Urinary Flashcards
Hydronephrosis
backup of urine in the kidney - blockage
ileal conduit
Urinary diversion of urine through the ileum
cystectomy
removal of the bladder
How much of filtrate reabsorbed by kidneys
99% reabsorbed
1% excreted as urine
what is creatinine
waste product from metabolism
elevated levels - means kidneys not functioning
detrusor muscle
smooth muscle that lines the bladder
contracts during urination- usually takes 250-400 ml to stretch it enough to contract it
Sympathetic - relaxes it to allow storage of urine
Parasympathetic - contracts it to allow for urination
Where does urine filtration take place?
Glomerulus
What is the average amount of urine per void for an adult?
250-500 ml
Adult normal voids per day?
6-8x
on awakening
within an hour after a meal
before bed
Average Adult Daily Void. Total
1,200-1,500
How much urine per hour would be an ECF deficit?
less than 30 ml/hr
possible renal failure
What is a neurogenic bladder?
Bladder dysfunction (Flaccid or Spastic) caused by neurogenic damage
brain or spinal cord injury
Overflow incontinence,
frequency (urinating often)
Urgency (I have to go now),
Urge incontinence, and retention. (Do not know when bladder is full)
Possible causes:
Stroke, parkinson’s, problem with reflex arc, spinal cord)
Stress Incontinence
Increased abdominal pressure causes small losses of urine.
RX - kegels, weight loss, estrogen
Urge Urinary incontinence
Overactive detrusor muscle, bladder infection, alcohol, caffeine,
External sphincter not holding
Try timed voiding or anticholinergic drugs - atropine
Reflex urinary incontinence
Predictable urinary loss when certain volume reached
Spinal cord injury, flaccid neurogenic bladder
Straight cath, anti-chol drugs
Functional urinary incontinence
Normally continent person
has altered environment mobility deficits
assistance, routine.
Urinary diversion
Nephrostomy tube
tube directly from the kidney to the skin
Ilial conduit
Urinary Retension
No void for 8-12 hours or frequent voids of 50-100 ml per void.
Pyelonephritis
Cystitis
Urethritis
Pyelonephritis - kidney infection
Cystitis - bladder infection
Urethritis- urethra infection
Percussion of a full bladder will sound _____
dull
What is a random urine sample
Not sterile. not looking for an infection
what is a clean catch or midstream urine sample
Looking for infection
Culture and sensitivity
Culture - what is the bacteria
sensitivity - what antibiotic will kill the bacteria
what is 24 hour specimen
start in morning, discard first urine
need ll voids,
refrigerate. use special container
checks for protein, uric acid, hormones,
what is normal urine pH
pH 6 normal range 4.6-8
<6 is respiratory or metabolic acidosis, diet high in meat, DM, starvation
>6 (alkaline) UTI respiratory alkalosis
Specific Gravity
normal
1.015-1.025
Normal 1.020.
Higher is concentrated 1.030. HIGH=DRY. Dehydration, N/V, Fever, Fluid Loss
LOW -DILUTE - DI, renal disease, diuretics fluid loss, increased fluid intake
URINE COLORS
Light - increased fluid
Dark - decreased fluid
Pink, red, dark brown - blood in urine
pink, orange, red, brown, blue-green - meds or foods
Patient in bathroom, can you leave?
No
Proactive voiding is
every ____ hours
4
Voiding regimens
every _____ hours
for altered function
2 hours
smoking will _____the bladder
constrict
What is IAD
Incontinence associated dermatitis
prevent with good perineal hygiene
Indications for indwelling catheter
- Critical or acute/severely ill
- Not able to manage with intermittent cath
- Stage 3 and 4 pressure injuries on sacrum
- Terminally ill
- If need continuous bladder irrigation
INFECTION POSSIBLE with foley and stool incontinence and poor hygiene
Indications for straight cath
- Need sterile specimen
- Check residual volume
- Intermittent/routine emptying for patients with neurogenic bladder
Why use a triple-lumen cath?
To irrigate bladder,
remove blood clots after surgery
Polyuria?
Polydipsia
Polyphagia
POLY = increase
increase in urination -uria
Increase in thirst -dipsia - water dipper
Increase in appetite -phagia
Cystectomy
is managed by—-
When Bladder removed
section of ileum is used to make a bladder than it comes out in the front as an ostomy
ilial conduit
Why a Nephrostomy tube?
If blockage in the ureter, tube goes from the kidney to the skin
urostomy
Coude Catheter
Used for BPH, curved
Bladder Ultra Sound
key tool
Kidney under 12th rib
Patient loses a small amount of urine when sneezing
this is _______in continence
Stress
Patient cannot void supine
what is the intervention
assist to standing
Patient is incontinent when being transferred from chair to bed
This is _______inconinence
functional
What med could increase urination
cholinergic agents
Residual volume of ______ ml is normal
<50 ml
What is normal
Smegma or reddened meatus
Smegma
Normal urinary volume
500-3000ml
2000ml
more than 3000 is abnormal
Would patient after prostatic resection need continuous bladder irrigation?
Yes prevents blood clots
Patient cannot retain urine due to loss of mobility
this is _______incontinence
functional
What would cause dark amber aromatic urine
Hypovolemia
N/V
Use _____ water for bladder irrigation
Sterile
Nephrostomy tube irrigation
A patient is having a seizure
This would cause ______incontinence
Total
Patient has a delay in reaching the bathroom.
This is _____incontinence
urge
After surgery, generally how soon will the catheter be removed?
_____hours
within 24 hours
Factors affecting urinary elimination
Fluid intake,
loss of body fluid
nutrition
body position, cognition, UTI, hypotension, Neuro injury, decreased muscle tone, PG, surgery, medications
NOT - Time of arising or HYPERtension
Catheter output is low,
what should the nurse access
kink in tubing
Steps in taking urine sample from cath
- wipe port with alcohol
- attach syringe to port
- withdraw 3-30 ml
- transfer urine to collection container
- transport to lab
inserting cath
tell patient to…..
bear down as if to void. relaxes sphinicter
