Urinary Elimination Flashcards
if someone is fluid deficit what do we do
give fluids
when someone has urinary issues what do we want to keep an eye on
I&O
what is the main involuntary muscle of the urinary system
detrussor muscle
what is included under voluntary control
imitating
stoping
interrupting
what is the minimum normal urine output
30mL/hr
can we control the internal sphincter
no
internal sphincter is controlled by
neurogenic
external sphincter is controlled by
you
- able to control this one
how does age influence urination
decreased ability to concentrate urine
decreased bladder tone
decreased bladder contractility
neuromuscular/cognitive problems
what does it tell you that older adults have decreased ability to concentrate urine
frequent getting up throughout the night which is a fall risk
- able to concentrate urine allows us to not have to go at night
what does it tell you that older adults have decreased bladder tone and bladder contractility
the bladder does not empty fully so they will have statsis of urine which leads to a UTI
what does it tell you that older adults have neuromuscular/cognitive problems
they are not aware they have to do
how can food and fluid intake affect urination
decreased drinking could lead to increased sodium
what do we want fluid intake at
2-3L
what are some pathology that can affect urination
renal disease, diabetes
what are some medications that can increase urine output
diuretics
what should we ask about voiding history
how often do you go
are you routinely going
who might be at risk for high post void residuals
BPH
what do we use to confirm how much fluid is in post void residual
bladder scanner
what is a normal post void residuals
> 50mL
what can be an assessment of urine include
color
clarity
odor
volume over 24 hour period
specimens
UA
urine analysis
how much do we need for a UA
10mL
is a UA a gross or specific
gross
what does a UA tell us
WBC, RBC, sugar, protein
if we notice a possible problem on the UA what will we order next
urine culture and sensitivity
how much do we need for a urine culture and sensitivity
3mL
CCMS
clean catch mid stream
how do we collect a CCMS in a patient with a catheter
specimen port
how do we collect a CCMS on a patient with no catheter
good peri care
start
stop
start and collect
stop
finish
why do we want the patient to pee at first when getting a CCMS
gets rid of any contaminants
if we have a patient with no catheter and they cannot perform a CCMS what do we do
straight Cath for the procedure
how do we do a 24 hour urine sample
at the time the 24 hour starts have patient void because this urine was now produced during that 24 hour. at the end of the 24 hour collect that urine because it was produced in that 24 hour
what happens if we dump a void for a 24 hour urine sample
start over
what can a 24 hour urine sample tell us
renal function
creatine
clearance
is culture and sensitivity a sterile procedure
yes
BUN normal
8-23
what does BUN measure
can the kidneys remove urea from blood
nitrogen in blood that comes out in urine
how well the kidneys work
what is urea
protein broken in body
who might we see a high BUN in
decreased kidney function or dehydrated
is creatine a more refined or gross test
refined
normal creatine
0.6-1.2
if you have increased creatine what does that tell you about your body
decreased kidney function
what is the most specific test
GFR
what contributes to GFR
age and race
what is a normal GFR
90
what do we want the minimum of GFR to get
> 60
if GFR is less than 60 for 3 months what does that mean
renal disease
GFR is a parameter for what medication
glucophage
what habits do we want to maintain while in the hospital
privacy
position
hygiene
how do we maintain muscle tone
kegal exercises and bladder training
what is kegal exercises
increase pelvic floor muscule
like holding in pee
what is bladder training
put patient on toilet every 2 hours
incontince
cannot control urinary flow
is inconntince a normal process of aging
no
ilulconduit
ureter to ilum to abdomen bag
uretostomy
ureters to surface
neobladder
small intestine and make fake bladder
pros and cons to neobladder
no signal about going
body image, no bag
UTI symtoms and signs
dysuria. frequency, cloudy urine and foul odor, back pain
how do we confirm a UTI
urine analysis and/or urine culture
what might we see in younger person
increase temp
increase WBC
what is the first sign of UTI in elderly
confusion
what do we find out from a urine culture and sensitivity
the bacteria and what antibiotics treat the infection
who has an increased risk factors for UTI
females (short urethra)
age (urinary statuses)
indwelling catheters (CAUTI)
diabetics (sugar allows bacteria to grow)
interventions for UTI
foley care
kegal
I &O
wipe front to back
pee after sex to clear bacteria
cotton underware
where can biofilm be harmful
indwelling cath
urinary retention increased risk
age
prostate
after foley is removed patient needs to go within
6 hours
diseases of what could cause urinary retention
spinal cord
what are some meds that cause urinary retention
anticholinergics
tricyclic antidepressants
calcium channel blockers
narcotic analgesics
anesthetic agents
why do anesthetic agents lead to urinary retention
paralyze internal sphincter
we want a urinary retention to be
less than 50mL
what PVR tells us there is urinary retention
150mL
who might a bladder scanner be inaccurate in
obesity
inadequate gel
improper aim
moving the probe during scanning
scar tissue
incisions
staples
straight cath
intermitten
put in, drain, pull out
indwelling cath
stays in
suprapubic cath
long term
normal position for Cath insertion
dorsal recumbent
when will an indwelling Cath be appropriate
acute urinary retention
accurate measurments
periop
healing of wounds
prolonged immobilization
end of life care
large volume infusions of diuretics during surgery
inappropriate uses of indwelling caths
substitue for nursing care
obtaining a urine culture when patient is capable
prolonged postop duration
what is an alternative to indwelling
pirwicks
what is the sanitation for putting in a cath
sterile/aseptic
why do we secure caths
so it cannot float in
when is the most common time to get CAUTI
after insertion
poor care after insertion
foley care
clean clean to dirty
6 in down tube
keep off floor
secure to thigh
green clip on bed
no dependent loops
bag never higher than bladder (back flow)
pericare
what suction is the perwicks
low
how often do we replace pirwicks
8-12 hours
how often do we change condom caths
24hr
how do we put a condom Cath on a patient who is uncircumsized
replace foreskin before putting Cath on
how much space do we leave at end of condom cath
1 inch
transient incontinence
appears suddenly and is usually caused by an illness or temporary problem that is short lived/treatable
stress
weak pelvic floor muscles and/or deficient urethral spinchter, loss of urine during increased intrabdominal pressure
urge
involuntary loss of urine that occurs soon after feeling an urgent need to void
mixed
combination of stress and urgency
overlfow
chronic retention of urine asscoated with overdistension and over flow
functional
inability to reach bathroom
reflex
spinal cord injuries emptying with no signal
how to help with stress
kegal
how to help with urge
bladder training
how to help with overflow
kegal
how to help with functional
bladder training
how to help with reflex
bladder training
