Potter & Perry cp 43- Urinary elimination Flashcards

Question

urinary diversion

Answer 1

a stoma to divert the flow of urine from the kidney directly to the abdominal surface is create for reason such as cancer, trauma, radiation injury to the bladder, fistulas, and chronic cystitis

Answer 2

involves separating a loop of intestinal ileum w/ its blood supply intact. the utterers are implanted into the isolated segment of ileum, when remaining ileum reconnected. the isolated ileal segment can then be used as a conduit for continuous urine drainage or fashioned into a continent reservoir -ontinent pouch provides urinary storage in a leak-proof pouch. A portion connected to the abdominal wall acts as a continent nipple, and intermittent catheterization is therefore needed for emptying

Answer 3

is that if urine outflow becomes obstructed, irreversible damage to the kidneys can occur secondary to chronic infections or hydronephrosis

Answer 4

bringing the end of one or both ureters to the abdominal surface -in some cases a tube may need to be placed directly into the renal pelvis to provide urinary drainage. this procedure is called a nephrostomy

Answer 5

-unprotected skin that comes in contact with urine will quickly become macerated and break down, causing pain, infection, increased hospital stays, and potential breakdown of the stoma

Answer 6

is an indirect method of cleaning the blood of waste products and excess fluid using osmosis and diffusion. The peritoneum functions as a semipermeable membrane for the procedure. A sterile electrolyte solution (dialysate) is instilled into the peritoneal cavity by gravity via a surgically placed catheter. The dialysate is left in the cavity for a prescribed time interval and then drained out by gravity

Answer 7

involves using a machine equipped with a semipermeable filtering membrane (artificial kidney) that removes accumulated waste products and excess fluids from the blood.

Answer 8

1500-1600 mL of urine daily or approx 500mL every 4h

Answer 9

volume remaining in the bladder after a void

Answer 10

- r/t poor hand hygiene - improper catheter care - faulty catherization technique

Answer 11

- flank pain usually develops if the kidneys become infected or inflamed nurse can assess for flank tenderness early in the disease by percussing the costovertebral angle (the angle formed by the spine and the twelfth rib). Auscultation is also performed to detect the presence of a renal artery bruit (sound resulting from tur- bulent blood flow through a narrowed artery)

Answer 12

painful or difficult urination

Answer 13

voiding more than eight times in 24 hours

Answer 14

difficulty initiating urination

Answer 15

voiding large amounts of urine

Answer 16

diminish urinary output relative to intake (usually 400mL in 24 hrs)

Answer 17

leakage of urine despite voluntary control of urination

Answer 18

blood in the urine

Answer 19

pelvic floor muscle strength can be digitally assessed in men by gently inserting a gloved finger into the rectum and asking the patient to squeeze around it.

Answer 20

pelvic floor muscle strength can be digitally assessed in women by gently inserting a gloved finger into the vagina. The examiner asks the patient to squeeze around the finger as firmly as possible, and then hold the contraction for up to 10 seconds

Answer 21

an hourly output of less than 30 mL for more than 2 hours is cause for concern. Similarly, consistently high volumes of urine (polyuria), over 2 000 to 2 500 mL daily, should be reported to a physician

Answer 22

Normal urine ranges from a pale, straw colour to amber, depending on its concentration. Urine is usually more concentrated in the morning or with fluid-volume deficits

Answer 23

- provide fluids 30 mins before urine collection - give pt soap, washcloth and towel to clean perineal area - clean from the urethral orifice to the back (left, right, then centre) - for men use circular motion and antiseptic swab to clean - initiate a stream, once stream is achieve, collect 30-60mL of fluid - remove specimen container before flow of urine stops and before releasing labia/penis - for men if foreskin was retracted, it must be replaced over the glans- if not swelling/constriction may occur cause pain and possible obstruction of urine flow - transport specimen to lab w/in 15-30 mins or refrigerate immediately (b/c bacteria grows quickly in urine)

Answer 24

Initial stream flushes out microorganisms that accumulate at the urethral meatus and prevents transfer into specimen

Answer 25

pH (4.6–8.0, average 6.0) -urine that stands for several hours becomes alkaline an acid pH helps protect against bacterial growth

Answer 26

not usually present | -it is seen in renal disease b/c damage to glomeruli or tubules allow protein to enter the urine

Answer 27

Diabetic patients have glucose in their urine as a result of the inability of tubules to reabsorb high glucose concentrations (180 mg/100 mL). Ingestion of high concentrations of glucose may cause some glucose to appear in the urine of healthy people

Answer 28

Patients whose diabetes mellitus is poorly controlled experience breakdown of fatty acids. Ketones are end products of fat metabolism. Patients with dehydration, starvation, or excessive aspirin usage also may have ketonuria

Answer 29

Damage to glomeruli or tubules may allow RBCs to enter the urine. Trauma, disease, or surgery of the lower urinary tract also may cause blood to be present -may also be a women's period-always check for this

Answer 30

Specific gravity measures concentration of particles in urine. High specific gravity reflects concentrated urine, and low specific gravity reflects diluted urine. Dehydration, reduced renal blood flow, and increased antidiuretic hormone (ADH) secretion elevate specific gravity. Overhydration, early renal disease, and inadequate ADH secretion reduce specific gravity.

Answer 31

indicates UTI the more presence of WBC

Answer 32

may indicate UTI. pt may or may not have symptoms

Answer 33

- sound of running water - stroking the inner thigh may stimulate sensory nerves and promote micturition reflex - you can also pour warm water of the pt's perineum to create the urge to urinate - educate pt on maintaining adequate fluid intake 1500 to 2000mL promotes continence b/c concentrated urine irritates the bladder mucosa - have them listen to music or read a book

Answer 34

-tobacco (smoker's cough aggravates stress incontinence) -alcohol (acts as a diuretic) caffeine coffee, tea, and chocolate increases frequency carbonate beverages artificial sweetness (aspartame) -constipation b/c it compresses the urethra and impede emptying (high fibre diet) -dehydration d/t concentrated urine can irritate the bladder

Answer 35

approx every 3-4 hours to maintain normal bladder capacity (400-500mL)

Answer 36

50mL | Those with consistently elevated PVRs (>100 mL) may require intermittent catheterization

Answer 37

10 minutes after the pts void -set the gender designation per manufacture guidelines- women who have had a hysterectomy should be designated as a male Palpate the patient’s symphysis pubis (pubic bone). Apply a generous amount of ultrasound gel (or, if available, a bladder scan gel pad) to the midline abdomen 2.5 to 4 cm (1 to 1.5 inches) above the symphysis pubis. The ultrasound gel ensures adequate transmission and thus accurate measurement.

Answer 38

-involves introducing a narrow tube through the urethra and into the bladder to allow in persons/ with spinal cord injury or spinal bifida

Answer 39

- a single-use straight catheter - introduced in the urethra for 5-10 minutes, just long enough to drain the bladder - straight catheter has a single lumen, w/ a small opening about 1.3 cm from the tip - urine drains from the tip, through the lumen, and into the receptacle - common in pts who have incomplete bladder emptying d/t neurogenic conditions (spinally cord injury) - catheters are washed w/ soaps and water, and left to air dry until next use - can be used to collect a sterile urine specimen but only in those who are unable to provide a midstream specimen

Answer 40

type of catheter that has a curved tip and is used in male pt w/ enlarge prostate that partly obstructs the urethra - it is less traumatic during insertion b/c it is stiffer and easier to control than the straight-tip catheter

Answer 41

- is retained for longer periods in the bladder by means of a small ballon that anchors it against the bladder neck - a blocked catheter should be changed ASAP - can either be two lumen or three lumen

Answer 42

one lumen drains urine and the other carries sterile water to inflate or deflate the ballon

Answer 43

- one lumen allows for irrigation | - is used for continuous bladder irrigation

Answer 44

after inserting an in-dwelling catheter, the nurse needs to maintain a closed urinary drainage system to minimize the risk of infection

Answer 45

- the bag can hold up to 1000 -1500mL of urine - bag should never be raised above the level of the pt's bladder - bag should hang on the bed frame or wheelchair w/out touching the floor - urine in the bag/tubing can become a medium for bacteria, and infection is likely to develop if urine flows back into the bladder - bag should never be hung on the side rails b/c it can be accidentally be raised above the level of the bladder - when pt ambulates, the drainage bag must be held below the pts waist - if catheter must be disconnected from the drainage tubing, both tips should be cleaned w/ an alcohol swab before being reconnected to minimize the transfer of microorganisms into the tubing

Answer 46

it is at the base of the bag and is used to empty the bag - should always be clamped expect during emptying, and tucked into the protective pouch on the side of the bag - to ensure that the drainage system remains obstructed the nurse should check for kinks or bends in the tubing, avoid positioning the pt on the drainage tubing, and observe for clots or sediment that may occlude the collecting tubing

Answer 47

- assess intake/output - assess bowel- abdominal distention? obstruction? (prevents passage of catheter through urethra into the bladder) - assess for allergies (including latex, shellfish) - for women- dorsal recumbent position (supine w/ knees flexed- hips externally rotated). if pt can't do this, assume a side-lying sims position w/ upper leg flexed at hip. must take extra precaution to cover the rectal area w/ drape to reduce chances of cross contamination - males-assist to supine position w/ thighs slight abducted (or Flowler's position) - provide perineal care - ensure to lubricate 2.5-5cm of catheter for women and 12.5-17.7 for men - if the labia closes during cleaning then the produce must be repeated b/c now the area is contaminated - ask pt to bear down during insertion - advance catheter 5-7cm in adult female or until urine flows out of the catheter - advance catheter 17 to 22.5 cm in adult male or until urine comes out (then advance another 2.5-5cm)

Answer 48

6-8 hrs, if they don't notice prescriber

Answer 49

- perform perineal hygiene at least twice (2-3x) daily, after a BM or as prn - ensure during perineal care not to advance the catheter upward into the bladder during cleaning as this action risks introducing bacteria into the bladder - encourage fluid intake at least 2000-2500 mL -flushes urine and keeps the catheter tubing free of sediment - observe pt for UTI symptoms

Answer 50

-irrigating the in-dwelling catheter using a triple-lumen catheter and sterile solution to maintain patency after urogenital surgery or to prevent blood clots from occulting the catheter -called CBI -occasionally the intermittent closed irrigation may be ordered if the catheter is occluded and it is deemed harmful to remove the catheter after a urological surgery -if a catheter becomes occluded by sediment and encrustation, should be changed to avoid flushing debris containing bacteria into the bladder -bladder irrigations or washouts to "unblock" such catheters that break the closed urinary drainage system risk of UTI Maintenance of a closed system is essential during continuous or intermittent irrigations and instillations.

Answer 51

-irrigating the in-dwelling catheter using a triple-lumen catheter and sterile solution to maintain latency after urogenital surgery or to prevent blood clots from occulting the catheter -called CBI -occasionally the intermittent closed irrigation may be ordered if the catheter is occluded and it is deemed harmful to remove the catheter after a urological surgery -if a catheter becomes occluded by sediment and encrustation, should be changed to avoid flushing debris containing bacteria into the bladder -bladder irrigations or washouts to "unblock" such catheters that break the closed urinary drainage system risk of UTI Maintenance of a closed system is essential during continuous or intermittent irrigations and instillations.

Answer 52

- The patient may experience some discomfort when voiding after initial removal of the catheter. Until the bladder regains full tone, the patient may experience urinary frequency or retention. Ongoing com- plaints of dysuria and frequency may indicate an infection - The patient’s urinary function is assessed by noting the first voiding after catheter removal and by documenting the time and amount of voiding during the next 24 to 48 hours. - The nurse should record the time and amount of voids, including incontinence, on a bladder record. An ultrasound bladder scanner can assist with monitoring PVR urine. If amounts are small, frequent assessment for bladder distension, abdom- inal pain, dribbling, incontinence, and any sensation of incomplete empting is necessary. If 8 hours elapse without voiding or if the patient experiences discomfort, it may become necessary to reinsert the cath- eter

Answer 53

- examine tubing for kinks, clots, or urine sediment - evaluate bladder distention - Notify prescriber if irrigant is retained, if patient complains of pain, or if bladder is distended. - Assess for shock (check vital signs, skin colour, and moisture). • -Closed intermittent—stop irrigation - Closed continuous—leave flowing - Monitor fever - obtain sterile urine specimen if ordered

Answer 54

- bright red bleeding w/ irrigation - increased cloudiness of urine, fever - increased pain - irrigating solutions doe not return or not flowing as prescribed rate, possible occlusion of catheter - if the urine is bright red/blood clots, increase irrigation rate until the drainage turns pink

Answer 55

- irrigating fluid must remain sterile - draw sterile solution into syringe using aseptic technique - avoid cold solutions =can cause discomfort and bladder spasms - clamp the in-dwelling catheter just distal to the injection (specimen) port - clear port w/ antiseptic swab - slowly inject the fluid into catheter and bladder (slow, continuous pressure reduces trauma to the bladder wall) - w/draw syringe, remove clamp, and allow solution to drain into drainage bag

Answer 56

- aseptique technique - insert top of sterile irrigation tubing into bag of sterile irrigating solution - close clamp on tubing and hang bag of solution on IV pole - open clamp and allow solution to flow through (prime) tubing, keeping the end of the tube sterile (remove air from tubing) - close clamp - wipe off irrigation port of triple-lumen catheter w/ antiseptic swab, and then attach to irrigating tubing - For intermittent flow, clamp tubing on drainage system, open clamp on irrigation tubing, and allow prescribed amount of fluid to enter bladder (100 mL is normal for adults). Close irrigation clamp and then open drainage tubing clamp - For continuous drainage, calculate drip rate and adjust clamp on irriga- tion tubing accordingly. Be sure that clamp on drainage tubing is open and check volume of drainage in drainage bag. Ensure that drainage tubing is patent, and avoid kinks - Calculate fluid used to irrigate bladder and catheter and subtract from total output

Answer 57

involves surgical placement of a catheter through the abdominal wall above the symphysis pubis and into the urinary bladder - better option for comfort, but CAUTI can still occur - catheter is anchored in place w/ sutures - long-term suprapiubic catheter users may have a Foley catheter, once the rack is healed, nurses can change this device - urine drains into a urinary drainage bag - relatively painless and reduce the incidence of infection commonly seen w/ indwelling catheters - Sediment, clots, encrustations, or the abdominal wall itself can block the suprapubic catheter. Adequate fluid intake will help minimize the risk of blockage by sediment or infection due to stagnation - nurses should also administer skin care around the insertion site

Answer 58

- suitable for incontinent or comatose men who still have complete and spontaneous bladder emptying. The condom is a soft, pliable sheath that slips over the penis. It may be worn at night only or continuously, depending on the patient’s needs - Care must be taken to ensure that whatever type or size of condom is used, blood supply to the penis is not impaired. Standard adhesive tape should never be used to secure a condom catheter because this tape does not expand with changes in penis size and is painful to remove - Condom catheters are associated with less risk of UTI, but infec- tions may result from buildup of secretions around the urethra, trauma to the urethral meatus, or buildup of pressure in the outflow tubing. Condom catheters must be applied and changed according to the manufacturers’ directions to prevent abrasion, dermatitis, ischemia, necrosis, edema, and maceration of the penis

Answer 59

- prolonged exposure of skin to urine and stool can lead to inflammation and maceration resulting in IAD - Continuous exposure of the perineal area or skin around an ostomy can also lead to gradual maceration and excoriation - Washing with pH-balanced soap and warm water or no rinse cleanser is the best way to remove urine. Body lotion keeps skin moisturized and barrier cream products help protect the skin

Answer 60

-lifestyle changes, pelvic floor muscle exercises, bladder retraining, and toileting schedules for management of urgency's stress, and mixed urinary incontience

Answer 61

improve the strength of pelvic floor muscles through hypertrophy and recruitment of additional muscle fibres associated w/ receptive contractions - These exercises are an evidence-informed treatment for stress incontinence, overactive bladders, and mixed causes of urinary incontinence - Patients begin these exercises by trying to suppress passing flatus rectally to teach them the correct muscles to contract. - hey also should be aware that it may take 12 to 16 weeks to notice appre- ciable change, but that maintaining the exercises is important in order to obtain a positive outcome.

Answer 62

- goal is to increase gradually the interval between voids and to decease voiding frequency - The first step in bladder training is establishing a baseline. The patient or caregiver completes a urinary diary to assess maximum voiding interval - Urge suppression techniques, such as counting backward from 100 when the urge to void is felt and per- forming pelvic floor muscle contractions, are helpful