Urinary Elimination Flashcards
What is micturition
process of voiding
Complex interaction between the bladder, urinary sphincter, & central nervous system
What happens during voiding
Bladder contraction + urethral sphincter and pelvic floor muscle relaxation
What happens when a person is ready to void
Central nervous system sends a message to the micturition centers
External sphincter relaxes and the bladder empties.
What are the 8 factors that influence urinary elimination
Growth & Development
Sociocultural Factors
Psychological Factors
Personal Habits
Fluid Intake
Pathological Conditions
Surgical Procedures
Diagnostic Examinations
When does voluntary control of bladder begin to happen
around 18-24 months
Urinary changes DECREASED in older adults
Amount of nephrons
Bladder muscle tone
Bladder capacity
Time between initial desire to void & urgent need to void
Urinary changes INCREASED in older adults
Bladder irritability
Bladder contractions during bladder filling
Risk of urinary incontinence
Personal habits for elimination
Need for privacy
Adequate time to void
sociocultural factors of elimination
Culture and gender norms vary
private versus communal toilet facilities
lifestyle behaviors
psychological factors of elimination
anxiety and stess
depression
fluid intake during elminiation
If fluid, electrolytes, solutes are balanced_ increase fluid intake will increase urine production
Alcohol
Caffeine
T/F increase in sodium causes decrease urination
TRUE
Pathological conditions that affect elimination
Diabetes Mellitus (DM), Multiple Sclerosis (MS), Stroke (CVA) Arthritis parkinsons dementia chronic pain spinal injury prostatic enlargement
Surgical Procedures
that affect elimination
Local trauma to abdomen or pelvic area
Post-operatively_ urinary retention
Medications that affect elimination
Diuretics (example, furosemide (Lasix))
Medications affect urine color
Anticholinergics (atropine)
Hypnotics & sedatives (analgesics, antianxiety meds)
Diagnostic Examinations for urinary elimination
cytoscopy
urinary catheterization
3 common urinary elimination problems
Urinary Retention
Urinary Tract Infections
Urinary Incontinence
What is urinary retention
Inability to partially or completely empty bladder
Symptoms of urinary retention
pressure
tenderness
restlessness
diminished output
acute retention
sudden onset
more sign and symtp
chronic retention
strain to void painless more frequent more urgency incontinence
what is post void residual PVR
how much urine left after voiding
what is overflow incontinence
Incontinence caused by urinary retention
what is the most common causative agent of UTIs
E Coli.
What are the 2 locations of UTIs
Upper- Kidneys
Lower - Bladder, urethra
Bacteruria
Does NOT always mean UTI
If bacteria present but asymptomatic, will not treat with antibiotics
Risk Factors for UTIs
Presence of indwelling catheter Any instrumentation of urinary tract Urinary retention Urinary or fecal incontinence Poor perineal hygiene Females Frequent sexual intercourse Uncircumcised patients
Symptoms of UTIs
Dysuria (burning or pain w/ urination) Cystitis (irritation of the bladder) Urgency Frequency Incontinence Suprapubic tenderness Foul-smelling cloudy urine Fever
Elderly symptoms of UTIs
Delirium, confusion, change in mental status Fatigue Loss of appetite Decline in function Incontinence Falls Subnormal temperature
what is a Major risk of development with presence of indwelling catheter and length of use
Catheter Associated Urinary Tract Infection (CAUTI)
what is the focus of Catheter Associated Urinary Tract Infection (CAUTI)
early recognition & prompt treatment
What is Urinary Incontinence (UI)
Involuntary loss of urine
What are the forms of urinary incontinence
Transient Functional Overflow or UI associated with chronic urinary retention Stress Urge or Urgency Reflex or Neurologic
Urinary Incontinence Risk Factors
More common in women & elderly Obesity Multiple pregnancies/ vaginal births Neurological disorders: Parkinson's, CVA, spinal cord injury, MS Medication therapy: diuretics, opioids, anticholinergics, calcium channel blockers, sedatives/hypnotics Confusion Dementia Immobility Depression
Urinary Incontinence Expected Findings
Loss of urine when laughing, coughing, sneezing Enuresis (bed-wetting) Frequency Urgency Nocturia
Considerations in the assessment of urinary elimination
Assess understanding and expectations of treatment
Be professional
Assess ability to perform necessary behaviors associated with voiding
Assess for any culture or personal considerations
Past medical & surgical history
Medication use
Normal bowel & urinary elimination patterns
Sleep, activity, & nutrition
What to know about pattern of urination
Frequency and times of voiding
Normal amount with each void
History of recent changes
symptoms of urinary alterations
Urgency Dysuria Frequency Hesitancy Polyuria Oliguria Nocturia Dribbling Hematuria Retention
what to physically assess during a urinary elimination assessment
Kidneys
Bladder
External genitalia & urethral meatus
Perineal skin
Assessment of intake & output
Evaluates bladder emptying
Renal function
Fluid & electrolyte balance
Can be an HCP order or nursing judgement
What is normal urine output
> 30 mls/hr
Concerned if < 30 mls/hr for 2 hours*
Characteristics of urine
Color
Clarity
Odor
Assessment of urine color
Normal Pale straw color to amber- depends on concentration Abnormal Hematuria Color changes
Assessment of urine clarity
Normal- transparent at first void
Urine that sits_ cloudy
Thick and cloudy_ bacteria and WBCs
Early morning void can appear this way as well since it sat in bladder all night
assessment of urine odor
Normal Odorless Ammonia smell Abnormal Offensive- May indicate UTI Some foods change odor Fruity- acetone
things to know as a nurse about urine testing
Know how to collect the urine
Label appropriately per hospital protocol
Send as soon as you receive unless it is a timed test
Know if you need a preservative or not
What is assessed with a urinalysis
pH Protein Glucose Ketones Specific gravity RBC WBC Bacteria Casts Crystals
nursing considerations with urinalysis
Collect during normal voiding, indwelling catheter, or urinary diversion
Must have freshly voided urine
Cannot take urine from catheter bag
Possibly use Reagent strips
what does specific gravity tell us
how concentrated the urine is
What is culture and sensitivity for
Obtained to determine presence of pathogenic bacteria
why is culture and sensitivity important
Important to test the sensitivity of any growing bacteria to various antibiotics
how to obtain urinary culture
Clean- voided or clean-catch/ mid-stream urine specimen
Urinary catheter
Urinary diversion
T/F must use sterile cup for urine specimen
TRUE
what does abdominal xray- KUB determine
size, shape, symmetry, location of structures of the Urinary Tract
common uses of abdominal xray- KUB
detect and measure urinary calculi
Urinary Elimination Alteration
Impaired Urinary Elimination Urinary Retention Incontinence Functional urinary Overflow urinary Reflex urinary Stress urinary Urge urinary
Associated Problems related to Urinary Elimination
Impaired Comfort or Pain Impaired Skin Integrity or Risk for impaired skin integrity Knowledge Deficit Body Image Disturbance Risk for Infection
Health Promotion & Patient Education of urinary elimination
Promote self-care practices
Maintain normal routine
Promote healthy nutrition and fluid intake
Things to avoid:
Constipation
Smoking
Strengthen pelvic floor muscles
Men: Be vigilant about your prostate health
Report any changes in urinary tract
Fluid intake considerations
2300 mls/day - if renal function is ok, no heart disease & no need for fluid restriction
Helps flush solutes to limit bladder irritability
If fluid intake needs increased: Schedule times to drink Identify fluid preferences High fluid foods (fruits) Stop drinking about 2 hours before bedtime to prevent nocturia
Nursing care for urinary retention
Assess & monitor urine output
Assess for bladder distention
Assist patients to normal position for urination
Run water or flush commode
Apply cold compress to abdomen
Encourage double voiding
If bladder does not empty fully, try around the clock voiding
Using the crede method is not recommended unless approved by HCP
Intermittent catheterization or catheterization
Preventing urinary infection
Follow hospital protocol
Assess for s/s of infection
Perform perineal hygiene
Void at regular intervals
Adequate fluid intake
Female considerations
incontinence care
Be respectful of patient’s feelings Pelvic floor muscle training Lifestyle changes Bladder retraining Toileting schedule Intermittent catheterization Meticulous skin care Absorbent pads & cathetersElectrical Stimulation There are meds that can help – example = anticholinergics Interventional Therapies: Bulking material injections Botox Nerve stimulators Surgery: Sling Bladder neck suspension Prolapse surgery Artificial urinary sphincter
DO’s of skin care
Identify & treat early Use skin risk assessment tools Use appropriate skin barrier products Ensure adequate hydration Consult WOCN if needed
DONT’s of skin care
Use traditional soap & water
Double padding the bed
Leave soiled pads
what is urinary catheterization
Tube placed through the urethra into the bladder to drain urine
Types of Urethral catheters
Single lumen Indwelling catheter 3-way/ 3 lumen Coude tip Curved rounded Suprapubic External Catheters
Nursing catheter care
Regular perineal care (Peri-Care)
Provide catheter care or baths per hospital protocol
Secure catheter to prevent movement or pulling
Empty drainage bags when ½ full
Ensure no kinks in catheter tubing & below bladder
Do not allow catheter drainage bag to touch the floor
Maintain a closed drainage system
Accurate monitoring of output
Timely removal
types of external catheters
Males: condom cath
Females: Purewick
suprapubic catheter
placed in the bladder through abdominal wall
Sutured in place
Used when blockage of urethra or when indwelling catheter causes irritation
