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NURS 402: Lecture > Urinary elimination > Flashcards

Urinary elimination Flashcards

1
Q

Job of Kidneys and Ureters

A
  1. Maintain composition and volume of body fluids
  2. Filter and excrete blood constituents not needed; retain those that are needed
  3. Excrete waste product (urine)
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2
Q

What do nephrons do to excrete waste product (urine)

A

The nephrons maintain and regulate fluid balance through the mechanisms of selective reabsorption and secretion of water, electrolytes, and other substances

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3
Q

Where do urine from nephrons empty?

A

Urine from the nephrons empties into the kidneys

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4
Q

What is the bladder made up of?

A

Smooth muscle sac innervated by ANS

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5
Q

What does bladder serve as?

A

Serves as a temporary reservoir for urine

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6
Q

What is the bladder composed of?

A

Composed of three layers of muscle tissue called detrusor muscle

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7
Q

What are the three layers the bladder is made up of

A

Composed of three layers of muscle tissue called detrusor muscle

The inner longitudinal layer, the middle circular layer, and the outer longitudinal layer

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8
Q

What opens between urinary bladder and sphincter

A

Sphincter guards opening between urinary bladder and urethra

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9
Q

What does Urethra do?

A

Urethra conveys urine from bladder to exterior of body

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10
Q

How are male urethras?

A

Male urethra functions in excretory and reproductive systems

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11
Q

How are women urethras?

A

No portion of female urethra is external to the body

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12
Q

Act of urination is also called?

A

Act of Urination (Micturition, Voiding)

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13
Q

Steps to emptying the bladder: What do detrusor, internal sphincters and urine do?

A

Detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra

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14
Q

Steps to emptying the bladder: what do muscles perineum and external sphincters do?

A

Muscles of perineum and external sphincter relax

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15
Q

Steps to emptying the bladder: what do muscles abdominal wall do?

A

Muscle of abdominal wall contracts slightly

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16
Q

Steps to emptying the bladder: What does diaphragm do?

A

Diaphragm lowers, micturition occurs

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17
Q

Factors Affecting Micturition

A

Developmental considerations
Food and fluid intake
Psychological variables
Activity and muscle tone
Pathologic conditions
Medications

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18
Q

What is included in development considerations affecting micturition

A

Toilet training
Effects of aging

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19
Q

More specific developmental considerations having to do with children?

A

Toilet training 2 to 3 years old, enuresis

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20
Q

More specific developmental considerations having to do with effects of aging?

A

Nocturia
Increased frequency
Urine retention and stasis
Voluntary control affected by physical problems

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21
Q

Diseases Associated with Renal Problems

A

Congenital urinary tract abnormalities
Polycystic kidney disease
Urinary tract infection
Urinary calculi
Hypertension
Diabetes mellitus
Gout
Connective tissue disorders

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22
Q

Effects of Medications on Urine Production and Elimination: Three medications to consider

A
  1. Diuretics
  2. Cholinergic meds
  3. Analgesics and tranquilizers
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23
Q

Diuretics:

A

prevent reabsorption of water and certain electrolytes in tubules

24
Q

Cholinergic medications:

A

stimulate contraction of detrusor muscle, producing urination

25
Analgesics and tranquilizers:
suppress CNS, diminish effectiveness of neural reflex
26
Medications Affecting Color of Urine
Anticoagulants: Diuretics: Pyridium: The antidepressant amitriptyline or B-complex vitamins: Levodopa:
27
Nursing History for urinary elimination
Usual patterns of urinary elimination Recent changes in urinary elimination Aids to elimination Present or past occurrence of voiding difficulties Presence of urinary diversion
28
Physical Assessment of Urinary Functioning: What parts of the body are focused on
Kidneys: Urinary bladder: Urethral orifice: Skin: Urine:
29
Physical Assessment of Urinary Functioning: Kidneys
Palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment
30
Physical Assessment of Urinary Functioning:Urinary bladder:
Palpate and percuss the bladder or use a bedside scanner
31
Physical Assessment of Urinary Functioning:Urethral orifice:
Inspect for signs of infection, discharge, or odor
32
Physical Assessment of Urinary Functioning:Skin:
Assess for color, texture, turgor, and excretion of wastes
33
Physical Assessment of Urinary Functioning:Urine:
Assess for color, odor, clarity, and sediment
34
Additional Assessment Techniques
1. Measuring urinary output 2. Routine urinalysis
35
Measuring urinary output
Continent patients Incontinent patients Indwelling catheter
36
What is included in routine urinalysis
Clean-catch or midstream specimen Sterile specimen Urinary diversion specimen 24-hour specimens
37
Measuring Urine Output: What do you ask pt to void in?
Ask the patient to void into a bedpan, urinal, or specimen container in bed or bathroom
38
Measuring Urine Output: After pt pees what do you do?
Put on gloves. Pour urine into the appropriate measuring device
39
Measuring Urine Output: How do you measure it?
Place the calibrated container on a flat surface and read at eye level Note amount of urine voided and record on the appropriate form
40
Measuring Urine Output: What do you do with urine after measuring?
Discard urine in the toilet unless specimen is needed. If a specimen is required, pour the urine into an appropriate specimen container
41
Patient Health Problems having to do with urine
Urinary functioning as the problem Urinary functioning as the etiology
42
Urinary functioning as the problem
Incontinence Pattern alteration Urinary retention
43
Urinary functioning as the etiology
Anxiety Caregiver role strain Risk for infection
44
Promoting Urinary Elimination
1. Maintaining regular voiding habits 2. Promoting fluid intake 3. Strengthening muscle tone 4. Assisting with toileting
45
Planned Patient Goals:
Produce urine output about equal to fluid intake Maintain fluid and electrolyte balance Empty bladder completely at regular intervals Report ease of voiding Maintain skin integrity Demonstrate appropriate self-care behaviors
46
Patients at Risk for UTIs
Sexually active people with female genitalia People who use diaphragms for contraception Postmenopausal people People with indwelling urinary catheter in place People with diabetes mellitus Older adults
47
Types of Urinary Incontinence
Transient: Mixed: Overflow: Functional: Reflex: Total: Stress:
48
Types of Urinary Incontinence: Transient
appears suddenly and lasts 6 months or less
49
Types of Urinary Incontinence: Mixed:
urine loss with features of two or more types of incontinence
50
Types of Urinary Incontinence: Overflow:
overdistention and overflow of bladder
51
Types of Urinary Incontinence: Functional:
caused by factors outside the urinary tract
52
Types of Urinary Incontinence: Reflex:
emptying of the bladder without sensation of need to void
53
Types of Urinary Incontinence: Total:
continuous, unpredictable loss of urine
54
Types of Urinary Incontinence: Stress:
involuntary loss of urine related to an increase in intra-abdominal pressure
55
Reasons for Catheterization
Relieving acute urinary retention Obtaining a sterile urine specimen when patient is unable to void voluntarily Accurate measurement of urinary output in critically ill patients Assisting in healing open sacral or perineal wounds in incontinent patients Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations Providing improved comfort for end-of-life care Prolonged patient immobilization
56
Types of Catheters
Intermittent urethral catheters Indwelling urethral catheter Suprapubic catheter
57
Nursing Interventions
Urethral catheter insertion and care for patients with an indwelling catheter Caring for a patient with a urologic stent Caring for a patient with a urinary diversion Caring for a patient receiving dialysis

NURS 402: Lecture (17 decks)

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