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Nursing 1J02 > Urinary Elimination, Fluid Balance & Intake and Output > Flashcards

Urinary Elimination, Fluid Balance & Intake and Output Flashcards

1
Q

How is balanced maintained?

A

ingestion, distribution and excretion of water and electrolytes

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2
Q

What system is fluid balanced primarily maintained by?

A

renal

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3
Q

How much does our intracellular fluid make up?

A

60%

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4
Q

Interstitial

A

fluid between cells in the tissue

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5
Q

Intravascular

A

blood and plasma

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6
Q

transcellular

A

fluid separated by epithelium (pleural, peritoneal)

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7
Q

Osmosis

A

movement of water through a semipermeable membrane from an area of lesser solute concentration to one of greater concentration

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8
Q

osmotic pressure

A

pressure needed to counter the movement of water across a semipermeable membrane from an area of low solute concentration to an area of high concentration

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9
Q

what does decrease in albumin result in?

A

decrease osmotic pressure

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10
Q

Active trasnport

A

movement of molecules across a concentration gradient using chemical energy

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11
Q

Where does diffusion happen?

A

diffusion of oxygen and carbon dioxide between alveoli and lung blood vessels

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12
Q

filtration

A

uses hydrostatic pressure gradient and results in 2-4L of fluid per day entering the interstitial fluid from intravascular space

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13
Q

What organs does output occur?

A

kidneys, skin, lungs and GI tract

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14
Q

What is the obligatory water loss per day?

A

500 mL minimum

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15
Q

Sensible water loss

A

urine and feces; see and measure

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16
Q

insensible water loss

A

skin and respiratory system; cant really measure

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17
Q

How much will the kidneys filter out per day?

A

filters 180L of plasma daily and creates 1.2-1.5L of urine each day

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18
Q

How much do the small intestines manage?

A

9L of fluid which gets secreted into the GI tract daily and most gets reabsorbed and 100mL is lost in feces daily

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19
Q

What is the fluid intake regulation?

A

thirst mechanism

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20
Q

Hormonal control of fluid intake?

A

ADH or aldosterone

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21
Q

ADH release

A

to increase serum osmolality and act on renal tubules and collecting ducts and make them more permeable to water which increases the amount of water reabsorbed into the blood circulation and decrease amount of water thats lost through urine

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22
Q

Aldosterone release

A

by adrenal cortex in response to high potassium levels and low sodium levels; counteract hypoyvelemia results, in increased absorption of sodium in distal renal tubules

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23
Q

When are osmoreceptors in the hypothalamus stimulated?

A

when serum osmolality increases or blood volume decreases

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24
Q

Intake Measures

A

oral- 1100-1400
Food- 800-1000mL
Metabolism- 300mL

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25
Q

Output measures

A

Skin (insensible)- 500-600mL
Lungs(insensible)- 400mL
Gi- 100-200mL
Urine- 1200-1500mL

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26
Q

Volume imbalances

A

disturbances in amount of ECF

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27
Q

Fluid volume deficit (nursing diagnosis)

A

dehydration, vomitting, decreased oral intake, extreme heat, diarrhea

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28
Q

Fluid volume excess (nursing diagnosis)

A

heart failure, kidney disease, IV therapy: body cannot regulate the fluid volume

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29
Q

aspects of fluid balance chart

A
  • all intake and output over a 24hr period and 24hr fluid balance (excess or deficit)
  • intake: oral fluids, IV, feeding tube
  • output: urine, NG drainage, wound drainage, loose stool, vomitus, other drainage tubes
  • need to look at trends over time (2-3 days before)
  • daily input-output should be about 500mL
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30
Q

Daily weight

A
  • consistent time, scale, same clothing

- A CHANGE OF MORE THAN 1KG PER DAY IS SIGNIFICANT

31
Q

Cardiovascular

A
  • blood pressure, pulse rate, and quality, capillary refill, edema
  • if dehydrated increase pulse rate or tachycardia (shows increased demands)
32
Q

Respiratory

A
  • presence of crackles on auscultation

- too much fluid can end up in the pulmonary vasculature and cause crackles

33
Q

Renal

A

urine output decrease amount (dark yellow colour)

34
Q

integumentary

A

mucous membranes, skin turgor

35
Q

Positive fluid balance

A
  • assess patient for signs of fluid overload
  • look at trends over time
  • consider patient context and condition
36
Q

Negative fluid balance

A
  • assess patient for dehydration
  • look at trends
  • consider patient context and condition
37
Q

Urinary Elimination (Micturition)

A

urination or voiding: complex neural response that allows bladder to contract, the urethral sphincter to relax and urine to leave the body through the urethra

38
Q

Urinary Elimination (Upper tract)

A

Kidneys- remove waste from blood to urine and normally protein and RBC do not filter through glomerulus
Ureters- transport urine from kidneys to the bladder

39
Q

Urinary Elimination (Lower tract)

A

Bladder- reservoir for urine until the urge to urinate develops
Urethra- passage through which urine travels from the bladder ending at the urethral meatus through the urine exits; transverse pelvic floor muscles

40
Q

How big is the urethra in females?

41
Q

How big is the urethra in males?

42
Q

Act of urination

A

sensory nerves from the bladder carry signals to the brainstem when the bladder is full

43
Q

When is the urge to void first felt?

A

when the bladder is 250-300mL full

44
Q

When is a strong urge to void felt?

A

500mL capacity

45
Q

Factors influencing urination

A
  • psychological factors: anxiety and stress
  • Socioculture factors: culture, gender & religion
  • Fluid balance: caffeine, alcohol
  • Diagnostic examination
  • Surgical procedures: anaesthesia
  • Pathological conditions: neurological disease, altered mobility, renal disease
  • Medication: diuretics
46
Q

What do UTI’s commonly result from?

A

catheterization: some other causes such as dysuria, hematuria, fever, malaise, cloudy urine can lead to bacteremia and urosepsis

47
Q

Urinary incontinence

A

involuntary leakage of urine: increased risk of skin breakdown

48
Q

Nocturia

A

waking at the night to urinate

49
Q

Urinary retention

A

accumulation of urine caused by the inability of the bladder to empty (underactive detrusor muscle, urethral obstruction, after surgery, medication, side effect, fecal impaction, prostate enlargement, altered bladder innervation)

50
Q

Urinary diversions

A

diversion of urine to external source

51
Q

Factors impacting urination

A

infection control and hygiene (urinary tract is considered sterile, asepsis to prevent infection with invasive procedures, catheterization and other procedures sterile technique)
Psychosocial and cultural considerations (may also alter sexuality and self concept, need for comfort and privacy, gender)

52
Q

Growth and development

A
  • infants and young children cannot concentrate urine effectively
  • increase frequency with pregnancy
  • changes with menopause
  • prostate enlargement in older men
  • older adults: reduced GFR, nocturia, decreased bladder contraction can lead to residual post void volume
53
Q

When does toilet training become full of ones control?

A

4-5 years of age

54
Q

How much should adults urinate daily?

A

1500-1600 mL of urine; approx every 4-5 hours

55
Q

Assessing urinary

A
  • Pattern of urination
  • symptoms of urinary alterations ( incontinence, urgency, frequency, hesitanccy, dribbling, dysuria, polyuria, oliguria, nocturia, hematuria)
  • elevated post void residual volume: incomplete bladder emptying
56
Q

Factors affecting urination

A
  • medical and surgery history
  • bowel elimination pattern
  • mobility
  • impact on quality of life
57
Q

PA: Skin and mucosal membranes

A

oral mucos and skin turgor

58
Q

PA: Kidneys

A

flank pink, renal artery bruit

59
Q

PA: Bladder

A

full bladder palpable between symphysis pubis and umbilicus (dull to percussion on full bladder)

60
Q

PA: Female perineum

A

skin integrity, rash, inflammation, discharge

61
Q

PA: Male perineum

A

urethral meatus

62
Q

T/F: change in urine volume is a signifiant indicator of fluid alterations or kidney disease?

63
Q

Amount

A

measured with urine hate (goes under seat) (no sharing)

64
Q

Urinal

A

pour urine from urinal into clear container with measurements

65
Q

Checking urine output

A

bedpan, catheter collection bag, weight diapers or briefs (1gram of liquid in diaper ways 1mL; know the size of dry diaper)

66
Q

When is output a cause for concern?

A

less than 30mL for 2hrs

67
Q

Peds: up to age 2 should produce

A

2mL/kg/hour

68
Q

Peds: ages 2 and up should produce

A

1mL/kg/hour

69
Q

Characteristics of urine

A

colour, clarity, odour

70
Q

Formula for calculation

A

how much urine is produce, divided by kg of weight divide by hours measuring for

71
Q

Urine testing

A
  • Random specimen, clean voided, catheter specimen, timed urine collection in children
  • Urinalysis (dip sticks)- protein, gluoce, ketones, blood, WBC, bacteria, casts
  • Specific gravity: concentration of urine particles, osmolality even more accurate
  • Urine culture
72
Q

Examples of urine diagnosis

A
  • disturbed body image
  • pain (acute or chronic)
  • self care deficit, toileting
  • impaired skin integrity
  • impaired urinary elimination
  • urinary incontinence
  • urinary retention
73
Q

Promoting regular micturition

A
  • voiding every 3/4 hrs
  • avoid constipation and promote regular bowel habits
  • assist patient to a normal position for voiding
  • promote privacy and relaxation
  • maintain adequate fluid intake- concentrated urine irritates bladder
  • promote complete bladder emptying
  • prevent infection ( good perineal hygiene, cleansing meatus)
  • Catheters and incontinence products (requires prescribers order)
74
Q

Incontinence alone is not a reason to insert urinary catheter

Nursing 1J02 (6 decks)

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