Urinary Elimination Flashcards
Micturition
complex process involving bladder, urinary sphincters and CNS
voiding
What muscles are involved in voiding?
bladder contraction
urethral sphincter
pelvic floor muscles
impulses from brain
What is the process of voiding by the body?
CNS sends response of urge
external sphincter activates
bladder empties
Factors influencing urinary elimination
growth and development
sociocultural factors
psych factors
surgery
personal habits
fluid intake
patho conditions
Dx tests
Urinary changes in OA
Decreased amount of nephrons, bladder control and capacity, time between desire and urgent need
Increased bladder irritability and contractions during filling, risk of incontinence
Urinary retention
inability to fully or partially empty bladder
can be acute or chronic
Dx of urinary retention
bladder scan post void
applying pressure watching for pain or tenderness
Is a bladder scan an independent or dependent intervention?
independent
UTI
most common HAI
from E. coli
Upper UTI
kidney infection
Risk factors for UTI
indwelling catheter use
urinary retention
incontinence
poor peri hygiene
FEMALES
sex frequently
uncircumcised males
How do elderly present with UTI?
neuro problems
falls
S/Sx UTI
dysuria
burning with peeing
urgency
frequency
incontinence
foul smell
cloudy, dark urine
CAUTI
catheter associated UTI
major risk of in dwelling catheter
Urinary incontinence
involuntary loss of urine
Types of urinary incontinence
Stress **women laugh, cough, sneeze
Overflow **men with prostate issues
Urgency
Nocturia
voiding at night
Risk factors for incontinence
women and elderly
obesity
multiple pregnancies/vaginal births
neuro disorders
meds
confusion, dementia
immobility, depression
What is a normal urine output?
> 30mL per hour
urine color
normal: pale straw to amber
abnormal: hematoma color changes
Urine clarity
normal: transparent
abnormal: cloudy, thick
(from sitting in bladder)
Urine odor
normal: odorless, ammonia
abnormal: offensive, food, fruity (acetone)
Measurement of urine
catheter
foley bag with urometer
q4-8 hours
urinals
specihat
Normal urine pH
4.6-8
Urinalysis
way to test urine
collect during normal void
fresh new urine needed
Can urine be taken from a catheter bag for a urinalysis?
no
What should be negative in a urinalysis?
electrolytes
ketones
proteins
WBC
Culture/Sensitivity
clean void/mia stream
catheter - sterile
urinary diversion
must be sent within 30 min
results in 24 hours
Abdominal x-ray KUB
determines shape, symmetry, locations and structures of urinary tract
detects and measures urinary calculus (kidney stones)
no special prep
Normal fluid intake
2300 mL per day if renal function is intact and no need for restrictions
helps flush out solute to limit bladder irritation
What should you do for nocturia patients before bed?
Stop drinking fluids 2 hours before
Urinary catheter care
single lumen (I and O)
indwelling (balloon)
3 lumen (meds or irrigation)
coude tip (curved)
suprapubic (thru abdominal wall)
external (condom or pure wick)
When should you empty a urine bag?
1/2 full
Can peri care before catheter insertion be delegated?
yes
How soon should patients void after removal of catheter?
6-8 hours
When doing an I and O catheter, should you use the same catheter each time?
No, use a different one each time
What output is necessary post surgery or catheter removal?
30mL/hr
What are labs to assess kidney function?
Creatinine
BUN
AST
ALT
What condition can place a patient at risk for UTI?
diabetes mellitus
What kind of catheter should be used for a male with an enlarged prostate?
coude tip catheter
Who is more likely to experience stress urinary incontinence?
women
