Urinary Elimination Flashcards
Primary functions of kidneys
filter metabolic wastes, toxins, excess ions, and water from the bloodstream and excrete them as urine.
regulate blood volume, blood pressure, electrolyte levels, and acid–base balance by selectively reabsorbing water and other substances.
Secondary function of kidneys
- Produce erythropoietin
- Secrete the enzyme rennin
- Activate vitamin D3 (calcitriol)
Urine is formed in the
nephrons
transport urine from the kidneys to the bladder.
ureters
stores urine until it is excreted.
bladder
transports urine from the urinary
bladder to the body exterior.
urethra
What quantity of urine in the bladder will stimulate the urge to void?
Approximately 200–450 mL of urine in adults
Identify at least three indications for determining whether hydration is adequate and urine output is within normal limits.
The person voids 1,500 mL in a 24-hour period in five to six voids.
• An infant has 8–10 wet diapers per day.
• For most adults, pale to clear urine indicates adequate hydration.
What common medications increase the amount of urine voided?
Diuretics increase urine output.
What types of medications are associated with urinary retention?
Medications with anticholinergic effects may lead to urinary retention.
A ________catheter has a single lumen and is inserted for ______ periods for immediate drainage of the bladder
straight
brief
An _________ catheter (Foley or retention catheter) is used for _______bladder drainage and may have two or three lumens
indwelling
continuous
Why is intermittent catheterization preferred for patients who must be catheterized over lengthy periods of time?
carries a substantially lower risk of infection than an indwelling catheter.
sandy particles around the urethral meatus of an indwelling catheter are signs of
encrustation and indicate the catheter should be replaced
How often should the urine collection bag be emptied?
Empty the urine collection bag at least every 8 hours, or more often if it is full, to make it more convenient for the patient to ambulate.
Labs - BUN
10 to 20
Labs - Creatinine
0.4 - 1.5
Important for 24 hour urine collection:
Collect first voiding and discard Record time Collect all urine for next 24 hours Keep container on ice Complete test by collecting next morning’s first void Compare I&O to amount in container
means blood can be seen in the urine
gross hermaturia
means blood can be only be seen with a microscope
microscopic hermaturia
Labs - Specific gravity
1.002 - 1.030
13% of Americans have a problem with
overactive bladder
Self catheterization is a _________ (clean/sterile) procedure?
CLEAN
Big risk factor for bladder cancer
smoking
s/s of bladder cancer
blood in urine frequency urgency maybe none until advanced then - dysuria, abd pain, pain in bone
Empty stomas when
1/2 - 2/3 full or sooner
occasional involuntary passage of urine
Enuresis
The size and functioning of the kidneys begin to decrease at about age
50
urination also called _______ and ______
voiding and micturition
The kidneys produce about _________ of urine per hour, or_______mL per day
50 to 60 ml or 1500
measure of dissolved solutes in a solution
Specific gravity
The normal specific gravity range for urine is
1.002 to 1.030.
Older adult Changes in Urinary:
lose ability to dilute and concentrate urine
reduction in renal blood flow & filtration
reduced bladder capacity - frequency/urgency/nocturia
Caffeine acts as a _____ and ______ urine production
diuretic and increases
alcohol impairs the release of _________ hormone (ADH), resulting in__________ production of urine.
antidiuretic
increased
a diet high in salt causes water________ and _______urine production.
retention and decreases
Risk factors for UTI
Sexually active women (short urethra)
Menopausal women (estrogen)
pregnant women
Diabetes (glucose in urine)
most common microorganism for UTI
Escherichia coli (E coli)
Interventions for UTI
lots of water showers instead of baths don't hold it in cranberry juice - (doesn't allow organism to stick) wipe from front to back
Which blood studies are commonly used to to assess renal function and hydration?
Blood urea nitrogen (BUN) and creatinine levels
Normal BUN
8–20 mg/dL
Normal creatinine
0.5–1.1 mg/dL
Direct visualization of the urethra, bladder, and ureteral orifices by insertion of a scope.
Cystoscopy
Done to determine whether a muscle or nerve problem is causing problems with how well the bladder holds or releases urine. A catheter is inserted into the bladder and a pressure probe into the rectum.
Cystometry
uses intravenous radiopaque contrast medium to visualize the kidneys, ureters, bladder, and renal pelvis. It evaluates renal function by analyzing flow of contrast over time.
Intravenous Pyelogram (IVP
uses radiopaque contrast medium to visualize the renal collecting system. Contrast media is injected via a ureteral catheter inserted through a cystoscope.
retrograde pyelogram
Causes of urinary retention
obstruction enlarged prostrate spinal cord injuries medications/anesthesia removal of catheter
The client must cleanse the genitalia before voiding and collect the sample in midstream because the initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum. A midstream sample is free of these contaminants
clean catch specimen
Obtain this specimen by inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter. Do not take the specimen from the collection bag because that urine may be several hours old.
Sterile urine specimen
Urinalysis WNL Color odor ph specific gravity glucose ketone protein
A freshly voided sample is pale yellow to deep amber. Fresh urine has a scent. 5.0-9.0, with an average of 6.0 1.002–1.030 Negative Negative < 20 mg/day
Blood in the urine.
Hematuria
Gross hermaturia
can be seen in the urine
The absence of urine, or urine output of less than 100 mL in 24 hours
Anuria
Painful or difficult urination
Dysuria
Involuntary loss of urine.
Enuresis
Urine output of less than 400 mL in 24 hours.
Oliguria
Excessive urination.
Polyuria
Credé’s maneuver
manual pressure over the bladder
Presence of __________ indicates impaired carbohydrate metabolism (e.g., diabetes, fever, fasting, high-protein diets, starvation, vomiting, or the post-anesthesia period)
ketones
is a single-lumen tube that is inserted for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure PVR volume, or to relieve temporary bladder distention). After the bladder is empty or the sample obtained, the catheter is removed and the patient resumes voiding independently.
Straight catheter
also known as a Foley or retention catheter, is used for continuous bladder drainage (e.g., when the bladder must be kept empty or when continuous urine measurement is needed). It is usually a double-lumen tube: one lumen is used for urine drainage, and the second lumen is used to inflate a balloon near the tip of the catheter.
indwelling catheter
used when the patient requires intermittent or continuous bladder irrigation. The inflated balloon holds the catheter in place at the neck of the bladder. The balloon is sized according to the volume of fluid used to inflate it. For most patients you will use a 5-mL balloon; and for achieving hemostasis after a prostatectomy, a 30-mL balloon
triple lumen catheter
is used for continuous urine drainage when the urethra must be bypassed (e.g., after gynecological surgery or where there is prostatic obstruction). It is inserted through an incision above the symphysis pubis
suprapubic cathete
CBI is ____ _____ _____ and monitoring ____ & ____ is important
continuous bladder irrigation
I&O
is a surgically created opening for elimination of urine
urinary diversion, or urostomy
Is the most common type of urinary diversion because it is the simplest to perform surgically and eliminates the need for ______ ________
ileal conduit
intermittent catheterization
is used to treat bladder and urethral pain, burning, increased urination, and increased urge to urinate. This medication turns the urine a deep orange-red color and is classified as an
Pyridium
Analgesic
Medication for incontinence
oxybutynin (Ditropan)
Medication for retention
Bethanechol (Urecholine)
Medication for dribbling/overflow (think men/prostrate)
Tamulosin (Flomax)
