Urinary elimination (Chapter 41) Flashcards
Healthy adults eliminate approx how many mL of urine daily?
1400 mL
The urinary system controls the consumption of blood by removing ________ and _________ and conserving useful substances.
Urea; creatinine
These organs filter liquid waste from the blood, balance electrolytes in the blood, regulate blood volume and pressure, produce erythropoietin for red blood cell formation, synthesize vitamin D to help control calcium levels, and maintain acid-base balance.
Kidneys
Urine is formed by tiny filtering units called ____ which are the functional units of the kidney.
Nephrons
Urine formation is a result of what 3 processes?
Filtration
Reabsorption
Secretion
This process of urine formation occurs in the glomerulus as fluid moves across a membrane as a result of a pressure difference.
Filtration
This process of urine formation occurs in the renal tubule as most of the filtrate moves back into the blood.
Reabsorption
This process of urine formation involves the end result of urine formation. Urea, water, and other waste form urine as they pass through the nephrons down the renal tubules.
Secretion
The failure of the kidneys to produce or excrete urine, can occur as a result of any process that limits the effective blood flow through the kidneys.
Anuria
When a person has anuria, they cannot filter waste products and artificial filtering may be necessary with renal _________
Dialysis
Technique by which fluids and molecules pass through an artificial semipermeable membrane and are filtered by means of osmosis.
Dialysis
This is defined as reduced urine volume, less than 500 mL/day in adults. Symptoms my include pt being breathless, pale, clammy skin, low blood pressure, edema, anemia, changes in heart rhythm, hepatomegaly, and hypertension may be present.
Oliguria
When an excessive volume of urine is formed and excreted each day, more than 2500 mL in adults.
Polyuria
Excessive urination at night that can disrupt sleep cycle. Commonly seen in men with benign prostatic hyperplasia and in post menopausal women because of decreased bladder tone, also can be due to diuretics, UTIs, cystitis, and diabetes.
Nocturia
Painful urination that can result from UTIS, bladder infection, STIs, yeast infection, kidney/bladder stones, prostatic enlargement, malignancy, reaction to soaps condoms or tampons.
Dysuria
The abnormal presence of red blood cells in the urine. Color of urine does not reflect degree of blood loss.
Hematuria
The inability to control the passage of urine
urinary incontinence
Loss of urine control during activities that increase intraabdominal pressure such as coughing, sneezing, laughing, or exercise.
Stress incontinence
Involves a sudden strong urge to void followed by rapid bladder contraction.
Urge incontinence
The lack of urine control in the absence of any abnormalities of the urinary tract. When some physical limitation in functioning occurs right before voiding occurs.
Functional incontinence
Seen in patients who are unable to empty the bladder completely resulting in a constant dribbling of urine or increased frequency of urination.
Overflow incontinence
Occurs in association with factors such as severe constipation, infections in the urinary tract or vagina, or medication usage.
Temporary incontinence
The inability of the bladder to empty, caused by an obstruction in the urinary tract or by a neurologic disorder.
Urinary retention
The involuntary passage of urine that may be structural or pathologic although may be related to nonurinary problems such as constipation, stress, and illness.
Enuresis
Which factors affect urine elimination? DPFMMSP
Developmental factors
Psychosocial factors
Fluid/food intake
Medications
Muscle tone
Surgical/diagnostic procedures
These are caused by the result of bacteria in the urine. E. coli usually invade the urethra and multiply.
Urinary tract infections UTIs
A surgical procedure performed when bladder function is impaired owing to trauma or disease involving the bladder, the distal ureters, or the urethra. Urine exits the body through a stoma created on the abdomen.
Urinary diversion
Color of urine is influenced by what 3 things?
Food
Medication
Pathologic conditions
Severe dehydration can cause urine to range between _______ and _______ color.
dark yellow-orange; tea
Patients with hypercalcemia may have what color urine
Blue-green urine
Adult urinary output of about _______ is considered normal.
0.5 to 1.5 mL /kg/hr
What tests are used to evaluate urinary function? BSU
Blood Urea Nitrogen (BUN)
Serum creatine
Urinalysis
24 hour urine collection
Normal values for BUN in the blood are __________
10-20 mg/dL
Normal values of serum creatinine are _________.
0.5-1.1 mg/dL for women
0.6-1.3 mg/dL for men
This is a screening tool for UTI, kidney disease, and other conditions.
Urinalysis
This test monitors the balance of water and solutes in urine. Normal range is 1.005 to 1.030.
Urinalysis for specific gravity.
Protein in the urine may be associated with what things? FVPK
Fever
Vigorous exercise
Pregnancy
Kidney disease
Urine glucose concentration is used to screen for _______ and assess glucose tolerance.
diabetes
The presence of ________ in the urine indicates that fat has broken down for energy. Large amounts in the urine may indicate ____________.
ketones; diabetic ketoacidosis
In this test urine is spun in a centrifuge and sediment settles at the bottom. Sediment is then spread on a slide and checked for red or white blood cells, casts, plugs, or crystals. If crystals are present, indicates stones are present.
Microscopic analysis
This urine collection is usually performed to determine the amount of creatinine cleared through the kidneys. Also used to measure levels of protein, hormones, minerals, and other chemical compounds.
24 hour urine collection
An ____________ may be performed to assess the size, shape, and location of the kidneys.
ultrasound scan
A diagnostic x-ray image centered on the iliac crest, typically used to investigate GI conditions such as bowel obstructions or gallstones, can also detect presence of kidney stones.
kidney, ureter, and bladder study.
An x-ray study of the kidneys, bladder, ureters, and urethra. The images show the size, shape and position of the urinary tract.
Intravenous pyelography
Used to diagnose kidney stones, bladder stones, or blockage of the urinary tract. Contrast media may be used to help identify blockages, growths, infections, or other diseases.
Computed tomography
An examination of the bladder and urethra through a cystoscope. Procedure permits visualization of areas that do not show up well on the x-ray. Used to determine the cause of hematuria, dysuria, incontinence, frequency, urgency, or retention.
Cystoscopy
This should not be used for urination if patient is unable to stand, maintained on a strict bed rest, and who independently cannot sit up safely.
Bedside commode
When creating a toileting schedule for a patient, establish voiding opportunities every _______ during the day, before bedtime, and every ________ at night.
1-2 hours ; 4 hours
These tips are food for the prevention of what?
-wear underwear with cotton-lined crotch
-avoid tight fitting clothes
-urinate when the urge is felt
-shower over baths
-practice good perineal hygiene
Urinary tract infections
What is used for these things:
-obtain samples of urine for analysis
-diagnose infection or kidney dysfunction
-drain residual urine found through a bladder scan
-empty a continent urinary diversion
-drain bladder of a paraplegic or quadriplegic
Urinary catheterization
These catheters are single-lumen devices, designed for one-time or short-term catheterization.
Straight catheter
These catheters are double-lumen indwelling. One lumen is for filling a balloon at the tip for anchoring and the other lumen is for draining urine.
Foley, coude
These catheters are used for bladder irrigation. Allows for sterile irrigation fluid to be introduced into the bladder to provide localized antibiotic treatment or to drain blood and blood clots after surgery or diagnostic procedures.
Triple lumen catheters
- Relief of acute urinary obstruction and retention
- Preventing contamination during complex surgical procedures
- Accurate measurement of urine in critically ill patients
- Maintaining dry tissue during perineal or sacral wound healing in incontinent patients
- Optimal management of patients who are immobilized for an extended period of time
- Support of patient comfort at the end of life
Indications to which catheter use is appropriate
Catheter bags should me emptied when how full?
2/3 full
Newer external catheters for women use ________ material placed between the labia and gluteal folds, with tubing attached to low continuous suction to drain excreted urine.
Wicking
External male catheters include __________ which are applied over the tip of the shaft of the penis.
condom catheters
When urine accumulates on the skin, it is converted to _______ which causes the skin to remain moist and possibly become macerated. Patient is at risk for skin breakdown, ulceration, and infection.
Ammonia
Obtaining urine specimen: patient voids into a specimen cup or into clean urinal or bedpan for which test?
Routine analysis
Obtaining urine specimen: urine is collected by the clean-catch, or midstream method, using a sterile specimen cup.
Culture and Sensitivity testing
Obtaining urine specimen: removal of a specimen from the tubing of an indwelling catheter or urinary diversion collection bag.
Straight catheterization
