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Fundamentals > Urinary Elimination > Flashcards

Urinary Elimination Flashcards

1
Q

Most common urinary elimination problems

A 
Urinary retention
Urinary tract infection
Urinary incontinence
Urinary diversion
Surgery
-inability to store urine or fully empty urine
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2
Q

Cause of urinary elimination problems

A 
Infection
Irritable/overactive bladder
Obstruction of urine flow
Impaired bladder contractility
Issues that impair innervation to the bladder
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3
Q

Postvoid residual (PVR)

A

Amount of urine left in the bladder after voiding, measured either by ultrasound or straight cath

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4
Q

Urinary retention causes

A 
Enlarged prostate
Urethral structure
Bladder or urethral stones
Stroke or spinal cord injuries
Anesthesia or other meds
Neurological impairment (MS, head injury)
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5
Q

S/S urinary retention

A 
Anuria: inability to pass urine
Bloating in the lower abdomen
Increased frequency
Urinary incontinence
Increased PVR, increased volumes on bladder scan
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6
Q

Urinary retention complications

A

Urinary stasis → Urinary Tract Infection
Back from bladder → ureters → kidneys → Pyelonephritis
Irreversible kidney damage with pyelonephritis
Pyelonephritis may move to bloodstream: urosepsis

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7
Q

Serum lab test that measures kidney function

A

Creatinine

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8
Q

Urinary retention interventions

A

Privacy, toilet instead of bedpan, men stand, run water, ambulation, increase oral fluids
Bladder scan
Intermittent catheterization or “Straight cath”

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9
Q

S/S UTI

A

Foul-smelling, cloudy urine
Dysuria, frequency, urgency, incontinence
E. coli: Most common pathogen
Older adults: confusion
Lower (bladder & urethra)
Upper (Kidney infection) Pyelonephritis (fever, chills, flank pain)

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10
Q

Functional Incontinence

A

Causes outside the urinary tract

-Altered mobility, cognitive impairment, poor motivation, environmental barriers

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11
Q

Overflow Incontinence

A

Involuntary loss of urine caused by overdistended bladder often related to obstruction or poor bladder emptying due to weak/absent bladder contractions

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12
Q

Stress Incontinence

A

Small volume loss of urine with coughing, laughing, exercise, sneezing
-Weak pelvic floor muscles, childbirth trauma

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13
Q

Reflex Incontinence

A

Involuntary passage of urine at predictable intervals when pt reaches specific bladder volume
-Spinal cord damage between C1 to S2

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14
Q

Urge Incontinence

A

Involuntary passage of urine associated with strong sense of urgency related to overactive bladder
-Caused by neurological problems, bladder inflammation, bladder outlet obstruction

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15
Q

Interventions for urinary incontinence

A 
Avoid caffeine
Adequate hydration
Pelvic floor exercises
Timed voiding or scheduled toileting 
Barrier cream
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16
Q

Ureterostomy or ileal conduit

A

Permanent diversion created by transplanting the ureters into a closed-off portion of the intestinal ileum and bringing the other end out onto the abdominal wall forming a stoma

17
Q

Nephrostomy tubes

A

Small tubes tunneled through the skin into renal pelvis

  • Drains renal pelvis when the ureter is obstructed
  • Permanent or temporary
18
Q

Indications for nephrostomy tubes

A

When ureters are blocked due to cancer, trauma from a large kidney stone that is lodged in the ureter

19
Q

Lab results indicating UTI

A

+ Bacteria (doesn’t necessary indicate a problem)
+ WBC (highly indicative of UTI)
+ Nitrite: with certain bacterial infections
+ Leukocyte esterase (highly indicative of UTI)
+ RBC- sometimes

20
Q

Culture and sensitivity

A

Culture: presence of bacteria
Sensitivity: antibiotics affective for strain

21
Q

Crede method (manual compression)

A

Hands compress bladder to assist in emptying

-should not be implemented until consult with HCP

22
Q

Single-lumen catheter

A

Used for intermittent/straight catheterization

23
Q

Double-lumen catheter

A

One lumen for urinary drainage and one to inflate balloon

-designed for indwelling catheters: Foley

24
Q

Triple-lumen catheter

A

Continuous bladder irrigation or to instill medications

-One lumen drains the bladder, one used to inflate the balloon, and one delivers irrigation fluid into bladder

25
Q

Suprapubic catheter

A

Inserted surgically from an opening in the abdomen
-Indicated for blockage of urethra or when long term catheterization is required
Dressing on new insertion, optional after site heals

26
Q

Advantages of suprapubic catheter

A

Less risk for UTI
Better for long term use
Less discomfort
Does not interfere with sex

27
Q

3-way catheter

A

For continuous bladder irrigation after prostate surgery or for urinary hemorrhage to prevent blood clots from blocking the catheter

  • 3 lumens: One for balloon, one for urine to drain and one for irrigation
  • Larger with larger balloon
28
Q

Most common catheter sizes

A

14-16 Fr: Catheter and balloon size printed on catheter

-French (Fr): internal diameter of the catheter

29
Q

Priority Assessment Upon D/C of Indwelling Urinary Catheter

A
  • Void by 4 hours after the Foley removal
  • If no output/small volume of output, encourage fluids
  • By 4- 6 hours try extra measures to promote voiding
  • By 6 to 8 hours, or if pain/discomfort, call HCP
  • Monitor voiding after removal for 24 to 48 hours
30
Q

Indications for indwelling catheter

A
  • Acute urinary retention or bladder outlet obstruction
  • Need for accurate I & O
  • Assist in healing of open sacral or perineal wounds in incontinent patients
  • GU surgery: Remove ASAP
  • End of life care
31
Q

Alternatives to Indwelling Catheters

A 
External catheters (condom catheter) for males
Female incontinence devices: Pure Wick
32
Q

Clean catch midstream specimen

A
  • Cleanse urinary meatus prior to collection
  • Collect the middle of the urinary stream (more accurate specimen)
  • Can delegate to UAP
33
Q

Other lab value indications

A

Ketones: May indicate Diabetes Myelitis
Glucose: May indicate Diabetes Myelitis
Bilirubin- May indicate liver disease

34
Q

24 Hour Urine Collection

A
  • Discard first void & start time
  • Collect all urine for 24 hours
  • Void one last time and collect. Record end time
  • Checks how much protein is being spilled into urine
  • Proteinuria sign of renal disease
35
Q

Blood test: Creatinine

A

0.7-1.4 mg/dL

Most reliable indicator of renal impairment

36
Q

Blood test: Blood urea nitrogen (BUN)

A

7-20 mg/dL

Indirect measurement of renal function

Fundamentals (2 decks)

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