Urinary Elimination Flashcards
Micturition
complex process involving bladder, urinary sphincters, and CNS
Voiding
bladder contraction and urethral sphincter and pelvic floor muscles
CNS + voiding
impulses from the brain respond or ignore the urge
- when brain responds, CNS send message and external sphincter relaxes and bladder empties
Factors influencing urinary elimination
- growth and development
- sociocultural factors
- fluid intake
- psychological factors
- personal habits
- pathological conditions
- surgical procedures
- diagnostic examinations
Urinary changes in older adults: decreased
amount of nephrons (impaired kidney function, increased chronic kidney disease, HTN)
bladder muscle tone
bladder capacity
time btw initial desire to void and urgent need to void
Urinary changes in older adults: increased
bladder irritability
bladder contractions during bladder filling
risk of urinary incontinence
Urinary retention s/s
restlessness, diaphoresis, anxiety, tenderness, pain
Urinary retention
inability to partially or completely empty the bladder, can be acute or chronic
Post-void residual
PVR
straight cath someone or bladder scan
Overflow incontinence problem =
urinary retention
Bladder scan
independent nursing intervention
UTI
most common is e-coli
Risk factors for UTI
- presence of indwelling catheter
- urinary retention
- urinary or fecal incontinence
- poor perineal hygiene
- females
- frequent sexual intercourse
- uncircumcised patients
- any instrumentation of urinary tract
Lower UTI
frequency, incontinence, burning with urination, dysuria, suprapubic tenderness, foul smelling cloudy urine
Upper UTI
flank tenderness
CAUTI
- costly -> no reimbursement
- major risk of development with presence of indwelling catheter, increased risk with length of time
- can be reasonably prevented
- focus on early recognition and prompt treatment
Urinary incontinence
involuntary loss of urine
often multifactorial
Stress incontinence
usually from effort or exertion, usually women, after childbirth, with laughing/coughing/etc.
Urgency incontinence
typically older adults, overactive bladder, can be idiopathic, pt has urge to pee but can’t get to bathroom
Overflow incontinence
poor bladder emptying, males with BPH, obstruction, leakage
Functional incontinence
can’t get to bathroom
- older adults = need cane, trouble walking, etc
Incontinence risk factors
- more common in women and elderly
- obesity
- multiple pregnancies or vaginal births
- neurological disorders: Parkinson’s, CVA, spinal cord injury, MS
- medications: diuretics, opioids, anticholinergics, CCB, sedatives/hypnotics
- confusion/dementia
- immobility
- depression
Assessment
- professional
- assess understanding and expectations of treatment
- meds
- medical/surgical hx
- assess ability to perform necessary behaviors associated with voiding
- normal bowel and urinary elimination patterns
- sleep/activity/nutrition
- cultural preferences
Pattern of urination
- normal amount with each void
- frequency and times of voiding
- hx of recent changes
Oliguria
low urine output
CVA tenderness
costovertebral angle
Assessment of urine
color, clarity, odor
I&O
- evaluates bladder emptying
- renal function
- fluid and electrolyte balance
- can be a HCP order or nursing judgement
Normal urine output
30ml/hr
concerned if <30/hr for greater than 2 hrs
If patient awake…
and hasn’t voided in 6 hours
Abnormal color
hematuria
color changes
Normal color
pale straw to amber
Normal clarity
transparent
Urine that sits
can get cloudy
Thick and cloudy
bacteria and WBCs
- early morning voids can look this way since it sat all night
Abnormal odor
offensive - may indicate UTI
some foods may change odor
Fruity -> acetone
Urine testing
send as soon as you receive, unless it is a timed test
- know if you need a preservative or not
pH
4.6-8.0
alkaline = loss of acid
acidotic = urine that sits for hours, sleep
Protein
up to 8mg/100ml
- abnormal is sensitive indicator of kidney function
Glucose
+ = DM
Ketones
abnormal
= DM, dehydration, starvation, excessive aspiring ingestion
Specific gravity
1.005-1.030
high = reflects concentrated, dehydration
low = overhydration
RBC
normal = up to 2
abnormal = damage to glomeruli, trauma, catheter trauma
WBC
normal = 0-4
abnormal = inflammation or infection
Bacteria
possible UTI
Leukocyte esterase
possible UTI
Casts
indicate renal disease
Crystals
indicate increased risk of renal calculi
Culture and sensitivity
send to lab within 30 minutes, prelim report should be available within 24hrs
C+S importance
- obtained to determine presence of pathogenic bacteria
- should obtain before abx admin
- important to test the sensitivity of any growing bacteria to various abx
- culture only done if UA suggests it
Adequate fluid intake
2300 mls/day
- if no heart disease, has good renal function
- helps flush solutes to limit bladder irritability
Nocturia
stop drinking about 2 hrs before bedtime
Crede method
pushing
need HCP order
Single lumen catheter
intermittent, i+o catheter
Indwelling catheter
foley, balloon
3 lumen/3 way catheter
bladder irrigation
Coude tip
curved, BPH pts
Suprapubic
placed in the bladder through the abdominal wall
- sutured in place
- used when blockage of urethra or when indwelling catheter causes irritation
Nephrostomy
procedure where a thin, flexible tube (nephrostomy tube or catheter) is inserted directly into a kidney through the skin, allowing urine to drain into a bag outside the body
Catheter emptying
empty when 1/2 full
Castile wipes
PRN and q-shift and before placement
CHG wipes
q-day and before placement
Post foley
6-8 hrs without voiding, scan
should be able to void within 6-8 hrs post removal
First voids
can be uncomfortable
- might need to I+O cath to start
Ureterostomy
a surgical procedure where one or both ureters are detached from the bladder and brought out to the surface of the abdomen through a surgically created opening called a stoma
