Urinary Elimination Flashcards
bacteremia
presence of bacteria in blood stream
bacteriuria
presence of bacteria in the urine but no symptoms
- e coli most common, often health care associated
catheter associated UTI
develop with presence of indwelling cath (break sterility on insertion)
- can be costly w no reimbursement
- can be reasonably prevented
- focus on early recognition and prompt treatment
catheterization
putting a catheter into the urinary tract
cystitis
inflammation of the bladder caused by bladder infection
dysuria
pain, burning, discomfort when urinating
hematuria
presence of blood in someones urine
micturition
to urinate
- complex process that involves the bladder, urinary sphincters, CNS
nephrostomy
an opening between the kidney and skin to allow for the removal or urine
pelvic floor muscle training
repeated contracting and relaxing of muscles to help with urination
postvoid residual
the amount of urine left in the bladder after a void
proteinuria
high levels of protein in the urine
pyelonephritis
kidney infection
suprapubic catheter
placed in the bladder through the abdominal wall
- sutured in place
- used when blockage or urethra or indwelling causes irritation
urinary incontinence
involuntary loss of urine
- urgency, stress, overflow
- often multifactorial
ureterostomy
surgery to create a urinary diversion
- have stoma for ureter or kidney
- urine bypasses bladder and exits through stoma
voiding
bladder contraction and urethral sphincters and pelvic floor muscles
- impulses sent from brain
- external sphincter relaxes and bladder empties
factors that influence urinary elimination
- growth and development
- sociocultural factors
- psychological factors
- personal habits
- fluid intake
- pathological conditions (nervous system)
- surgical procedures (post op, abdomen area)
- diagnostic examinations
urinary changes in older adults
decreased
- amount of nephrons
- bladder muscle tone
- bladder capacity
- time btw initial desire and becomes urgent
increased
- bladder irritability
- bladder contractions during bladder filling
- risk of urinary incontinence
common urinary problems
- urinary retention
- UTI
- incontinence
urinary retention
inability to partially or completely empty bladder
- acute or chronic
- diagnose w bladder scan (postvoid residual)
- incontinence considered overflow incontinence
bladder scanner
- independent nursing intervention
- should be done after post void
- can lead to i and o cath before full cath
risk factors for UTI
- presence of indwelling catheter
- any instrumentation of urinary tract
- urinary retention
- urinary or fecal incontinence
- poor peri care
- female
- frequent sexual intercourse
- uncircumcised pts
incontinence of risk factors
- more common in women and elderly
- obesity
- multiple pregs / vaginal birth
- neurological disorders (parkinsons, CVA, spinal cord, MS)
- med therapy: diuretics, opioids, anticholinergics, Ca channel blockers, sedatives, hypnotics
- confusion
- dementia
-immobility - depression
assessment of pts w urinary problems
- assess understanding and expectations of treatment
- be professional
- assess ability to perform necessary behaviors associated w voiding
- assess for any culture or personal considerations
- past medical and surgical hx
- med use
- normal bowel and urinary elimination patterns
- sleep, activity, nutrition
focused assessment for urinary incontinence
- focused urinary and abdominal
- looking at kidneys, bladder, external genitalia, meatus, urethra, perineal skin
pattern of urination
- frequency and times
- normal amount w each void
- hx of recent changes
assessment: nursing hx
- pattern of urination
- symptoms of urinary alterations
- urination, dysuria, freq, hesitancy, polyuria, oliguria, nocturia, dribbling, hematuria, retention
CVA
costovertebral angle
- checks for kidney infection
assessing urine
- input and output
- characteristics of urine
intake and output assessment
- evaluates bladder emptying
- renal function
- fluid and electrolyte balance
- can be HCP or nurse decision to measure
normal urine output rate
more than 30 mls for every hour
characteristics of urine
- color
- clarity
- odor
color
normal
- pale straw color to amber
abnormal
- hematuria
- color changes
clarity
normal
- transparent to void
- urine that sits could become cloudy
- thick and cloudy can indicates bacteria and WBC
- early morning voids can look like cloudy
odor
normal
- odorless
- ammonia smell
abnormal
- offensive, may indicate UTI
- some foods can alter smell
- fruity indicates acetone
strict i and os
must have a catheter
- often used for people with kidney disease, heart failure
urinalysis info
- collect freshly voided urine
- cant take out of catheter bed
- sometimes can use reagent strips
- send to lab w/in 30 mins
- use sterile specimen cup
urinalysis normal results
- clear, amber, yellow
- aromatic
- ph 4.6-8.0
- protein 8 mg/100 mls
- glucose, bacteria, ketones all negative
- specific gravity 1.005-1.030
- RBC up to 2
- WBC 0-4
abdominal x-ray
determines size, shape, symmetry, location of structures of urinary track
- detects and measures urinary calculi
- no special prep like NPO
nursing problems for urinary elimination
- impaired urinary elimination
- urinary retention
- incontinence
- impaired comfort and pain
- impaired skin integrity or risk for impaired skin integrity
- knowledge deficit
- body image disturbance
- risk for infection
health promotion and pt education
- promote self care practices
- maintain normal routine
- promote healthy nutrition and fluid intake
- avoid smoking and constipation
- strengthen pelvic floor muscles
- be aware of mens prostate
- report changes in urinary tract
maintaining adequate fluid intake
- 2300 mls/day (if no renal function problems, no heart disease)
- helps flush solutes to limit bladder irritability
- if fluid needs to be inc, schedule times to drink, identify preferences, high fluid fruits, stop drinking about 2 hrs before bed
urinary retention
- assess and monitor urine output, bladder distention
- assess for normal elimination position
- run water or flush commode
- apply cold compress
- encourage double voiding
- around the clock voiding
- crede method (applying manual pressure, not recommended)
- intermittent cath, cath
preventing infection
- follow hospital protocol
- assess for s/s of infection
- preform peri care
- void at regular intervals
- adequate fluid intake
- female considerations (wiping, solutions for leakage, inc pelvic floor strength)
incontinence care
- be respectful of feelings
- pelvic floor muscle training
- lifestyle changes
- bladder retention
- toilet schedule
- inter cath
- meticulous skin care
- absorbant pads and catheters
- electrical stimulation
- meds (anticholinergic)
- interventional therapies
- surgery
skin care do
- identify and treat early
- use skin risk assessment tool
- use appropriate skin barrier problems
- ensure adequate hydration
- consult wound
skin care donts
- use traditional soap and water
- double padding the bed
- leave soiled pads
types of catheters
- single lumen
- indwelling cath
- 3 lumen
- coude tip
- suprapubic
external
nursing catheter care
- regular peri care
- secure cath to prevent movement
- empty drainage bag when 1/2 full
- ensure no kinks
- bag below bladder
- drainage bag cant touch floor
- maintain closed system
- accurate monitoring
- timely removal
before cath insertion
- peri care (front to back, uncircumcised)
- can delegate to assistant
- CHG or castille wipes (done before insertion, daily/qshift)
- follow algorithm for removal
post cath removal
- pt should void w/in 6-8 hrs
- monitor ability to void and empty
- measure accurate urine output
- check for retention
- pt education like firrst void can cause discomfort)
