urinary objectives Flashcards
What pathological conditions commonly influence urinary elimination?
Spinal cord injury, prostate issues (BPH), neurologic conditions (MS, Parkinson’s), and dementia.
What physical characteristics commonly affect urinary elimination?
Pregnancy and overweight/obesity.
What surgical procedures may affect urinary elimination?
Lower abdominal and pelvic surgeries, use of anesthetic agents.
How can medications influence urinary elimination?
Diuretics increase urine output; sedatives may decrease the urge to void and some medications can change urine color.
Which diagnostic examinations can influence urinary elimination?
Cystoscopy and urinary catheterization.
What is urinary retention?
The inability to completely or partially empty the bladder, leading to an accumulation of urine.
What is Post Void Residual (PVR)?
The amount of urine left in the bladder after an attempt to void, measured via bladder scan.
What are the common types of urinary tract infections (UTIs)?
Bacteriuria (bacteria in the urine), pyelonephritis (kidney infection), and cystitis (bladder infection).
What is an iatrogenic urinary infection?
An infection resulting from medical procedures, such as catheterization.
What is urinary incontinence?
Involuntary leakage of urine.
Describe urgency incontinence.
A sudden, intense urge to urinate with involuntary loss.
Describe stress incontinence.
Leakage due to increased abdominal pressure, such as coughing or sneezing.
Describe functional incontinence.
Urinary leakage caused by factors outside the urinary system, such as mobility issues or cognitive impairment.
What should be included in a nursing history for a client with urinary elimination problems?
Past urinary issues, current symptoms, medication use, dietary habits, and lifestyle factors.
What are key nursing interventions for the acute care of urinary problems?
Maintaining elimination habits, allowing time/privacy, using medications, and catheterization if necessary.
What is the purpose of parasympathetic stimulation of the detrusor muscle?
It aids in bladder emptying.
How do cholinergic drugs assist with urinary elimination?
They increase bladder contraction and improve emptying.
What medication is used to increase bladder contraction and capacity?
Oxybutynin.
What are some nursing measures to promote normal micturition and reduce incontinence?
Encouraging scheduled voiding, providing a comfortable environment, and using assistive devices.
What are nursing measures to reduce urinary tract infection?
Maintaining a closed system, preventing catheter-associated infections, and using sterile solutions.
How should a clean void/midstream specimen be collected?
Explain the procedure, provide a specimen hat or sterile cup, and use a cleansing technique.
Can collecting a clean void/midstream specimen be delegated?
Yes, clean void/midstream specimens can be delegated, but sterile specimens cannot.
How should a urine specimen be stored or transported to the lab?
Specimens should be sent within 2 hours, and those for C&S should be refrigerated or preserved within 30 minutes.
How should a 24-hour urine specimen be collected?
Collection begins after the first void (not included), with urine transferred into a specific lab container and stored as per policy.
What happens if a timed urine specimen collection is contaminated?
If contamination occurs (e.g., feces or TP), the collection must start over.
When can a urine specimen be collected from a catheter drainage bag?
Only immediately after catheter insertion.
How is a catheter specimen collected?
Using a needle-free system and following manufacturer/policy instructions for port sampling.
What are the components analyzed in a urinalysis?
Urine appearance, concentration, glucose, protein, ketones, nitrites, leukocytes, and pH.
What does specific gravity in a urinalysis indicate?
Urine concentration, with values ranging from 1.005 (less concentrated) to 1.030 (more concentrated).
What is the purpose of a urine culture and sensitivity (C&S) test?
To identify and treat urinary tract infections.
What are indications for non-invasive incontinence appliances?
KUB, CT, MRI, bladder scans, and uroflowmetry are non-invasive tools used to assess urinary issues.
What is a KUB scan?
A non-invasive imaging procedure of the kidneys, ureters, and bladder.
What is a bladder scan?
A non-invasive ultrasound to measure the volume of urine in the bladder.
What is the purpose of intravenous pyelogram (IVP)?
To visualize the urinary tract using contrast dye.
What invasive procedures assess urinary issues?
Cystoscopy and arteriography.
What is a condom catheter used for?
For patients with complete bladder emptying who have incontinence or nocturia.
How is a condom catheter held in place?
With adhesive and attached to a drainage bag (bedside or leg bag).
What are the indications for intermittent catheterization?
One-time bladder emptying, relieving bladder distention, obtaining a sterile specimen when clean-catch is unobtainable, assessing residual urine, managing patients with spinal injuries, neuromuscular degeneration, or incompetent bladders long-term.
What are the indications for short-term indwelling catheterization?
Obstruction to urine outflow, surgical repair of bladder or urethra, preventing urethral obstruction post-surgery, measuring urinary output in critical patients, and continuous or intermittent bladder irrigation.
What are the indications for long-term indwelling catheterization?
Severe urinary retention with recurrent UTIs, skin issues irritated by urine, terminal illness for comfort, and when linen changes are painful.
What are the steps for maintaining a catheter?
Check vital signs, ensure adequate urine output, maintain a closed system, prevent obstructions, keep the bag below bladder level, avoid bag contact with the ground, and perform perineal/catheter care every 8 hours.
How should catheter insertion and care be managed to prevent CAUTIs?
Follow aseptic techniques, secure the catheter, use the smallest size necessary, and maintain closed drainage; avoid urine flow obstructions, and empty the bag when it’s half-full.
What are the steps for removing an indwelling catheter?
Confirm need and order, ensure balloon is deflated, document voiding post-removal for 24-48 hours, and monitor for inadequate bladder emptying.
What are proper catheter care techniques?
Keep the meatus clean, perform perineal care, cleanse the first 4 inches of the catheter, and use sterile techniques after defecation if needed.
Can catheter care be delegated?
Yes, but assessment cannot be delegated. If the patient has had recent surgery or trauma, catheter care should not be delegated.
What nursing diagnoses are appropriate for clients with urinary elimination issues?
Risk for infection/UTI, urinary incontinence (stress or urge), impaired urinary elimination, urinary retention (acute or chronic), toileting self-care deficit, and impaired skin integrity.
What are nursing responsibilities before invasive diagnostic exams?
Obtain signed consent, assess allergies (especially to contrast agents), administer bowel-cleansing agents, and ensure the patient follows any pre-test diet or NPO instructions.
What are nursing responsibilities after diagnostic exams?
Monitor I&O, assess urine for color, clarity, and dysuria, and encourage fluid intake.
What are interventions to reduce the risk of UTIs?
Educate on hygiene (front-to-back), use cotton underwear, avoid perfumed products, void before/after sex, and consider acidifying urine with vitamin C or cranberry juice.
What interventions support normal micturition?
Regular voiding intervals, sufficient fluid intake, and complete bladder emptying.
What interventions address stress urinary incontinence?
Weight loss, smoking cessation, regular toileting, and pelvic floor muscle exercises (e.g., Kegels).
What interventions address urge urinary incontinence?
Limit fluids at bedtime, avoid bladder irritants, and perform pelvic floor muscle exercises.
What are causes and interventions for acute urinary retention?
Causes: surgery, anesthesia, medications. Interventions: catheterization, bladder scan.
What are causes and interventions for chronic urinary retention?
Causes: progressive blockage (prostate, stricture), medications, nerve issues. Interventions: long-term catheter, bladder training.
What is pelvic floor muscle training?
Identifying and strengthening pelvic floor muscles through exercises like Kegels, aiming for 3 sets of 10-15 reps daily.
What are restorative care techniques for men and women?
Women: manage urinary incontinence, pain during intercourse. Men: manage urinary incontinence, erectile dysfunction.
What are considerations for urinary elimination in older adults?
Frequent toileting, hydration, bladder emptying at regular times, and limiting fluids before bedtime.
What is a suprapubic catheter?
A surgically inserted catheter that directly drains the bladder; if dislodged, it must be reinserted immediately.
What are signs of infection to report in a patient with a suprapubic catheter?
Drainage, foul odor, redness, and irritation at the insertion site.
What is a urostomy and when is it used?
A surgical diversion for continuous urine drainage, often for patients who have had their bladder removed.
How is a urostomy pouch changed?
Clean skin, measure and cut pouch opening, press firmly over the stoma, and ensure no skin exposure to urine.
What are nephrostomy tubes, and when are they used?
Small tubes tunneled through the skin into the renal pelvis to drain when the ureter is obstructed.
What is the difference between intermittent and indwelling catheters?
Intermittent: single-lumen for temporary emptying; Indwelling: double/triple lumen for longer use, with options for irrigation.
What is a Coude catheter?
A single-lumen catheter with a stiffer, angled tip for easier insertion in patients with enlarged prostates.
What is an indwelling triple lumen catheter used for?
Continuous or intermittent bladder irrigation and to clear clots or sediment; helps maintain catheter patency.
Why is catheter irrigation performed, and can it be delegated?
It’s done post-surgery to prevent clots and maintain flow; it cannot be delegated, though a UAP can report changes to the RN.
