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N1213 > Urinary Elimination > Flashcards

Urinary Elimination Flashcards

1
Q

Palpation of the kidney

A
  • not normally palpable

- however palpation could detect enlargement

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2
Q

Which kidney is lower?

A
  • right kidney

- easier to detect

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3
Q

Renal dysfunction?

Where is the tenderness?

A
  • tenderness between bottom rib and spine
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4
Q

Auscultation for bruits (kidneys)

A

Auscultate to assess for bruits (low pitched murmurs)

- indicate renal artery stenosis or aortic aneurysm

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5
Q

Ascites

A
  • accumulation of fluid in the peritoneal cavity which may occur with kidneys as well as liver dysfunction
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6
Q

Percussion over bladder

A
  • after patient voids
  • begin at midline (above umbilicus), proceeds downward
  • sound changes from tympanic to dull
  • dullness over the bladder after voiding = incomplete bladder emptying
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7
Q

Palpating the bladder

A
  • palpated only if it is moderately distended
  • feels like a smooth firm round mass rising out of abdomen (usually at midline)
  • > 150mL of urine
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8
Q

Short-term catheterization (fewer than 14 days) (5)

A

1) obstruction to urine flow (ex: prostate enlargement)
- when bladder, urethra, and surrounding structures have been surgically repaired
2) prevent urethral obstruction from blood clots
3) prostate surgery
4) ) measuring urinary output on critically ill clients
5) continuous or intermittent bladder irrigations are required

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9
Q

Long-term catheterization (more than 14 days)

A

1) severe urinary retention (recurrent UTI)
2) skin rashes, ulcers or wounds irritated by contact with urine
3) terminal illness when bed linen changes or toileting are painful for client

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10
Q

Intermittent catheterization (insertion and removal of a catheter several times a day to empty the bladder.)

A

1) relieve discomfort due to bladder distention
2) obtain sterile urine specimen
3) assess residual urine volume
4) management of urethral structures
5) long term
- spinal cord q6h
- neuromuscular degeneration
- incompetent bladders

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11
Q

What is a straight catheter? (5)

A
  • single lumen
  • urine drains from tip, through lumen, into a receptacle
  • intermittently
  • in and out to drain when required
  • sterile
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12
Q

Coude catheter

A
  • curved tip
  • male patients = enlarged prostate
  • less traumatic, stiffer/easier to control
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13
Q

In-dwelling or Foley catheter

A
  • retained for longer periods in the bladder
  • small balloon that anchors it against the bladder neck
  • remains in place until daily review of necessity indicates removal
  • requires frequent cleaning
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14
Q

Triple lumen

A

clot drainage & irrigation

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15
Q

Plastic

A

intermittent use only, due to there inflexibility

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16
Q

Latex and rubber catheters

A

recommended use up to three weeks

- be aware of allergies

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17
Q

Silicon and teflon

A
  • long term (2-3 mo)
  • cause less encrustation at urethral meatus
  • durable/comfort
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18
Q

Hydrophilic coated catheters

A
  • more comfortable and less likely to inflame urethral tissue than non-hydrophilic catheters
  • encrustation develops slowly
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19
Q

Silver hydrogel catheters

A
  • short term use
  • delaying onset of bacteriuria
  • antimicrobial
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20
Q

Order for catheterization

A
  • type
  • size
  • type of drainage system
  • frequency of catheterization
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21
Q

List information required in order for urinary catheterization?

A
  • physician order
  • strict aseptic technique
  • organize equipment before procedure
  • steps for insertion for either indwelling or single use catheters are the same
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22
Q

Female Catheterization

1) When would you position the client in the Sim’s (side-lying) position?
2) Why do cleanse the client from below the clitoris downward?
3) How much of the catheter do you lubricate for the female client?
4) How far will you likely insert the catheter before you see urine flow?
5) Why do you hold the catheter with the non-dominant hand while you inflate the balloon?
6) Why do you secure the catheter to the inner thigh with tape?

A

1) abduct hip in supine position
- sims or side-lying
- inverted bedpan

2) Cleansing from the area of least contamination to area of the most contamination. Use a single cotton ball for each wipe.
3) 2.5 - 5cm
4) 5 - 7.5 cm after urine flow starts advance 2.5 - 5cm - never force against resistance.
5) The dominate hand is sterile and is needed to inflate the balloon.
6) Reduces pressure on the urethra, thus reducing possible tissue injury.

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23
Q

Male Catheterization

1) When would you position the male client supine, with knees slightly apart?
2) What do you do if a client is not circumcised?
3) Describe how to clean around the urinary meatus of a male client.
4) How much of the catheter do you lubricate for the male client?
5) How far will you likely insert the catheter before you see urine flow?
6) Why do you hold the penis perpendicular to the body for insertion ?

A

1) Supine
2) Pull back on foreskin, clean from meatus to rest of glans penis x3
3) With sterile hand (dominate hand) pick up the cotton ball with forceps to clean the penis. Move in circular motion from urethra meatus down to base of glans. Repeat cleansing three more times, using clean cotton ball each time.
4) 12.5 -17.7cm
5) 17 - 22.5 cm after urine flow starts advance 2.5 - 5cm - never force against resistance.
6) Straightens urethral canal to ease catheter insertion.

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24
Q

Disconnection

A

alcohol swabs on both ends

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25
Q

Avoid pooling

A

gravity/kinks

- ensure bag is lower

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26
Q

Aseptic technique

A

Sterile

27
Q

What should be done first, if the drainage bag must be elevated above the level of the patient’s bladder?

A

Clamp the tube to prevent reflux of urine back into the bladder.

28
Q

How often do you provide perineal care to patients with and indwelling catheter?

A

At least twice daily, after a bowel movement

- 3X/day

29
Q

How often should the urinary drainage bag be emptied during the day? Why?

A

q8H

- when bag is half full

30
Q

What is the purpose of bladder irrigation?

A

Wash out the bladder or treat local infection.

31
Q

What can be the result of accumulated clots, sediment or pus in a catheter?

A

Can cause bladder distension and the build-up of stagnant urine.

32
Q

How do you assess for catheter blockage?

A
  • amount of urine drainage is less then the client’s intake or less than the output during the previous shift blockage can be suspected.
  • urine does not drain freely you may milk the tubing.
33
Q

What volume of urine should be encouraged?

A

2000-2500 mL a day

34
Q

Mechanisms on the drainage system to prevent backflow of urine into the bladder

A

anti-reflux valve prevents the urine from re-entering the drainage tube

35
Q

Individual measuring containers

A
  • prevents cross-contamination
36
Q

Describe a continuous irrigation system and its indications? when is it most often used?

A
  • three way catheter
  • genitourinary surgery
  • risk for blood clots/mucus fragments blocking catheter
37
Q

When might you open the closed system to irrigate a catheter?

A
  • greater risk of infection

- needed when blocked/undesirable to change the catheter (prostate surgery)

38
Q

What is a urometer attached too?

A
  • special receptacle attached between in-dwelling catheters and drainage bags (holds 100-200 mL of urine)
  • hourly measuring device
  • for acutely ill patients (q1h)
39
Q

Straight drainage collection system?

A
  • preferred/cost effective, cumulative urine measurements
  • hourly output less than 30mL for more than 2 hrs = concern
  • over 2000-2500 mL daily = cause for concern
40
Q

Steps for urine sample collection?

A

1) clamp tubing (15 mins)
2) then access urinary catheter port
3) wipe needless aspiration port with alcohol
4) wait 30 secs
5) syringe to point 20mL
5) aspirate (5-10 mL)
6) place specimen in specimen container
20 mL urinalysis

41
Q

Removal of catheter

A

1) check on volume used to inflate balloon
2) sterile syringe
3) do not cut off port
4) empty drainage bag/record output
5) blue pad underneath
6) explain some burning upon removal

42
Q

After removal of a catheter? (4)

A

1) measure voids in bedpan
2) no voiding after 8 hr = call MD or NP
3) is small frequent voids/distended bladder (25-60mL) call MD
4) normal to have some frequency/dysuria for first few days

43
Q

Aspects of continuous bladder irrigation?

A

1) post urological surgery
- prostate cancer
2) Purpose
- patency of urethra
3) Assessment of blockage
- urine output is decreased
4) Three way lumen catheter
- in/out balloon
5) Irrigation
- blockage and do not want to change

44
Q

Normal urinary output for an adult?

A

1500-1600 mL per day

45
Q

Factors influencing urination? (7)

A

1) disease conditions
2) fluid balance
3) medications
4) diagnostic tests
5) surgical procedures
6) psychological
7) kinked catheters

46
Q

What should you make note of while palpating the kidneys? (also important landmarks)

A
  • costovertebral angle
  • flank pain
  • symphysis pubis
47
Q

Polyuria

A

Inc. urine

48
Q

Oliguria

A

dec. urine

49
Q

Anuria

A

failure

50
Q

Caffeine and alcohol

A

increased diuresis

51
Q

Febrile conditions

A

dec. urine output

- encourage fluid for fever

52
Q

Dysuria

A

pain when urinating

53
Q

Assessment of urine

A

1) intake/output
2) characteristics
3) urine specimens

54
Q

Common alterations in urinary health

A

1) urinary incontinence
2) UTI (40% of nosocomial infections)
3) nocturia
4) urinary retention
5) urinary diversions

55
Q

Health Promotion - Primary Prevention

A

1) client education
- hygiene
- cranberry juice
- risk factors
2) promoting regular urinary patterns
- sensory awareness
- positioning
- adequate fluid intake (1500-2000mL)
3) promoting complete bladder empyting
- take your time
- bladder scanner

56
Q

Health Promotion - Secondary Prevention

A
  • promote complete bladder emptying
  • take time to urinate
  • provide privacy
57
Q

Health Promotion - Tertiary Prevention

A
  • assess urine output/consistency
  • catherize as necessary
  • intake/output
  • vitals
  • hand hygiene/catheter care
  • administer antibiotics
58
Q

Purpose of catheterization?

A
  • drain urine from bladder
  • instill medication or irrigating solution
  • obtain sterile specimen of urine for lab tests
59
Q

A straight catheter has a ____ risk for UTI, and requires reg. assessment.

A

increase

60
Q

For males, you should grasp the penis at a ___ angle to ensure no damage/discomfort.

A

90 degree

61
Q

Where do you insert the catheter for a female?

A

the urethra

62
Q

When should a suprapubic catheter be prescribed?

A

trauma to urethra

63
Q

How much sample do you need for a urinalysis?

A

20 mL

N1213 (9 decks)

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