
* External female catheter (purewick)
44
What is intermittent/straight catheterization?
Catheter is inserted, urine is drained and catheter is removed
45
What are some benefits to intermittent/straigh catheterization?
* As an alternative for patients with urinary retention/continence
* Less risk for infection (UTI) than an indwelling catheter
* Perineal care/sterile technique should be used
46
List 4 indications for an indwelling catheter
* Monitoring critically/acutely ill patients when accurate urinary output is necessary
* Management of terminally/severely ill patients (palliatative/comfort care)
* Urinary retention not manegable by intermittent catheterization or other means (bladder scan). Includes: inability to ambulate, prostate enlargement, post op anesthesia, and the inability to release urine
* Management of urinary incontinence in patient with stage 3-4 pressure injuries on the trunk
47
After placing an indwelling catheter, how often should you recieve new orders on whether to keep/remove the catheter? Why is this important?
* Every 24 hours
* Used to make concious decisions on why the catheter is in place and if it is still necessary
48
What is a CAUTI?
* Catheter Associated Urinary Tract Infection
* A UTI that develops when an indwelling catheter is in place longer than 2 days prior to the onset of infection
49
True/False: A CAUTI is the most common HAI
True! 80%
50
True/False: CAUTIs are reimbursable by insurance companies
FALSE! They are considered preventable and CMS will not reimburse for care.
51
What causes a CAUTI?
* Created by a biofilm that develops on the catheter surface and leads to drug-resistant infections
52
CAUTIs can lead to a ____ blood infection which can be fatal
Gram-negative
53
Ways to prevent a CAUTI
* Evaluate alternatives and remove as soon as it is no longer indicated
* Quality perineal care prior to insertion
* Use of sterile technique when inserting
* Perineal/catheter care at least BID and with fecal incontinence
* Proper catheter securement (Stat Lock)
* Keep drainage bag below bladder and empty with any transport
* Care when emptying drainage bag (using an alcohol pad to clean tip of tube)
54
What is a suprapubic catheter and what are some benefits to using one?
* Surgically iserted above the pubic bone into the bladder
* Used for muscular dysfunction, chronic retention, or spinal cord injury
* Decreased risk of infection (no pathogens from GI tract)
