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PCC > Urinary Elimination (Exam 3) > Flashcards

Urinary Elimination (Exam 3) Flashcards

1
Q

UTI

A

infection through urinary tract; most common nosocomial infection

CAUSES: bacteria entering CATHETERS, diagnostic procedures (cystoscopy), residual urine, hygiene, sex, urinary retention (enlarged prostate), E. COLI!

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2
Q

UTI S/S

A

strong persistent urge (cystitis)
burning
frequency (polyuria)
blood in urine
fever and chills
n/v and malaise
cloudy and smelly urine
dysuria (uncomfortable sensations while peeing)
pyuria (urine containing elevated WBCs)
cloudy, concentrated foul smelling urine
flank pain, tenderness (pyelonephritis)

ELDERLY: CHANGES IN MENTAL STATUS, incontinence, fatigue, anorexia, BE MINDFUL OF FALLS!

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3
Q

UTI Tx

A

antibiotics (complete whole course)
increase fluids
avoid catheters

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4
Q

Retention

A

inability to empty bladder completely

CAUSES: neurological issues (spinal cord injury), obstruction (prostate), meds (antihistamines and antidepressants), inflammation and swelling, anxiety

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5
Q

Retention S/S

A

pressure
pain
urgency
small/no output

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6
Q

Retention Tx

A
  1. insert catheter (straight, Foley (indwelling), suprapubic)
  2. use heat and warm water
  3. Credes maneuver (applying pressure to bladder)
  4. meds (alpha blockers or cholinergic)
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7
Q

Incontinence

A

loss/lack of voluntary control over urination

stress, urge (overactive), overflow, reflex, functional, transient, mixed

CAUSES: UTI, meds, obesity, obstructions, mobility, stroke, AGE (not a normal part of aging)

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8
Q

Incontinence S/S

A

involuntary urination
lack or urgency
retention
frequent bladder spasms
fever
back pain
nocturia
enuresis

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9
Q

Incontinence Tx

A
  1. Kegels
  2. bladder training
  3. meds (cholinergic)
  4. surgery
  5. prevent skin breakdown
  6. encourage/teach lifestyle modifications
  7. anti-incontinence devices
  8. develop strategies to promote independent urination
  9. parental teaching for enuresis
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10
Q

Purposes of Urinary System

A

eliminate wastes (urea, creatinine, uric acid)
maintain fluid balance
maintain electrolytes
maintain acid/base and pH balance
regulate BP
produce erythropoietin

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11
Q

Urinary Elimination

A

99% of filtered urine is returned to plasma
1% excreted as urine

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12
Q

Bladder

A

holds as much as 500-1000 mL of urine
urge to void can be sensed with 200 mL

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13
Q

Urinary Output

A

adults normally void 1500-2000 mL per day
minimum output is at least 30 mL/hr or 240mL/8hrs

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14
Q

Pale Straw to Amber Urine Color

A

normal!

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15
Q

Reddish urine color

A

menses
bleeding from bladder or ureters
eating beets, rhubarb, blackberries

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16
Q

Bright Orange/Rust Colored urine

A

pyridium

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17
Q

Dark Amber urine color

A

high level of bilirubin resulting from liver dysfunction

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18
Q

Urine Clarity

A

should be clear, becomes cloudy after standing several minutes

initially cloudy could mean protein or bacteria

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19
Q

Urine Odor

A

stronger odor when concentrated
ammonia smell means stagnant urine

sweet fruity odor- diabetes mellitus, ketonuria

normally there are no ketones in urine

20
Q

Infants

A

8-10 wet diapers per day; no voluntary control

21
Q

Children

A

toilet training

common problems are enuresis, nocturnal enuresis

22
Q

Older Adults

A

kidney function decreases
urgency and frequency common
loss of bladder elasticity and muscle tone leads to nocturia and incomplete emptying

23
Q

Pathological Conditions Affecting Urinary Elimination

A

bladder/kidney infections
kidney stones
hypertrophy of the prostate
mobility problems
decreased blood flow through glomeruli
neurological conditions
communication problems
alteration in cognition

24
Q

History Assessment of Urinary System

A

past problems and surgeries (UTI, stones, prostate problems, incontinence, renal insufficiency)
voiding pattern
medications

25
Q

Assessment of Current Symptoms of Urinary System

A

OLDCARTS
dysuria
hematuria
polyuria
oliguria
anuria
frequency
urgency

26
Q

Physical Assessment of Urinary System

A

inspect urine (COCA)
palpate and percuss bladder
CVA tenderness
post-void residual
bladder scan

27
Q

Female UTI Risk Factors

A

poor perineal hygiene/poor handwashing
proximity of urethra to anus
shorter urethra
vaginal infections

28
Q

Male UTIs

A

secretions from prostate contain antibacterial substance
urethra is longer which prevents organisms from traveling up to bladder

29
Q

UTI Prevention

A

fluid intake
void after intercourse
avoid/discontinue catheters
proper perineal hygiene
cranberry juice
avoid baths

30
Q

Urosepsis

A

organisms spread into bloodstream

31
Q

Antibiotics for UTI

A

depends on location and severity of infection
most bladder infections can be treated with oral antibiotics
more severe infections (pyelonephritis) may require IV antibiotics

32
Q

Nursing Considerations for Retention

A

prevent UTIs
prevent backflow of urine
encourage fluids
perineal hygiene

33
Q

Incontinence Risk Factors

A

infections
meds (diuretics, anticholinergics, psychotropics, caffeine, ETOH)
metabolic issues (diabetes, hypercalcemia, stones)
mobility issues
structural issues (BPH, pelvic organ prolapse, cystocele, rectocele)
obesity
neurological disease (stroke)

34
Q

Health Promotion for Normal Urination

A

provide privacy
assist with positioning if needed
facilitate toileting routines
encourage proper hydration and nutrition
assist with hygiene

35
Q

Urinalysis

A

pH 6.0 (4.6-8.0)
protein (0-8.0 mg/100mL)
Ketones (none)
Blood (up to 2 RBCs)
Specific gravity (1.001-1.030)
Microscopic exam (WBCs (0-4), bacteria (none), casts (none))

36
Q

UA

A

clean container

37
Q

Urine Culture and Sensitivity (C&S)

A

sterile container
clean catch
straight cath
sample from Foley

38
Q

24-hr urine

A

discard 1st void
save all urine
have patient void at 24 hour mark

39
Q

Timed Urine Specimen

A

time required may be 2,12, or 24 hour collections

  1. have patient completely empty bladder, this urine is discarded! time starts immediately after void
  2. patient voids in clean container
  3. urine is emptied into special collection container, may need to be kept on ice
  4. at end of time required, ask patient to empty bladder and place urine in specimen container
  5. send urine to lab
40
Q

Urinary Catheterization

A

measured in “french” scale; larger lumen=larger number

41
Q

Straight (I+O)

A

obtain specimen
relieve urinary retention

42
Q

Indwelling (Foley)

A

accurate I+O
post-op
not for incontinence

43
Q

3-Way

A

CBI (Murphy Drip)

44
Q

Post Cath Patient Education

A

first void after catheter removal must be measured
(male: place urinal at bedside in bathroom)
(female: insert hat in toilet or use bedpan)

ensure fluid intake is adequate
be alert for first void within 4 hours

45
Q

Urinary Diversions

A

diverts urine from kidney to abdomen or back, may be temporary or permanent

bladder cancer, radiation injury to bladder, trauma, fistulas, chronic cystitis

46
Q

Ileal Conduit

A

mucous in urine
increased risk of infection
stoma
pouching
teaching self care
psychosocial concerns
WOCN (Wound Ostomy Continence Nurse)
ostomy association

PCC (11 decks)

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