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Fundamentals 2 > Urinary Elimination > Flashcards

Urinary Elimination Flashcards

1
Q

What is micturition

A

process of voiding

Complex interaction between the bladder, urinary sphincter, & central nervous system

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2
Q

What happens during voiding

A

Bladder contraction + urethral sphincter and pelvic floor muscle relaxation

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3
Q

What happens when a person is ready to void

A

Central nervous system sends a message to the micturition centers

External sphincter relaxes and the bladder empties.

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4
Q

What are the 8 factors that influence urinary elimination

A

Growth & Development

Sociocultural Factors

Psychological Factors

Personal Habits

Fluid Intake

Pathological Conditions

Surgical Procedures

Diagnostic Examinations

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5
Q

When does voluntary control of bladder begin to happen

A

around 18-24 months

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6
Q

Urinary changes DECREASED in older adults

A

Amount of nephrons
Bladder muscle tone
Bladder capacity
Time between initial desire to void & urgent need to void

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7
Q

Urinary changes INCREASED in older adults

A

Bladder irritability
Bladder contractions during bladder filling
Risk of urinary incontinence

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8
Q

Personal habits for elimination

A

Need for privacy

Adequate time to void

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9
Q

sociocultural factors of elimination

A

Culture and gender norms vary

private versus communal toilet facilities

lifestyle behaviors

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10
Q

psychological factors of elimination

A

anxiety and stess

depression

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11
Q

fluid intake during elminiation

A

If fluid, electrolytes, solutes are balanced_ increase fluid intake will increase urine production
Alcohol
Caffeine

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12
Q

T/F increase in sodium causes decrease urination

A

TRUE

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13
Q

Pathological conditions that affect elimination

A 
Diabetes Mellitus (DM), Multiple Sclerosis (MS), Stroke (CVA)
Arthritis
parkinsons
dementia
chronic pain
spinal injury
prostatic enlargement
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14
Q

Surgical Procedures

that affect elimination

A

Local trauma to abdomen or pelvic area

Post-operatively_ urinary retention

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15
Q

Medications that affect elimination

A

Diuretics (example, furosemide (Lasix))
Medications affect urine color
Anticholinergics (atropine)
Hypnotics & sedatives (analgesics, antianxiety meds)

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16
Q

Diagnostic Examinations for urinary elimination

A

cytoscopy

urinary catheterization

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17
Q

3 common urinary elimination problems

A

Urinary Retention
Urinary Tract Infections
Urinary Incontinence

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18
Q

What is urinary retention

A

Inability to partially or completely empty bladder

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19
Q

Symptoms of urinary retention

A

pressure
tenderness
restlessness
diminished output

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20
Q

acute retention

A

sudden onset

more sign and symtp

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21
Q

chronic retention

A 
strain to void
painless
more frequent
more urgency
incontinence
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22
Q

what is post void residual PVR

A

how much urine left after voiding

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23
Q

what is overflow incontinence

A

Incontinence caused by urinary retention

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24
Q

what is the most common causative agent of UTIs

A

E Coli.

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25
Q

What are the 2 locations of UTIs

A

Upper- Kidneys

Lower - Bladder, urethra

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26
Q

Bacteruria

A

Does NOT always mean UTI

If bacteria present but asymptomatic, will not treat with antibiotics

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27
Q

Risk Factors for UTIs

A 
Presence of indwelling catheter
Any instrumentation of urinary tract
Urinary retention
Urinary or fecal incontinence
Poor perineal hygiene
Females
Frequent sexual intercourse
Uncircumcised patients
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28
Q

Symptoms of UTIs

A 
Dysuria (burning or pain w/ urination)
Cystitis (irritation of the bladder)
Urgency
Frequency
Incontinence
Suprapubic tenderness
Foul-smelling cloudy urine
Fever
29
Q

Elderly symptoms of UTIs

A 
Delirium, confusion, change in mental status
Fatigue
Loss of appetite
Decline in function
Incontinence
Falls
Subnormal temperature
30
Q

what is a Major risk of development with presence of indwelling catheter and length of use

A

Catheter Associated Urinary Tract Infection (CAUTI)

31
Q

what is the focus of Catheter Associated Urinary Tract Infection (CAUTI)

A

early recognition & prompt treatment

32
Q

What is Urinary Incontinence (UI)

A

Involuntary loss of urine

33
Q

What are the forms of urinary incontinence

A 
Transient
Functional
Overflow or UI associated with chronic urinary retention
Stress
Urge or Urgency
Reflex or Neurologic
34
Q

Urinary Incontinence Risk Factors

A 
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
35
Q

Urinary Incontinence Expected Findings

A 
Loss of urine when laughing, coughing, sneezing
Enuresis (bed-wetting)
Frequency
Urgency
Nocturia
36
Q

Considerations in the assessment of urinary elimination

A

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

37
Q

What to know about pattern of urination

A

Frequency and times of voiding
Normal amount with each void
History of recent changes

38
Q

symptoms of urinary alterations

A 
Urgency
Dysuria
Frequency
Hesitancy
Polyuria
Oliguria
Nocturia
Dribbling
Hematuria
Retention
39
Q

what to physically assess during a urinary elimination assessment

A

Kidneys
Bladder
External genitalia & urethral meatus
Perineal skin

40
Q

Assessment of intake & output

A

Evaluates bladder emptying

Renal function

Fluid & electrolyte balance
Can be an HCP order or nursing judgement

41
Q

What is normal urine output

A

> 30 mls/hr

Concerned if < 30 mls/hr for 2 hours*

42
Q

Characteristics of urine

A

Color
Clarity
Odor

43
Q

Assessment of urine color

A 
Normal
	Pale straw color to amber- depends on concentration
Abnormal
	Hematuria
	Color changes
44
Q

Assessment of urine clarity

A

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

45
Q

assessment of urine odor

A 
Normal
	Odorless
	Ammonia smell
Abnormal
	Offensive- May indicate UTI
	Some foods change odor
	Fruity- acetone
46
Q

things to know as a nurse about urine testing

A

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

47
Q

What is assessed with a urinalysis

A 
pH
Protein
Glucose
Ketones
Specific gravity
RBC
WBC
Bacteria
Casts
Crystals
48
Q

nursing considerations with urinalysis

A

Collect during normal voiding, indwelling catheter, or urinary diversion
Must have freshly voided urine
Cannot take urine from catheter bag
Possibly use Reagent strips

49
Q

what does specific gravity tell us

A

how concentrated the urine is

50
Q

What is culture and sensitivity for

A

Obtained to determine presence of pathogenic bacteria

51
Q

why is culture and sensitivity important

A

Important to test the sensitivity of any growing bacteria to various antibiotics

52
Q

how to obtain urinary culture

A

Clean- voided or clean-catch/ mid-stream urine specimen
Urinary catheter
Urinary diversion

53
Q

T/F must use sterile cup for urine specimen

A

TRUE

54
Q

what does abdominal xray- KUB determine

A

size, shape, symmetry, location of structures of the Urinary Tract

55
Q

common uses of abdominal xray- KUB

A

detect and measure urinary calculi

56
Q

Urinary Elimination Alteration

A 
Impaired Urinary Elimination
Urinary Retention
Incontinence 
	Functional urinary 
	Overflow urinary 
	Reflex urinary
	Stress urinary 
	Urge urinary
57
Q

Associated Problems related to Urinary Elimination

A 
Impaired Comfort or Pain
Impaired Skin Integrity or Risk for impaired skin integrity
Knowledge Deficit
Body Image Disturbance
Risk for Infection
58
Q

Health Promotion & Patient Education of urinary elimination

A

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

59
Q

Fluid intake considerations

A

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
60
Q

Nursing care for urinary retention

A

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

61
Q

Preventing urinary infection

A

Follow hospital protocol

Assess for s/s of infection

Perform perineal hygiene

Void at regular intervals

Adequate fluid intake

Female considerations

62
Q

incontinence care

A 
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
63
Q

DO’s of skin care

A 
Identify & treat early
Use skin risk assessment tools
Use appropriate skin barrier products
Ensure adequate hydration
Consult WOCN if needed
64
Q

DONT’s of skin care

A

Use traditional soap & water
Double padding the bed
Leave soiled pads

65
Q

what is urinary catheterization

A

Tube placed through the urethra into the bladder to drain urine

66
Q

Types of Urethral catheters

A 
Single lumen
Indwelling catheter
3-way/ 3 lumen
Coude tip
Curved rounded
Suprapubic
External Catheters
67
Q

Nursing catheter care

A

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

68
Q

types of external catheters

A

Males: condom cath
Females: Purewick

69
Q

suprapubic catheter

A

placed in the bladder through abdominal wall
Sutured in place
Used when blockage of urethra or when indwelling catheter causes irritation

Fundamentals 2 (5 decks)

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