Urinary Elimination Flashcards
Function of Kidneys:
major excretory organs
filter liquid waste from blood
balance salt and electrolytes in blood
regulate blood volume and pressure
produce erythropoietin for RBC formation
synthesize vitamin D
maintains acid-base balance of extracellular fluid
Urine is formed by:
tiny filtering units called nephron
Nephron:
functional units of the kidneys—-> consists of renal corpuscle and renal tubule
Renal Corpuscle:
compromised of a network of blood capillaries called glomerules
Renal Tubule:
compromised of the proximal tubule, loop of Henle, and the distal convoluted tubule
Filtration:
begins in the glomerulus as fluid moves across a membrane as the result of a pressure difference
Reabsorption:
occurs in renal tubule as most of the filtrate moves back into the blood; waste products are secreted
Secretion:
urine is produced
After exiting the kidneys, urine is carried to the bladder by:
ureters
The ureter wall muscles continually tighten and relax, forcing urine:
downward
Bladder walls relax and expand to:
store urine
Bladder walls contract and flatten to:
empty urine
Normal urine is:
sterile
Average adult passes:
960-1920mL/day
Urge:
innervation of the bladder signals when it is time to go
The brain signals the bladder muscles to tighten and the sphincter muscles to:
relax
when all the signals occur in correct order, urination occurs
Other names for urination:
voiding or micturition
Anuria:
failure of the kidneys to produce or excrete more than 50 - 100 mL of urine in 24 hours.
Ultrafiltrate:
liquid form which blood cells and blood proteins have been filtered out.
Oliguria:
defined as reduced urine volume. - less than 1mL in an infant - less than 0.5 ml in children - less than 400 mL in adults (symptom of acute/chronic renal failure)
Pre-renal failure:
result of reduction in blood flow to kidneys; causes dehydration, vascular collapse, and low cardiac output
Renal Failure:
seen in patients with actual kidney damage. (structural issues)
Post-renal failure:
related to mechanical or functional obstruction of urine flow
Polyuria:
excessive volume of urine found and excreted each day. Adult: 2500mL or more of urine per day
Causes of Polyuria:
consumption of large amounts of fluid (especially caffeine or alcohol), ingestion of too much glucose, use of diuretic meds, diabetes, etc.
How to diagnosis anuria:
catheter is passed into the bladder and no urine is present
Causes of anuria:
any process that limits effective blood flow through the kidneys
inadequate flow or complete obstruction by anything that blocks both ureters and the bladder or obstructs the urethra, can lead to an anuric state resulting in acute/chronic renal failure
Dialysis:
technique by which fluids and molecules pass through an artificial semipermeable membrane and are filtered by osmosis
Hemodialysis:
patient’s blood flows continually from the body through vascular catheters to the dialysis machine—-> it then goes through the machines filters and ultra-filtrate is created
Peritoneal Dialysis:
performed by instilling dialysis solution into the patients’s abdominal cavity through an external catheter —> after the solution rests within the peritoneal cavity for a prescribed period of time, it is removed from the body through the catheter. (the abdominal cavity functions as the dialyzing membrane)
Urge Incontinence:
a strong sudden urge to void followed by rapid bladder contraction. the affected person does not have enough time for toileting between recognition of urge to urinate and the onset of voiding
Mixed Incontinence:
combination of both stress and urge incontinence
Functional Incontinence:
lack of urine control in the absence of any abnormalities of the urinary tract; it occurs when some physical limitation, such as difficulty with clothing fasteners or impaired mobility, hinders reach the toilet before voiding occurs
Overflow Incontinence:
patients are unable to empty the bladder completely resulting in a constant dribbling of urine or increased frequency of urination. results from weakened muscles of the bladder
Temporary Incontinence:
can occur in addition with factors such as constipation, infections, or medication usage
Urinary Retention:
inability of the bladder to empty.
caused by an obstruction in the urinary tract or by a neurological disorder
Nocturia:
excessive urination at night = disrupts sleep cycle
*most commonly seen in men with BPH and in postmenopausal women as a consequence of decreases bladder tone
Dysuria:
painful urination—> may result from UTI, cystitis, STD’s, yeast infection, kidney or bladder stones, prostatic enlargement, malignancy and/ or allergies
Patients with dysuria often complain of:
burning that follows urination, often a delay in initiating voiding or hesitancy is associated
Hematuria:
abnormal presence of red blood cells in the urine; bleeding can originate at any point along the urinary tract
Gross, visible, or microscopic hematuria may represent:
serious underlying disease
Color of urine does not:
reflect the degree of blood loss
Urinary Incontinence:
unable to control passage of urine
Stress Incontinence:
loss of urine control during activities that increase intraabdominal pressure such as coughing, sneezing, laughing, or exercise
Characteristics of urinary retention:
difficulty starting a stream or emptying the bladder, weak urine flow, chronic/acute pain
Chronic pain:
mild and constant discomfort
Acute pain:
medical emergency
Factors affecting urinary elimination:
pathological and surgical conditions privacy issues and embarrassment medications food and fluid intake ambulatory ability muscle tone enuresis
Enuresis:
involuntary passing of urine
Age considerations:
loss of muscle tone in the bladder in older adult individuals contributes to incontinence and frequency.
Nocturia is common as well; the bladder does not empty as efficiently in older people
Pregnancy considerations:
growing fetus compromises bladder space and compresses the bladder—–> results in frequent urination
Gender considerations:
enlargement of the prostate in men age 40 and older may lead to urinary frequency, hesitancy, and retention
UTI considerations:
more prevalent in women because women have a shorter urethra and experience a decrease in muscle tone with age and child birth
Culture considerations:
patients may not seek treatment
Disability considerations:
may lead to urinary incontinence or retention. (paraplegics can be taught to empty the bladder using straight catheterization every 4 hours
Urinary Diversion:
surgical procedure performed when bladder function is impaired due to trauma or disease involving the bladder, ureters, and rarely the urethra.
Incontinent Diversions:
(ileal conduits, ureterostomies) a bag must be worn to collect urine
Continent Diversions:
(kock pouch, indiana pouch) a collection reserve is surgically created using a segment of the intestine
Determining the level of urinary retention by ultrasound scanning of the bladder can prevent:
unnecessary catheterization
Ultrasounds are safe for:
pregnant women and those with allergies to contrast media
KUB x-ray:
centered on the iliac crest used to investigate GI conditions—-> can detect kidney stones
(IVP) intravenous pyelogram:
contraindications: shellfish/iodine allergies, pregnancy involves contrast media to show the size, shape, and position of the urinary tract.
Cystoscopy:
examination of the bladder and urethra via a cystoscopy (pink tinged urine common several days after)
8ox of ice chips = how many mL?
4mL (ice chips are approximately 1/2 of their volume
If the patient has consumed more fluid than has been excreted, the balance is:
positive
When the patient excreted or loses more fluid than what is consumed, the balance is:
negative
Avoid using indwelling catheters is a primary method for:
UTI prevention
Catheters have to be changed:
monthly
Common causes for urine discoloration:
food
medications
pathologic conditions
Urine can be dilute or very concentrated
(light—->pale to dark amber); never cloudy
Urea is the end product of protein metabolism and is measured as:
BUN
BUN levels:
7-20 mg/dL
Creatinine is a waste product that is produced in the blood as a by-product of:`
muscle metabolism
Creatinine levels in woman:`
0.6-1.2
Creatinine levels in men:
0.8-1.4`
Urinalysis:
assess urine at a single point in time (screens for UTI and kidney disease)
Normal pH:
6
4 would be considered acidic; 9 would be alkaline
UTI suspicion?
check for nitrates
24 hours urine collection:
performed to determine amount of creatinine cleared through the kidneys
