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Skills Lecture > skills lecture 5 > Flashcards

skills lecture 5 Flashcards

1
Q

sterile technique

A

also known as surgical asepsis, prevents contamination of an area

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2
Q

WHAT ARE THE STEPS OF APPLYING STERILE GLOVES

A

-open outer wrapper
-open inner glove package on work surface
-pick up glove at cuff and insert fingers while pulling gloveover hand
-pick up other glove inside cuff
-pull on both hands properly

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3
Q

LOWER UTIs

A

CYSTITIS
BLADDER AND URETHRA AFFECTED

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4
Q

SYMPTOMS OF LOWER UTI

A

Suprapubic tenderness
Urinary Issues:
Dysuria
Urgency
Frequency
Incontinence
Foul-smelling cloudy urine

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5
Q

UPPER UTI

A

Pyelonephritis
Kidneys affected along with bladder & urethra
If a lower UTI is not treated appropriately, bacteria will travel superior to kidneys

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6
Q

UPPER UTI SIGNS AND SYMPTOMS

A

Signs and symptoms
() Those of a Lower UTI
CVA Tenderness
Systemic Issues:
Fever
Chills

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7
Q

SYSTEMIC SYMPTOM OF UPPER UTI

A

FEVER
CHILLS

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8
Q

LOCALIZED SYMPTOMS OF UPPER UTI

A

CVA TENDERNESS

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9
Q

PREVENTIONS MEASURES OF UTI

A

ENCOURAGE FLUIDS
DONT HOLD URINE
PROPER PERI CARE

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10
Q

STRESS INCONTINENCE

A

Involuntary urine loss from increasing abdominal pressure

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11
Q

Urge Incontinence

A

-STRONG URGE AND UNABLE TO MAKE IT TO THE BATHROOM IN TIME
-Most common type of incontinence in older adults

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12
Q

Functional Incontinence

A

Incontinence due to inability to get to the bathroom;
- physical limitations,
-loss of memory (progressed dementia),
-disorientation
-DEPENDANT ON OTHERS

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13
Q

OVERFLOW INCONTINENCE

A

Involuntary loss of urine associated with bladder distention; may occur due to prostate enlargement

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14
Q

TOTAL INCONTINENCE

A

-Continuous LOSS OF URINE
-Unpredictable Loss of Urine
-Neurological impairement,
-surgery,
-trauma

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15
Q

WHAT DO NURSES NEED TO DO WHEN A RESIDENT IS INCONTINENT?

A

-Keep patient clean and dry
-Ask patient about needing to use bathroom
-Skin on buttocks and perineal area may become reddned and irritated, monitor for skin breakdown
-Assess for signs and symptoms of a UTI

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16
Q

the inability to empty the bladder completely during attempts to void

A

URINARY RENTENTION

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17
Q

ACUTE URINARY RETNETION CAN BE CAUSED BY WHAT

A

Anesthesia,
Medications,
Local Trauma to Urinary Structures

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18
Q

CHRONIC URINARY RETENTION CAN BE CAUSED BY WHAT

A

-Enlarged Prostate MALES ONLY
-Medications,
-Strictures,
-Tumors

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19
Q

Pattern of Urination WHEN ASSESSING PT

A

Frequency
Time of day
Amount

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20
Q

Focused Urinary Assessment Questions

A

Urinate more than usual?
Pain or burning upon urination?
Changes in color of urine? Any blood? Dark Tea-Like color? Cloudy? (Hematuria, Infection)
Difficulty starting or maintaining the stream of urine?
Changes in characteristics of urine? Peeing Less or More? (Polyuria, Oliguria)
Feel like the bladder is still full after you urinate?
Dribbling of urine occur after urinating?
Continent? Incontinent?

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21
Q

NOCTURIA

A

GOING TO THE BATHROOM AT NIGHT

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22
Q

DYSURIA

A

PAIN WITH URINATION

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23
Q

DARK URINE INDICATES WHAT?

A

DEHYDRATION

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24
Q

HEMATURIA

A

BLOOD IN THE URINE

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25
Q

POLYURIA

A

EXCESSIVE URINE PRODUCTION

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26
Q

OLIGURIA

A

SCANT URINE PRODUCTION

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27
Q

PHYSICAL ASSESSMENT OF URINARY TRACT ISSUES KIDNEY

A

PALPATE LOWER BACK FOR KIDNEY PAIN
CVA

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28
Q

PHYSICAL ASSESSMENT OF URINARY TRACT ISSUES BLADDER

A

PALPATE FOR BLADDER ON ABDOMIN FOR BLADDER DISTENTION

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29
Q

PHYSICAL ASSESSMENT OF URINARY TRACT ISSUES PERINEAL

A

LOOK AT SKIN
External genitalia and urethral meatus

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30
Q

CVA TENDERNESS TEST

A

Place flat palm over kidney
With the other hand, make a first and thumb your hand currently resting over the kidney
If patient reports pain or discomfort, CVA tenderness is present

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31
Q

Laboratory Tests to Assess Kidney Function

A

BUN - NORAML 10-20, CRITICAL >100 COULD BE ELEVATED IF CONSUMING A HIGH PROTEIN DIET , SPECIFIC TO KIDNEY
Creatinine - NORAML 0.6-1.2, CRITICAL >4. , SPECIFIC TO KIDNEY
eGFR - >60 NORMAL, SERUM TEST TESTED WITH THE BLOOD. BEST SERUM TEST TO DETERMINE KIDNEY FUNCTION
24 hour urine - NUMBER 1 WAY TO DETERMINE KIDNEY FUNCTION
Creatinine Clearance

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32
Q

BUN NORMAL CRITICAL

A

NORAML 10-20, CRITICAL >100 COULD BE ELEVATED IF CONSUMING A HIGH PROTEIN DIET

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33
Q

BEST SERUM TEST FOR KIDNEY FUNCTION

A

EGFR

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34
Q

NUMBER 1 WAY TO DETERMINE KIDNEY FUNCTION

A

24 HOUR URINE
CREATINE CLEARANCE - COLLECTED WITH THE URINE WITHIN 24 HOURS

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35
Q

CREATININE

A

NORMAL 0.6-1.2, CRITICAL >4. , SPECIFIC TO KIDNEY

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36
Q

WAYS TO COLLECT URINE FOR A UA

A

Midstream Collection
Straight catheterization
Indwelling catheter specimen
About 10 mL of urine collected

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37
Q

URINALYSIS

A

Common test, performed to assess urinary system, kidneys, systemic disease

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38
Q

URINE CULTURE AND SENSITIVITY

A

Usually collected with urinalysis
Ensure urine specimen collected before antibiotic given
Urine culture identifies organisms present; usually bacteria
Urine sensitivity test determines antibiotic that will destroy bacteria

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39
Q

24 HOUR URINE COLLECTION RULES

A

Start at 0800 (or per policy), discard the very first void
Save all urine for 24 hours, keeping it on ice

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40
Q

HOW TO COLLECT A MIDSTREAM URINE SAMPLE

A

Patient urinates in a sterile cup: midstream collection
Educate appropriately!
Instruct patient to clean perineal area with cleansing cloth
Clean front to back
Females: hold labia open entire time (while cleaning and during urination process)
Begin urine stream into toilet
Stop urine stream and place cup under urethral opening
Begin urine stream into cup (this is a midstream collection)
After cup is filled, continue urine stream into toilet

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41
Q

WHAT DO YOU NEED TO PUT ON THE CUP WHEN COLLECTING URINE SAMPLE

A

DATE
TIME
INITIALS

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42
Q

NORMAL URINE CHARACTERISTICS: AMOUNT

A

1,000 to 2,000 mL/24 Hours
Should be no less than 30-40 mL/hr is concerning, possible kidney injury

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43
Q

NORMAL URINE CHARACTERISTICS: COLOR

A

STRAW
AMBER

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44
Q

NORMAL URINE CHARACTERISTICS: CLARITY

A

CLEAR

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45
Q

NORMAL URINE CHARACTERISTICS: SPECIFIC GRAVITY

A

1.005 to 1.030
Lower = Dilute urine (more fluid than waste)
Higher = Concentrated (more waste than fluid)

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46
Q

NORMAL URINE CHARACTERISTICS: PH

A

4.5-8.0

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47
Q

NORMAL URINE CHARACTERISTICS: CONSTITUENTS

A

95% Water
Waste Products: Urea, Creatinine, Uric Acid

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48
Q

URANALYSIS TESTS YOU NEED TO KNOW

A

ph, specific gravity, protein, glucose, bilirubin, nitrite, leukocyte esterase, rbc, wbc

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49
Q

HOW DO WE ENCOURAGE PTS TO VOID

A

-PROPER POSITION
-ADEQUATE FLUID INTAKE
-WATER SOUNDS
-MAINTING ELIMINATION HABITS

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50
Q

HOW DO WE PROMOTE COMPLETE BLADDER EMPTYING?

A

PROVIDE PRIVACY

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51
Q

WHAT IS A URINARY CATHETER?

A

A pliable tube that is placed through the urethral open into the bladder to drain urine
Urinary catheters are always placed using sterile technique

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52
Q

Why would a health care provider insert an indwelling catheter?

A

Urinary obstruction
Urinary retention
Strict intake & output necessary
Coma
Surgery & Anesthesia
Urinary incontinence with skin breakdown/wounds

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53
Q

Why would a health care provider insert an intermittent catheter?

A

Urine sample necessary
Patient unable to provide clean-catch
Urine retention present, drain bladder and then attempt to see if patient can void on own

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54
Q

IF A RESIDENT HAS RED AREAS ON BUTTOCKS, GENITALS OR LEGS WHAT WOULD THE NURSE DO?

A

MAKE SURE THEY STAY CLEAN AND DRY TO AVOID SKIN BREAKDOWN

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55
Q

Catheter sizes

A

Measured in French
12 French, 14 French, 16 French, 18 French
Larger the number, the larger the diameter
The catheter sizing is located on the catheter tubing

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56
Q

TYPICAL SIZE OF INDWELLING CATH IS?

A

12 AND 14 FRENCH

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57
Q

HOW TO DOCUMENT CATH INSERTION

A
  • CATH SIZE
    -BALLOON FLUID AMOUNT
    -STERILE TECHNIQUE USED
  • position
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58
Q

SIGNS OF INFECTION OF SUPRAPUBIC CATH

A

SWELLING
REDNESS
TENDERNESS
FEVER CHILLS
ODOR
DRAINAGE

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59
Q

INDWELLING CATH INSERTION

A

-OPEN STERILE KIT
-OPEN STERILE GLOVES
-PREPARE STERILE AREA
-MOVE KIT TO A WORK AREA (BETWEEN LEGS)
-RESTART STERILE PROCEDURE IF STERILE FIELD IS BROKEN
-MALE URETHRA CLEAN IN CIRCULAR MOTION
-FEMALE URETHRA CLEANING
-NON DOMINANT TO HOLD OPEN LABIA-NOW NOT STERILE
-WITH DOMINANT HAND YOU WILL INSERT CATH
- MAKE SURE CATH IS SECURE IN HAND
-INSERT CATH UNTIL YOU SEE URINE RETURN
-ADVANCE CATH ONE TO TWO MORE INCHES
-INFLATE BALLOON
- SECURE BAG TO LEG OR NONMOVABLE PART OF THE BED
-MAKE SURE THERE ARE NO KINKS IN THE TUBING
-WANT THERE TO BE SOME SLACK SO WE DONT CAUSE TUGGING

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60
Q

HOW FAR DO YOU NEED TO INSERT CATH FOR MALES?

A

7-8 INCHES
GO ALL THE WAY TO BIFORCATION?

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61
Q

HOW FAR DO YOU INSERT CATH FOR WOMEN?

A

2-3 INCHES

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62
Q

WHERE DO YOU PUT CATH BAG AFTER INSERTION

A

ON A NON MOVABLE PART OF THE BED LOWER THAN THE BLADDER

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63
Q

WHAT DO YOU DO AFTER CATH INSERTION?

A

DOCUMENT THE PROCEDURE
NOTE THE COLOR OF URINE AND PRESENCE OF URINE

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64
Q

CATH TROUBLE SHOOTING FOR WOMEN NO RETURN

A

-Leave the catheter in the vagina as a landmark
-May not have urine in bladder
-Leave catheter in place and perform bladder scan

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65
Q

CATH TROUBLE SHOOTING FOR MEN RESISTANCE

A

Hold in place for a moment to see if prostate & sphincter will relax and then attempt to advance catheter
If resistance occurs when inflating balloon, deflate balloon and insert catheter further

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66
Q

TROUBLE SHOOTING CATH FOR PAIN

A

If pain occurs when inflating balloon, stop, deflate balloon and insert catheter further

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67
Q

TROUBLE SHOOTING FOR CATH WITH BLEEDING

A

Bleeding may occur after insertion due to local trauma
Notify provider and document, continue to assess urine

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68
Q

TROUBLE SHOOTING FOR CATH WITH Leakage around catheter

A

Catheter diameter may not be large enough, insert larger catheter

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69
Q

TROUBLE SHOOTING FOR CATH WITH UNABLE TO INSERT IN URETHRA

A

Do not force, contact urology

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70
Q

how do you collect a urine sample from an indwelling cath

A

-collect sample from foley cath tubing
-cleanse hub of port prior to connecting syringe and collect sample
-may need to kink tubing distal to port to collect urine
-never collect from drainage bag

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71
Q

REMOVING INDWELLING CATH

A
  1. Hand hygiene, don gloves
  2. Release catheter from stabilization device
  3. Drain all urine from tubing and bag
  4. Bring bag to bed, place on disposable pad
  5. Secure catheter at urethra with non dominant hand
  6. Connect syringe to port to empty water from balloon
    Ensure you empty all water from balloon
    How do you know how much water is in the balloon?
  7. Inform patient to take a deep breath in and out, slowly remove catheter
  8. Inspect tip to ensure it is intact
    9.Provide perineal care
  9. Discard all supplies
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72
Q

DOCUMENTATION FOR CATH REMOVAL

A

-HOW MUCH FLUID AND CHARACTERISTICS OF FLUID
-DOCUMENT CATH INTACT
-DOCUMENT YOU PROVIDED PERI CARE
**DOCUMENT IN THE ORDER YOU DID IT IN

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73
Q

HOW LONG AFTER REMOVAL SHOULD THEY VOID AND WHAT PROBLEMS CAN OCCUR AFTER REMOVAL

A

-4-6 HOURS TO VOID AFTER REMOVAL
-IF VOIDING IN SMALL AMOUNTS THEY COULD BE RETAINING URINE

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74
Q

PATIENT EDUCATION AFTER REMOVAL OF CATH

A

-fluid intake
-voiding after removal
-urine retention
-infection

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75
Q

Sterility is

A

the absence of viable life that has the potential to reproduce and spread dangerous and disease-causing germs and bacteria

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76
Q

if the object or area is touched by any object that is not sterile what is is considered?

A

contaminated

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77
Q

sterile technique also known as asepsis prevents contamination of what kind of areas?

A

-open wounds
-isolates and operative or procedural areas from unsterile environment
-maintains sterile field for surgery or procedural intervention

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78
Q

where is sterile technique most often used?

A

operating room

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79
Q

other than the operating room, when should sterile technique be used?

A

when performing any procedure that could introduce microbes into a patient

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80
Q

how will you know if sterile technique should be used?

A

there will be an order placed for sterile technique with the order for the procedure

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81
Q

If you break sterile technique what should you do?

A

start over

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82
Q

sterile sites include:

A

organs
central vascular system
bone or bone marrow
cerebrospinal fluid
pericardial fluid
peritoneal fluid
pleural fluid
joint fluid

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83
Q

what is not a sterile site?

A

passageways that are open to the outside

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84
Q

examples of sites that are not sterile

A

-nasal passage
-throat
-sputum
-esophagus/stomach
-rectum
-vagina
-skin
-local soft tissue infections
-abscesses

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85
Q

what organs require sterile technique

A

-heart
-brain
-gallbladder
-kidney
-pancreas
-ovary
-nodes
-spleen
-liver

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86
Q

medical asepsis is referred to what

A

clean technique

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87
Q

medical asepsis _______ the number of pathogens

A

reduces

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88
Q

surgical asepsis ________ all pathogens

A

eliminates

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89
Q

medical asepsis is used in administration of:

A

-medications
-enemas
-tube feedings
-daily hygiene

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90
Q

what is the number one way medical asepsis is used:

A

hand hygiene

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91
Q

surgical asepsis is also know as what

A

sterile technique

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92
Q

what is surgical asepsis/sterile technique used in?

A

-dressing changes
-catheterizations
-surgical procedures

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93
Q

principles of surgical asepsis

A

1.A sterile object remains sterile only when touched by another sterile object.This principle guides a nurse in placement of sterile objects and how to handle them.
2.Only sterile objects may be placed on a sterile field.
3.A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated.
4.The edges of a sterile field or container are considered to be contaminated.

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94
Q

sterile touching sterile remains _______

A

sterile

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95
Q

sterile touching cleans becomes ________

A

contaminated

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96
Q

sterile touching contaminated becomes ________

A

contaminated

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97
Q

sterile state is ________

A

questionable

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98
Q

what type of objects can be placed in the sterile field?

A

all items that are properly sterilized before use

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99
Q

where are sterile objects stored?

A

clean, dry storage area

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100
Q

if a package containing sterile items are punctured, wet, torn, or open they are considered what?

A

unsterile

101
Q

is the outside of a sterile package considered sterile?

A

no

102
Q

what position should you be in when your sterile field is prepared?

A

facing sterile field with hands above waist and below shoulders
never turn back to sterile field

103
Q

what are ways you can break sterile with clothing?

A

a piece of clothing dangling over sterile field

104
Q

how big is the border around the sterile field when placing a drape down that is considered contaminated?

A

1 inch

105
Q

the edges of sterile containers become exposed to air after they are opened and then considered what?

A

contaminated

106
Q

when performing sterile procedures you need a:

A

sterile work area

107
Q

a sterile field is an area free of ________ and prepared to receive _______ items

A

microorganisms, sterile

108
Q

what can you use to transfer sterile items to a sterile field?

A

sterile forceps
sterile gloves

109
Q

what can you use to prepare a sterile field on?

A

inner surface of a sterile wrapper
sterile drape
dressing tray

110
Q

when transferring items that are not in a sterile kit the sterile gloves you are wearing cannot what?

A

touch the wrappers of the sterile items you need to open

111
Q

what should you do before opening a sterile kit?

A

wash hands

112
Q

what is a nurses role in urinary elimination?

A

assess patients urinary tract functions and provide support for bladder emptying

113
Q

urinary elimination can be compromised by what?

A

illness and conditions

114
Q

organs of urinary elimination

A

kidneys
ureters
bladder
urethra

115
Q

filtering blood through nephrons to make urine and many other functions

A

kidneys

116
Q

transport urine from the kidneys to the bladder

A

ureters

117
Q

reservoir for urine until the urge to urinate develops

A

bladder

118
Q

where urine exits the body

A

urethra

119
Q

kidney functions

A

-formation of urine
-Acid-base balance
-excretion or conservation of Water
-Electrolyte balance
-excrete bacterial Toxins, water-soluble drugs, and drug metabolites
-regulate Blood pressure via renin-angiotensin-aldosterone system (RAAS)
-production of Erythropoietin
-activation of vitamin D

120
Q

kidney function acronym

A

a wet bed

121
Q

cysto-

A

bladder

122
Q

temporary storage of urine and its elimination

A

bladder

123
Q

smooth muscle _______ during bladder filling and _______ with emptying

A

expands, contracts

124
Q

what prevents reflux of urine from bladder traveling to ureter

A

sphincter

125
Q

length of female urethra

A

2 - 3 inches

126
Q

length of male urethra

A

7 to 8 inches

127
Q

who is more prone to UTIs and why

A

females because the urethra is shorter

128
Q

A patient with a long-standing history of diabetes mellitus is voicing concerns about kidney disease. The patient asks the nurse where urine is formed in the kidney. The nurse’s response is the:
A. bladder.
B. kidney.
C. nephron.
D. ureter.

A

c nephron

129
Q

other than urinary organs what plays a big role in bladder function?

A

the brain

130
Q

where is the micturition center?

A

sacral spinal cord

131
Q

stretching of the bladder wall signals the what?

A

micturition center in the sacral spinal cord

132
Q

the brain either responds or ignores impulse from the micturition center when the bladder fills making urination what?

A

voluntary control

133
Q

when a person is read to void, the _______ ________ relaxes, the ________ _________ stimulates the _________ muscle to contract and the bladder empties

A

external sphincter
micturition reflex
detrusor

134
Q

an accumulation of urine in the bladder due to the inability of the bladder to empty

A

urinary retention

135
Q

what is the amount of urine a patient should void for urinary retention to not be a concern?

A

30 - 40 mL per hour

136
Q

results from a catherization or procedure

A

urinary tract infection

137
Q

involuntary leaking of urine

A

urinary incontinence

138
Q

artificial route for urine is called what

A

urinary diversions

139
Q

examples of urinary diversions

A

nephrostomy
urostomy

140
Q

what is a urinary tract infection?

A

invasion of urinary tract by bacteria

141
Q

causes of a uti

A

-stasis of urine in bladder
-contamination in perineal/urethral area
-instrumentation
-reflux of urine
-previous utis

142
Q

why is it important to know a residents urinary history?

A

so you can know if they are having uti symptoms or if something is out of normal so we can catch it early

143
Q

urinary tract infection nursing care

A

-monitor symptoms
-monitor intake and output
-pain control
-keep area clean
-encourage fluids
-teaching

144
Q

what teaching do nurses need to do for uti?

A

medications- take all antibiotics
prevention - dont hold urine, proper pericare, encourage fluids

145
Q

what symptoms can older adults have with uti?

A

-confusion
-decrease LOC
-agitation
-s/s delirium

146
Q

involuntary urine loss from increasing abdominal pressure

A

stress incontinence

147
Q

involuntary urine loss with abrupt/strong desire to void; unable to make it to the bathroom in time

A

urge incontinence

148
Q

what is the most common type of incontinence in older adults?

A

urge incontinence

149
Q

what is is the goal with urinary incontinence

A

to have no involuntary leakage

150
Q

incontinence due to inability to get to the bathroom; physical limitations, loss of memory (progressed dementia), disorientation

A

function incontinence

151
Q

when an individual is usually dependent on others what type of incontinence is it?

A

functional

152
Q

involuntary loss of urine associated with bladder distention

A

overflow incontinence

153
Q

incontinence that may occur due to prostate enlargement

A

overflow incontinence

154
Q

continuous, unpredictable loss of urine

A

total incontinence

155
Q

incontinence seen with neurological impairment, surgery or trauma

A

total incontinence

156
Q

acute reasons for urinary retention

A

anesthesia
medications
local trauma to urinary structures

157
Q

chronic reasons for urinary retention

A

-enlarged prostate
-medications
-strictures
-tumors

158
Q

things to monitor/do with urinary retention

A

-monitor urine output
-palpate to identify bladder distention
-change positions, ambulate, turn on water to help them urinate
-perform bladder scan

159
Q

how much urine should be in the bladder after urination?

A

less than 50mL

160
Q

how much residual urine in the bladder after urination indicates the need for treatment?

A

150-200 mL

161
Q

A health care provider may suspect that a patient is experiencing urinary retention when the patient has, select all that apply
A. large amounts of voided cloudy urine.
B. Pain and distension in the suprapubic region.
C. spasms and difficulty during urination.
D. small amounts of urine voided two to three times per hour.

A

B and D

162
Q

things involved in an assessment of urinary elimination

A

-self care ability
-cultural considerations
-health literacy
-nursing history
-fluid overload
-dehydration
-pattern of urination

163
Q

what should you assess with fluid overload?

A

-lung sounds
-edema
-daily weights

164
Q

what should be assessed with dehydration?

A

-skin turgor
-oral mucosa

165
Q

what should be assessed with pattern of urination?

A

frequency
time of day
amount

166
Q

focused urinary assessment questions

A

-urinate more than usual?
-pain or burning upon urination
-changes in color of urine?
-difficulty starting or maintaining the stream of urine
-changes in the characteristics of urine?
-feel like the bladder is still full after you urinate
-dribbling of urine occur after urinating?
-continent or incontinent

167
Q

if patient has costovertebral tenderness (cva tenderness) what could it indicate?

A

pyelonephritis
polycystic kidney disease

168
Q

what is involved in a physical assessment of urinary elimination

A

-check for cva tenderness
-palpate bladder for tenderness and fullness, distention
-external genitalia and urethral meatus
-perineal skin

169
Q

how to do a cva tenderness test

A

-place flat palm over the kidney
-with the other hand, make a fist and thumb your hand currently resting over the kidney
-if patient reports pain or discomfort cva tenderness is present

170
Q

physical assessment of urine

A

-intake and output
-characteristics of urine

171
Q

ways you can collect urine to measure intake and output

A

-hat
-urinal
-foley catheter drainage bag

172
Q

how often should you empty a cath drainage bag?

A

at least every four hours

173
Q

what type of patient will you have to measure strict fluid intake for and why?

A

kidney disease because they are on fluid restrictions typically

174
Q

characteristics of urine include:

A

-color
-clarity
-odor
-amount

175
Q

labs to assess kidney function

A

-bun
-creatinine
-egfr
-24 hour urine - creatinine clearance

176
Q

lab tests for urinary system

A

-urinalysis
-urine culture and sensitivity
-24 hour urine

177
Q

how can you collect a UA

A

-midstream collection
-straight cath
-indwelling cath

178
Q

what volume of urine needs to be collecting for a ua

A

about 10mL

179
Q

what is the best way for urine to be collected for a UA

A

any catheter

180
Q

what must you ensure when collecting a urine culture and sensitivity?

A

that antibiotics have not already been given

181
Q

what does a urine culture idenitify?

A

organisms present usually a bacteria

182
Q

what does a sensitivity test determine?

A

the antibiotic that will destroy the bacteria

183
Q

how do you do a 24 hour urine?

A

start at 0800, discard the very first void, save all urine for 24 hours and keep on ice

184
Q

can you delegate a collection of a midstream urine sample?

A

yes

185
Q

instructions for midstream urine sample

A

-clean perineal area with cleansing cloth provided
-instruct females to hold labia open entire time
-begin urine stream into toilet
-stop urine stream and place cup under urethral opening
-begin urine stream into cup
-after cup is filled continue urine stream into toilet

186
Q

what info should nurse put on urine cup?

A

time
date
initials

187
Q

when should you take a urine sample to the lab when you get it?

A

as soon as possible

188
Q

normal urine amount

A

1,000 - 2,000 mL in 24 hours

189
Q

normal urine color

A

straw or amber

190
Q

normal urine clarity

A

clear

191
Q

normal urine specific gravity

A

1.005 to 1.030

192
Q

if specific gravity is less than 1.005 what does that indicate?

A

dilute urine - more fluid than waste
excessive fluid intake
diabetes mellitus

193
Q

if specific gravity is higher than 1.030 what does it indicate?

A

concentrated urine - more waste than fluid
dehydration
SIADH
heart failure

194
Q

what is the normal pH of urine

A

4.5 to 8.0

195
Q

what is the normal constituents of urine

A

95% water
5% waste products

196
Q

what waste products are in urine?

A

urea
creatinine
uric acid

197
Q

what can cause brown urine

A

-fava beans
-antibiotics like metronidazole and nitrofurantoin
-over the counter laxatives

198
Q

what can cause light brown urine

A

-kidney failure
-muscle breakdown from extreme exercise

199
Q

what can cause orange urine

A

-vitamin c
-carotene from carrots
-antibiotics used for TB rifampicin
-liver disease

200
Q

red/pink urine

A

-foods like beets and berries
-blood

201
Q

blue/green urine

A

-food coloring
-vitamin b
-medications like amitriptyline, propofol, indomethacin

202
Q

what does cloudy urine indicate

A

could be a sign of infection like a UTI

203
Q

if pH of urine is greater than 8 what does it indicate?

A

-infection
-metabolic alkalosis

204
Q

if urine pH is less than 4.5 what does it indicate?

A

metabolic acidosis

205
Q

what is the normal level for protein in urine?

A

less than 20 mg/dL

206
Q

what would persistent elevated protein in the urine indicate?

A

kidney disease
fever
dehydration

207
Q

what is a normal glucose range for urine

A

negative

208
Q

if a patient has an abnormal glucose level in urine what can this indicate

A

excessive glucose in blood
uncontrolled diabetes

209
Q

what is a normal level for bilirubin in urine

A

negative

210
Q

if a patient has an abnormal bilirubin level in urine what can this indicate

A

liver issues

211
Q

what is a normal nitrite level in urine

A

negative

212
Q

what does an abnormal nitrite level indicate

A

infection

213
Q

what is a normal leukocyte esterase level in urine

A

negative

214
Q

what does an abnormal leukocyte esterase level mean?

A

urine infection

215
Q

what is the normal level for red blood cells in urine

A

less than 5/hpf

216
Q

what does an abnormal level of red blood cells in the urine indicate

A

kidney stones
trauma

217
Q

what is a normal level of white blood cells in the urine?

A

less than 5/hpf

218
Q

what does an abnormal level of white blood cells in the urine indicate

A

infection
inflammation

219
Q

if a patient has excessive amounts of white blood cells >15-20 it can indicate what?

A

pyelonephritis

220
Q

ways to promote normal micturition

A

-maintaining elimination habits
-maintaining adequate fluid intake
-maintain appropriate body position while voiding if safe to do so
-encourage micturition with running water/sounds

221
Q

urinary retention may be secondary to what?

A

body positioning

222
Q

health promotion for urine elimination

A

-patient education
-promoting normal micturition
-promoting complete bladder emptying
-preventing infection

223
Q

how will we help a patient prevent urinary infection at clinicals?

A

by providing perineal care with soap and water at least once per shift for patients who cannot self-perform

224
Q

what is a urinary catheter

A

a pliable tube that is placed through the urethral opening into the bladder to drain urine

225
Q

why would a healthcare provider insert an indwelling catheter?

A

-urinary obstruction
-urinary retention
-strict intake and output necessary
-coma
-surgery and anesthia
-urinary incontinence with skin breakdown/wounds

226
Q

why would a healthcare provider insert an intermittent catheter?

A

-urine sample necessary
-urine retention present -drain bladder and then attempt to see if pt can void on own

227
Q

why wouldnt a healthcare provider insert a catheter

A

if a patient is incontinent

228
Q

examples of external caths

A

condom cath
female external cath

229
Q

intermittent (straight) cath

A

temporary (in and out)

230
Q

indwelling cath (foley)

A

longer duration goes in and stays in for a while

231
Q

triple lumen cath

A

irrigation of the bladder

232
Q

coude cath tip

A

a cath with a firm, bent tip
used on men

233
Q

suprapubic cath

A

surgically inserted in the abdomen typically for cancer

234
Q

how much fluid is typically inserted in a cath balloon

A

10mL

235
Q

what are catheter sizes measured in?

A

french

236
Q

WHAT IS A STRAIGHT CATH USED FOR

A

URINARY RETENTION
PATIENTS THAT CANT MAKE IT TO THE BATHROOM
URINE COLLECTING

237
Q

WHEN A PATIENT HAS A SUPRAPUBIC CATH WHAT SHOULD YOU WATCH OUT FOR

A

INFECTION SYMPTOMS
REDNESS
TENDERNESS
DRAINAGE
ODOR
FEVER
CHILLS

238
Q

IF A LONG-TERM CATH IS IN PLACE WHEN IS IT CHANGED OUT?

A

DEPENDS ON FACILITY
TYPICALLY ABOUT 4-6 WEEKS

239
Q

STABILIZATION DEVICES ON A CATH

A

DEVICE THAT KEEPS THE EXTERNAL PIECE OF CATH TUBING AND DRAIN TUBING IN PLACE
-STATLOCK
-LEG BAG

240
Q

There is a seal that connects the Foley catheter to the drainage tubing keeps it all in one piece
Do not separate the Foley catheter from its drainage tubing unless absolutely necessary what is this called?

A

closed drainage system

241
Q

what does cauti stand for?

A

catheter associated urinary tract infections

242
Q

will insurance pay for cauti (catheter associated urinary tract infection)?

A

no they will not reimburse facility for any infections related to cath

243
Q

when inserting cath in penis what angle should you use to be able to see urine come out of bladder?

A

90 degree angle

244
Q

how often should you do indwelling cath care and perineal care

A

perform per facility policy/orders at least once per shift

245
Q

how to perform indwelling cath care and perineal care

A

-expose urethral meatus anc cath, secure with non-dominant hand
-utilize mild soap and water to clean urethral meatus and cath
-clean away from meatus and remove all traces of soap
-provide additional cleaning if area gets soiled, appears dirty, ect

246
Q

cauti prevention measures:

A

-keep drainage tubing without any kinks or excessive coils to avoid urine backflow
-clean the cath tubing away from the meatus with soap and water
-keep drainage bag below the level of the bladder on a non-moveable part of the bed
-avoid touching the spigot to the receptacle when emptying the drainage bad

247
Q

what must you measure when a catheter is in place?

A

intake and output

248
Q

what can you use to measure urine from a cath

A

urometer
urinal
graduated cylinder

Skills Lecture (7 decks)

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