Urinary Elimination Flashcards
Functions of the kidney?
primary- filter metabolic wastes, toxins, excess ions, and water. Regulate blood volume, blood pressure, electrolyte levels, acid-base balance
secondary- produce erythropoietin, secrete renin, activate vit d3
What is the term used for voiding?
micturition
What muscle is responsible for forcing urine out of the bladder? What in the voluntary mechanism for voiding?
The detrusor muscle pushed urine out of the bladder and open the internal urethral sphincter. The external urethral sphincter is the one we have control over to get to the bathroom on time.
What urinary changes do the kidneys go through in older adults?
- renal blood flow decreases
- bladder volume decreases due to lost elasticity
- greater risk for urinary retention (and utis)
How does personal affect urinary elimination?
anxiety, lack of time, lack of privacy
How does sociocultural affect urinary elimination?
person may want someone to assist of same gender
How does nutrition affect urinary elimination?
- coffee, tea, cola, chocolate, alcohol are diuretics
- sodium decreases urine production
How does hydration affect urinary elimination?
less urine output after heavy workout bc sparing
How does medication affect urinary elimination?
- diuretics increase
- anticholinergic, nephrotoxic, antibiotics, aspirin, ibuprofen all affect urine
How does surgery/anesthesia affect urinary elimination?
decreased bp means less urine, bladder distention due to lack of feeling to void after spinal anesthesia
What are some problems that affect urinary elimination?
- infection or inflammation of the bladder, ureters, or kidneys
- renal calculi (kidney stones)
- tumors
- hypertrophy of the prostate
- cardiovascular/metabolic disorders
- nervous system disorders
- immobility
- cognitive changes
***What are the blood labs that are useful in assessing renal function?
BUN (10-31)
Creatinine (0.5-1.2)
How much urine do the kidneys produce?
approximately 50-60ml per hour
What things need to be counted towards fluid intake?
- oral fluids
- semiliquid foods
- ice chips
- IV fluids
- tube feedings
- irrigations instilled and not immediately withdrawn
What things need to be counted towards fluid output?
- urine output
- vomiting
- diarrhea
***Types of urine specimen collection and how to get them? (4)
Freshly voided- collect as you would for I&O
**Clean catch (midstream catch) cleanse genitals and get a midstream sample
Sterile- catheter into bladder (NOT FROM BAG)
**24-hour urine- have patient void in the morning and record the time. Collect everything after that. Post sign on the door. Restart if pt forgets.
***How to perform urinalysis? What does it test?
- at bedside
- ph, specific gravity (urine concentration), protein, glucose, ketones, occult blood
What is a refractometer for and why is it better?
- specific gravity of urine
- quick, easy, precise, dont need a large sample,
***What are some nursing diagnosis’ for urinary incontinence?
- stress incontinence (pressure from a sneeze, laugh, cough causes bladder to leak)
- overflow incontinence (bladder does not empty completely, may not feel the urge to void so urine leaks)
- functional incontinence (all GU components work but the person cannot make it to the restroom)
- urinary retention (unable to start urination, or if able to start, cannot fully empty)
- urinary frequency (need to go many times a day of either a lot or a little urine)
- UTI (increased urge, burning)
What is the most common goal for urinary elimination?
Pt will void approx 1.5L light yellow urine in 24hr
How to promote normal urination?
- provide privacy
- assist with positioning
- identify client’s pattern
- promote adequate fluid intake
- assist with hygiene
What is urethritis?
infection limited to the urethra
What is cystitis?
bladder infection
What is a straight catheter and who it is used for?
- single lumen
- immediate drainage of the bladder
- removed immediately
What is an indwelling catheter?
- foley or retention are other names
- continuous bladder drainage
- double lumen (one for drainage, one for inflating the balloon)
- triple lumen can be used for pts who need bladder irrigation frequently
What is a suprapubic catheter?
- used for continuous drainage
- bypasses the urethra
- incision above the symphysis pubis
What are the goals of nursing care for an indwelling catheter?
- prevent infection
- maintain patency
- prevent transmission of infection
- promote normal urine production
- maintain skin integrity
What medications may be prescribed for someone with urge incontinence?
- medications that relax the detrusor muscle and increase bladder capacity
- anticholinergics, smooth muscle relaxants, calcium-channel blockers, antidepressants
What medications may be prescribed for someone with stress incontinence?
- medications that improved urethral sphincter muscle
- triaminic
What urinary conditions may require surgical intervention?
- cystocele
- rectocele
- enlarged prostate gland
What is overflow incontinence?
-frequent or constant dribbling because the bladder does not empty completely
What is hydronephrosis?
distention of the kidneys with urine, resulting from obstruction of the ureter
Pros and cons to a cutaneous urostomy?
pros-
cons- infection, small, difficult to fit with a collection device
What are pros and cons to a conventional urostomy? Other names?
- ileal conduit, Bricker’s loop, ileal loop
- pros- the surgery is easy, eliminates catheterization
- cons- urine can back up to the kidneys causing infection or stone formation
What are the pros and cons of a continent urinary reservoir?
urine drains into a pouch made of intestine
pros- no external bag needed, valve protects against fluid from backing up to the kidneys
cons-
What is a neobladder? pros and cons?
- intestine is made into a pouch
- patient voids by bearing down, not by catheter
***What is anuria?
kidneys fail to produce urine
***What is hematuria?
blood in the urine
***What is dysuria?
painful or difficult urination
***What is oliguria?
abnormally small amounts of urine
***What is polyuria?
abnormally large amounts of urine
***What is glycosuria?
excretion of glucose in the urine
***What are symptoms and treatment for UTIs?
Symptoms: urgency, frequency, hematuria, pelvic pain, fever
Treatment: antibiotics, pt education (hydrate, urinate before/after sex, shower not baths, personal hygiene)
***What does costovertebral angle tenderness (CVAT) indicate?
infection of the kidneys
