Urinary Elimination Flashcards
Normal urinary output rids the body of ______.
Waist
Clients with urinary alterations are at risk for altered _____ ______.
body image
What is important for the nurse to understand about urinary elimination?
- the importance of begin sensitive to clients needs
- factors which alter urinary elimination patterns
- nursing strategies to support normal patterns
What factors can influence urination?
- age related changes
- physical condition/function of kidneys, bladder, and urethra
- environment
- fluid balance
- psychological
- surgery or diagnostic tests
- medications
- psychosocial cultural
What are some age related changes related to urinary output?
- by age 80 30% of nephrons are lost
- decreased pelvic floor muscle tone and elasticity
- decreased ability of kidneys to concentrate urine
- residual urine
- men suffer from enlarged prostate which causes incomplete emptying
- women suffer from stress incontinence/increased UTI’s
- cognitive impairment
- decreased mobility
Define nocturia.
having to wake at night for one or more times to void
What is residual urine?
urine left in bladder after voiding, increases risk of infection
What is a result of decreased pelvic floor muscle tone and elasticity?
Causes frequency of urination and nocturia
How do physical condition/function of kidneys, bladder, and urethra effect urinary output?
- diseases that affect the nervous system (stroke, parkinsons), UTI’s, tumours, blockages (stricture, stones), MS, spinal cord injury, diabetes
- conditions which affect the blood flow to the kidneys results in oliguria or anuria
Define oliguria.
decreased capacity to form urine
Define anuria.
inability to produce urine due to fluid loss of another means (hemorrhage, diarrhea, CHF (congestive heart failure), etc.)
What are some environmental factors that may affect urination?
- access to bathroom
- assistance
What fluid balance issues affect urination?
- increase in fluid increases output
- polyuria
- diuresis
Define polyuria.
excess urine output, common in diabetics
Define diuresis.
increased production of urine and excretion
What psychological issues can affect urination?
- embarrassment
- need for own bathroom
What affect does surgery/diagnostic test have on urination?
- may cause localized edema or spasm
- surgery may produce difficulty in initiating urine stream
- surgery to urinary system
What affect to medications have on urination?
- may affect production of urine by affecting electrolyte balance
- may affect kidney or bladder directly
- may need to adjust dose
What psychosocial/cultural issues affect urination?
- incontinence may impact self worth or self image, sexuality
- may need to social isolation
- may have cultural influences (types of facilities, religious practice, male or female nurse aiding)
What are Gordon’s elimination patterns questions?
- normal output
- changes
- experience urinary frequency, dysuria, nocturia, urgency, incontinence, hematuria or retention
- medications
- excess persperation
Define micturition.
release of urine from the bladder; urination
What are Gordon’s patterns for urination; health history?
- baseline (diary)
- changes
- dysuria
- leakage/dribbling
- hesitancy
- frequency
- incontinence
- factors that precipitate leakage or incontinence (coughing, sneezing)
- identify factors that affect urination
- complete a bladder history
What physical aspects should be assessed?
Skin, kidneys, bladder, female perineum, male perineum
What skin assessment in needed?
- turgor
- oral mucosa
- hydration status
- skin breakdown r/t incontinence
What kidney assessment is needed?
flank pain r/t infection or inflammation
What needs to be assessed on the bladder?
- distention
- swelling
- feeling of needing to void
- tenderness and pain
What needs to be assessed on the female perineum?
- check for rashes r/t use of incontinence pads
- skin integrity
- redness/inflammation
- dischange
What needs to be assessed on the male perineum?
- discharge
- inflammation
- lesion
What aspects of urine input and output are assessed and what is cause for concern?
- changes in volume
- normal input 1500-2000ml /output 1500-1600ml
- measure input and output
- report extreme changes
- oliguria (less than 30ml/ 2hr or 15ml/hour causes for concern)
- polyuria (more than 2000-2500 ml is concerning)
- anuria (inability to produce urine)
What is normal input and output of urine?
normal input 1500-2000ml /output 1500-1600ml
Define oliguria.
Production of abnormally small amount of urine. Less than 30 ml/2hrs or less than 15ml/hour causes for concern.
Define polyuria.
Production of an abnormally large volume of dilute urine. Urinating 2000-2500ml a day causes for concern.
Define anuria.
An inability to produce urine.
What are the 4 things that need assessing in urine?
- input output
- colour
- odour
- clarity
Describe aspects of assessing colour.
- normal colour is pale to straw coloured to amber (depending on concentration; more concentrated in the morning)
- presence of blood (hematuria)
- ask about food intake that could alter colour of urine (beets, dyes from tests)
Describe aspects of assessing clarity of urine.
- transparency
- mucous plugs, thick
- cloudy, foamy
If urine is cloudy or foamy what might this indicate?
bacterial infection or high protein intake
Define hematuria.
presence of red blood cells in the urine
Describe the aspects of odour for assessment in urine.
- faint aromatic
- strong, offensive, musty, ammonia
What could cause strong offensive smelling urine?
- infection
- asparagus, etc
- excess glucose excretion
What are 2 types of urine tests?
Urinalysis R&M (routine and microscopic)
Urine culture for C&S (culture sensitivity)
What does urinalysis R&M (routine and microscopic) test for?
- pH
- protein (nitrogen not typically in urine)
- glucose
- ketones (fat metabolism)
- blood (may have a few red blood cells
- specific gravity and kidneys not concentrating
- stones
What does the urine culture C&S (culture sensitivity) test for?
bacteria
