Urine Elimination Flashcards
1
Q
Males Genitourinary System GU
A
Meatus
Urethra
Bladder
Prostate gland
2
Q
Females Genitourinary System GU
A
See ppu
3
Q
Anatomy and physiology of the genitourinary system GU
A
Kidneys 2
Ureters 2
Bladder
Urethra
4
Q
Urinary elimination
A
Is a precise system of filtration, reabsorption, and excretion
5
Q
Urinary elimination process helps
A
Maintain fluid and electrolyte balance, while filtering and excreting water soluble waste
6
Q
Primary organ for urinary elimination
A
Kidneys
Nephrons
7
Q
Characteristics of urine
A
Color
Odor
Turbidity
pH
Specific gravity
Constituents
8
Q
Color
A
Pale, yellow straw colored, Amber, other colors may depend upon medication, fluids, and time of day
9
Q
Odor
A
Non-odorous, mellow, malodorous, the more it stands, the more ammonia, odor, musty smell
10
Q
PH of urine
A
4.6-8.0
It becomes more alkaline as it stands
11
Q
Specific gravity
A
Concentration of dissolved solids in urine
-more concentrated greater specific gravity
-less concentrated, less specific gravity
12
Q
Constituents
A
Urea, uric acid, creatinine, ammonia, should not have blood, puss, bacteria, or ketones
13
Q
What does dark urine indicate?
A
Dehydration
14
Q
Expected daily urine production
A
30 mLs and hour
Approx. 1000-2000mLs in 24 hours
15
Q
Output less than 30 mLs per hour indicates
A
Renal insufficiency
16
Q
Measuring urine output for voiding pts
A
Hats, urinals, graduates
read at eye level, flat surface, document every time
17
Q
Measuring urine output for indwelling catheter
A
Empty per policy
2/3 full
Gloves, floor barrier, clean with alcohol wipe
18
Q
Factors that influence urinary elimination
A
Age – young and old
Pregnancy
Diet - caffeine, alcohol, (increase) salt – decrease
Immobility – able to reach the bathroom
Psychosocial factors – time, public restrooms, in front of others
Pain- hurts to pee, hurts to move to get to the bathroom
Surgical procedure – anesthesia
Medication‘s – diuretics, anti-histamine slows, chemotherapy meds increase
19
Q
How does Phenazopyridine affect urine color?
A
Orange or red
20
Q
How does amitriptyline affect urine color?
A
Green or blue
21
Q
How does levodopa affect urine color?
A
Dark
22
Q
How does riboflavin affect urine color?
A
Bright yellow
23
Q
What do you call drugs that may damage the kidneys
A
Nephrotoxins
24
Q
What are some drugs that damage kidneys?
A
Aspirin – ASA
Vancomycin
NSAIDs – Motrin Advil
25
Patient assessment for kidneys
Kidneys – check for costovertebral tenderness – the 12th rib
26
Patient assessment for bladder
Normally sits below the symphysis pubis, should not be able to palpate
27
Patient assessment for perineal skin
Inspect for signs of inflammation, discharge or foul odor
28
Patient assessment for urine
Assess the color, odor, clarity, sediment, and output
29
Palpating bladder
A descended bladder can be palpated above the symphysis pubis
Can also do a bladder scan or ultrasound to determine amount of urine bladder. This is done when retention is suspected.
30
Is the bladder a sterile cavity?
Yes
31
Is the urethra a sterile cavity?
No
32
The bladder has a defense mechanism
A healthy bladder is not susceptible to infection, although an injured one is more vulnerable
33
What can pathogens introduced into the bladder cause
Kidney infection
34
How many milliliters of urine does it take for an adult to feel the urge to void?
150 to 200 mL
Younger adults may be 150 to 400 mL
35
How many milliliters of urine does it take for a younger child to feel the urge to void
50 to 100 mL
36
Alterations in urinary elimination
Urinary retention
Urinary incontinence
Urinary track infection – UTI
Urinary diversion’s
Cystocele
Uterine prolapse
37
What is urinary retention?
The inability to partially or completely empty, the bladder and urine accumulates in the bladder and causes pain at the suprapubic region
Can lead to problems with stagnant urine and UTIs
38
What is urinary retention caused by?
Urine flow obstruction, enlarged prostate, pregnancy, fecal, impaction, trauma, medication, such as anesthesia
Low fluid intake
Other meds such as anti-depressants, or anticholinergics-atropine
39
What is urinary incontinence?
Loss of control over avoiding, or troubles to hold or urinate
40
Transient incontinence
Incontinence caused by a treatable medical condition such as a fecal impaction or a UTI
41
Functional incontinence
Loss of continence from causes outside of the urinary tract, such as psychosocial or environmental or mobility issues or location of bathroom
42
Overflow incontinence
Involuntary loss caused by over, descended bladder
Examples are from a poor bladder, emptying, absent or weak bladder contractions
43
Stress incontinence
Increased, abdomen pressure, stress, or pressure on abdomen cavity, sneezing, obesity, pregnancy, weak, pelvic muscles
44
Urge incontinence
Involuntary loss of urine after strong sensation to avoid
Causes could be low bladder capacity, compared to fluid intake or irritation from alcohol or caffeine
45
Reflex incontinence
Involuntary loss, unpredictable, no urge to void, usually due to Nuro trauma or upper or lower, spinal cord injury
46
Nursing care for incontinent clients
Establish a toileting schedule
Monitor and increase fluid intake during the daytime and decrease at nighttime
Remove or control barriers to toileting
Provide incontinence garments
Apply and external or condom catheter for males
Avoid the use of indwelling urinary catheter’s
Providing continent care each, and every time they are incontinent
Education
Change garments
Avoid constipation,
Kegel exercises
Medication’s
47
Ileal conduit urinary diversion
External pouches used— ureters are attached to a piece of small intestine and pouch is created with a stoma, and a person wears an external pouch
48
Nephrostomy urinary diversion
An incontinent urinary diversion in which the surgeon attaches a tube from the renal pelvis via a stoma to the surface of the abdomen wall
49
Continent urostomy
An internal pouches is created from intestine and it drains into it and patient can self-catch during the day to empty it
50
Neobladder urinary diversion
An internal pouch is created with part of intestine, and it makes a new bladder, and the ureters and urethra are attached to it. There is a valve in place so a person can void using a Valsalva technique, but they may need to self cath
51
Urologic stents
A type of urinary diversion where stents are temporary placed in ureters
Permanent stents can be placed in urethra
This diversion provides a path for urine flow, relieves urine obstruction, when not a candidate for urinary diversion surgery
52
Patient care for urinary diversion
Notify doctor if urine becomes bright red, you have severe pain, change in urinary drainage, or experience signs and symptoms of infection and patient should wear a medical alert bracelet
53
Urinary track infection
E. coli is the most common cause – most common in females
54
Who is high risk for urinary track infection
Sexually active women
Menopausal women
Those with indwelling catheter- CAUTIs is the most common
Individuals with diabetes mellitus
Uncircumcised clients
Elderly people
55
Symptoms of urinary track infection UTI
Burning with urination
Frequency
Dysuria – difficulty urinating
Back pain
Fever
Hematuria – blood in urine
56
Infection, control, and hygiene to avoid UTIs
Drink up to 2300 mL of water daily
Wipe front to back after toileting
Drink, water and void after sexual intercourse
Take showers instead of baths no bubbles
Avoid tight clothing
Where cotton underwear
57
Why are women more prone to UTIs?
They have a shorter urethra and close proximity of the urethral opening to the rectum
58
Is urinary retention common after surgery
Yes
59
Cystocele
A bulge of the bladder into the vagina
60
Risk factors of cystolcele
Obesity
Advancing age
Family history
Multiparity
Increased abdominal pressure
Strain or injury during vaginal birth
61
Signs and symptoms, and expected findings of a cystolcele
Urinary frequency and urgency
Stress incontinence
Frequent UTIs
Sense of vaginal fullness
Fatigue
Back and pelvic pain
62
How to diagnose a cystocele
Pelvic exam
Bladder ultrasound
Urine culture and sensitivity
X-ray
63
Patient centered care for a cystocele
Bladder training
Vaginal pessary
Kegel exercises
Surgical repair
64
Uterine prolapse
When the uterus slips down or protrudes out of the vagina
65
Those at risk for a uterine prolapse
One or more pregnancies and vaginal birth
Giving birth to a large baby
Obesity
Prior pelvic surgery
Chronic constipation or frequent straining during BMs
Family history
66
Symptoms of a uterine prolapse
Sensation of heaviness or pulling in your pelvis
Tissue protruding from the vagina
Urinary problems
Trouble having bowel movements
Feeling as if you’re sitting on a small ball or as if something is falling out of your vagina
67
How to diagnose a uterine prolapse
Pelvic exam
68
Patient centered care for a uterine prolapse
Losing weight
Treating constipation
Vaginal Pessary
Kegel exercises
Surgical repair
69
What is a pessary?
A device that is inserted into the vagina to support the uterus or bladder or rectum
It helps decrease urine leakage
70
Common diagnostic testing
Bedside sonography with bladder scanner
KUB – kidneys, ureter, bladder- x-ray
IV.P – intravenous pyelogram.
71
Types of collecting urine specimens
 Routine urinalysis
Urine specific gravity
Clean, catch midstream for culture and sensitivity
Collecting 24 hour specimens
72
What is urine specific gravity?
It is measuring the concentration of the solution in the urine
Normal ranges are 1.005 to 1.030
73
Do specimen, containers expire
Yes
74
If patient is using Met Forman and you will use contrast
The client needs to stop meds, 24 hours in advance
And the kidneys need to be checked before starting up the medicine again
75
Steps of clean, catch midstream
Perry care, start, urinating, stop, collect, stop and remove collection cup, then finish
76
What is a urinary catheterization?
The placement of a rubber or plastic tube through the urethra and into the bladder
77
Reasons for catheterization
Relieve urinary retention
Obtain a sterile sample from a woman
measure amount of PVR post void residual urine in the bladder
Obtain a urine specimen when it cannot be secured by other means
To empty the bladder before, during or after surgery, and before diagnostic examination
78
Hazards of catheterization
Sepsis/infection – is the most common cause of HAIS or nosocomial infections
TRAUMA, ESPECIALLY males, STRUCTURES, IRREGULAR OPENING, OR ELDERLY MILLS IN LARGE PROSTATE
79
Types of catheters
Indwelling/retention/Foley urethral Dash use of balloons
Intermittent/straight catheter
Suprapubic catheter - into bladder through abdomen
Condom catheter – external
Coudè catheter – has a dent end and is often used when males have an enlarged prostate
80
Procedures for insertion of a catheter
Must have doctors orders
Know the type of
Size of catheter bulb
How often the catheter should be done – daily, monthly, PRN
Look at slides 42 through 47 on PowerPoint
81
Procedure for insertion of a straight and indwelling catheter for a female
Spread the labia
Cleanse from top to bottom – far side, closest side, center
Have patient bear down as you insert cath
Insert 2 to 3 inches or until urine flows
If indwelling insert 2 to 3 inches in advance, 1 to 2 inches after urine flow
Slight tug on catheter after bulb is inflated
82
Procedures for insertion of a catheter for a male
Hold penis perpendicular to the body at a 90° angle
Cleanse, glans penis from center outward—first top of penis, middle of penis in base of penis in a circular motion
Lubricate tip of catheter 6 to 8 inches
Tell patient to bear down as you insert cath
A straight Cath insert 6-8 inches or until urine flow
A indwelling catheter insert to the bifurcation
Slightly tug after balloon is inflated
83
What would you do if you accidentally insert a catheter into the vagina
Leave it in place until you insert another one in the correct opening and then remove
84
What kind of catheter do you use if the patient has an in large prostate?
Coude catheter
85
What to document when doing a catheter?
Record the type and size of the catheter
Amount of fluid in the balloon to inflate
Characteristics of urine
Amount of urine
Reason for the catheter
Patient’s response
Patient education
86
Interventions to minimize infections
Observe tubing for color, blood, clots
Tubing free of kinks
Good hand washing
Collection bag is off the floor
Do not open the drain system to collect urine use the special port
Position tubing, so there is no backflow
Anchor, catheter with strap
Do catheter care per institution policy at least two times per shift
87
Catheter removal
Have supplies
Know procedure
Document
88
Reasons for Catheter irrigation
To instill fluids, or to flush out
Instill medication
Usually use 30 to 60 cc
89
Intermittent irrigation
Closed system irrigation
90
Continuous irrigation- CBI
Continuous bladder irrigation
91
What is irrigation?
Flushing of the catheter with a solution through the tubing
92
What doctors orders do you need for catheter irrigation?
What type of irrigation intermittent or continuous?
How often catheter should be irrigated
Amount of solution for irrigation
And solution or irrigation fluid to be used
93
Purpose of catheter irrigation
Maintain or restore patency of the catheter
Instill medication into the bladder
94
Supplies needed for a intermittent or continuous system irrigation
Irrigation solution
Syringe 30 to 50 mil with 18 to 19 gauge needle
Alcohol swabs
Gloves for nurse
95
Supplies needed for a continuous bladder irrigation CBI or an intermittent
Physicians orders
Room temperature irrigation solution
IV pole to hang solution 2 1/2 to 3 feet above patient’s bladder
Priming the tubing to remove air
Connect to irrigation port on a three-way foley Cath
Regulate flow as ordered
Monitor for clots, irrigation can apply ice to abdomen to reduce cloths
96
Ways to promote elimination
Maintain normal voiding patterns – safety, hygiene, and positioning
Bladder retraining programs – extending time in between voiding by a few minutes each time
Promoting fluid intake – 2 to 3 L a day
Strengthening muscle tone – Kegel exercises
Stimulating, urination – running water, warm water, over perineum, position, blow through a straw
Creedy maneuver – manual pressure with hand right above the Previsisis
97
What is a bifurcation?
A split in the catheter tubing
98
What is polyuria?
Excessive urination
99
Oliguria
Difficulties, urinating, or urinary retention
100
The urinary track consists of
Kidneys, ureters, bladder, urethra
101
The digestive track consists of
Liver, pancreas, gallbladder, and a series of hollow organs originated at the mouth. These organs are in the mouth, esophagus stomach, small and large intestines and the anus. 
102
Peristalsis
Contractions that occur throughout the digestive system, that move food along a pathway to be digested
103
Urinary Incontinence
The inability to control urination, resulting in involuntary passage, and can because they many factors
104
Uroflowmetry
Measures urine speed in volume
105
Post void residual measurement
Measures the amount of urine left in the bladder after voiding 
