Uninary Elimination Flashcards
Enuresis
Continued incontinence of urine past the age of toilet training.
Nocturia
The diminished ability of the kdneys to concentrate urine may result .
Anticoagulants may cause
Hematuria (blood in the urine), leading to a pink or red color.
Directics can lighten the color of uriine to a pale
Yellow
Levodopa an antiparkinson drug, and injectable iron compaounds can lead to
Black or brown urine
Factors afffecting Micturition
Children Effects of agin Food and fluid intake Psychological variables Activity and muscle tone Pathologic conditions Medications
Pathologic Conditions
-Congential urinary tract abnormalities (absence of kidney) Polycystic kidney disease (fluid filled cysts in kidney) Urinary tract infection Urinary calculi (kidney stones) Hypertension Diabetes Mellitus Gout Connective tissue disorders
Effects of Medication
Nephrotoxic drugs-Can damage kidneys
Diuretic-Hypertention disorder
Cholinergic medications- Stimulate contracts of detrusor muscles
Analgesics and tranquilizers- Suppress central nervious system, intecting by nueral reflex
Medications affecting color
Pink red Diuretics- Pale Yellow Pyridium- Orange Red Elavil - Green blue Levodopa-brown black Propofol?
Nursing Assessment
Voiding patterns, habits, past/current history of problems
Explore its duration, severity, and precipitating factors
Note patient’s perception of the problem
Check adequacy of patient’s self-care behaviors
Physical Assessment
Kidneys (costovertebral tenderness)
Urinary bladder (palpate and percuss the bladder or use bedside scanner)
Urethral meatus (inspect for signs of infection, discharge, or odor)
Skin (color, texture, turgor, and excretion of wastes)
Urine (color, odor, clarity, and sediment)
Measuring Urine Output
Patient to void into bedpan, urinal, or specimen
container
Note amount and appearance
Document
Determine 24-hr intake and output
Positive fluid balance (fluid volume overload) can cause increases in blood pressure and migration of fluid into lung spaces.
Negative fluid balance (fluid volume deficit) can cause kidney dysfunction, electrolyte imbalance, low blood pressure, shock and hypoperfusion of other organs.
Collecting Urine Specimines
Routine urinalysis: pH, glucose, ketones, protein, WBC, RBC, bilirubin, specific gravity
Normal urine output for an average adult is 1 ml/kg/hr (40-80 ml/hr)
Specific gravity: 1.010-1.025
Specimens from infants and children (disposable bags)
Clean-catch or midstream specimens
Sterile specimens from indwelling catheter (culture and sensitivity)
24-hour urine specimen: nutritional studies, urine urea nitrogen levels
1st void is discarded, time begins
Special container/may need to be refrigerated
Characteristics of Urine
Color: pale yellow, straw, amber (darker → concentrated)
Odor: aromatic, develops ammonia odor over time
Turbidity: clear or translucent – standing urine becomes cloudy over time (fresh urine that is cloudy is abnormal)
pH: 6.0; range from 4.6 to 8
Specific Gravity: 1.010 to 1.025
Constituents:
Organic (urea, uric acid, creatinine, nitrogen)
Inorganic: ammonia, sodium, chloride, iron, phosphorus, sulfur, potassium and calcium)
Nursing Diagnoses
Urinary functioning as the problem
Incontinence (functional, stress, urge, overflow, reflex, and total)
Pattern alteration (anuria, oliguria, dysuria, nocturia, polyuria, urgency, frequency)
Urinary retention: trauma, obstruction, BPH, malformation (stricture)
Urinary functioning as the etiology
Impaired Uninary Elimination (functional, stress)
Impaired Skin Integrity
Risk for infection
Toileting Self-Care deficit
Urinary Retention
Types of Urinary Incontinence
Stress Urge Mixed Overflow Functional Reflex Total
Expected Outcomes
Urine output about equal to fluid intake Maintain fluid and electrolyte balance Empty bladder completely at regular intervals Report ease of voiding Maintain skin integrity Bladder control if possible
Reasons for Catheterization
Relieving urinary retention
Obtaining a sterile urine specimen
Measuring amount of post void residual (PVR) urine in bladder – a sign of urinary retention
Obtaining a urine specimen when usual methods can’t be used
Emptying bladder before, during, or after surgery
Monitoring critically ill patients
# 1 cause for Nosocomial infection
Use of Absorbent Products
Functional disability of the patient Type and severity of incontinence Gender Availability of caregivers Failure with previous treatment programs Patient preference Meticulous skin care or protective products applied to skin
Nursing Evaluation
Maintain fluid, electrolyte, acid–base balance
Empty bladder completely at regular intervals with no discomfort
Provide care for urinary diversion and note when to notify physician
Develop a plan to modify factors contributing to problem
Correct unhealthy urinary habits
Prevent complications associated with urinary diversions (permanent)
Unexpected situation
Use of bladder scan
No urine flow after catheterization
Urine leaks around the catheter
Intense pain when inflate balloon
Unable to advance catheter in male patient
Break in skin integrity due to condom catheter
Color
Urine is darker than normal when it is scanty and concentrated. Urine is lighter than normal when it is excessive and diluted.
Odor
Some foods cause urine to have a characterstic odor
Turbidity
Cloudiness observe in freshly voided urine is abnormal and may be due to the precsence of red blood cells, white blood cells, bacteria, vaginal discharge, sperm, or prostatic fluid.
Ph
A high protein diet cause urine to become excessibely acidc.
Specific gravity
1.015 to 1.025, concentrated urine will have a higher than normal spefic gravity, and diluted urine will have a lower than normal specific gravity.
Constituents
Anormal constituents of urine include blood, pus, albumine, glucose, ketone bodies, casts, gross bacteria and bile.
Measuring Urine Output in Patients With an Indwelling Catheter
- Put on clean gloves
- Place a calibrated measuring device beneath the urine collection bag at the bedside. To prevent the spread of infection, each pataent should have his or her own calibraded measuring device.
- Place the drainage spout from the collection bag above, but not touching, the calibrated measuring device and open the clamp.
- Allow the urine to flow from the collection bag into the measuring device.
- Reclamp the drainage tube, wipe the spourt tube with and alcohol pad, and repace the tube into sot on the drainage bag. Proceed with measurement of urine.
Keigal exercises
target ommer ,isc;es tjat ;oe imder amd support the bladder.
Riske of UTI
Sexaually active women
Women who use diaphramgms for contraception.
Postmenopaus women
Inviduals with an indewelling urinary catheter in place.
Indivuals with diabetes mellitus.
Elderly people.
Treatment UTI
Drink 8 to 10 oz of water Observe the urine for color, amount, odor and fequecncy Dry perineal area after urination Take shower rather than baths Wear underwear of cotton crotch
Transient incontinence
Appears suddnely and last for 6 months or less
Stress incontinence
Occurs when there is an involuntary loss of urine related to an increase in intra abdominal pressure.
Urge Incontinence
Is the involuntary loss of urine that occurs soon after feeling an ungent need to void.
mixed incontinence
Indicates that there is urine loss with feature of two or more types of inontinence.
Function incontinence
Caused by the inability to reach the toilet because of environment barrier.
Reflex inonctiness
Experience emptying of the bladder without the sensation of the need to void.
Total Incontinece
Is a contuous and unprediable loss of urine, resulting from surgery trauma, or physical malformation.
Intermittent urethral catheters
Straight cathetoer, not used to drain the bladder for short periods
Indwelling Urethral catheter
If a catheter is to remain in place for continous drainage.
Suprapubic catheter
Used for long term continous drainage. It is inserted through surgery.
