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NSG352 > NSG352 Urinary Elimination > Flashcards

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
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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
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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
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4
Q

What are the two functions of the urinary tract?

A

Urine formation/excretion

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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)
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6
Q

When does urine excretion occur?

A

When 250-400 mL of urine stretches/distends the bladder muscle

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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
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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18
Q

How does hypotension affect urinary elimination?

A
  • Inadequate circulating volume/heart’s ability to adequately pump blood
  • Shunting (kidneys not considered necessary)
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19
Q

How does a neurologic injury affect urinary elimination?

A
  • Can lead to incontinence
  • Neurogenic bladder can cause OAB or underactive bladder
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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
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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
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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
Q

What is polyuria? What can it be caused by?

A
  • 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
Q

What is oliguria? What is is caused by?

A
  • 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
Q

What is anuria? What is the cause?

A
  • formation/excretion of less than 100mL every 24 hrs
  • When the kidneys approach complete failure
28
Q

What is urgency? What is the cause?

A
  • 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
Q

What is frequency? What is the cause?

A
  • Voiding at frequent intervals less than 250 mL of urine
  • Increased intake
  • Infection
  • Pressure on bladder
30
Q

Frequency can be combined with __________

A

Urgency (OAB)

31
Q

What is nocturia? What is the cause?

A
  • 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
Q

What patients may experiene nocturia?

A

Heart failure patients

33
Q

What is hematuria? What is the cause?

A
  • Blood in the urine either visible (gross) or invisible (occult)
  • Infection
  • Tumors
  • Kidney stones
  • Poisoning/trauma
34
Q

What is pyuria?

A
  • Urine containing pus containing microorganisms/WBCs
  • Causes cloudy color/unpleasant odor
35
Q

What is urinary retention? What is the cause?

A
  • Inability to empty bladder
  • Loss of sensation of bladder fullness
  • Inability to relax the bladder neck/external sphincter
36
Q

What complication does urinary retention create?

A

Continuous bladder distension which can cause loss of bladder tone, hydronephrosis and bladder stasis

37
Q

Bladder stasis can cause an increased risk for ____ and ____

A

UTI and Kidney Stones

38
Q

What is urinary incontinence? What is the cause?

List the types of incontinence

A
  • 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
Q

What is enuresis? What is it also referred to at night time?

A
  • involuntary voiding when no underlying reason after the age of 4-5 years old
  • Bedwetting
40
Q

What is urinary diversion? What is is this procedure performed?

A
  • 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
Q

Describe ways to promote healthy urination

A
  • 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
Q

Describe the problems associated with urinary incontinence

A
  • 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
Q

What are some ways to manage incontinence?

A
  • Absorbent products
  • External male catheter
  • External female catheter (purewick)
44
Q

What is intermittent/straight catheterization?

A

Catheter is inserted, urine is drained and catheter is removed

45
Q

What are some benefits to intermittent/straigh catheterization?

A
  • 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
Q

List 4 indications for an indwelling catheter

A
  • 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
Q

After placing an indwelling catheter, how often should you recieve new orders on whether to keep/remove the catheter? Why is this important?

A
  • Every 24 hours
  • Used to make concious decisions on why the catheter is in place and if it is still necessary
48
Q

What is a CAUTI?

A
  • 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
Q

True/False: A CAUTI is the most common HAI

A

True! 80%

50
Q

True/False: CAUTIs are reimbursable by insurance companies

A

FALSE! They are considered preventable and CMS will not reimburse for care.

51
Q

What causes a CAUTI?

A
  • Created by a biofilm that develops on the catheter surface and leads to drug-resistant infections
52
Q

CAUTIs can lead to a ____ blood infection which can be fatal

A

Gram-negative

53
Q

Ways to prevent a CAUTI

A
  • 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
Q

What is a suprapubic catheter and what are some benefits to using one?

A
  • 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)

NSG352 (3 decks)

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