Urinary Elimination Flashcards
Urinary System
- Function of the kidneys
* To filter and regulate
> Filter metabolic wastes, toxins, excess ions, & water from blood & excrete as urine
> Help regulate blood volume, blood pressure, electrolyte levels, & acid-base balance by selectively reabsorbing water & other substances
> Secondary functions are to produce erythropoietin, secrete enzyme renin, & activate vitamin D3
Urinary System cont’d
- Anatomy
- Formation of urine
- Ureters transport urine
- Bladder stores urine
- Urethra transports urine
Urinary System - Anatomy
Kidneys are ___ (located against the posterior abdominal wall behind the peritoneum)
Average kidney weighs about 5 oz & is the shape of a kidney bean
The ___ form urine. The ___ is the basic structural & functional unit of the kidney. Each __ consists of:
- A ___ (a double-walled hollow capsule), enclosing a ___ (a knotty ball of capillaries)
- A series of filtrating tubules
- A collecting duct
retroperitoneal
nephrons
Bowman’s capsule; glomerulus
The ureters transport urine: each kidney has ___ ureters that transport urine from the renal pelvis to the urinary bladder
2
The urinary bladder stores urine: The urinary bladder, a sac-like organ, receives urine from the ureters & holds it until it is discharged from the body
The ___ transports urine. The ___ transports urine from the bladder to the body’s exterior. The mucous membrane of the ___ (in both men and women) is continuous with the bladder and ureters. Therefore, infection in the ___ can easily spread through the bladder and up into the kidneys
urethra
Urinary Elimination
Known as ___, ___
Process
- Filling of bladder 200 to 450 mL of urine
- Activation of stretch receptors in bladder wall
- Signaling to the voiding reflex center
- Contraction of detrusor muscle
- Conscious relaxation of external urethral sphincter
voiding, micturition
Normal Urination Patterns
- Kidneys produce about 50 to 60 mLs of urine per hour - output may fluctuate between 1000-2000 mLs per day
- Most people void about 5 or 6 times per day
* Increased fluid intake increases urination
* Frequent urination may be a sign of medical issues such as ___ or ___
* Infrequent urination may be related to ___
diabetes, urinary tract infection
dehydration
Characteristics of Normal Urine
?
Is a measure of dissolved solutes in a solution
* High concentration of urine solutes leads to high ___
- The ___ of distilled water is 1.000 because there are no dissolved solutes
Normal urine ___ ranges from ___ to ___
specific gravity
1.002 to 1.030
As fluid intake increases, urine becomes more ___, lighter in color, and specific gravity ___ (1.000)
As fluid intake decreases or whenever there is fluid losses (diarrhea/vomiting), urine becomes more ___, darker in color, and specific gravity ___ (above 1.030)
dilute; decreases
concentrated; increases
Life Span Considerations Related to Urination
Infants
* Newborn specific gravity 1.008
* 15 to 60 mL per kg
* Produce 8 to 10 wet diapers per day
* No voluntary control
Life Span Considerations Related to Urination cont’d
Children
Timing of toilet training
* Depends on culture
Toilet training requires
* Mature neuromuscular system
> Depends on toddlers’ ability to control the external urethral sphincter and sense the urge to void
* Adequate communication skills
* Ability to remove clothing
Problems include enuresis, nocturnal enuresis
?
Occurs in a child who has had at least 6 months of nighttime dryness
secondary enuresis
?
Is bedwetting in a child who has not achieved consistent dryness at night
Primary enuresis
Life Span Considerations Related to Urination cont’d
Older Adults
* Kidney size & function decreases around age 50
* Urgency & frequency common
* Loss of bladder elasticity & muscle tone leads to nocturia, incomplete emptying
Factors Affecting Urinary Elimination
- Personal
- Sociocultural
- Environmental
- Nutrition
- Hydration
- Activity level
Factors Affecting Urinary Elimination cont’d
- Medications
> analgesics
> diuretics
> anticholinergics
> anti-depressants
> anti-spasmodics
> muscarinic receptor antagonists
> estrogen
> Botulinum toxin
- Surgery & anesthesia
Consuming large amounts of alcohol impairs the release of ___, resulting in increased production of urine
A diet high in salt causes water ___ and ___ urine production
antidiuretic hormone (ADH)
retention; decreases
Diuretics, sometimes called “water pills”, treat BP, fluid retention, & edema by increasing elimination of urine
Diuretics are classified as thiazide, potassium sparing, or loop acting diuretics
* Study box 28-1 common diuretic classes, pg 710
Factors Affecting Urinary Elimination cont’d
Pathological conditions
- Bladder/kidney infections
- Kidney stones
- Hypertrophy of the prostate (male)
Factors Affecting Urinary Elimination cont’d
Diseases in other systems
- Decreased blood flow through glomeruli
- Neurological conditions
- Immobility
- Communication problems
- Alteration in cognition
Assessment
- Nursing history
- Physical examination - assessment guidelines in Volume 2
Assessment cont’d
- Diagnostic procedures
> Blood studies
> Visualization studies of the urinary system
- Urine assessment
> Interpreting intake and output data
> Measuring intake and output data
> Obtaining samples/specimens for urine studies
> Routine urinalysis
Blood urea nitrogen (BUN) and creatinine levels are commonly measured to assess renal function and hydration
Direct visualization studies tend to be invasive and, therefore, require a signed consent form
Kidneys produce approx 50 to 60 mL of urine per hour (1,500 mL per day); urinary output fluctuates depending on the following;
- Quantity of fluids patient drinks
- Ability of heart to circulate blood
- Kidney functioning
- Ability of patient to void urine
- Amount of fluid being excreted (e.g. excessive sweating or significant vomiting and diarrhea)
- High fever can also contribute to reduced urine output
Measure I&O at end of each shift and for each 24 hour
In some units like the intensive care units you may measure I&O hourly
Practice asepsis - follow universal precautions
Urine Assessment cont’d
Obtaining samples/specimens for urine studies
- Freshly voided specimen
- Clean catch
- Sterile specimen
- 24-hr urine
- Urinalysis
- Dipstick testing
- Specific gravity
Urinalysis techniques include ___ and/or microscopic analysis
Is commonly performed at the bedside; microscopic examination done in the lab
Can determine pH and specific gravity and presence of protein, glucose, ketones, and occult blood in the urine
Commercially prepared kits contain a reagent designed to detect a specific substance (i.e. glucose); reagent may be a paper test strip, fluid, or tablet
dipstick testing
?
Is an indicator of urine concentration & it can be measured with a reagent strip
When you need it to be precise & accurate, should use a refractometer
specific gravity
A ___ measures the extent to which a beam of light changes direction when it passes through the urine (the ___)
If the concentration of solids is high, the light is refracted ___
Method is quick and easy to perform and requires only a few drops of urine
This is more precise, requires a smaller specimen, is more compact, and poses less risk of spills and exposure to body fluids than does a ___
refractometer
refractive index
more
urinometer
Very important to know for the exam
- How to collect urine specimens
- How to calculate an intake and output (I&O)
Analysis/Nursing Diagnosis
- Infection, Risk for
- Urinary Elimination, Impaired
- Urinary Elimination, Readiness for Enhanced
- Urinary Incontinence (functional, reflex, stress, urge, risk for urge)
- Urinary Retention
- Urinary Tract Injury, Risk for
Planning Outcomes/Evaluation
- Kidney function
- Urinary continence
- Urinary elimination
- Tissue integrity, skin, and mucous membranes (b/c urinary elimination problems often place the patient at risk for impaired skin integrity)
