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)
The general goal for urinary elimination is that patients will comfortably void approximately ___ mL of light yellow urine in ___ hr
Because normal urine elimination patterns vary, you must consider the individual’s pattern, food and fluid intake, medications, and other factors when setting target amounts
1,500 (mL)
24 (hr)
Safe, Effecting, Nursing Care - Client With Urinary Tract Infection (UTI)
Thinking
- Infection that starts in lower urinary tract can ascend up the ureters into the kidney structures
- Bacteria in stool (like E. coli or Klebsiella) commonly cause UTI & can also lead to kidney infection (pyelonephritis)
- Uncommonly, bacteria from skin or environment cause infection in urinary system; conditions that create reduced urine flow make kidney infections more likely
- When urine flow slows or stops, bacteria can more easily travel up the ureters
- Some causes of obstruction are BPH & abdominal or pelvic masses (cancer); kidney stones also irritate the tissue & provide a place for bacteria to grow
Safe, Effecting, Nursing Care - Client With Urinary Tract Infection (UTI) cont’d
Doing
- Administer antibiotics for bacterial infection to bladder or kidneys
- Advise to take phenazopyridine to relieve burning and urgency for first 2-3 days of UTI
- Encourage liberal fluid intake to flush out bacteria; advise to void coffee & alcohol until infection has cleared (these can aggravate a frequent or urgent need to urinate)
Caring
- Offer a heating pad for abdomen or lower back or side to reduce feelings of pressure or pain
- Offer comfort measures for fever, nausea, & pain
Clicker Check
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:
a. Stress incontinence
b. Urge incontinence
c. Functional incontinence
d. Unconscious incontinence
Answer: a
Stress incontinence results from increased pressure within the abdominal cavity
Promoting Normal Urination
- Provide privacy: curtains, doors
- Assist with positioning: men - standing; women - seated upright
- Facilitate toileting routines: identify the client’s pattern
- Promote adequate fluids & nutrition
- Assist with hygiene
Alterations in Urinary Elimination
* Urinary tract infections
- Definition
- Transmission
- Types of UTIs
- Complications
- Risk factors
- Symptoms
- Diagnostic tests
- Treatments
- Interventions
- Teaching
?
Infection in any part of the urinary system - kidneys, ureters, bladder, urethra
Urinary tract infection (UTI)
?
Occurs when microorganisms, usually Escherichia coli (E. coli), which normally lives harmlessly in the colon, enter the urethra and begin to multiply, overwhelming the normal flora
Transmission
An infection limited to the urethra is called ___
___ occurs when bacteria travel up the urethra into the bladder, causing a bladder infection
If not treated promptly, the infection may progress superiorly (upward) to the ureters or kidneys (___)
Catheter associated urinary tract infections (CAUTI)
urethritis
Cystitis
pyelonephritis
