Urinary Flashcards
Book Ch. 30 ATI Ch. 44
What are some characteristics that a child is ready for toilet training?
- Mature Neuromuscular System
- Adequate Communication Skills
- Able to Dress & Undress on Their Own
Define Enuresis.
Having an episode of incontinence
Is enuresis normal in children?
YES!
- Even in early school years.
- Especially when the child is intensely involved in a game or other absorbing activity.
What are 3 types of enuresis?
- Nocturnal Enuresis - nighttime bedwetting.
- Primary Nocturnal Enuresis - bedwetting in a child who has not achieved consistent dryness at night.
- Secondary Enuresis - occurs in a child who has at least 6 months of nighttime dryness & then begins to wet the bed again.
How does urinary elimination change as we age?
- Kidney Function Decreases - decline in glomerular filtration is the most important functional deficit.
- Urgency & Frequency are Common
- Loss of Bladder Elasticity & Muscle Tone lead to - nocturia & incomplete emptying.
What are some factors that affect urinary elimination?
hint there are 15 in total
- Pregnancy
- Diet/Nutrition
- Mobility
- Psychosocial
- Pain
- Medications
- Pathological Conditions:
a. Bladder/Kidney Infections
b. Kidney Stones
c. Hypertrophy of the Prostate (males)
d. Mobility Problems
e. Decreased Blood Flow through Glomeruli
f. Neurological Conditions
g. Communication Problems
h. Alteration in Cognition
What do we want to assess during a urinary assessment?
- Pain - it should NOT be painful to urinate.
- Urine Color - can vary from almost clear to coca-cola color
- Urine Contents - determine if there is sediment
- Urine Frequency & Amount - how frequently they urinate.
How much should adults in non-critical conditions urinate ?
30 mL/hr
What laboratory tests can be done to further assess urine?
- Urinalysis (UA) - NOT a sterile specimen.
- Urine Culture & Sensitivity (Urine C&S) - STERILE specimen.
- 24-hour Specimen - starts AFTER the client voids & discards first urine.
- Serum Creatinine - normal levels 0.5-1.5
- BUN - normal levels 10-20
There is a 24-hr urine collection in process for a client. The NAP inadvertently empties one specimen into the toilet instead of the collection “hat.” The nurse should…
A. Continue w/ the collection of urine until 24-hour period is finished.
B. Make a note to the lab to inform them that one specimen was missed during collection.
C. Begin filling a new collection container & take both container to the lab at the end of the collection period.
D. Dispose of the urine already collected & begin an entirely new 24-hour collection.
D. Dispose of the urine already collected & begins an entirely new 24-hour period.
- Once 1 specimen is missed during a 24-hour urine collection, the results of the laboratory test will be inaccurate & the collection MUST be restarted.
What are some diagnostic tests that can be done to assess the GU tract?
- Renal Scan
provides views to the kidneys w/o use of contrast. - Renal Ultrasound
uses ultrasound waves to view abnormalities of the kidneys. - IV Pyelogram
utilizes contrast w/ iodine to view anatomy. - Kidneys, Ureter, Bladder (KUB)
“X-Ray of kidneys,” use to visualize structures of the GU tract. - Cystoscopy
invasive scope of the bladder for visualization. - Urodynamic Testing
test muscle bladder function, provides pressure readings to the bladder. - Bladder Scan
provides estimated volume of urine & bladder, can be used for noninvasive estimate for post residual.
Define Urinary Retention.
- Inability to completely empty bladder.
- Urine remains in bladder as a growth medium for bacteria.
- Promotes UTIs as a potential effect.
What are some causes of urinary retention?
- Obstruction
from enlarged prostate, tumor, or calculi. - Inflammation
Causes swelling, which impedes exit of urine. - Neurological
affects body’s ability to sense bladder distention will lead to retention & can necessitate regular self-catherization to avoid urinary retention. - Medications
- Pain/Anxiety
painful urination will cause someone to hold their urine as long as possible; anxiety, particularly in public, can lead to retention.
Define Incontinence.
Lack of control over urination.
What are some side effects of incontinence?
- Skin Impairment moistures leads to skin breakdown - Reduced Mobility - UTI - Depression - Caregiver Role Strain
What are the different types of incontinence?
- Stress Incontinence
due to increase of abnormal pressure that causes compression of bladder leading to urine leakage (laughing, sneezing, coughing, etc.). - Urge Incontinence
inability to make it to the bathroom on time due to overactive detrusor muscle w/ increased bladder pressure. - Overflow Incontinence
over-distended bladder - Reflex Incontinence
involuntary loss w/o warning due to hyperreflexia to detrusor muscles. - Functional Incontinence
issues w/ cognitive motility & environmental factors. - Total Incontinence
unpredictable incontinence, does not usually respond well to Tx. - Nocturnal Incontinence
bedwetting past toilet training.
The female client states to the nurse, “I’m so distressed. It seems like every time I laugh hard, I wet myself.” The nurse knows that this condition is known as…
Stress Incontinence
Results when there is increased pressure in the abdominal cavity.
What are some ways we can manage urinay incontinence?
- Promote Normal Urination - privacy, encourage patient not to ignore the urge.
- Toileting Schedule - take patient to restroom at the SAME time each day.
- Bladder Training - similar to toilet training, regularly take patient to bathroom and progressively start going longer between trips until patient is able to go an acceptable amount of time between trips w/o episode of incontinence.
- Incontinence Briefs - encourage patient not to be ashamed of them, do NOT refer to them as diapers.
- Avoid Indwelling Catheters
- Skin Care
keep skin clean & dry, apply barrier cream PRN, encourage patient to notify caregiver quickly of incontinence, check patient frequently for skin care needs. - Educate - educate patients to keep their skin clean, avoid caffeine or EtOH due to diuretic use, practice Kegel exercises.
- Medication
anticholinergics or antispasmodics.
What are some risks for UTIs?
E. Coli is MOST common cause.
- Females more likely to develop UTI b/c urethra is shorter.
- Sexual Intercourse - encourages bacteria getting into UT tract, encourage females to void after intercourse.
- Hormones changes as women age.
- Uncircumcised Males b/c or poor hygiene of foreskin
- Catheters introduce bacteria into sterile UT tract.
- Decreased Fluid Intake b/c bacteria is not being flushed out of UT tract as frequently.
- Poor Perineal Care usually in women, educate women to wipe for FRONT TO BACK.
What are some S/S of UTIs?
- Dysuria
- Bladder Spasms
- Hematuria
- Increased Urge
- Urinary Retention
- Fever
- Confusion in older adults
What are some nursing interventions for UTIs?
- Encourage fluid intake
- Send ordered lab tests and culture BEFORE starting antibiotics!
- Administer prescribed medications like antibiotics or pain or antispasmodic medications
- Educate on preventative measures
drink plenty of fluid; NOT hold urine; practice good hygiene.
How can we prevent CAUTIs?
- Maintain aseptic technique for insertion
- D/C catheter ASAP
- Regular catheter care
- Prevent urine backflow to bladder through drainage bag below bladder and no kinks.
A nurse is teaching a client who reports stress urinary incontinence. Which of the following instructions should the nurse include? (Select All That Apply.)
A. Limit total daily fluid intake. B. Decrease or avoid caffeine. C. Take calcium supplements. D. Avoid drinking alcohol. E. Use the Crede maneuver.
B. Decrease or avoid caffeine.
- Caffeine is a bladder irritant & can worsen stress incontinence.
D. Avoid drinking alcohol.
- Alcohol is a bladder irritant and can worsen stress incontinence.
A client who has an indwelling catheter reports the need to urinate. Which of the following actions should the nurse take?
A. Check to see whether the catheter is patent.
B. Reassure the client that it is not possible for them to urinate.
C. Recatheterize the bladder with a larger gauge catheter.
D. Collect a urine specimen for analysis.
A. Check to see whether the catheter is patent.
- A clogged or kinked catheter causes the bladder to fill and stimulates the need to urinate.
