urinary elimination ch. 45 Flashcards
urinary urgency (feeling of need to void immediately) what are some causes of this?
full bladder, bladder irritation or inflammation from infection, overactive bladder, psychological stress
what are some causes of dysuria(painful or difficult urination)?
Bladder inflammation, trauma or inflammation of urethral sphincter
What would cause frequency (voiding at frequent intervals (less than 2 hours)
Increased fluid intake, bladder inflammation, increased pressure on bladder (pregnancy), diuretic therapy.
What are some causes of hesitancy (difficult initiating urination)
Prostate enlargement, anxiety, urethral edema
what can cause oliguria (diminished urinary output relative to intake [usually 400 mL/24hr])
Dehydration, renal failure, UTI increased ADH secretion, heart failure.
Causes for Nocturia ( Voiding one or more times at night)
Excessive fluid intake before bed (especially coffee or alcohol), renal disease, aging process, prostate enlargement.
what are some causes of dribbling (leakage of urine despite voluntary control of urination)
Stress incontinence, overflow from urinary retention (e.g from BPH)
what are some causes of incontinence (involuntary loss of urine)
Multiple factors: unstable urethra, loss of pelvic muscle tone, fecal impaction, neurological impairment, overactive bladder.
Hematuria ( blood in urine)
Neoplasms of kidney or bladder, glomerular disease, infection of kidney or bladder, trauma to urinary structures, calculi, bleeding disorders.
what are some causes for urinary retention ( Accumulation of urine in bladder, with inability of bladder to empty fully)
Urethral obstruction (stricture), decreased sensory activity, neurogenic bladder, prostate enlargement, post-anesthesia effects, side effects of medications(anticholinergics, opioids).
some causes of residual urine (volume of urine remaining after voiding (>or equal to 100 mL)
Inflammation or irritation of bladder mucosa from infection, neurogenic bladder, prostate enlargement, trauma, or inflammation or urethra.
during and after menopause, vaginitis and increased susceptibility to UTIs is the result of what hormone deficiency in older woman
estrogen
assessment of urine involves what assessment?
Measuring patient’s I&O and observing characteristics of their urine.
normal urine color is what
pale, star color to amber.
Urine is usually more concentrated when
morning and when patient has fluid volume deficit
Bleeding from kidneys or ureters cause what color of urine. And what of the bladder and urethra?
Dark red urine; and bright red urine
Dark amber urine is the result of what
high concentrations of bilirubin caused by liver dysfunction.
what does the urine appear like in a patient that has renal disease?
appears cloudy or foamy because of high protein concentrations.
Urine that appears thick and cloudy may be the result of what
bacteria and WBCs in urine.
stagnant urine has what kind of odor?
ammonia. is common in patients who are repeatedly incontinent.
A sweet or fruity urine odor occurs from what
acetone or acetoacetic acid (by-products of incomplete fat metabolism). seen with diabetes mellitus or starvation
what is acute renal failure?
Reversible; Sudden loss of function; Overdose, meds, poisoning, excessive blood loss can progress to chronic renal failure
what are the brain structures that influence bladder function
Cerebral cortex, thalamus, hypothalmus, and brainstem.
an adult normally voids every?
2 to 4 hours
how much urine in the bladder is enough for and adult and child to have a sense of desire to urinate?
150- 200 mL and 50 to 100 mL
toilet training should normally begin when
24 months (2 years) some at 36 months(3 years)
how is urination under voluntary control?
As the volume increases inside the bladder, sensory impulses to the micturition center is sent to the sacral spinal cord. Impulses from the micturition center respond to or ignore this urge, thus making urination under voluntary control
What are some disease conditions that influence urination?
Diabetes mellitus and neuromuscular diseases such as multiple sclerosis cause changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions.
Older men often suffer from BPH, which makes them prone to urinary retention and incontinence. Some patients with cognitive impairments, such as Alzheimer’s disease, lose the ability to sense a full bladder or are able to recall the procedure for voiding.
Degenerative joint disease and parkinsonism are examples of conditions that make it difficult to reach and use toilet facilities.
what is uremic syndrome
an increase in nitrogenous wastes in the blood,
What is peritoneal dialysis?
an indirect method of cleaning the blood of waste products using osmosis and diffusion, with the peritoneum functioning as a semipermeable membrane. This method removes excess fluid and waste products form the bloodstream when a sterile electrolyte solution (dialysate) is instilled into the peritoneal cavity by gravity via a surgically placed catheter. The dialysate remains in the cavity for a prescribed time interval and then is drained out by gravity, taking accumulated wastes and excess fluid and electrolytes with it.
what is hemodialysis?
a machine equipped with a semipermeable filtering membrane (artificial kidney) that removes accumulated waste products and excess fluids from the blood. In the dialysis machine dialysate fluid is pumped through one side of the filter membrane (artificial kidney) while a patient’s blood passess through the other side. The processes of diffusion, osmosis, and ultrafiltration clean the patient’s blood. Then the blood returns through a specially placed vascular access device (Gore-Tex graft, arteriovenous fistula, or hemodialysis catheter).
what are the symptoms of uremic syndrome
fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome.
What are some sociocultural factors influencing urination
the degree of privacy needed for urination varies with cultural norms. North americans expect toilet facilities to be private. European cultures accept communal toilet facilities.
what are some psychological factors influenceing urination
Anxiety often prevents a person from being able to urinate completely; as a result, the urge to void returns shortly after voiding.
Emotional tension/stress makes it difficult to relax ABD and perineal muscles. Attempting to void in a public restroom sometimes results in a temporary inability to void. Privacy and adequate time to urinate are usually important to most people.
what are some fluid balance factors influencing urination?
drinks that contain caffeine promote increased urine production (diuresis). Alcohol inhibits the release of ADH, also resulting in increased water loss in urine
what is oliguria?
is the low output of urine, It is clinically classified as an output below 300-500ml/day. Often occurs when fluid loss through other means (e.g. perspiration, diarrhea, or vomiting) increases. Causes: renal failure, dehydration, increased ADH secretion.
how does febrile conditions affect urine production?
Pt that is febrile excessively perspirates and loses large amounts of fluids through insensible water loss, which decreases urine production. fever causes an increase in body metabolism and accumulation of body wastes. Although urine volume is reduced, it is highly concentrated.
what are some indications for dialysis
- Renal failure that can no longer be controlled by conservative management ( such as dietary modification and administration of medications to correct electrolyte abnormalities).
- Worsening of uremic syndrome associated with ESRD( nausea, vomiting, neurological changes, pericarditis)
- Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures (hyperkalemia, pulmonary edema)
the stress response releases and increased amount of what hormones
ADH, which increases water resorption. It also elevates the level of aldosterone, causing retention of sodium and water.Both of these substances reduce urine output in an effort to maintain circulatory fluid volume.
what is overflow incontinence
occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine.
what are some causes of overflow incontinence
head injury (damage to the cerebral cortex, hypothalamus, and brainstem), spinal injury; MS; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia.
what is Hyperreflexia
a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage.
How does Anesthetics and narcotic analgesics reduce urine output
slow the glomerular filtration rate
what are some Meds contributing to urinary retention and overflow incontinence:
Antipsychotics, antidepressants, alpha-adrenergic agonists, and calcium channel blockers
what are some Meds that can cause urinary incontinence:
Alpha-antagonists, diuretics, sedative hypnotics, opiod analgesics, angiotensin-converting enzyme (ACE) inhibitors, and antihistamines
what are some surgical procedures that influencing urination?
Surgery of lower abdominal and pelvic structures sometimes impairs urination because of local trauma to surrounding tissues. After returning from surgery involving the ureters, bladder, and urethra, patients routinely have urinary catheters.
what medications may cause urinary urgency and subsequent incontinence.
antiparkinson meds
Phenazopyridine (pyridium) colors the urine what color?
bright orange to rust
what color urine does Amitriptyline (is used to treat symptoms of depression.) make
green or blue discoloration
Levadopa causes the urine to turn into what color?
brown or black.
what is the most common causative pathogen to cause CAUTIs
E.coli and patients own colonic flora.
Patients with chronic kidney conditions cannot produce sufficient quantities of erythropoietin, therefore they are prone to what?
anemia
why are women more susceptible to infection in the perineum area.
because of a short urethra and the proximity of the anus to the urethral meatus.
flank pain, tenderness, fever, and chills are common in what upper urinary tract infection
pyelonephritis
Two or more PVR determinations greater than ___ mL are associated with the development of UTI and indicate the need for catheterization.
150 mL
An obstruction within a ureter such as a kidney stone (renal calculus) results in strong peristaltic waves that attempt to move the obstruction into the bladder. These waves result in pain often referred to as
renal colic
Poor control of micturition or incontinence results from muscle wasting caused by what factors
Prolonged immobility, muscle damage during vaginal childbirth, being overweight, caffeine use because caffeine relaxes the smooth muscle of the sphincter, muscle atrophy secondary to menopause, or other traumatic damage to pelvic nerve and muscles.
nocturnal enuresis
nighttime voiding without awakening (some children do not gain full control until age 4 to 5).
typical daily output for an adult is
1200 to 1500
an output of less than how many mL indicates possible circulatory, blood volume, or renal alterations.
30mL
If yeast (candidiasis) if found, it is important to inspect what areas for the source
vagina, groin area, under the breasts, and in the mouth.
eating beets,rhubarb, or blackberries cause what color urine
red urine.
what is urine specific gravity
measures the kidney’s ability to concentrate or dilute urine in relation to plasma. Because urine is a solution of minerals, salts, and compounds dissolved in water, the specific gravity is greater than 1.000. The more concentrated the urine, the higher the urine specific gravity
normal pH values
4.6-8.0
what does the pH indicate
it indicates acid-base balance. An acid pH helps protect against bacterial growth. Urine that stands for several hours becomes alkaline.
what is the normal values for protein in blood
(none or up to 8 mg/100 mL) Normally protein si not present in urine. It is common in renal disease because damage to glomeruli or tubules allows it to enter urine.
