Urinary Elimination (Exam 2) Flashcards
How does the kidney help maintain normal bodily functions
Remove urea and excess water
Regulates the ph
Secrets hormones that manages homeostasis
Marian’s sodium, potassium, chloride, bicarbonate, magnesium, copper and phosphate
What is the role of the bowels in elimination
Maintains immunity
Produces bicarbonate
Removes solid waste from the body
The bacterial flora absorbs nutrients, vitamins and protect the gut
When you do a physical assessment for characteristics of urine what are u looking for?
The color
pH
Specific gravity: 1.15-1.025
Constituent: urine acid , creatinine
Odor
Turbidity
What is the normal color of urine. And what is abnormal
Normal is pale yellow or amber
Dark colored urine
Normal ph range of urine
5-6 with a range of 4.5-8
What is the normal specific gravity for urine
1.015-1.025
What is the normal smell for urine
Urine should be aromatic. If it is sweet in smell is a sign of glucose
Normal findings for turbidity of urine
Should be clear or translucent
Abnormal findings for turbidity of urine
Freshly voided is cloudy
What assessment can be used to identify altered elimination
Physical characteristics
Intake and output
Bladder assessment
Voiding pattern
Urine output measurement incontiney patients: foley
Urine output measurement continent patient who are incontinent: remove foley after use
What are some habits or conditions that cause a risk factor with altered urinary elimination
Smoking
Pregnancy
Pain
Impaired mobility
Sedentary lifestyle or not exercising enough
Impaired muscle tone in abdomen
Decrease exercise gastrointestinal mobility
Not drinking enough water
Constipation
Who is at greater risk for UTI
Pregnant women
Sexually actively with genitalia
People who use diaphragm for contraception: silicone cup inserted in vagina
People with diabetes
Older adults
This e with urinary catheter
Post menopausal
Pathological conditions that causes altered urinary elimination
- Congenital GI tract abnormalities or bladder disease
- Renal failure: inability to remove waste or regulate fluid, electrolyte and ph balance in the body
What test and procedures should we do for one’s with alteration in urination
Urinalysis
Specific gravity from urine
Bladder scan
Clean catch midstream spicemen
Urine culture
24 hour urine collection
What is the normal specific gravity
1.015-1.025
What is the normal intake of fluid daily
2,000-3,000 ml daily
Purpose of a bladder scan
Obtain bladder volume post void residual
Clean catch midstream spicemen
To confirm a urine infection and determine the best antibiotics to treat the infection
How much ml of urine for clean catch test
3 ml
Which urine test is used for a urine sample
Midstream clean catch
Urine culture: how do you obtain this?
Obtain a sterile urine specimen via a port of urinary catheter
Which urine sample is strike and which one is not sterile
Sterile: collected from the bladder (catheter)
Non sterile: collected from a container (bed pan)
Purpose of. 24 hour urine collection
Check for kidney problem, protein, hormone or mineral in urine
Provide enough hormone
How can kidney stone affect urinary elimination
Cause urinary elimination problems
What questions are you asking the patient
How often do you urinate?
Characteristics of urine?
Recent changes in urine elimination
Recent or past urinary elimination problems
What’s one important medication to give the patient who has urinary elimination
Opioid: it is a stool softener which lessens constipation
What order do you assess the abdomen
Inspect
Auscultate
Percuss
Palpate
What are you assessing
- Inspect the abdomen for any distention
- Palpate for tenderness or masses
- Assess bladder for pain/burning upon urination
- Assess urine color, odor and sediment
- assess urinary retention (bladder scan)
- Inspect urethral Meatus for signs of inflammation
- Skin color, texture, turgor, excretion of wastes and integrity
- Inspect presses if urinary catheter diversion
Name some nursing diagnosis related to urinary elimination
Incontinence
Urinary retention
Pattern altercation
Risk for infection related to INDWELLING catheter
Actuate pain related to bladder spasm, dysuria, retention, kidney infection
Impaired skin integrity related to incontinence
What are some patient goals/planning
Incontinence under control
Maintain fluid, electrolytes and acid base
Patient able to demonstrate appropriate hygienic self care behaviors
Schedule toilet time
Urine output almost equal to fluid intake
Implementation
Provide privacy and time to urinate
Upright position to urinate
Encourage adequate fluid intake 2-4 liters a day
Limit high caffeine foods, sodium and sugar
Assist with toilet
Keep perineal area dry
Promote mobility
Provide and teach catheter care
Initiate bladder training
What are some common causes of urinary elimination
Dysuria: pain with elimination
Bladder control
Trauma
Infection
Obstruction: urinary retention
Illnesses: hypertension, diabetes and ckd(chronic kidney disease)
What is dysuria
Pain or difficulty with urination
What are some causes of dysuria
Infection: uti
Trauma to perineal area
Vaginal or urethral irritation
Pregnancy
Depression
Urologic obstruction
What are some findings that might show that your patient has dysuria
Fever
Flank pain (towards back)
String smelling urine/ foul smell
Cloudy urine
Increase I’m frequency to urge
Hesitancy
Burning or tingling
What are some interventions
Monitor for changes
Promote ambulation
Keep the perineal area clean and dry
Promote good hand hygiene
Increase fluid intake
Admin med
How much fluid intake should we have
2-4 liters a day
What is urinary retention
The inability to urinate appropriate amount of urinate voluntarily
What might urinary retention cause
Bladder distention
Urine accumulation
What might cause urinary retention
Mediation or surgery
And obstruction
Weakness to the bladder muscle
Neurological: stroke signal from the brain to the bladder is blocked
What are some findings to show that a patient has urinary retention
Abdominal distention
Increased abdominal pressure
Firmness and pain
Urgency, inability to urinate
Painful urination
Sever lower abdominal pain
Bloating
Frequency
Hesitancy
Urgency
Nocturia
What are some nursing interventions for a patient with urinary retention
Teach the patient about a bladder diary
Timed voiding
Losing weight, decrease caffeine intake, avoid constipation and lifting heavy
Prescribed diuretic morning or early afternoon
What time should a diuretic be prescribed
Early morning or early afternoon
Whern do we use an indwelling catheter
Short term
When do we use a intermittent catheter / straight catheter
Quadriplegic patient
Chronic urinary retention
When do we use a suprapubic catheter
When the urethra is blocked
Long term
What is the ultimate plan for a patient with incontinence
Restore continence and educate patient intervention
Transient incontinence
Sudden and last up to 6 months
From treatable factors
Eg: uti
Stress incontinence
Weak pelvic floor muscles
Infra abdominal pressure increases
Eg: laugh, cough or sneeze
Urge Incontinence
Urine lost during abrupt and string desire to pee
Mixed incontinence
Combination of stress and urge
Overflow incontinence
Chronic retention keeping to distention and overflow of the bladder
Functional
When the patient cannot get to the bathroom
Functional problem
Cognition orientation or physical
Reflex/spastic
Involuntary loss of urine without the feeling or sensation of need to void
Spinal cord injury
Neurologenic
Damage to the nervous system with the bladder nerves
Total incontinence
Continuous, unpredictable loss of urine
What are the causes of urinary incontinence
Temporary: spicy, acid food, citrus food,chocolate, alcohol, caffeine, carbonated drinks, artificial sweeteners, surgery, medication
Chronic: ages, pregnancy, childbirth, menopause, BPH, UTI, DM, prostate cancer, tumor, neurological disorders
History and assessment for urinary incontinence
Obtain a list of traditional and non traditional medications
Timing and volume of urine
What patient does when the leakage occurs
How often
Nocturia?
Abdominal assessment
PCP for gyn exam
Nursing intervention for urinary incontinence
Teach about diary
Timed voiding
Changes in lifestyle
Prescribed diuretic
Are some evidenced based practiced interventions
- Fluid intake of 2,000-3,000
- Intake and output
- Promote privacy and hygiene
- Normal voiding habits
- Obtain urine specimens
- Assess skin integrity
- Bedside assessment
- Bladder diary
Pelvic floor muscle training/ kegal exercise
Usually used for women
Timed voiding
This is a bladder training on a set schedule
every hour etc
UTI: who is at risk
Females
Sexually active
Hygiene
Use of diaphragm for birth control
Menopause
Urinary obstruction
Infection to the urinary tract is caused by what
E. coli
Nursing interventions for uti
Wipe from front to back
Keep perineal area dry and clean
Urinate when you feel the urge
Showers instead of bath tub
Wear cotton underwear
Increase fluid intake
Avoid caffeine, species, alcohol, carbonated drinks
Administer antibiotics
Prevent cauti
- Assess the urinary output and characteristics
- Maintain the tubing below the waistline
- Wipe the end of the catheter with antiseptic solution prior to attaching a new drainage
4.empty the foley at least every 8 hour
When should you change the catheter
Signs and symptoms of infection
Crusting around the meats, sediment in foley
Leakage, blockage or bleeding
What should you teach the patient to prevent reoccurring urinary elimination
Urine flow by gravity: men stand up , women sit
Stop smoking
Avoid caffeine ( restrict the amount of caffeine)
Avoid constipation
Urinate after and before sex
Use cotton underwear
Maintain healthy weight and exercise
Drink at least 2,000-3,000 ml of fluid
Urinate in a relaxed positions and wipe from front to back
Wait up to 3 minutes
Urinate when youfeel the urge
Stop drinking at least 2 hour before bed
Assist with toileting and measure input
Prevent uti
Name foods that are good for the gu system
Pears
Banana
Winter squash
Green bean
Potatoes
Lean meats
Whole grain
Kale
Cauliflower
Breads
Nuts
Eggs
Berries and vegetables
Food that irritate gu system
Coffee
Caffeine
Citrus food
Spicy food
Alcohol
Tomato products
Artificial sweeteners
Which catheter lessens risk for cauti
Straight catheter or intermittent
Tools that identify/diagnose altered urinary pattern elimination
Urodynamic test
Never e and muscle function
Urine flow rates
Internal and external pressure measured
A post residual volume of how much indicates that the bladder is unable to empty properly
100 ml
How do you assess for functional incontinence
Beside commode
Ability to use assistive devices in bathroom
Timed voiding
How you document urine
How often it occurred
The urine characteristics
Bladder diary
How do you document for infants
You weigh their diapers
For infants who do you teach
The parent
How many glasses of water a day
6-8
How to avoid uti with female condom
Lubricant
Sterile specimen for urine
Catheter
How to get a sterile specimen of urine
From the catheter
