NSG352 Urinary Elimination Flashcards
Ureters structure
- Smooth muscle
- Serves as passageway for urine flow from kidneys –> bladder
- Contains valves that prevent reflux of urine from bladder –> kidney
What type of muscle is the bladder made of? Where is it found in women/men?
- Smooth muscle
- In front of uterus/vagina in women
- In front of rectum/above prostate in men
- Function of the urethra
- Length of the urethra (male vs female)
- What type of muscle is the urethra made of?
- Exit pathway for urine
- Women: 1-2 inches
- Men: 8 inches
- External sphincter made of muscle that relaxes to release urine
What are the two functions of the urinary tract?
Urine formation/excretion
Describe the process of urine formation
- 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)
When does urine excretion occur?
When 250-400 mL of urine stretches/distends the bladder muscle
Urine excretion involves __________ involvement; an involuntary reflex. How could this cause issues with excretion?
- Sacral spinal cord involvement
- If a patient has a spinal cord injury, they could have an issue with involuntarily excreting urine
Adults need a minimum of how many mL/hr of output? What if it is below this number?
- 30 mL/hr
- Could show kidney damage
Characteristics of Urine
- 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)
How does fluid intake affect urinary elimination? What hormone controls volume?
- Increased intake = increased output
- Volume hormonally controlled by ADH secreted by the posterior pituitary
How does loss of body fluid affect urinary elimination?
- 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
How does diet affect urinary elimination?
- 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
How does a persons body position affect urinary elimination?
- Sitting for women
- Standing for men
- Inability to maintain that position can result in an inability to void/empty the bladder completely
How does cognition affect urinary elimination?
- 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
What psychological factors affect urinary elimination?
- Hearing/thinking about voiding can cause you to void
- Stress/anxiety can cause an increased need to void/urinary retention
What causes urinary obstruction? How does an obstruction of urine flow affect urinary elimination?
- 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
How do infections of the urinary tract affect urinary elimination?
- 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
How does hypotension affect urinary elimination?
- Inadequate circulating volume/heart’s ability to adequately pump blood
- Shunting (kidneys not considered necessary)
How does a neurologic injury affect urinary elimination?
- Can lead to incontinence
- Neurogenic bladder can cause OAB or underactive bladder
What causes the muscles of the urinary tract to weaken? How does this affect urinary elimination?
- 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
How can pregnancy affect urinary elimination?
- 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
How can surgery affect urinary elimination?
- 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
How can medications affect urinary elimination?
- 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
What is dysuria? What may it be associated with?
- Painful voiding
- UTI, bladder inflammation, trauma to urethra
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)
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
What is anuria? What is the cause?
- formation/excretion of less than 100mL every 24 hrs
- When the kidneys approach complete failure
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
What is frequency? What is the cause?
- Voiding at frequent intervals less than 250 mL of urine
- Increased intake
- Infection
- Pressure on bladder
Frequency can be combined with __________
Urgency (OAB)
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)
What patients may experiene nocturia?
Heart failure patients
What is hematuria? What is the cause?
- Blood in the urine either visible (gross) or invisible (occult)
- Infection
- Tumors
- Kidney stones
- Poisoning/trauma
What is pyuria?
- Urine containing pus containing microorganisms/WBCs
- Causes cloudy color/unpleasant odor
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
What complication does urinary retention create?
Continuous bladder distension which can cause loss of bladder tone, hydronephrosis and bladder stasis
Bladder stasis can cause an increased risk for ____ and ____
UTI and Kidney Stones
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
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
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)
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
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
What are some ways to manage incontinence?
- Absorbent products
- External male catheter
- External female catheter (purewick)
What is intermittent/straight catheterization?
Catheter is inserted, urine is drained and catheter is removed
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
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
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
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
True/False: A CAUTI is the most common HAI
True! 80%
True/False: CAUTIs are reimbursable by insurance companies
FALSE! They are considered preventable and CMS will not reimburse for care.
What causes a CAUTI?
- Created by a biofilm that develops on the catheter surface and leads to drug-resistant infections
CAUTIs can lead to a ____ blood infection which can be fatal
Gram-negative
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)
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)
