Urinary Elimination Flashcards
What does it mean when urinary output is 50 to 100 ml in 24 hours?
Anuria
What is a sudden desire to void (urinate) followed by rapid bladder contraction?
Urge incontinence
What is excessive urination at night?
Nocturia
What is a constant dribbling of urine or frequency in urination?
Overflow incontinence
What is painful urination?
Dysuria
What is the involuntary passing of urine?
Enuresis
What does it mean when urinary output is 100 to 500 ml in 24 hours?
Oliguria
What is blood in the urine?
Hematuria
What is the loss of urine control during activities that increase intra-abdominal pressure?
Stress incontinence
What is excessive production and excretion of urine?
Polyuria
What is the average daily urine output?
1400 ml in 24 hours or min of 30 ml/hr
How to check for urinary retention?
Inspect and palpate the suprapubic area and use a bladder scanner.
What factors influence urinary output?
- Psychological factors
- Food and fluid intake
- surgical and diagnostic procedures
- urinary tract infection
What treatment might be needed for patients with oliguria and anuria?
Dialysis
What are the differences between hemodialysis and peritoneal dialysis?
- Hemodialysis takes the patient blood and has it flow through the filter of a machine to ultrafiltrate.
- Peritoneal dialysis uses the abdominal cavity as the membrane to exchange fluid and molecules.
What is the goal of dialysis?
The goal is to remove toxins and maintain fluid, electrolyte, and acid-base balance.
What is cautious monitoring for a patient with a renal (kidney) disorder?
- Strict intake and output (I&O)
- Daily weights
- Assessment of vitals, neurological status, and overall condition.
What is dysuria often related to?
- Bladder infection or UTI
- Cystitis
- Sexually transmitted disease (STD)
- Yeast infection
- Kidney stone or bladder stone
- Prostate enlargement
Which group of patients are more prone to urinary incontinence?
- Women
- Older adults
- Pregnant women
What are factors that contribute to urinary retension?
- Vaginal birth
- Infection of the brain or spinal cord
- Diabetes
- Stroke
- Medications
What are the signs and symptoms of an enlarged prostate?
- Urinary frequency
- Hesitancy
- Retention
- Feeling of bladder fullness
- Pressure or Pain
How does dehydration influence urinary elimination?
It reduces urinary output
How do diuretics influence urinary elimination?
It increase urinary output
How does paraplegia (paralysis in the lower half of the body) influence urinary elimination?
Loss of control and and sensation causes urinary rentension
How does renal calculi (kidney stone) influence urinary elimination?
PPossible obstruction of urinary flow
Why do women experience more UTIs than men?
The female urethra is significantly shorter than the male urethra and closer to bacteria sources (anus and vagina).
What physical assessment determines renal and bladder status?
Inspect the bladder for color, symmetry, and distension
Palpation and percussion of the bladder
What are normal assessment findings for the urinary system?
Soft abdomen
Absence of indentation and scarring
What are abnormal assessment findings for the urinary system?
- Distention over the suprapubic area
- Bruit (abnormal sound caused by turbulent blood flow in an artery) heard over the left renal artery
- Discomfort from the percussion of the kidney
- Bilateral ecchymosis (bruising) to the lower abdominal quadrant
How do beets and blackberries affect the appearance of urine?
Turn urine pink or red
How does Warfarin affect the appearance of urine?
Turn urine red
How does liver failure affect the appearance of urine?
Turn urine brown or tea color
What are the expected (normal) characteristics of urine?
Pale yellow
Clear
pH = 6
No glucose
What blood tests check renal (kidney) function?
BUN and creatine levels
What preparation is needed for an intravenous pyelogram (IVP)?
The patient is NPO for 8 to 12 hours before and may need a laxative or enema to empty the bowels.
Pregnant women should not have an IVP with _____?
Radiographs and contrast dyes are contraindicated for pregnant women.
What can patients expect with a cystoscopy?
- A biopsy may be done
- Patient NPO 8 to 12 hours before
- Patient may feel the urge to void
- Urine may be pink-tinged for several days after the procedure
What are patient teachings to promote urinary function and prevent infections?
- Safe transfer techniques
- Patient to respond promptly to urine urge
- Maintain adequate fluid intake to flush system
- Report pain or burning, changes in urine color, odor, and voiding patterns promptly
- Washing front to back for female patients and retract foreskin for males
What are the important teachings for indwelling catheters?
Emptying and cleaning the device
Maintaining a closed system
Bladder irrigation or flushing as needed
How can the nurse provide hospitalized patients with optimum conditions to promote voiding?
- Provide privacy (close bathroom door, pull curtain closed around the bed, facing away from patient
- Warm the bedpan before use
- Assist the patient to a normal position as possible while on the bedpan (standing, sitting, head of bed elevated)
- Run water to stimulate the urge to void
- Respond promptly to patient urge to void
- Treat the patient with dignity
When should patients use a commode?
For those weak and unsteady on their feet and those with shortness of breath during ambulation.
When should patients NOT use a commode?
Those on bed rest or who cannot stand or transfer safely.
How can nurses assist patients with functional incontinence to void?
Toileting schedule
What does a toileting schedule mean?
Urinate at awakening, Q 1 to 2 hours during the day and before bedtime, Q 4 hours at night with time intervals slowing increasing.
What can patients do to decrease nocturia?
Do not drink liquids within 2 hours before bedtime.
How can patients prevent UTIs?
- Wear cotton underwear
- Cleanse the perineum front front to back
- Drink at least 64 oz of water/day
- Cleanse the genital area before bed and after intercourse
How can the risk of UTI be decreased with an indwelling catheter?
- Follow sterile technique during insertion
- Follow the asepsis technique during routine catheter care
- Maintain a closed system
- Keep the drainage bag below the level of the bladder
- Recommend removal of catheter ASAP
- The smallest size silver alloy or silver-impregnated catheter should be used
What is the most common hospital-acquired infection related to the urinary system?
Urinary tract infections (UTIs) related to catheterization
What do you understand about the different lumens of an indwelling catheter?
One lumen allows the efflux of urine once the catheter is placed, and the other lumen is for inflation/deflation to infuse water into the retention balloon.
When is a straight catheter performed?
- Collect urine samples
- Remove residual urine
- Empty a continent urinary diversion
When is an indwelling catheter performed?
- Provide continuous bladder drainage
- Allow for bladder irrigation
- Use for constricted urethra
- For extended periods due to immobility
How do you cleanse the perineum for routine perineal care?
Soap and water or no-rinse cleansers. Moister barrier cream may be used to prevent/heal skin breakdown.
What are the correct steps for female* catheterization?
- Prepare the sterile field and catheter
- Cleanse the perineum area
- Insert the catheter 2 to 3 inches advancing after urine appears
- Inflate the balloon
- Release the labia*
- Connect the drainage system
Why is bladder irrigation performed?
- Maintain patency of the catheter
- Post-operative after GU (genital urinary) surgeries, 3. Decrease infection
What actions are needed when resistance is noted during catheterization?
- Pull back the catheter and gentle reinsertion/repositioning
- Ensure the catheter is properly lubricated
- Ensure the insertion site is correct
- Check that the smallest cath is being used
- if resistance continues, contact MD for possible coude cath order per policy
What is a coude catheter?
A urinary catheter that has a curved tip that helps it pass through tight spots.
What actions are needed when no urinary drainage is noted during catheterization?
- Assess the catheter, its placement, and the system
- Verify correct placement
- Check when the patient last voided and the quantity
- Check the patient volume of intake
- Ask the patient to cough (increases pressure and flow of urine)
- Ask patient to take deep breaths in and out to relax abdominal muscle
- Check the catheter for kinks or obstruction
- Push the catheter in slightly and rotate it, or pull out the catheter slightly and rotate it
- Assess bladder for fullness or distention
Can lidocaine 2% gel be used as a lubricant during catheterization?
Yes, if there is no allergy, use for male* catheter insertion
What actions are needed when equipment contamination is noted during catheterization?
Stop the procedure, obtain new material, and restart the procedure.
What is a nursing intervention for the diagnosis: Stress incontinence associated with decreased pelvic muscle tone?
Teach kegel exercise (helps to strengthen your pelvic floor muscles).
It helps improve incontinence and is beneficial for women during and after pregnancy
How to do kegel exercise?
Empty your bladder
Sit or lie down
Tighten your pelvic floor muscles
Hold for a count of 3 to 5 seconds
Relax your muscles and count 3 to 5 seconds
Repeat 10 times, 3 times a day
What does correct teaching for patients with indwelling catheters include?
Empty the drainage bag when 2/3 full.
What is a common symptom of a bladder infection?
Hematuria
What is the correct technique for collecting a sterile urine specimen from a patient with an indwelling catheter?
Use a syringe to withdraw urine from the catheter port
What are normal BUN levels?
BUN 10 to 20 (high level indicates kidney disease)
What is important to know about patients undergoing IVP (intravenous pyelogram)?
Check for an allergy to iodine.
What is an appropriate action for a patient unable to void?
Rinse the perineum with warm water.
For the nursing diagnosis: Alteration in elimination, retention, what assessment finding is expected?
Feels pressure and only voiding small amounts
What is the correct technique for collecting a clean-voided urine specimen from a patient?
Collect the specimen after the initial stream of urine has passed.
Which assessment finding is expected with a patient that has overflow incontinence?
Constant dripping of urine
When would the collection be restarted* during a timed specimen collection?
Patient voids in the toilet (by mistake)
***Specimen is collected in a container that has preservative and needs to be kept cold until the end of urine collection.
What is included in the care plan for a patient with incontinent urinary diversion?
Careful skincare is a priority
What is the correct technique when inserting a catheter in a female patient?
Inflating the balloon to test it before catheter insertion ONLY if indicated by the manufacturer
If 950 ml of normal saline irrigant was instilled and there is 1725 ml in the drainage bag, what is the patient’s urinary output?
775 ml
What are the expected findings from a urinalysis?
Specific gravity of 1.018
pH
No protein
No WBC
What are the correct steps when discontinuing a urinary catheter?
- Draping the female patient
- Obtaining a specimen before removal
- Deflate the balloon with a syringe
- Checking the patient output for 6 to 8 hours after removal
(Do not cut the catheter to deflate the balloon)
What is the appropriate technique for applying a condom catheter to a male patient?
Leave a 1 to 2-inch space between the tip of the penis and the end of the catheter
What is a suprapubic catheter?
A surgically created tube that drains urine from the bladder through a small incision in the lower abdomen
What is important to know for a patient with a suprapubic catheter?
Daily cleansing around the site with soap and water
What urinary symptoms are common for patients with diabetes?
Polyuria
What is postrenal failure related to?
Functional obstruction
What is a urinary diversion?
A surgical procedure that reroutes the urinary tract to allow urine to exit the body safely. It’s performed when the bladder can’t store urine or the normal urine flow is blocked.
Which urinary diversion requires patients to have a stoma created?
IIeal conduit
How do you calculate fluid intake and output and know if there is a positive or negative fluid balance?
- Calculate all fluid intake (including jello and liquid meds)
- Calculate all output (including wound drainage)
- Subtract output from intake to calculate the fluid balance
What do you do if a patient with an indwelling catheter reports a need to void?
Check to see if the catheter is patent.
At times, the end of the catheter may become lodged against the side of the bladder, preventing urine flow into the tubing.
Which instruction is correct when a urine specimen is collected for culture and sensitivity testing from a patient without a urinary catheter?
Ask the patient to void first into the toilet, stop midstream, and finish voiding into the sterile specimen container.
What is the procedure for a 24-hour urine collection?
Discarding the entire first void and saving urine in a chilled, opaque container with a preservative.
How can female patients prevent frequent urinary tract infections?
Wiping from the front to back after voiding.
What factors may change the color of urine?
- Taking the urinary tract analgesic phenazopyridine
- A diet that includes a large number of beets or blackberries
- An enlarged prostate or kidney stones
- High concentrations of bilirubin secondary to liver disease
- Dehydration
- Infection
What self-care measure is most important for a patient who will be discharged with a urostomy?
Cleanse the peristomal skin with mild soap and water.
What is the priority concern of the nurse performing an indwelling catheter?
Maintaining strict aseptic technique
If the catheter is not draining and the patient’s bladder is distended. What action should the nurse take next?
Assess the tubing for kinks and ensure a downward flow.
If the indwelling catheter is accidentally inserted into the vagina, what is the next action for the nurse to implement?
Leave the catheter in place and insert a new catheter into the urethra.
By leaving the first catheter in place in the vagina, the nurse can more accurately identify the urethra for insertion of the new catheter. This prevents misplacing the new catheter into the vagina during the second catheterization attempt. The catheter that was placed in the vagina is no longer sterile, so it should not be reused and should be discarded after the new catheter is properly placed into the bladder.
Which intervention would be the highest priority when caring for a patient complaining of voiding small amounts of urine in relation to his fluid intake?
Palpating the patient’s bladder for distention before scanning for possible retention.
The highest-priority nursing intervention for a patient experiencing oliguria (reduced urine volume) is to check the patient for bladder distention and retention.
