Urinary Elimination and Fluids Flashcards
- What is Micturition
- Act of urination
Urinary developmental considerations for children
- What age does toilet training generally begin?
- What is urinary problem associated usually w/ children?
- 2 to 3 years old
- Enuresis (bed wetting)
- What is the parameter for anuria?
- What are the parameters for oliguria?
- What is the difference?
- What would be the cause of these two?
- urine output < 50 mL/d (based on the day)
- Urine output < 0.5 mL/kg/h (based on weight)
- Acute or chronic kidney failure.
What is bacteriuria?
the presence of bacteria in the urine
- What is dysuria?
- What are possible causes? (name 3/6)
- Painful or difficult voiding
- Lower UTI
- Inflammation of bladder or urethra.
- Acute prostatitis (inflammation of prostate)
- Kidney stones
- Foreign bodies
- Tumors in bladder
What is enuresis
What are possible causes? (name 3/6)
- involuntary voiding during sleep
- Delay in functional maturation of CNS
- Obstructive disease of UTI
- Genetic factors
- Failure to concentrate urine
- UTI
- psychological stress
What are the parameters for urinary frequency?
- voiding more than every 3 hours
What is hematuria?
- Blood in the urine may range from very obvious to microscopic and not visible at all.
What is incontinence?
Involuntary loss of urine
What is nocturia?
Awakening during the night to urinate
What is polyuria?
What are possible causes (3/6)
Increase volume of urine voided
- Diabetes mellitus
- Diabetes insipidus
- Diuretics
- Excess fluid intake
- Lithium toxicity
- Kidney disease (hypercalcemia, hypokalemic)
What is proteniuria?
Protein in the urine
What are the 3 diagnosis related to urinary output?
- Polyuria (excess urinary output)
- Oliguria (< 0.5 mL/kg/hr (based on weight)
- Anuria (< 50 mL/d (day))
What are 5 diagnosis related to urine composition?
- Bacteremia
- Hematuria
- Proteinuria
- Pyuria (WBC in urine)
- Glucosuria (glucose in urine)
What is normal urine output levels?
800 to 2000 mL a day.
Does fluid intake match fluid output?
Theoretically, yes but impossible to measure as there are many factors of output (urine, feces, skin, sweat, evaporation via the lungs)
1 cup = ? oz
1 oz = ? mL
1 cup = 8 oz
1 oz = 30 mL
What are the physical assessments of urinary functioning?
- Kidney palpation (done by advance practionier)
- Urinary bladder
- Urethra orifice (the external opening (or meatus) of the urethra.)
- Skin
- Urine
What is the expected normal finding for urine?
- Color
- consistency
- odor
- Straw color
- Clear
- Faint
How is a clean catch conducted?
What is the purpose?
- Cleaning urinary meatus before collection, collect midstream sample.
- The clean-catch urine method is used to prevent germs from the penis or vagina from getting into a urine sample. (reduces % of false positive)
What is the appropriate direction to clean a vagina?
What is the appropriate direction to clean a penis?
- Female starts the front to back (avoids brining bacteria from the anus to the vagina)
- Males starts from the inner portion to the outer portion of the head in circular motion.
If urine collection is needed is it possible to collect the urine from the urine collection receptible?
Why or why not?
urine has been staying in the receptible for a long time causing it to be tainted.
Stasis urine allows room for bacterial growth.
Does insertion of a Foley Cather require medical asepsis or surgical (sterile) asepsis?
Surgical (sterile) asepsis
What are reasons for Foley Catheterization?
(Name 3/7)
- Urinary retention
- Prolonged patient immobilization
- Obtaining urine specimen when patient is unable to void voluntarily
- Accurate measurement of urinary output in critically ill patients
- Assisting in healing open sacral or perineal wounds in incontinent patients
- Surgery
- Providing improved comfort for end-of-life care.
When using a bladder scanner how much retention would require a Cather insertion?
at least 400 mL
What is urine specific gravity?
What is the normal range?
- urine specific gravity test compares the density of urine to the density of water
- 1.005 to 1.030
Which people are at greatest risk for UTI?
(name 4/7)
- Sexually active women
- Women who use diaphragms for contraception
- Postmenopausal women
- People with indwelling urinary catheter
- People with Diabetes mellitus
- Older adults
- Urinary retenetion (bacteria breed in stasis urine)
What would the possible causes of the following color in urine?
- Pink
- Tea (brown)
- Orange
- Black
- Blue
- Pink = Blood
- Tea (brown) = kidney failure
- Orange = medications
- Black = medications
- Blue = food dye
What would decreased USG indicate? (< 1.005)
What would increased USG indicate? (> 1.030)
- Urine is to dilute (e.g., overhydration)
- excess hydration would mean urine consistency is closer to water.
- Urine is to concentrated (e.g., dehydrated)
- increased solutes compared to water in urine.
What would be some appropriate nursing strategies for nocturia, frequency and/or urgency?
(Name 4/8)
- Easy access to bathroom or commode
- Discourage fluid intake and alcohol at bedtime.
- Evaluate medication regimen and schedule (e.g., diuretics, drugs that produce sedation or confusion)
- Use of a night light
- Use clothing that is easily removed for voiding
- Keep assistive ambulatory devices (e.g., walker, canes) readily available.
- Evaluate gait and ability to ambulate safely
- Assess for UTI
What would be Nursing Strategies for Incontinence (loss of bladder control)?
Name 4/10
- Maintain a fluid intake of 1,500 to 2,000 mL/day
- Discourage use of alcohol, artificial sweeteners, and caffeine.
- Provide easy access to bathroom
- Assess factors that influence voiding
- Use assistive devices when necessary (raised toilet seat, grab bars, walker)
- Use of collection devices when necessary (urinal, bed pan)
- Ensure safety when ambulating (skid-proof slippers)
- Encourage use of whole, unprocessed, coarse wheat bran to prevent constipation and fecal impaction
- Perform pelvic floor muscle training (PFMT) exercises several times daily
- Encourage participation in a bladder retraining program.
What are Nursing Strategies to address UTI
Name 3/6
- Maintain a liberal fluid intake
- Encourage shower instead of tub bath to decrease opportunity for bacteria to enter urethra
- Encourage appropriate perineal care and frequent changing of incontinence briefs
- void at frequent intervals intervals; every 2 hours if possible
- void immediately after intercourse
- women should avoid use of potentially irritating feminine products (deodorant sprays, douches, powders) in genital area.
Between Na+ and K+, which is more prevalent in ECF v ICF?
Na+ is found more outside the cell (ECF)
K+ is found more inside the cell (ICF)
What are causes for deficient fluid volume (hypovolemia, dehydration)
Think: injury, illness, intake, skin.
- Blood loss or burns, interal bleeding.
- Loss from vomiting, diarrhea, GI suctioning (Salem sump)
- Decreased intake
- hyperhidrosis (excess sweating)
What are the manifestation of hypovolemia
(deficient fluid volume)
- Vital signs
- What’s going on in the head
- Urine
- Skin
- Hypotension
- Tachycardia w/ +1, weak thready pulse
- Impaired cognitive function
- Fatigue
- Headache, Dizziness
- Dark urine, ↑ USG
- Tenting
- Loss of weight
What would the lab results be for deficient fluid volume?
BUN, USG, and Hematocrit?
Increase in BUN, USG, and Hematocrit
What are the signs of dehydration for
Tongue, Urine, and Skin?
- Tongue - Fissures, cracks
- Urine - Dark color, High USG
- Skin - Checking turgor (tenting would be present)
What are the causes of hypervolemia (excess fluid volume)
- Fluid overload
- Diminished homeostatic mechanism (heart, renal or liver failure)
How may hypervolemia manifest in the following areas?
- Skin
- Lungs
- Vital signs
- Urinary
- Edema
- Juglar venous distention (JVD)
- Abnormal lung sounds (crackles)
- Tachycardia, +4 pulse (bounding), Hypertension
- Increased urine output and low USG.
Which electrolyte needs to be monitored closely when using diuretics?
Which system in the body would it greatly effect?
Potassium (hypokalemia)
The cardiovascular system
Third spacing is the shift of fluids into transcellular compartments.
What are two areas this may occur in?
Pleural (Pleural effusion)
Peritoneal (Ascites)
What is dextrose?
What does D5W mean?
Dextrose is sugar added into a solution (e.g., saline, water, lactated ringer)
5% dextrose in solution
What is the average intake and output for a normal adult per day?
What is the range?
2000 mL
1500 mL to 3000 mL
Urinary retention in older are adults can be associated with what factors?
- inability to void related to muscular weakness
- Deceased ability to sense bladder being full
- Medications: anticholinergic (antihistamines)
- Enlarged prostate
- Prolapse vagina
What are the following?
Isotonic
Hypotonic
Hypertonic
Isotonic have similar contents to that of blood
Hypotonic has less solute (sodium) than blood
Hypertonic has more solute (sodium) than blood
Which solution would you use to pull fluid out of areas of the body?
Isotonic, Hypotonic, Hypertonic?
Hypertonic
What is the first sign of a UTI in elderly patients?
Change in mental status (e.g., confusion)
Is urinary incontinence a normal consequence of old age?
urinary incontinence is not a normal consequence of aging
Which gender has a longer urethra?
What role does that play in catherization injuries?
What role does that play with risk in UTIs?
- Males have a longer urethra
- Males are more prone to injury during catheter insertion due to longer length.
- Females are more prone to UTIs due to the shorter catheter length.
Which electrolytes are higher intracellular?
(Na+, K+, Ca++, Mg++, Cl-, HCO3+, Phosphate, SO4-)
- K+
- Mg+
- Phosphate
What is normal urine output per kg?
0.5 to 1.5 mL per kg an hour
