Urinary Elimination Flashcards
Volume Minimum per hour
30 ml per hour
What does Urine Color indicate?
- indicates hydration status
- impacted by meds
Dark amber urine
dehydration
Clear Urine
adequate hydration
Odor
-Ammonia is normal smell
Strong odor
Is infection
What urine has less of a smell?
Dilute Urine
Which would you Assess clarity? Fresh or unfresh urine
Fresh!
Newborn and Infant
Urinate frequently
No bladder control
Toddler and preschooler
Develop voluntary urine control
Toilet training
School-age child and adolescent
Nocturnal enuresis
Adult and older adult
With older age incontinence, nocturia
An older adult with confusion is a strong indicator for a urinary tract infection
Voiding
Term means to urinate
Dysuria
Painful urination
Polyuria
Excessive urination
Anuria
Severely decreased or absent urine
Oliguria
decreased urination
Urgency
Feeling like one is unable to delay voiding voluntarily
Urinary Retention
Urine remains in the bladder after voiding
Nocturia
Waking up to void at night
Frequency
Voids frequently in small amounts
Hematuria
Blood in the urine
Pyuria
When urine contains pus
incontinence
Involuntary loss of urine from the bladder
Any intake of fluids
Oral
Intravenous
Nasogastric or PEG tube
What hormone makes the body retain fluid?
ADH
What triggers the release of that hormone?
Increased plsama osmolarity
How many oz 1 ML
30
How can the body lose fluids?
Multiple routes
Vomiting, diarrhea, diaphoresis, wound drainage, urine, burns, or blood loss
You can record fluid loss by measuring
output
Output should
match intake or be within 200-300 mL
What does it indicate if output is less?
Decreased kidney perfusion or dehydration
What do you use to get urine output without a catheter?
Graduate, hat, urinal, bedpan
How does Hypotension affect the kidneys?
Leads to poor renal perfusion
Kidneys are unable to filtrate
What conditions cause decreased muscle tone?
Obesity
Multiple pregnancies
Chronic constipation
Continuous bladder drainage
Surgery
Volume deficit
Urinary retention from anesthesia
Need to void within 8 hours of surgery
What medications increase urine output
and what medications cause retention?
Diuretics = increase urine output
Opioids, tricyclic, antihistamines = urinary retention
Diet: What foods promote diuresis and what foods promote retention?
Alcohol and caffeine promote diuresis
Salty foods promote retention
What position makes it difficult for a patient to use a bedpan or urinal?
Difficult to use a bedpan or urinal while laying flat
Cognitive/ Psychological factors
Neurologic conditions, brain tumor, stroke, confusion can all impair drinking or voiding
Heat can promote urination, cold can prevent it.
Hearing water running can promote urination
Obstruction
Tumor, renal stones, prostate
Kinked or clogged urinary catheter
Increases risk of urinary stasis and infection
Risk Factors for UTI
- female anatomy: shorter urethra and incorrect wiping
- sexual intercourse
- urinary catheter
- CAUTI
What is a CAUTI
Catheter-associated urinary tract infection (CAUTI)
A UTI that develops when a catheter is in place greater than 48 hours prior to the onset of infection
One of the most common healthcare-acquired infections
Increases morbidity and morality for patients
Education on prevention of UTIs
- Adequate water intake? flush microorganisms
- Aim to void at least every 4 hours
- Void immediately after sexual intercourse?
- flushing miccroorganisms
- Wash hands carefully with soap and water
S/s of UTI
Fever Flank pain Dysuria Frequency Urgency Pyuria Hematuria
Timed Voiding
Timed voiding
Used for cognitive or physical impairment
Void on a fixed schedule
Urge urinary incontinence
Habit retraining
- Schedule bathroom trips around when incontinence episodes occur
- Functional and total urinary incontinence
Prompted Voiding
- Take time to check to see if there is a need to void
- Functional and total urinary incontinence
Bladder training
- schedule voiding times with a narrow range of 2 hours
- Eventually widen range to 4 hours
- Urge and reflex incontinence
Urinary Diversion
- Surgical procedure to alter the pathway of urine elimination
- commonly performed after the removal of the bladder (cystectomy)
- Two types: Ileal conduit and neobladder
What happens if a patient doesn’t void after surgery?
- Use a bladder scanner to check bladder for urine
Urine specimen types: Random
-Can be poured from nonsterile container into cup
Urine specimen types: Clean-catch
- sterile cup or bedpan
- seek specimen without microorganisms
Urine specimen types: 24 hour
- Specific measurement of kidney’s excretion of substances
- Educate all personnel and family about need to keep all urine for the 24 hour period
Urine specimen types: Catheter
- In and out to obtain specimen at a specific time
- Indwelling, can collect from a port near the top of catheter (not from drainage bag)
Urine Tests: Reagent Strips
-Detect substances an their amounts such as pH, glucose, protein, ketones
Urine Tests: Urine culture and sensitivity
- Determine microorganism that causes UTI
- Determine correct antibiotic to use
Urinalysis Color
Normal: Light yellow- amber Almost colorless: increase fluid intake Dark color: decrease fluid intake Red, pink , dark brown: rbcs in urine Pink, Orange, Dark-brown, Blue-green: medications or foods
Urinalysis Turbidity
Normal: Clear
Hazy, Cloudy, Smoky: urine specimen allowed to stand at room temp
RBCs, WBCs, bacteria, mucus threads: mucosal irritation
Urinalysis pH
Normal: 6
Range: 4.6-8
<6: Diet high in meat or some fruits, metabolic acidosis( DM, starvation), respiratory acidosis (emphysema).
>6: Diet high in vegetables and citrus fruits, UTIs, metabolic alkalosis (hyperventilation)
Specific Gravity
Range: 1.015-1.025
<1.015: increased fluid intake, diuretic therapy, diabetes insipidus, renal diseases
>1.025: decreased fluid intake, increase fluid loss (vomiting, diarrhea, fever), ADH secretion (trauma, stress).
Protein
Normal: None-trace
-Protein is present in severe stress, renal disease, preeclampsia
Glucose
Normal: None
-Present in DM
Ketones
Normal: None
Present in DM, Ketoacidosis, Starvation
Microscopic Exam
RBCs: Normal 0-30 abnormal: >30 UTI, bleeding, urinary tract trauma, anticoagulant therapy
WBCs: 0-5 abnormal: > UTI
Bacteria/ yeast: None-few abnormal: few- contamination from perineal skin
Casts: None-occasional abnormal: many- possible renal diseases
BUN Test
Urea is normally excreted
Impaired kidneys are unable to excrete urea leading to an increased BUN
Creatinine
Creatinine is a waste product excreted by the kidneys
Increased creatinine indicates renal impairment
More sensitive indicator than BUN for renal impairment
Creatinine Clearance
Need creatinine level from urine and blood
Need the amount of urine developed in 24 hours
Estimates the kidneys glomerular filtration ability
Glomerular Filtration Rate
Best indicator of kidney function
Requires multiple data
Age, race, gender, serum creatinine
External Catheter Method:
External or condom catheter
Other noninvasive form is PrimaFit
External Catheter Indications
Indications for use:
Sphincter damage
Spinal cord injury
Impaired skin integrity in areas where incontinence occurs
Urinary Catheterization
Inserting a small tube through the urethra to the bladder to promote urine drainage
Intermittent or Straight
In-and-out catheter, temporary for a single voiding session or specimen collection
Indwelling
Inserted and kept in place by inflating a balloon
Connected to a drainage bag
A securement device is used on the thigh
What techniques is important in placement of all catheters!
Sterile technique is paramount
Indications for catheterization
Critically or acutely ill patients that need accurate intake and output measurements
Urinary retention that persists despite multiple intermittent or straight catheter attempts
Management of urinary incontinence with a stage III or IV pressure ulcer on the trunk
Catheter types and sizing
Catheters are sized using the French system
The higher the number the larger the lumen
Average range is 12-22 (16 most common)
Catheter Tube
Straight or intermittent
Catheter tube with bend created in it
Coude catheter: good when patient has prostate problems
Catheter tube with one port and balloon
Indwelling
Catheter tube with 2 ports and balloon
Bladder irrigation
DO NOT __________ the drainage bag from catheter
disconnect
How often should you empty drainage bag
every 8 hours
Why do we empty drainage bag
to prevent the development of microorganisms
Always keep drainage at what level?
Below the bladder
When to wash hands?
before and after handling catheter and wear clean gloves
Catheter care tips
Clean patient’s perineal area and catheter after any bowel movement
Clean at least once a shift if no bowel movement present
Use soap and water for cleaning
