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 )

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

Urinary Elimination (Exam 3) Flashcards by Gabriella Arias

UTI

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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UTI S/S

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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UTI Tx

antibiotics (complete whole course)
increase fluids
avoid catheters

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Retention

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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Retention S/S

pressure
pain
urgency
small/no output

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Retention Tx

insert catheter (straight, Foley (indwelling), suprapubic)
use heat and warm water
Credes maneuver (applying pressure to bladder)
meds (alpha blockers or cholinergic)

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Incontinence

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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Incontinence S/S

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

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Incontinence Tx

Kegels
bladder training
meds (cholinergic)
surgery
prevent skin breakdown
encourage/teach lifestyle modifications
anti-incontinence devices
develop strategies to promote independent urination
parental teaching for enuresis

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Purposes of Urinary System

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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Urinary Elimination

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

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Bladder

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

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Urinary Output

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

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Pale Straw to Amber Urine Color

normal!

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Reddish urine color

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

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Bright Orange/Rust Colored urine

pyridium

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Dark Amber urine color

high level of bilirubin resulting from liver dysfunction

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Urine Clarity

should be clear, becomes cloudy after standing several minutes

initially cloudy could mean protein or bacteria

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Urine Odor

stronger odor when concentrated
ammonia smell means stagnant urine

sweet fruity odor- diabetes mellitus, ketonuria

normally there are no ketones in urine

Infants

8-10 wet diapers per day; no voluntary control

Children

toilet training

common problems are enuresis, nocturnal enuresis

Older Adults

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

Pathological Conditions Affecting Urinary Elimination

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

History Assessment of Urinary System

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

Assessment of Current Symptoms of Urinary System

OLDCARTS dysuria hematuria polyuria oliguria anuria frequency urgency

Physical Assessment of Urinary System

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

Female UTI Risk Factors

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

Male UTIs

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

UTI Prevention

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

Urosepsis

organisms spread into bloodstream

Antibiotics for UTI

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

Nursing Considerations for Retention

prevent UTIs prevent backflow of urine encourage fluids perineal hygiene

Incontinence Risk Factors

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*)

Health Promotion for Normal Urination

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

Urinalysis

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)*)

clean container

Urine Culture and Sensitivity (C&S)

sterile container clean catch straight cath sample from Foley

24-hr urine

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

Timed Urine Specimen

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

Urinary Catheterization

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

Straight (I+O)

obtain specimen relieve urinary retention

Indwelling (Foley)

accurate I+O post-op not for incontinence

3-Way

CBI (*Murphy Drip*)

Post Cath Patient Education

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

Urinary Diversions

diverts urine from kidney to abdomen or back, may be temporary or permanent *bladder cancer, radiation injury to bladder, trauma, fistulas, chronic cystitis*

Ileal Conduit

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