Urinary Exam 3 Flashcards
What are the main anatomical components involved in urinary elimination?
Kidneys, bladder, urethra, ureter
What factors can influence urinary elimination?
Pathological, developmental, nutrition and hydration, medications, surgery, sociocultural and personal
What are the key elements of a focused urinary assessment?
History, changes in urinary habits, intake and output, physical assessment
What common tests are used for urinary dysfunction?
Urinalysis, blood studies, visualization studies
List the steps in obtaining a urine specimen.
- Clean catch
- Sterile
- 24-hour urine
What nursing interventions can promote normal urinary elimination?
- Privacy
- Positioning
- Facilitate routines
- Fluid and nutrition
- Hygiene
What alterations in urinary elimination may require nursing interventions?
- Retention
- Incontinence
- UTIs
What is the primary function of the kidneys in relation to urinary elimination?
Filter metabolic wastes, toxins, drugs, hormones, salts, and water from the bloodstream
What is the estimated glomerular filtration rate (eGFR)?
The amount of filtrate formed by the kidneys per minute
What hormones are secreted by the adrenal glands that affect urinary elimination?
Aldosterone
What does aldosterone regulate?
Sodium and potassium in the blood
What is the normal urine production rate for kidneys?
50-60 mL’s of urine per hour (1000 – 2000 mL’s per day)
What is the normal specific gravity range for urine?
1.002 to 1.030
What developmental factors affect urinary elimination in infants and children?
Toilet training (should begin between 18 and 36 months), nocturnal enuresis
What are the common pathological conditions affecting urinary elimination?
- Infection
- Kidney stones or tumors
- Prostate gland issues
- Cardiovascular or metabolic disorders
- Nervous system disorders
What medications can affect urinary elimination?
- Thiazide diuretics
- Potassium-sparing diuretics
- Loop diuretics
- Analgesics
- Anticholinergics
- Antidepressants
- Diabetes medications
What is a urinary diversion?
A surgically created opening for elimination of urine
List the four major options for urinary diversion.
- Conventional urostomy (ileal conduit)
- Nephrostomy
- Continent urinary reservoir
- Neobladder
What is the purpose of a 24-hour urine collection?
To assess urinary volume, pH, calcium, citrate, magnesium, phosphate, sulfate, oxalate, and uric acid
What is the typical blood urea nitrogen (BUN) range?
8-20 mg/dL
What does a high level of nitrite in urine indicate?
E. Coli infection
What is the purpose of a cystoscopy?
Direct visualization of the urethra, bladder, and ureteral orifices
What should be monitored post-procedure after a cystoscopy?
Urinary output, I and O, report suprapubic or flank pain, chills, or difficulty urinating
True or False: Urinary retention can be caused by prostate gland enlargement in older adults.
True
Fill in the blank: The kidneys help regulate blood volume, blood pressure, electrolyte levels, and ______ balance.
acid-base
What is the color and characteristics of a healthy stoma?
Deep pink to brick red, shiny, and moist
What is the primary risk associated with urinary diversion?
Infection and permanent kidney damage
What does an Intravenous Pyelogram (IVP) use to visualize the urinary system?
Radiopaque contrast.
What does a Retrograde Pyelogram involve?
Injection of radiopaque contrast into ureteral catheter through a cystoscope.
What should be assessed before performing a pyelogram?
Shellfish or iodinated dye allergy.
What is a key intervention after a pyelogram procedure?
Encourage fluids post procedure.
What does urine indicate in a clinical assessment?
Hydration status.
What type of incontinence involves loss of small amounts of urine due to increased abdominal pressure?
Stress incontinence.
What defines urge incontinence?
Inability to stop urine flow long enough to reach the bathroom.
What are the three types of urinary incontinence?
- Stress
- Urge
- Functional
How do cultural factors influence urinary elimination?
They impact voiding practices, beliefs about incontinence, and treatment-seeking behaviors.
What should be assessed during a urinary elimination evaluation?
Color, clarity, odor, and amount of urine.
What is a nursing diagnosis related to urinary issues?
Impaired Urinary Elimination.
What is the goal regarding urine output during a nursing shift?
Urine output is adequate in amount and expected color.
What critical thinking question relates to blood pressure medications?
How would BP meds affect UOP?
What should be done to assess urinary output in ambulatory patients?
Inform them you are monitoring their I&O and explain how they can help.
What vital signs were noted for the 78-year-old patient?
BP 100/70, HR 60, RR 16, O2 Saturation 97%.
What is a common question to ask a patient experiencing urinary issues?
Ask about urinary habits and history.
What nursing intervention is crucial for patients receiving diuretics?
Perform daily weights.
Fill in the blank: Cultural norms dictate preferred _______ for urination.
postures
What is a potential outcome for patients after urinary intervention?
Patient will report zero pain level during and after urination.
What should be monitored if giving diuretics?
Labs for electrolyte replacement.
True or False: Functional incontinence occurs due to cognitive or mobility barriers.
True.
Urine
30 mL/HR
eGFR
the estimated glomerular filtration rate (eGFR) is the amount of filtrate formed by the kidneys per minute.
hyponatermia
Holding fluid = fluid overload = hyponatremia
Hypernatremia
Releasing too much fluid = fluid deficit = hypernatremia
Less than 30 mL’s per hour would require an intervention.
The normal specific gravity range for urine is 1.002 to 1.030.
What if a potty-trained child begins experiencing nocturnal enuresis?
bed wetting, sexual abuse, UTI, diabetes type 1—age 6 or higher
Developmental factors affecting elimination
Young Adult to Middle Age: pregnancy, cancers, trauma
Developmental factors affecting elimination Older Adults
hardening of the blood vessels, loss of muscle tone in the bladder, prostate gland enlargement in males, and loss of perineal muscle tone due to childbearing occurs. Urinary leakage, nocturnal frequency, and urinary and bladder
*infections occur more frequently in older adults.
UTI
What are the causes? short uretha, wipe front to back
What are the treatments? antibiotics
How would the practitioner decide on antibiotics? urinalysis and culture
What would you teach the client about prevention? hydrate, dont hold urine, change briefs often
What labs would be ordered? CBC-WBC
Thiazide diuretics (hydrochlorothiazide):
used for high BP, reduce the amount of sodium, potassium, and water in the body.
Potassium- sparing diuretics (spironolactone):
ed for high bp, fluid overload due to heart failure, DO NOT CAUSE POTASSIUM LOSS.
Loop Diuretics (Lasix):
used for high BP, CHF, LOSE POTASSIUM, sodium and fluid. Work in Loop of Henle to decrease reabsorption of fluids.
MONITOR- potassium
Analgesics, diuretics, anticholinergics (bladder spasm medication), antidepressants, estrogen, meds to treat Parkinson’s, diabetes medications, and botox can all affect urinary elimination.
What do you know about Metformin? diabetes, PCOS, acne
NO IV CONTRAST
Goal of these meds?
fluid output, labs check BUN and Creatine
Nephrotoxicity
Vancomycin is an antibiotic that requires monitoring of a peak and trough.
What is a peak and trough? monitor therapedic levels of meds (kidneys)
What about IV contrast? check kidney fuction first, give fluidds if needed.
What labs might the practitioner consider when ordering possible nephrotoxic medications or IV contrast? BUN and Creatine
What could the nurse do to help the kidneys eliminate contrast or medications? give fluids
what if urine is not typical?
Bladders issues, prostate issues, kidney issues, congenital issues, and heart issues along with other disease processes can affect urination patterns and function.
What have you seen at clinical impacting UOP?
What would cause urinary retention? What about excess elimination of urine? enlarged prostate, anxiety, medications
What s/s would the nurse see in a patient with urinary retention? Excess elimination?
Bladder check
Check every six hours
bladder scan over 400mL
in/out cath
6 hours
Bladder scan over 400mL
in/out cath
6 hours
bladder scan
give FOLEY
Diabetics have more what in there pee?
sugar
Normal amount of urine
150-250mL
Over 400 mL of urine, you do what?
bladder scan
in and out cath
A urinary diversion, or urostomy, is a surgically created opening for elimination of urine, required when the bladder must be removed or bypassed. They can be temporary or permanent.
Conventional urostomy (ileal conduit): This is the most common type of urinary diversion
Nephrostomy: Tubes placed directly into renal pelvis and drain from back typically.
Continent urinary reservoir (ileal reservoir, Indiana pouch, Kock pouch
Neobladder: A neobladder mimics the function of a urinary bladder.
A pale, dusky, or black stoma often indicates inadequate blood supply. Immediately report such findings to the healthcare provider.
Skin care is critical
High levels of nitrite indicate E Coli.
24 hour urine
You will need to use a large container and preserve all the urine. Keep on ice. Start with second urine of the day. End with the last urine of the 24-hour period.
Urinalysis vs Urine Culture vs 24-hour Urine Collection
urinalysis- uti, yes
urine culture- type
24 hour- calcium, mag, ect
What type of patients may need a 24-hour urine?
TPN, nutrition therapy
Cystoscopy
direct visualization of the urethra, bladder, and ureteral orifices by insertion of a scope.
Interventions:
pre-procedure: Consent and restrict food or fluids after MN, if using sedation.
post-procedure: monitor UOP, I and O, report suprapubic or flank pain, chills, or difficulty urinating.
Intravenous Pyelogram and Retrograde Pyelogram: IVP uses radiopaque contrast to visualize kidneys, ureters, bladder, and renal pelvis. It evaluates kidney function by monitoring flow of contrast over time.
Retrograde Pyelogram: uses radiopaque contrast injected into ureteral catheter inserted through a cystoscope.
Interventions: Assess for shellfish or iodinated dye allergy. Ensure consent.
Monitor baseline BUN and Creatinine.
Encourage fluids post procedure. Observe for allergic reaction to contrast at start of procedure.
socialcultural influence on elimination
Cultural beliefs and practices can also affect how individuals manage their urinary health, including dietary choices, fluid intake, and bladder training techniques.
How would BP meds affect UOP?
When would the nurse need to monitor output?
What would determine how often the nurse would monitor output?
lower
Every 6 hours
Every hour if patient more critically ill
ecognize cues: The nurse receives the following report:
A 78 yo patient, assigned male at birth and identifying as male, was admitted to the hospital with complaints of frequent voiding with low urine output and dribbling. The patient’s vital signs are: BP 100/70, HR 60, RR 16, and O2 Saturation 97%. They are alert and oriented. The patient denies pain. The patient is warm, dry to touch, and has brisk capillary refill. Lungs are clear. Heart sounds are normal. The patient has a distended, firm abdomen. Positive pedal pulses and no edema is noted. Their spouse is at the bedside.
What other questions will the nurse ask about the patient?
Last prostate exam?
any pain?
last BM?
What meds?
Analyze Cues: What information stood out? What are the cues?
BP, abdomen
Hypothesis: What do we think is going on with the patient?
UTI/ enlarged prostate
Planning: What do we do now? Culture
Evaluate: Labs and urine output
Culture positioning EXAM
Positioning - Cultural norms dictate preferred postures for urination.For example, Western cultures often involve sitting on a toilet, while Asian and African cultures commonly squat on a squat toilet.
Urine amount normal
up to 400ml
If shellfish allergy
post procedure- give fluids
dehydrated—> highest #
not sure but mention on exam notes
Retrograde pleogram
nurse needs CONSENT
labs before contrast
BUN/Creatine
colonoscopy
skin breakdown
