Urinary Elimination Chapter 27 Flashcards
Identify the major structures of the urinary system.
Answer:
The urinary system comprises the following major structures:
● Two kidneys
● Two ureters
● Bladder
● Urethra
What are the functions of the kidneys?
Answer:
Kidneys have the following functions:
Primary functions
● The kidneys filter metabolic wastes, toxins, excess ions, and water from the bloodstream and excrete them as urine.
● The kidneys also help to regulate blood volume, blood pressure, electrolyte levels, and acid–base balance by selectively reabsorbing water and other substances.
Secondary functions
● Produce erythropoietin
● Secrete the enzyme rennin
● Activate vitamin D3 (calcitriol)
Briefly describe how urine is formed.
Answer:
Urine is formed in the nephrons. The renal arteries bring blood to the kidneys and into the glomeruli. Blood pressure forces plasma, dissolved substances, and small proteins out of the porous glomeruli into the Bowman’s capsule to form a liquid called filtrate. The filtrate moves from Bowman’s capsule into the tubular network of the nephrons where 99% of the fluid is reabsorbed. About 1% of filtrate returns, as urine, to the collecting tubule, which transports it into the ureters.
What role do the ureters, bladder, and urethra play in urinary elimination?
Answer:
The structures of the urinary system have the following roles:
● The ureters transport urine from the kidneys to the bladder.
● The bladder stores urine until it is excreted.
● The urethra transports urine from the urinary bladder to the body exterior.
What quantity of urine in the bladder will stimulate the urge to void?
Approximately 200–450 mL of urine in adults (50–200 mL in children) are sufficient to stimulate the urination reflex. Less may be required in older adults.
Identify at least three methods for determining whether hydration is adequate and urine output is within normal limits.
Answer:
Methods for determining if hydration is adequate and urination is normal include the following:
● 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?
Answer:
Diuretics increase urine output.
What types of medications are associated with urinary retention?
Answer:
Medications with anticholinergic effects may lead to urinary retention
What types of conditions or surgeries are associated with a high incidence of altered urination?
Answer:
Patients with surgeries or pathology involving the genitourinary tract have a high incidence of altered urination.
What should you discuss with your client when performing a nursing history focused on urinary elimination?
Answer:
The following items should be part of a nursing history focused on urinary elimination:
● Normal urination pattern
● Appearance of urine
● Changes in urination habits or urine appearance
● History of urination problems
● Use of urination aids
● Lifestyle questions
● Presence of urinary diversions,
● What are the key elements of a physical assessment for a client with urination problems?
Answer:
Physical assessment for urinary elimination includes examination of the kidneys, bladder, urethra, and skin surrounding the genitals.
How would you examine the kidney
by assessing for costovertebral angle tenderness (CVAT).
How would you examine the bladder
Assess the bladder with inspection, palpation, and percussion.
● Begin the assessment by observing for swelling of the lower abdomen. Lightly palpate the lower abdomen to define the bladder margin. Observe the patient’s response to palpation, noting any signs of tenderness or discomfort.
● Next, percuss the area. A distended bladder that has risen into the abdomen produces a dull sound, as opposed to the normal tympanic sound of intestinal air.
● Correlate the findings with data about the client’s fluid intake and voiding.
How would you examine the urethra
Assess the urethra by inspecting the urethral orifice. Look for erythema, discharge, swelling, or odor. These are all signs of infection, trauma, or inflammation.
How would you examine the perineal area
Inspect the skin in the perineal area for signs of breakdown or irritation.
Explain how to collect a clean-catch urine specimen.
Answer:
To collect a clean-catch specimen, the client must cleanse the genitalia before voiding and collect the sample in midstream.
You are caring for a patient on a hospital unit from 0700 to 1200. Based on the following information, calculate the I&O and comment on your findings.
Receiving IV fluid at 125 mL/hr
0800 breakfast—4 oz juice, toast, scrambled eggs, 8 oz coffee
0930—3 oz water
0700 to 1200—wound drainage: 360 mL
0700 to 1200—urine output per indwelling catheter: 180 mL
Answer:
● Intake. The patient’s fluid intake is 1075 mL in 5 hours; this includes IV fluid and oral fluid.
● Output. The patient’s fluid output is 540 mL in 5 hours; this includes urine and wound drainage.
● Comments. There is a +535 mL balance, although the urine output is low at an average of 36 mL/hr
Identify activities that promote normal urination patterns.
Answer:
The following activities promote normal urination patterns:
● Provide privacy.
● Assist with positioning.
● Position the patient in his preferred position whenever possible
● Provide a bedpan, urinal, or bedside commode if the patient cannot ambulate to the bathroom.
● Facilitate toileting routines; determine the patient’s usual voiding pattern and assist him to the toilet at these times and upon request.
● Promote adequate fluids and nutrition; encourage an intake of 10 large glasses of water daily for patients without health concerns that limit their fluid intake. Encourage more water for those who are engaging in prolonged exercise or exposed to a hot, humid environment.
● Assist with perineal hygiene if the patient cannot provide self-care.
Describe the difference between a catheter used for straight catheterization and one used for ongoing drainage.
Answer:
The catheters have the following differences:
● A straight catheter has a single lumen and is inserted for brief periods for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure post-void residual volume, or to relieve temporary bladder distention).
● An indwelling catheter (Foley or retention catheter) is used for continuous bladder drainage and may have two or three lumens. The first lumen drains urine, the second lumen is used to inflate the balloon that holds the catheter in place, and a third lumen may be used for bladder irrigation.
Why is intermittent catheterization preferred for patients who must be catheterized over lengthy periods of time?
Answer:
For patients who must be catheterized over lengthy periods of time, intermittent catheterization is preferred because it carries a substantially lower risk of infection than an indwelling catheter.
What actions should you take before inserting a catheter?
Answer:
The following actions should be taken before inserting a catheter:
● Verify the order
● Gather appropriate supplies
● Explain the procedure to the patient
● Answer any questions the patient may have
● Provide privacy
When caring for a client with an indwelling catheter you notice sandy particles around the urethral meatus. What should you do?
Answer:
Sandy particles are signs of encrustation and indicate the catheter should be replaced. Provide perineal care to the patient and obtain an order for replacement of the catheter from the primary care provider.
How often should the urine collection bag be emptied?
Answer:
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.
A _________________________ is an instrument that is used to measure the specific gravity of urine.
Answer:
refractometer
