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Theory Unit 5 > Urine Elimination > Flashcards

Urine Elimination Flashcards

1
Q

Males Genitourinary System GU

A

Meatus
Urethra
Bladder
Prostate gland

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2
Q

Females Genitourinary System GU

A

See ppu

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3
Q

Anatomy and physiology of the genitourinary system GU

A

Kidneys 2
Ureters 2
Bladder
Urethra

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4
Q

Urinary elimination

A

Is a precise system of filtration, reabsorption, and excretion

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5
Q

Urinary elimination process helps

A

Maintain fluid and electrolyte balance, while filtering and excreting water soluble waste

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6
Q

Primary organ for urinary elimination

A

Kidneys

Nephrons

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7
Q

Characteristics of urine

A

Color
Odor
Turbidity
pH
Specific gravity
Constituents

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8
Q

Color

A

Pale, yellow straw colored, Amber, other colors may depend upon medication, fluids, and time of day

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9
Q

Odor

A

Non-odorous, mellow, malodorous, the more it stands, the more ammonia, odor, musty smell

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10
Q

PH of urine

A

4.6-8.0

It becomes more alkaline as it stands

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11
Q

Specific gravity

A

Concentration of dissolved solids in urine

-more concentrated greater specific gravity
-less concentrated, less specific gravity

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12
Q

Constituents

A

Urea, uric acid, creatinine, ammonia, should not have blood, puss, bacteria, or ketones

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13
Q

What does dark urine indicate?

A

Dehydration

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14
Q

Expected daily urine production

A

30 mLs and hour

Approx. 1000-2000mLs in 24 hours

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15
Q

Output less than 30 mLs per hour indicates

A

Renal insufficiency

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16
Q

Measuring urine output for voiding pts

A

Hats, urinals, graduates

read at eye level, flat surface, document every time

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17
Q

Measuring urine output for indwelling catheter

A

Empty per policy

2/3 full

Gloves, floor barrier, clean with alcohol wipe

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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

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19
Q

How does Phenazopyridine affect urine color?

A

Orange or red

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20
Q

How does amitriptyline affect urine color?

A

Green or blue

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21
Q

How does levodopa affect urine color?

A

Dark

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22
Q

How does riboflavin affect urine color?

A

Bright yellow

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23
Q

What do you call drugs that may damage the kidneys

A

Nephrotoxins

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24
Q

What are some drugs that damage kidneys?

A

Aspirin – ASA
Vancomycin
NSAIDs – Motrin Advil

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25
Q

Patient assessment for kidneys

A

Kidneys – check for costovertebral tenderness – the 12th rib

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26
Q

Patient assessment for bladder

A

Normally sits below the symphysis pubis, should not be able to palpate

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27
Q

Patient assessment for perineal skin

A

Inspect for signs of inflammation, discharge or foul odor

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28
Q

Patient assessment for urine

A

Assess the color, odor, clarity, sediment, and output

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29
Q

Palpating bladder

A

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.

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30
Q

Is the bladder a sterile cavity?

A

Yes

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31
Q

Is the urethra a sterile cavity?

A

No

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32
Q

The bladder has a defense mechanism

A

A healthy bladder is not susceptible to infection, although an injured one is more vulnerable

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33
Q

What can pathogens introduced into the bladder cause

A

Kidney infection

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34
Q

How many milliliters of urine does it take for an adult to feel the urge to void?

A

150 to 200 mL

Younger adults may be 150 to 400 mL

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35
Q

How many milliliters of urine does it take for a younger child to feel the urge to void

A

50 to 100 mL

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36
Q

Alterations in urinary elimination

A

Urinary retention
Urinary incontinence
Urinary track infection – UTI
Urinary diversion’s
Cystocele
Uterine prolapse

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37
Q

What is urinary retention?

A

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

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38
Q

What is urinary retention caused by?

A

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

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39
Q

What is urinary incontinence?

A

Loss of control over avoiding, or troubles to hold or urinate

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40
Q

Transient incontinence

A

Incontinence caused by a treatable medical condition such as a fecal impaction or a UTI

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41
Q

Functional incontinence

A

Loss of continence from causes outside of the urinary tract, such as psychosocial or environmental or mobility issues or location of bathroom

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42
Q

Overflow incontinence

A

Involuntary loss caused by over, descended bladder

Examples are from a poor bladder, emptying, absent or weak bladder contractions

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43
Q

Stress incontinence

A

Increased, abdomen pressure, stress, or pressure on abdomen cavity, sneezing, obesity, pregnancy, weak, pelvic muscles

44
Q

Urge incontinence

A

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
Q

Reflex incontinence

A

Involuntary loss, unpredictable, no urge to void, usually due to Nuro trauma or upper or lower, spinal cord injury

46
Q

Nursing care for incontinent clients

A

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
Q

Ileal conduit urinary diversion

A

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
Q

Nephrostomy urinary diversion

A

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
Q

Continent urostomy

A

An internal pouches is created from intestine and it drains into it and patient can self-catch during the day to empty it

50
Q

Neobladder urinary diversion

A

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
Q

Urologic stents

A

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
Q

Patient care for urinary diversion

A

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
Q

Urinary track infection

A

E. coli is the most common cause – most common in females

54
Q

Who is high risk for urinary track infection

A

Sexually active women
Menopausal women
Those with indwelling catheter- CAUTIs is the most common
Individuals with diabetes mellitus
Uncircumcised clients
Elderly people

55
Q

Symptoms of urinary track infection UTI

A

Burning with urination
Frequency
Dysuria – difficulty urinating
Back pain
Fever
Hematuria – blood in urine

56
Q

Infection, control, and hygiene to avoid UTIs

A

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
Q

Why are women more prone to UTIs?

A

They have a shorter urethra and close proximity of the urethral opening to the rectum

58
Q

Is urinary retention common after surgery

A

Yes

59
Q

Cystocele

A

A bulge of the bladder into the vagina

60
Q

Risk factors of cystolcele

A

Obesity
Advancing age
Family history
Multiparity
Increased abdominal pressure
Strain or injury during vaginal birth

61
Q

Signs and symptoms, and expected findings of a cystolcele

A

Urinary frequency and urgency
Stress incontinence
Frequent UTIs
Sense of vaginal fullness
Fatigue
Back and pelvic pain

62
Q

How to diagnose a cystocele

A

Pelvic exam
Bladder ultrasound
Urine culture and sensitivity
X-ray

63
Q

Patient centered care for a cystocele

A

Bladder training
Vaginal pessary
Kegel exercises
Surgical repair

64
Q

Uterine prolapse

A

When the uterus slips down or protrudes out of the vagina

65
Q

Those at risk for a uterine prolapse

A

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
Q

Symptoms of a uterine prolapse

A

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
Q

How to diagnose a uterine prolapse

A

Pelvic exam

68
Q

Patient centered care for a uterine prolapse

A

Losing weight
Treating constipation
Vaginal Pessary
Kegel exercises
Surgical repair

69
Q

What is a pessary?

A

A device that is inserted into the vagina to support the uterus or bladder or rectum

It helps decrease urine leakage

70
Q

Common diagnostic testing

A

Bedside sonography with bladder scanner
KUB – kidneys, ureter, bladder- x-ray
IV.P – intravenous pyelogram.

71
Q

Types of collecting urine specimens

A

 Routine urinalysis
Urine specific gravity
Clean, catch midstream for culture and sensitivity
Collecting 24 hour specimens

72
Q

What is urine specific gravity?

A

It is measuring the concentration of the solution in the urine

Normal ranges are 1.005 to 1.030

73
Q

Do specimen, containers expire

A

Yes

74
Q

If patient is using Met Forman and you will use contrast

A

The client needs to stop meds, 24 hours in advance
And the kidneys need to be checked before starting up the medicine again

75
Q

Steps of clean, catch midstream

A

Perry care, start, urinating, stop, collect, stop and remove collection cup, then finish

76
Q

What is a urinary catheterization?

A

The placement of a rubber or plastic tube through the urethra and into the bladder

77
Q

Reasons for catheterization

A

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
Q

Hazards of catheterization

A

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
Q

Types of catheters

A

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
Q

Procedures for insertion of a catheter

A

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
Q

Procedure for insertion of a straight and indwelling catheter for a female

A

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
Q

Procedures for insertion of a catheter for a male

A

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
Q

What would you do if you accidentally insert a catheter into the vagina

A

Leave it in place until you insert another one in the correct opening and then remove

84
Q

What kind of catheter do you use if the patient has an in large prostate?

A

Coude catheter

85
Q

What to document when doing a catheter?

A

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
Q

Interventions to minimize infections

A

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
Q

Catheter removal

A

Have supplies
Know procedure
Document

88
Q

Reasons for Catheter irrigation

A

To instill fluids, or to flush out

Instill medication

Usually use 30 to 60 cc

89
Q

Intermittent irrigation

A

Closed system irrigation

90
Q

Continuous irrigation- CBI

A

Continuous bladder irrigation

91
Q

What is irrigation?

A

Flushing of the catheter with a solution through the tubing

92
Q

What doctors orders do you need for catheter irrigation?

A

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
Q

Purpose of catheter irrigation

A

Maintain or restore patency of the catheter

Instill medication into the bladder

94
Q

Supplies needed for a intermittent or continuous system irrigation

A

Irrigation solution

Syringe 30 to 50 mil with 18 to 19 gauge needle

Alcohol swabs

Gloves for nurse

95
Q

Supplies needed for a continuous bladder irrigation CBI or an intermittent

A

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
Q

Ways to promote elimination

A

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
Q

What is a bifurcation?

A

A split in the catheter tubing

98
Q

What is polyuria?

A

Excessive urination

99
Q

Oliguria

A

Difficulties, urinating, or urinary retention

100
Q

The urinary track consists of

A

Kidneys, ureters, bladder, urethra

101
Q

The digestive track consists of

A

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
Q

Peristalsis

A

Contractions that occur throughout the digestive system, that move food along a pathway to be digested

103
Q

Urinary Incontinence

A

The inability to control urination, resulting in involuntary passage, and can because they many factors

104
Q

Uroflowmetry

A

Measures urine speed in volume

105
Q

Post void residual measurement

A

Measures the amount of urine left in the bladder after voiding 

Theory Unit 5 (2 decks)

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