Urinary Elimination Flashcards
Major structures of the urinary system
kidneys
ureters
bladder
urethra
Primary functions of the kindey
- filter metabolic wastes, toxins, access ions, and water from the bloodstream and secret them as urine.
- They also help to regulate blood volume, blood pressure, electrolyte levels, and acid-base balance by selectively reabsorbing water and other substances
secondary functions of the kidneys
- produce erythropoietin
- secrete enzyme rennin
- activate vitamin d3 (calcitrol)
Role of ureters, bladder and urethra in urinary elimination
- ureters transport urine from the kidneys to the bladder
- the bladder stores urine until it is excreted
- urethra transports urine from the urinary bladder to the body exterior
What quantity of urine in the bladder will stimulate the urge to void
200-450 of urine in adults (50-200ml in children) are sufficient to stimulate urination.
three methods for knowing if hydration is adequate and output is normal
- person voids 1500mL in 24 hours in 5-6 voids
- an infant has 8-10 wet diapers in a day
- pale clear urine indicates adequate hydration
What medication increases amount of urine voided
diuretics
what type of medication are associated with urinary retention
anticholinergic effects may lead to urinary retention
What conditions and surgeries are associated with high incidence of altered urination
surgeries with pathology involving the genitourinary tract have a high incidence of altered urination
what should you discuss with a patient during a focused history
- normal urination pattern
- appearance of urine
- changes in urination habits or urine appearance
- history of urination problems
- use of urination aids
- lifestyle questions
- presence of urinary diversions if any
Key elements of a physical assessment
- kidneys: examine the kidneys by assessing for costovertebral angle tenderness
- bladder: asses the bladder with inspection, palpation and percussion.
- Urethra: asses the urethra by inspecting the urethral orifice. Look for erythema, discharge, swelling or odor. These are all signs of infection, trauma, or inflammation.
- perineal area: inspect the skin in the perineal area for signs of breakdown or irritation
What activities promote normal urination patterns
- Privacy
- Assist with positioning: preferred position
- facilitate toilet routines
- promote adequate fluid and nutrition: 8 to 10 large glasses a day
An instrument used to measure specific gravity
refractometer
the application of gentle, manual pressure over the bladder to promote bladder emptying
crude’s maneuver
a urinary diversion that involves implanting the ureters into a small segment of the small intestine, which is then brought to the abdominal wall where a stoma is created
conventional urostomy or ill conduit
involuntary urination after the age of 5 or 6 is sometimes this condition
enuresis
During chemotherapy what labs should be checked
serum blood urea nitrogen and serum creatinine
what is frequently responsible for UTIs
esherichia coli
specific gravity
is the measure of resolved solutes in a solution. high gravity means the person is dehydrated and low gravity may mean the kidney is not concentrating the urine enough
signs of UTI
back pain bladder spasms chills dysuria edema fever foul0smelling urine hematuria sauce and vomiting pyuria urgency urinary frequency
reasons for urinary retention
obstruction inflammation and swelling neurological problems medications anxiety
urge incontinence
involuntary loss of larger amounts of urine accompanied by a strong urge to void. its is often referred to as overactive bladder.
stress incontinence
is an involuntary loss of small amounts of urine with activities that increase intra-abdominal pressure. etiological factors include pregnancy, childbirth, obesity, chronic constipation and straining at stool. activities that produce leakage of urine also include exercise, laughing sneezing and coughing
mixed incontinence
is a combination of urge and stress incontinence
overflow incontinence
is the loss of urine in combination with a distended bladder. causes of overflow incontinence include fecal impaction, neurological disorders, and enlarged prostate
functional incontinence
is the untimely loss of urine when no urinary or neurological cause is involved
reflex incontinence
is loss of urine when the person does not realize the bladder is full and has no urge to void. CNS cause problems
enuresis
is familial, is involuntary urination after about 5 to 6 years of age, when control is usually established. Is primary if bladder control was never achieved and secondary if control was established and then lost
nocturnal enuresis
bedwetting
acute renal failure (ARF)
an acute rise in the serum creatinine level of 25% or more. may be caused by inadequate blood flow to the kidney, injury to the kidney glomeruli or tubules, or obstruction of kidney outflow
anuria
absence of urine. less than 100mL in 24 hours. often associated with kidney failure or congestive heart failure
dysuria
painful or difficult urination. associated with infection or partial obstruction o the urinary tract as well s medications that trigger urinary retention
end-stage renal disease (ESRD)
a chronic rise in serum creatinine levels associated with loss of kidney function that must be treated with dialysis or transplantation. AKA chronic renal failure
enuresis
involuntary loss of urine
hematuria
blood in urine. due to trauma, kidney stones, infection, or menstruation.
micturition
the start of stream of urine
nephropathy
a broad term meaning disease of the kidney
nephrotoxic
a substance that damages kidney tissue. some antibiotics, NSAIDs, lead, chemo
nocturia
frequent urinatiins after going to bed
nocturnal enuresis
involuntary loss of urine while asleep
oliguria
urine output of less than 400mL in 24 hours.
pessary
an incontinence device that is inserted into the vagina to reduce organ prolapse or pressure on the bladder
polyuria
excessive urination. may be caused by hydration, diabetes mellitus, diabetes insidious or kidney disease .
proteinuria
the presence of protein in the urine/ may be a sign of infection or kidney disease
pyuria
pus in the urine. may be caused by lesions or infection in the urinary tract.
urgency
a sudden, almost uncontrollable need to urinate
pyelonephritis
an infection of the kidneys
cystitis
infection involving the bladder
urethritis
infection of the urethra
prostatitis
infection of the prostate
prompted voiding
part of bladder training. learns to void on schedule rather than to empty bladder
crede technique
is applying manual pressure with your hands to the top portion of the bladder to initiate urine flow
Urate crystals
common in newborn period. indicated dehydration. in older people they result from too much uric acid in the blood, not age related
Cutaneous ureterostomy
reroute the ureters directly to the surface of the abdomen forming a small stoma
conventional urostomy
a small piece of ileum is removed and sutured closed at one end the other end is brought out to the abdominal wall to create a stoma.
continent urinary reservoir
urine drains from the ureters into a surgically created ileal pouch. stoma created on abdomen with nipple value to prevent leaking. patient inserts a catheter into stoma.
neobladder
mimics function of urinary bladder. portion of intestine is made into a pouch that is connected to urethra.
