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Nursing Fundamentals II > Urinary System > Flashcards

Urinary System Flashcards

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1
Q

urinary system consists of….

A

two kidneys, two ureters, the urinary bladder, and the urethra

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2
Q

length of male urethra

A

3-5 inches

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3
Q

length of female urethra

A

2-3 inches

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4
Q

why is it hard to put in a cath for a male?

A

prostrate gland

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5
Q

coude

A

specially designed catheter to help get past prostrate; prostrate disease cancer

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6
Q

metal guide

A

need dr or someone from anesthia; not used too often; may bleed in urine for one to two days after; helps to get cath around prostrate gland; more invasive; used in males to get past prostrate gland

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7
Q

what is the role of kidneys?

A

produce urine

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8
Q

urine consists of…

A

95% water and 5% nitrogenous waste products of protein

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9
Q

what makes up nitrogenous waste of urine?

A

urea, uric acid, and creatinine

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10
Q

secondary functions of kidney

A

Erythropoietin (makes red blood cell) production, renin production, and the activation of Vitamin D3

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11
Q

Erythropoietin is produced and released in response to…

A

decreased oxygen in kidney blood supply which triggers RBC production in bone marrow

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12
Q

Unhealthy kidneys will have reduced erythropoietin production which in turn can make you…

A

anemic

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13
Q

role of vitamin D

A

promotes absorption of Ca in GI tract and regulate Ca balance

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14
Q

role of renin

A
  • assists in blood pressure control
  • ## anytime the kidneys sense a drop in fluid volume and blood pressure
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15
Q

excess electrolytes eliminated in the urine which include

A

Na, Ca, K, and phosphates.

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16
Q

why do you look at med doses when there is kidney dysfunction?

A

metabolism of medicine could be altered; may need to change dose

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17
Q

other functions of kidneys

A
  • Assist the body to regulate blood volume by excreting or conserving water; ADH in endocrine system.
  • Regulation of electrolyte balance.
  • Regulation of the acid-base balance.
  • Regulates the same components in tissue fluid.
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18
Q

where is urine produced?

A

kidney

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19
Q

how is the urine moved from kidney to bladder?

A

moved by virtue of peristalsis thru the ureters into the urinary bladder

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20
Q

how full is the bladder when it sends a signal to the spinal cord and brain to empty the bladder?

A
  • 250-300cc’s is a general amount

- Some may have less and some may have more

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21
Q

micturition

A

expel urine from bladder

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22
Q

where are kidneys located?

A

retroperitoneal space

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23
Q

what hormone is responsible for producing RBCs?

A

erythropoietin

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24
Q

how does kidney assist in acid-base balance of the body?

A

secretes renin

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25
Q

what do you have to worry about when there is surgery on kidneys?

A
  • always a high risk to bleed

- highly vascular in that area

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26
Q

3 parts of kidney

A

renal cortex, renal medulla and renal pelvis

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27
Q

renal cortex

A

outer most part of kidney

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28
Q

renal medula

A
  • middle portion

- contains the collecting tubules and the renal pyramids

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29
Q

renal corpuscle

A
  • glomerulus

- bowman’s capsule

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30
Q

glomerulus

A

a ball-like network of capillaries formed from an arteriole within the Bowman’s capsule

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31
Q

Bowman’s capsule

A

surrounds the glomerulus

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32
Q

where does Lasix start to work?

A

loop of henle

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33
Q

where do diuretics work?

A

ascending/descending loop tubule

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34
Q

Bowman’s capsule is attached to…

A

a long looped and coiled structure called the renal tubule

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35
Q

where does the blood go from the capillary network that is formed around the tubules?

A

collected by the venules

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36
Q

most of the contents except for large molecules and large blood cells are…

A

forced out of the blood from the capillaries of the glomerulus and into the Bowmans capsule

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37
Q

glomerular filtrate

A

matter that is filtered out of blood

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38
Q

what type of pressure does the capillary system have?

A

high pressure

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39
Q

what is in the matter that is filtered out of the blood?

A

water, electrolytes, various toxic substances, and other waste products

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40
Q

how much blood is processed by the kidneys?

A

400 quarts each day

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41
Q

GFR

A

changes with age; how well kidneys take on blood and how well it gets rid of unwanted parts and excrete

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42
Q

GFR produces…

A

about 2 quarts of waste products and extra water as urine

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43
Q

tubular reabsorption

A

During the process of filtration some of the necessary elements are reabsorbed and returned to circulation

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44
Q

what happens to the filtrate that is not reabsorbed?

A

is now urine and continues to travel thru the tubules

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45
Q

where does the urine go once it leaves the tubules?

A

to the collecting ducts and into the pelvis of the kidney and then to the rest of the urinary system

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46
Q

normal output of urine

A

1000-2000ml in 24 hours

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47
Q

average output of urine

A

1500 mL in 24 hours

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48
Q

minimum output of urine

A

30 mL per hour; need this much to have healthy kidney function

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49
Q

should urine be clear?

A

yes

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50
Q

what is the color range of urine?

A

pale yellow to amber or straw colored

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51
Q

what color of urine do you want?

A

pale yellow

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52
Q

what urine color is more dilute?

A

lighter color

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53
Q

what urine color is more concentrated?

A

darker color

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54
Q

urine screen

A

dip sticks; color shows what is wrong with them

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55
Q

who might use a urine screen

A

Camp counselor and emergency room

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56
Q

can the urine screen test check for ketones?

A

yes

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57
Q

can the urine screen test check for glucose?

A

yes

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58
Q

what does cloudy urine indicate?

A

presence of pus, red blood cells, or bacteria

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59
Q

dark red in urine indicates..

A

bleeding in the area of the kidney and high in ureter

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60
Q

bright red in urine indicates…

A

bleeding in the lower urinary tract/bladder and urethra

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61
Q

Interstitial cystitis

A

infection in walls of bladder; strands appear in urine

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62
Q

dark yellow urine…

A

may indicate the presence of bilirubin

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63
Q

brown looking urine…

A

Rhubarb and liver/gallbladder disease

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64
Q

beets make urine look…

A

bloody

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65
Q

pyridium makes urine look….

A

blaze orange; used to treat pain, dysuria and spasms

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66
Q

mandelamine makes urine look…

A

dark brown; made from sterile horse urine

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67
Q

foul smelling urine indicates…

A

infection

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68
Q

sweet smelling urine indicates…

A

glucose

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69
Q

should freshly collected urine be sweet or foul smelling?

A

no

70
Q

Normal pH of urine

A

4.6 to 8.0 with an average of 6

71
Q

The pH of urine indicates…

A
  • the acid-base balance

- under 6 are more acidic; higher more alkaline

72
Q

what does an alkaline measure in urine indicate?

A
  • possible infection or bacteria

- high intake of citrus fruits or vegetables

73
Q

what does acidic urine indicate?

A
  • starvation
  • dehydration
  • diet high in meat/cranberries
  • Atkins diet
74
Q

should protein be positive or negative?

A

negative

75
Q

why test urine for protein?

A

indicates renal function

76
Q

how often are pregnant women checked for protein?

A

every visit

77
Q

Normal specific gravity

A
  • 1.010 to 1.025
  • determine the ability of the kidney to concentrate and excrete urine
  • hydration level of the patient
78
Q

Normal specific gravity test allows you to…

A

correct fluid volume, get to better balance and help to decide on correct flow of iv

79
Q

Nitrites

A
  • should be negative

- if present would indicate possible infection

80
Q

Ketones

A

should be negative

81
Q

what are ketones?

A

end products of fatty acid breakdown

82
Q

situation you might find ketones

A
  • diabetic or special diets

- extreme athletes (should go away within a week)

83
Q

crystals present in urine indicate…

A
  • renal stone formation

- additional test to look for kidney stones

84
Q

what are casts in urine?

A
  • clumps of materials or cells that are abnormal in urine

- structures that form around other particles

85
Q

each cast indicates…

A

a different problem

86
Q

when are casts sometimes found in urine?

A

after exercise

87
Q

Hyaline casts indicate…

A
  • protein problems

- Atkin’s diet

88
Q

Granular casts indicate…

A
  • some type of nephrotic syndrome
  • problem with kidneys
  • 85% loss of nephrons
89
Q

Epithelial casts indicate…

A

possible glomerulonephritis

90
Q

Waxy casts indicate…

A

chronic renal disease or renal failure

91
Q

WBC

A
  • more than 5 indicate infection

- Culture and sensitivity will be done

92
Q

RBC

A
  • more than two could indicate kidney disease, trauma, or tumor
  • Blood in the urine can also indicate infection
93
Q

BUN

A
  • 8-20 mg/dl
  • Reflective of age - higher with age
  • Less hydrated - higher it will be
  • not foolproof to diagnose kidney disease
94
Q

Creatinine

A
  • 0.5-1.1mg/dl
  • True kidney disease for anything above 1.1
  • Reliable test for diagnosis of kidney disease
95
Q

Cystoscopy

A
  • Scope to see what is going on in bladder (infection, tumor, polyps)
  • Can do biopsy as they are looking
  • Direct visualization of bladder
96
Q

complications of cystoscopy

A
  • change in vital signs
  • stronger bleeding
  • some blood in urine after procedure
97
Q

Cystometry

A
  • check to see when they feel the urge to go
  • irrigate bladder
  • should get urge at 250-300 mL
  • don’t put in more than 1000 mL
98
Q

who would you perform a cystometry on?

A
  • people with some degree of incontinence
  • neuromuscular disease (ALS, multiple sclerosis)
  • don’t feel the urge to urinate
99
Q

how do you treat someone who doesn’t have the urge to urinate?

A
  • kegel exercise
  • meds
  • suprapubic cath
100
Q

IVP

A
  • check for allergy to dye
  • x-ray to see the flow of the dye
  • look for abnormalities
  • drink water after test
101
Q

Ultrasound

A
  • look at kidney and pelvis
102
Q

kidney biopsy

A
  • highly vascular

- look for signs of bleeding

103
Q

What is the urination pattern?

A
  • Number of times, ask targeted questions

- Would you say you urinate 10 times per day?

104
Q

Is there any sense of urinary retention after urination?

A
  • Men over 50 yrs start to feel like they always have urine left
  • Postpartum women or surgical intervention
105
Q

how much urine can you take at a time?

A
  • max is 1000 mL

- take too much could affect blood pressure

106
Q

Does the client have complaints of excessively dry skin or pruritus?

A
  • Not able to clear waste products

- Urea starts to come to the skin

107
Q

Uremic frost

A

end stage renal disease; waste product comes to surface of skin; bile and ureic salts

108
Q

should you be able to palpate the bladder?

A
  • not usually

- usually about 400-500 mL before you can feel it

109
Q

how much urine does a newborn produce?

A

15 to 60 ml of urine per kilogram per day

110
Q

how do you measure urine output for newborn?

A

Weigh diaper before you put it on and when you take it off

111
Q

how do newborns concentrate urine?

A

poorly

112
Q

how many times does a newborn void in the first 24 hours?

A

25 times

113
Q

how many times do infants void in 24 hours?

A

8 - 10 times

114
Q

what do you ask parent when infant is experiencing nausea or vomiting and not feeling well?

A

how many wet diapers

115
Q

when is toilet training done?

A

18-24 months

116
Q

Enuresis

A

daytime wet

117
Q

Nocturnal enuresis

A

nighttime wet

118
Q

what age should you be concerned if child is not toilet trained?

A

6 yrs

119
Q

reasons for difficulty in toilet training

A
  • cognitive delays

- bad tonsils

120
Q

geriatric considerations

A
  • Decline in filtration rate

- Decreased capacity

121
Q

Anuria

A

without urine, less than 100 mL in 24 hours

122
Q

Oliguria

A

less than 300 - 400 mL in 24 hours

123
Q

Polyuria

A

excessive urination

124
Q

Dysuria

A

painful urination

125
Q

Urgency

A

the feel to go

126
Q

Frequency

A

how often

127
Q

Nephrotoxic

A

tylenol beyond healing doses

128
Q

Pyridium

A

dysuria, spasm, turn urine bright orange

129
Q

Diuretics

A

Thiazides, Potassium-Sparing

130
Q

Meds that can cause urinary retention:

A

antihistamines, tricyclic antidepressants, MAO inhibitors, antispasmodics, Parkinson drugs, and Beta blockers

131
Q

Med to treat urinary retention

A

Urecholine

132
Q

Meds that are nephrotoxic

A

Gentamycin/Garamycin (ototoxic), Amphotericin B, aspirin, and Motrin, Tylenol

133
Q

Infection/inflammation

A
  • Symptoms can be kind of the same
  • Dysuria, burning, low grade temp
  • No WBC or bacteria in inflammation
  • Treat both with antibiotics
134
Q

Renal calculi

A
  • Stones
  • Miserable
  • Need a lot of fluid
  • Pain better when stones are passed
135
Q

BPH

A
  • Benign prostatic hyperplasia
  • Men
  • May need to remove part of prostrate
  • Prostrate - look for growth and nodules
  • PSA - if elevated check to cancer, 0-4 i
  • Cath males over 50, use coude cath
136
Q

cardiac disease

A

decreased blood flow to kidneys

137
Q

kidney output ok

A

profuse adequate 30 mL/hr

138
Q

Urinary Incontinence

A

he uncontrolled loss of urine from the bladder. Incontinence has many causes some of which might be a result of a urinary tract problem, a neurological problem, and some medications as well as others

139
Q

Stress incontinence

A

the most common type of incontinence and women are more likely a ffected. There is leakage of urine when the person does anything that strains the abdomen such as coughing, sneezing, laughing, jogging, dancing, and lifting.

140
Q

treatment of stress incontinence

A

bladder retraining, medications such as estrogens, surgery, and teaching of Kegel exercises

141
Q

Atrophic vaginitis

A

painful intercourse, slight bleeding after intercourse, irritation,

142
Q

treat atrophic vaginitis

A
  • estrogen, vaginal is less risky than oral

- don’t use estrogen if risk of breast cancer

143
Q

Urge incontinence

A

Occurs when a person is unable to suppress the sudden urge to urinate. Sometimes urine may leak without warning. Often an irritated bladder is the cause stemming from infection or concentrated urine.

144
Q

treatment of urge incontinence

A

Suprapubic cath as last resort

145
Q

Total incontinence

A

no urine can be retained in the bladder. The cause of this is usually neurological and can be treated with a Foley catheter. Treatment might also include urinary diversion or suprapubic catheter.

146
Q

who can have total incontinence?

A
  • people with delayed cognitive ability

- Neurologic - paraplegic, quadriplegic

147
Q

treatment of total incontinence

A
  • Use incontinent products

- Urinary diversion products

148
Q

Nocturnal enuresis

A
  • during sleeping
  • not unusual up to the age of 6-8.
  • typically the client will be checked to rule out infection by ordering a urinalysis and urine culture.
149
Q

treatment for nocturnal enuresis if no infection

A

limiting fluids, awakening the child, setting alarms, and etc

150
Q

possible causes of nocturnal enuresis include

A

pinworms, constipation, diabetes, sickle cell anemia, sexual abuse, stress, and sleep disorders

151
Q

meds to treat nocturnal enuresis

A
  • Ditropan (adults)
  • DDAVP (diabetes insipidus, urinate less often, nasal spray)
  • Tofranil (low dose antidepressant)
152
Q

Urinary Retention

A

Urinary retention is when a person has the urge to void but cannot empty the bladder. When urinary retention is present it creates urinary stasis and increases the risk of infection.

153
Q

causes of urinary retention

A

Stress, obstruction by calculi, tumor, infection, interference of the urinary sphincter during a surgical procedure, side effect of medications, and perineal trauma as in childbirth.

154
Q

symptoms of urinary retention

A

Discomfort, anxiety, frequency of urination which can result in small frequent amounts, incontinence, may occur, can palpate the distended bladder over the pelvis.

155
Q

treatment of urinary retention

A

Urinary analgesics such as Pyridium, antispasmodics, catheter, or surgery if an obstruction is present. Urecholine is also used to treat urinary retention. Doctor may order to measure residual volumes which should be less than 50 ml.

156
Q

Voided specimen

A

implies that a hat in toilet; not good (better than nothing)

157
Q

Midstream clean catch

A
  • Wash genital area; start urine stream; put cup midway through; take cup out and finish
  • Best specimen short of cath
158
Q

Mini-cath

A
  • females only
  • sterile procedure
  • one way to get sterile specimen
159
Q

condom cath

A
  • Urine specimen for a male who is incontinent
  • Works for younger males but not so much for older men
  • Connect to leg or drainage bag
  • Good for quadriplegic or paraplegic who don’t like to be wet
160
Q

Straight cath

A

One lumen - straight; go in, get urine and come out; not meant to stay in; used mostly with men

161
Q

U-bag (peds)

A
  • attach to genitalia (labia or penis)

- put diaper back on and wait for them to go

162
Q

Sterile collection - foley

A
  • Just put Foley on - very first urine in bag can be taken from bag
  • Foley has been on for awhile - clamp on cath, come back in 15 minutes, bring syringe (needless), let clamp go and aspirate into syringe
163
Q

24 hour urine collection

A
  • Know type and let lab know so that you get the appropriate container (some may have preservatives)
  • Void at a specific time; start collecting after that for the next 24 hours
  • Refrigerate or bucket of ice to keep it cool
164
Q

Foley cath - two lumen

A
  • meant to stay in
  • one lumen for urine
  • one lumen for water to inflate balloon
  • 5, 10, & 30 cc balloon
165
Q

Foley cath - three lumen

A
  • meant to stay in
  • one lumen for urine
  • one lumen for water to inflate balloon
  • one lumen to irrigate
  • 5, 10, & 30 cc balloon
166
Q

what do you do when you irrigate a bladder?

A

keep track of how much solution you use so you can subtract from output

167
Q

Water intoxication

A

irrigation drifts into vascular system; had alert patient and a while later they have a change of personality; behavior changes, etc.; Call dr because now you may have an electrolyte imbalance

168
Q

Urometer

A

accurately measures amount of urine, attached to collection bag of Foley cath

169
Q

Strainer

A

strain all urine; look for kidney stones; should have dr orders but can do because of std practice

170
Q

Urostomy bag

A

remove bladder; ureters are places in small intestine and surgical opening in pelvis; plate area attached into bag (kock pouch)

171
Q

caths are measured in ….

A
  • French

- 12-16 french is average size

Nursing Fundamentals II (13 decks)

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