Urinary elmination Flashcards
Abnormal find
Hematuria
Blood in the urine
- *Causes**
- Cancer
- Kidney disease
- UTI
- Kidney stone
A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is:
A. Cystitis.
B. Hematuria.
C. Pyelonephritis.
D. Dysuria.
A
A male patient returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the patient to void?
A. Suggest he stand at the bedside
B. Stay with the patient
C. Give him the urinal to use in bed
D. Tell him that, if he doesn’t urinate, he will be catheterized
A
A mid-stream urine sample means?
- DO NOT collect the first or last part of urine
- Risk of the sample being contaminated with bacteria
A patient is scheduled to have an intravenous pyelogram (IVP) the next morning. Which nursing measures should be implemented before the test? (Select all that apply.)
- Ask the patient about any allergies and reactions.
- Instruct the patient that a full bladder is required for the test.
- Instruct the patient to save all urine in a special container.
- Ensure that informed consent has been obtained.
- Instruct the patient that facial flushing can occur when the contrast media is given.
1,4,5
A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is at risk for: (Select all that apply.)
A. Infection.
B. Retention.
C. Stagnant urine.
D. Reflux of urine.
A and D
A postoperative patient with a three-way indwelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurse’s initial intervention(s)? (Select all that apply.)
- Increase the rate of the CBI.
- Assess the patency of the drainage system.
- Measure urine output.
- Assess vital signs.
- Administer ordered pain medication.
2,3
Abnormal finds
- *a) Hesitancy**
- *b) Incontinence**
- *c) Nocturia**
a) Delay or difficulty in urination
Partial urethral obstruction
b) Inability control
Neurogenic bladder, bladder infection
c) Frequent urination at night
Kidney disease
Heart failure
Abnormal find
Oliguria
Decrease of urine in a time period
(100-400ml/24h)
Severe dehydration
Shocks
End-stage
Abnormal finds
- *a) Pneumaturia**
- *b) Polyuria**
a) Passage of urine containing gas
Gas forming UTI
b) Large volume of urine at the time period
Diabetes, chronic kidney disorder
Abnormal find
Stress incontinence
Involuntary urination with high pressure
-coughing, sneezing
lack of estrogen
Urinary retention
Abnormal find
Retention
Inability to urinate even though bladder contains excess
amount of urine
After pelvic surgery
Childbirth
Catheter removal
Ureteral stricture
An ambulatory elderly woman with dementia is incontinent of urine. She has poor short-term memory and has not been seen toileting independently.
What is the best nursing intervention for the pt?
- Recommend that she be evaluated for an overactive bladder(OAM) medication.
- Establish to toileting schedule
- Recommend that she be evaluated for ab indwelling catheter.
- Start a bladder-retraining program
2
An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to:
A. Help him stand to void.
B. Place a condom catheter.
C. Have him practice Credé’s method.
D. Initiate Kegel exercises.
D
Clean-voided or midstream
Urine may be collected by pt with proper technique
- Check UTI
Normal Physical assessment
Costovertebral angle tenderness
Normal-no tenderness
Abnormal finds
- *a) Anuria**
- *b) Burring on urination**
- *c) Dysuria**
a)Acute kidney injury
No urination less than <100ml/24h
End-stage renal disease
b) Stinging pain
UTI
c) Painful
UTI
Elimination changes that result from inability of the bladder to empty properly may cause which of the following? (Select all that apply.)
A. Incontinence
B. Frequency
C. Urgency
D. Urinary retention
E. Urinary tract infection
ALL OF THE ABOVE
Abnormal finds
- *a) Enuresis**
- *b) Frequency**
a) Involuntary nocturnal urination
Lower urinary tract disorder
b) Incidence of urination increase
inflamed bladder
rotation is overflow
- *Causes**
- Lower urinary tract disorder
- Acute bladder inflammatory
Functional incontinence?
An individual with normal bladder and urethral function, but difficulty getting to the toilet before urination occurs
- *immobility**
- *delirium**
- *dementia**
How much should a patient void per hour?
Median volume of 220 ml 6 times daily
Produced 83 ml urine/h during the day
Produce 48 ml/h during the night
Total 1-2L/day
Intervention
Health promotion
- *Maintain hydration**
- drink 6-8 glasses
- Limit caffeine, soda
- *Prevent UTI**
- Wipe to the top to bottom
- *Keep good voiding habits/**排尿
- *Keep the bowels regular**
- *Stop smoking**
Normal Physical assessment
Kidney and bladder
Normal- non palpable kidney and bladder
nursing assessment questions
Effect on life
How often are you awakened to an urgent void?
How many times is that?
How have these symptoms affect your life?
nursing assessment questions
Patten and history
- *Daily pattern**
- Hove you noticed any patterns in your urinary change?
- How did you first notice?
- How long has this problem lasted?
- Any medications?
- What usually eat? drink?
Nursing assessment
Assess voiding pattern (frequency and amount) Compare urine output with fluid intake.
Nursing role
Provide support for bladder emptying
Minimize risk for infection
Overactive bladder incontinence?
“urgency incontinence,”
when have a strong urge to pee but can’t get to a toilet in time
caused by problems related to the nerves and muscles in the bladder
Overflow incontinence?
The bladder doesn’t empty completely
As a result, the bladder soon becomes full again
Can lead to leaking between bathroom breaks
Overflow–あふれ出る
Paruresis? (pehr·yr·ee·suhs)
“Shy bladder”
Social anxiety bladder
Inability to urinate in public
More common in men than women
Random/routine urinalysis
- Electrolyte balance
- UTI
DO NOT collect from the drainage bag, from the catheter.
Sometimes the nurse do by strips test.
Reflex incontinence?
Involuntary loss of a moderate amount of urine
Due to spinal cord dysfunction
(stroke, a spinal cord lesion)
Perform Crede Valsalva(bladder compression)
Since the removal of the patient’s Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first?
A. Check for bladder distention
B. Encourage fluid intake
C. Obtain an order to recatheterize the patient
D. Document the amount of each voiding for 24 hours
A
urinary retention in the bladder due to its incapacity to void normally
It may occur because there is an obstruction or a loss of tone in the bladder muscles
Stress incontinence?
When an activity or movement causes to leak urine
-Coughing, laughing, running, dancing, bending, lifting, or even walking
Weak pelvic floor muscles typically contribute to stress incontinence
Perform Kegel exercises
自制不可能なこと/《医》失禁
The factor that affects normal urinary function
Psychological
Anxiety can cause urgency, frequency, incomplete emptying of the bladder
The factor that affects normal urinary function
Diet and fluid intake
High sodium diet can decrease urine output
Alcohol and caffeine increase urine output
The factor that affects normal urinary function
Medication
Diuretics increase urine output
Some medication change the color of urine(educate the pt)
The factor that affects normal urinary function
Muscle tone
Weak pelvic and abdominal muscles
Prolonged use catheter affect smooth muscle tone
The factor that affects normal urinary function
Pain and mobility issue
Painful urination tend to avoid voiding
The pain also affect mobility(cannot go to the toilet)
Immobility can increase risk for UTI and kidney stone
The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to:
A. Use the double-voiding technique.
B. Perform Kegel exercises.
C. Use Credé’s method.
D. Keep a voiding diary.
C
The nurse directs the NAP to remove a Foley catheter at 1300. The nurse would check if the patient has voided by:
A. 1400.
B. 1600
C. 1700.
D. 2300.
C
The nurse notes that the patient’s Foley catheter bag has been empty for 4 hours. The priority action would be to:
A. Irrigate the Foley.
B. Check for kinks in the tubing.
C. Notify the health care provider.
D. Assess the patient’s intake.
B
The patient is incontinent, and a condom catheter is placed. The nurse should take which action?
A. Secure the condom with adhesive tape
B. Change the condom every 48 hours
C. Assess the patient for skin irritation
D. Use sterile technique for placement
C
The pt states, “My pee looked dark yellow this morning” Based on this statement, the nurse concludes that
a) Urinalysis may indicate urinary tract infection
b) Urinalysis may indicate fluid volume deficit
c) Urinalysis may indicate ketone bodies in urine
d) Urinalysis may indicate elevated specific gravity
b
To minimize the patient experiencing nocturia, the nurse would teach him or her to:
A. Perform perineal hygiene after urinating.
B. Set up a toileting schedule.
C. Double void.
D. Limit fluids before bedtime.
D
Urinalysis Crystals
Crystal is not normally present
Increased risk for renal calculi(stone)
Pt with high uric acid level(gout) may develop uric acid crystal
Urinalysis Glucose
Glucose is not normally present
Pt with poorly controlled diabetes
Urinalysis gravity
Urinary gravity 1.005 to 1.030
Test for the concentration of pt urine
High-concentrated
Low-diluted
Urinalysis ketones
ketone is not normally present
Poor control diabetes experience breakdown of fatty acid.
Urinalysis pH
pH 4.6 to 8.0
pH level indicates acid-base balance.
Acid helps protect bacteria growth
Urinalysis Protein
Protein up to 8mg/100ml
Protein is normal not present in urine
It may cause kidney function, membrane impaired
Urinary elimination 排尿
The removal of waste products from the body through the urinary system
What cause concentrated urine?
Dehydration
-diarrhea, excessive sweating, high sodium diet
-UTI
Hold in until the limited(because of pain)
what does mean by concentrated urine?
- There are more solutes and less water in the sample
- Darker yellow
- Smell strongly of ammonia
What is a critical step when inserting an indwelling catheter into a male patient?
- Slowly inflate the catheter balloon with sterile saline.
- Secure the catheter drainage tubing to the bedsheets.
- Advance the catheter to the bifurcation of the drainage and balloon ports.
- Advance the catheter until urine flows, then insert ¼ inch more.
3
What is a ketone?
Ketones are chemicals made in your liver.
You produce them when you don’t have enough of the hormone insulin in your body to turn sugar (or “glucose”) into energy.
What should the nurse teach a young woman with a history of UTIs about UTI prevention?
1, Maintain regular bowel elimination
2, Limit water intake to 1 to 2 glasses
3, Wear cotton underwear
- Cleans the perineum from front to back
- Practice pelvic muscle exercise daily
1,3,4
Which instruction should the nurse give the assistive personnel (AP) concerning a patient who has had an indwelling urinary catheter removed that day?
- Limit oral fluid intake to avoid possible urinary incontinence.
- Expect patient complaints of suprapubic fullness and discomfort.
- Report the time and amount of first voiding.
- Instruct patient to stay in bed and use a urinal or bedpan.
3
Which nursing intervention decreases the risk for catheter-associated UTI?
- Cleansing the urinary meatus 304 times daily with an antiseptic solution
- Hanging the urinary drainage bag below the level of the bladder
- Empty the bag daily
- Irrigating the urinary catheter with sterile water
2
Which nursing interventions should a nurse implement when removing an indwelling urinary catheter on an adult pt? Select all that apply
- Attach a 3ml syringe t to the inflation port.
- Allow the balloon to drain into the syringe be gravity
- Initiate a voiding record/bladder diary
- Pull the catheter quickly
- Clamp the catheter before removal
2,3
Urinary retention
a) causes
b) Assessment findings
a) Urethral obstruction
Surgical trauma
Motor and sensory innervation
medication side effects
Anxiety
b) find out pressure, discomfort, tenderness
Retention overflow 25-60 ml
Retention–保持
