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Therapeutic Skills > Week 9 - Urinary Elimination Care > Flashcards

Week 9 - Urinary Elimination Care Flashcards

1
Q

Micturition

A

Process of emptying the bladder

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2
Q

Volume of normal adult voiding

A

1500-1600mL/day

Q3-4 hours

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3
Q

Sign of renal dysfunction

A

Voiding less than 30mL/hr

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4
Q

Factors Influencing Urinary Elimination (7)

A 
Medication
Environment
Psychological factors
Sociocultural factors
Fluid balance
Surgical procedures/ diagnostic examinations
Pathological conditions
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5
Q

Process of Micturition (5)

A
  1. Stretch receptors in bladder
  2. Impulses sent to spinal cord
  3. Signals travel to pontine micturition centre in brainstem
  4. Signals sent back down resulting in relaxation of internal sphincter & contraction of detrusor muscle
  5. Conscious relaxation of external urethral sphincter
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6
Q

When might we initiate monitoring of ins and outs? (7)

A
  • suspected urinary retention
  • after surgery
  • pts with renal/kidney issues
  • CHF pts
  • pts on diuretics
  • pts with diarrhea and emesis
  • pts with a lot of drainage
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7
Q

Measuring output with: Graduated Cylinder

A

Emptying urine bag for a very accurate measurement

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8
Q

Measuring output with: urometer

A

Helps us measure without having to transfer from the urine bag (attached to urine bag)

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9
Q

Measuring output with: urine hat

A

Attaches to the toilet and pt voids right into the hat

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10
Q

Urinals

A

Used for collection and measurement

There are types for people with penises and for vaginas

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11
Q

Incontinence

A

Symptom of urinary alteration

Involuntary loss of urine

NOT a normal part of aging

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12
Q

Dysuria

A

Symptom of urinary alteration

pain or difficulty urinating

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13
Q

“Frequency”

A

Urinating more than 8x per day

Symptom of urinary alteration

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14
Q

Dribbling

A

Symptom of urinary alteration

Leakage of urine despite voluntary control

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15
Q

Hesitancy

A

Symptom of urinary alteration

Difficulty initiating urination

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16
Q

Polyuria

A

Symptom of urinary alteration

Large volume while voiding

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17
Q

Oliguria

A

Symptom of urinary alteration

Diminished volume while voiding

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18
Q

Nocturia

A

Symptom of urinary alteration

Waking up to pee

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19
Q

Hematuria

A

Symptom of urinary alteration

Blood in urine

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20
Q

Elevated post-void residual urine

A

Symptom of urinary alteration

Urine that remains in bladder after client has voided

More than 100ml remaining in bladder is abnormal

Can contribute to incontinence and bacterial infection

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21
Q

Strategies for Promoting Continence (7)

A
  • Lifestyle modification
  • Pelvic floor muscle exercises (aka Kegel exercises)
  • Bladder training
  • Habit retraining and prompted voiding
  • Intermittent catheterization
  • Medications
  • Maintaining skin integrity
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22
Q

Causes of urinary retention

A

Under active detrusor muscle

Urethral obstruction

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23
Q

Causes of acute urinary retention (4)

A
  • Surgical or childbirth trauma
  • Medication side effects
  • Fecal impaction
  • Surgery/anesthesia
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24
Q

Causes of chronic urinary retention (4)

A
  • Enlarged prostate
  • Pelvic organ prolapse
  • Urethral stricture
  • Alterations in motor and sensory innervation of the bladder
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25
Q

Signs and symptoms of Urinary Retention (6)

A
  • Feelings of pressure & discomfort
  • Restlessness, diaphoresis
  • Distended bladder
  • Dullness over suprapubic area
  • Absence of urine output (acute)
  • Small frequent voiding or dribbling
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26
Q

Pathology of prolonged retention

A
  1. Prolonged retention
  2. Stagnation/Stasis of urine
  3. Greater Risk of UTI
  4. Kidney Infections
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27
Q

Bladder Scanner

A

Ultrasound technology using high-frequency sound waves to detect urine volume in bladder

28
Q

Intermittent (straight/in-and-out) Urinary Catheter

A

Inserted for ~5-10 minutes or just long enough to empty the bladder.

Performed by nurse or patient

Clean procedure.

29
Q

Indwelling (foley/retention) Urinary Catheter

A

Retained for longer using small balloon that keeps catheter in the bladder.

Sterile procedure

30
Q

“French”

A

Unit to measure a catheter.

Larger the French the wider the lumen.

31
Q

When to use intermittent catheterization (5)

A
  • Bladder distension
  • Sterile urine specimen
  • Assess post-void residual
  • Urethral strictures
  • Management for patients with SCI, neuromuscular degeneration, incompetent bladder
32
Q

When to use SHORT TERM indwelling catheterization (6)

A
  • Some surgical procedures
  • Continuous measurement
  • Bladder irrigation
  • Prolonged immobilization d/t trauma
  • Acute retention/obstruction
  • End-of-life (only if required)
33
Q

When to use LONG TERM indwelling catheterization (3)

A
  • Chronic retention
  • Pressure injury or wounds
  • Intractable incontinence
34
Q

How far to advance a urinary catheter?

A

Vaginas: 5-7.5”

Penises: 22cm (slightly longer than client’s anatomy)

35
Q

Considerations for urine collection bag

A

Hang below level of pt bladder to prevent backflow

36
Q

Catheter care - perineal care

A

At least BID, post BM and prn

Soap and water, clean to dirty

37
Q

Catheter care

A
  • Per policy, usually TID and post BM
  • Urethral meatus followed by
    catheter (10cms)

Promote fluid intake to flush bladder

38
Q

Potential sites for introduction of infection in a urinary catheter (5)

A
  1. insertion site
  2. junction of where bag connects to catheter
  3. junction where tube meets bag
  4. bag itself (reservoir)
  5. spigot
39
Q

Preventing Catheter-Associated Urinary Tract Infection (CAUTI) (8)

A
  • Hand hygiene
  • Strict aseptic technique
  • Maintain closed system
  • Prevent pooling of urine in tubing
  • Avoid kinks in catheter tubing
  • Don’t let bag drag on floor
  • Empty drainage bag at least q8h (or ½ full)
  • Remove catheter as soon as clinically possible!!
40
Q

Closed bladder irrigation

A

Triple-lumen catheter required

Used for pts post-genitourinary surgery to remove clots

Allows for intermittent irrigations or continuous irrigation (CBI)

41
Q

Suprapubic Catheterization

A

Surgically placed through the abdominal wall above the symphysis pubis and into the urinary bladder

Usually sutured into place

Tends to reduce the incidence of infection

Used for pts urethral trauma, gyne procedures, or pts at home

42
Q

Condom Catheter

A

Used for urinary incontinence and nocturia (penis only)

Little risk of infection, BUT skin breakdown is a concern

MUST use the tape provided in the kit, because it stretches as the penis changes size

43
Q

Urinary Tract Infections (UTIs)

A

Infection of lower urinary tract leading to cystitis, urethritis and prostatitis

Easy to treat but can spread to blood or kidneys

Occur more in vaginas – shorter urethra and proximity of rectum to urethral meatus

44
Q

Risk factors for UTIs (9)

A 
Sexual activity
Pregnancy
Low levels of vaginal estrogen
Obstruction of urinary tract
Incomplete bladder emptying
Abnormal anatomy 
Older age
Antibiotics
Decreased immunity
45
Q

Signs and symptoms of UTI (9)

A 
Dysuria
Fever
Chills
Nausea
Vomiting
Frequency
Urgency
Hematuria
Urine concentrated and cloudy (possibly foul smelling)
46
Q

Prevention of UTIs (4)

A
  • good hygiene
  • showers not baths
  • daily intake of 1500-2000ml
  • frequent voiding q2-4
47
Q

Routine/routine and microscopic urine specimen for urinalysis (R and M)

A

Checks for: Urine pH, protein, glucose, ketones, blood, urine-specific gravity (urine concentration)

Micro: WBC, bacteria, casts (produced by the kidney, indicative of renal dysfunction)

Collected via normal urination in specimen cup or from urinary catheter or diversion bag

48
Q

Culture and Sensitivity test (C and S)

A

Culture: bacterial growth
Sensitivity: which antibiotic is most effective

Can be collected by midstream or catheter

49
Q

Midstream urine specimen/clean-catch specimen/clean-voided specimen (C and S)

A

Used to avoid contamination of urine sample

50
Q

Sterile Urine Specimen

A

Collected from tube port of closed drainage system

51
Q

Timed Urine Specimens

A

Collected over a defined period of time (i.e., numerous voids)

Must document when the collection time-frame begins and ends

52
Q

Urinary diversions

A

Used to bypass the bladder and the urethra, urine needs to exit via another route

Indications:

  • bladder cancer
  • bladder trauma
  • radiation injury
  • fistula
  • chronic cystitis
53
Q

Ureterostomey

A

Urinary diversion

bringing the end of one or both ureters to the abdominal surface

54
Q

Nephrostomy

A

Urinary diversion

tube placed directly into the renal pelvis to provide urinary drainage

55
Q

Ileal loop or conduit

A

Urinary diversion

Ureters are attached to a segment of the ileum, used to drain urine externally

56
Q

Indication for dialysis

A
  • Renal failure that can no longer be treated with medication or diet modification alone
  • Worsening of the uremic syndrome in end-stage renal disease
  • Severe fluid or electrolyte imbalances that cannot be controlled
57
Q

Peritoneal dialysis

A

Indirect using osmosis and diffusion

58
Q

Hemodialysis

A

Machine using semi-permeable filtering membrane (akin to an artificial kidney)

59
Q

Transient urinary incontinence

A

Urine loss resulting from causes outside of or affecting the urinary system

Resolved when causes are treated

Delirium, intake of fluids, stool impaction, atrophic vaginitis, psychological problems, pharmaceuticals, excess urine output, abnormal lab values, restricted mobility (DISAPPEAR)

60
Q

Urge urinary incontinence

A

Urine loss associated with or immediately preceded by a sudden and urgent need to void that cannot be postponed.

  • Overactive bladder syndrome.
  • Common in pts with CNS disorders
61
Q

Stress urinary incontinence

A

Urine loss resulting from increased intra-abdominal pressure (coughing, sneezing, laughing, lifting)

62
Q

Mixed urinary incontinence

A

Urine loss that has features of both stress and urgent incontinence

63
Q

Functional urinary incontinence

A

Urine loss due to inability to reach the toilet in time

Pts with cognitive, physical, or mobility impairments

64
Q

Urinary incontinence associated with Chronic Retention

A

Involuntary loss of urine when the bladder does not completely empty with a high residual urine volume or a palpable nonpainful bladder remaining after voiding

Pts with prostate enlargement, spinal lesions, neurological conditions

65
Q

Multifactorial urinary incontinence

A

Urine loss due to multiple interacting factors both inside and outside of the urinary tact

(medications, age-related changes, environmental factors, etc.)

Therapeutic Skills (11 decks)

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