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NUR151-Urinary
Urinary Elimination and Incontinence
| Question | Answer |
|---|---|
| Where are the kidneys? | Lie on either side of vertebral column behind peritoneum - Left higher than right because of position of liver. |
| How much of CO does kidneys receive? | Highly vascular; receive about 25% of cardiac output |
| Urinary output norms | normal adult urine output is 1500 to 1600 mL/day. An output of less than 30 mL/hr indicates possible renal alterations |
| 3 causes of kidney failure | intrarenal, postrenal, prerenal |
| Intrarenal | anything that directly damages the kidney tissue (drugs like vancomicine), |
| Postrenal | kidney stones or anything that obstructs flow of urine out of the body - disease conditions of the renal tissue (renal), or obstruction in the lower urinary tract that prevents urine flow from the kidneys |
| Prerenal | affects blood flow to kidneys - Decreased blood flow to and through the kidney |
| Renal corpuscle | responsible for filtration – 125 mL/minute or about 20% is filtered through our glomerulus |
| lasix works here | Loop of Henle –– water reabsorption |
| The kidneys are responsible for maintaining a normal RBC volume by producing | erythropoietin - chronic alterations in kidney function cannot produce sufficient quantities of this hormone; therefore they are prone to anemia. |
| Diseases that cause irreversible damage to kidney tissue result in | end-stage renal disease (ESRD). |
| Kidneys also affect Calcium & Phosphate regulation by | producing substance which converts vitamin D into active form |
| Calcium binds to | phosphate |
| Urine production should be a minimum of | one half ml/kg/hour (30 ml/ hr for 132 |
| Proteinuria | sign of renal injury or infection - presence of large proteins in the urine (proteinuria) is a sign of glomerular injury. |
| Pressure within the bladder is usually | low, even when partly full, a factor that protects against infection. |
| As the volume increases, the bladder walls stretch, sending sensory impulses to | the micturition center in the sacral spinal cord - Impulses from micturition ctr respond to or ignore this urge - voluntary control. |
| Adult bladder can store up to | 600ml - urge to void felt at 150-200ml – 50 – 100 in a child. |
| When bladder full it | Expands and extends above symphysis pubis - Not palpable unless distended. |
| Length of urethra | In women 4-6.5 cm long, in men 20cm |
| What are 5 disease conditions which may affect renal function or urine elimination? | diabetes, multiple sclerosis, BPH (benign prostate hypertopy), Alzheimer’s, dementia |
| Damage to the spinal cord above the sacral region causes | loss of voluntary control of urination, but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void. |
| reflex incontinence | Damage to the spinal cord above the sacral region causes loss of voluntary control of urination |
| How does diabetes mellitus and multiple sclerosis affect urination? | cause changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions |
| End stage renal disease | do not produce urine so all the fluid backs up in body - uremic syndrome |
| uremic syndrome | increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. |
| Peritoneal dialysis is an indirect method of | cleansing blood of waste products using osmosis & diffusion w/peritoneum functioning as semipermeable membrane - removes excess fluid & waste products |
| Dialysate | sterile electrolyte solution instilled into peritoneal cavity by gravity via surgically placed catheter - remains in cavity & then drained out removing wastes |
| Hemodialysis | uses machine equipped with a semipermeable membrane (artificial kidney) that removes accumulated waste products and excess fluids from the blood. processes of diffusion, osmosis, and ultrafiltration cleanse the client's blood. |
| Epidurals affect bladder how? | relax the bladder and cause urinary retention. |
| The stress of surgery initially triggers the general adaptation syndrome body release an increased amount of | ADH - increases water reabsorption and aldosterone - causing retention of sodium & water. Both reduce urine output to maintain circulatory fluid volume. |
| pyridium turns urine | orange (and it stains) |
| Anesthetics and narcotic analgesics slow the | glomerular filtration rate, reducing urine output & impair sensory & motor impulses traveling between the bladder, spinal cord, & brain |
| Cystoscopy | water used to distend bladder -allows visualization of bladder mucosa & urine - retained which can increase chance of UTI. |
| Decreased blood flow to kidneys results in | decreased ability to conserve Na, dilute and/or concentrate urine & excrete acid load |
| Decreased estrogen levels in females result in | decreased elasticity in tissues including bladder & urethra in females resulting in decreased blood supply – makes it difficult to find the meatus because it has relaxed so much. |
| BPH - benign prostatic hypertrophy | Results in hesitancy, retention, slow stream & UTI’s –residual in the bladder. Dribbling and up at night. |
| Conditions that reduces blood flow to kidneys and lead to kidney impairment | Decreased intravascular volume R/T dehydration, hemorrhage, burns & shock; Altered peripheral vascular resistance, sepsis, anaphylactic reactions; Cardiac pump failure, CHF, MI, hypertensive heart disease, valvular disease |
| Urine elimination problems not related to kidney function are generally due to inability to store urine or fully empty bladder | Impaired bladder function, Obstruction to urine outflow, Inability to control micturition |
| The client with a urinary diversion has a stoma (artificial opening) on the | abdomen to drain urine - many special needs because urine drains to the outside through a stoma. |
| Contenent urinary diversions | illeal conduit – ureters are implanted into the intestines |
| Urinary retention | urine accumulation due to inability of bladder to fully empty - stress, urethral obstruction, childbirth, postop patients due to anesthesia. |
| Symptoms would be discomfort, low output, distended bladder - In the suprapubic area below umbilicus | urinary retention |
| Urinary Tract Infections – UTI | bacterial infection, can be caused by catheterization, hygiene, urinary retention – symptoms would be dysuria (pain), fever |
| Urinary incontinence | involuntary leakage of urine - Can occur when you have a disruption of muscle tone during trauma like surgery or childbirth. |
| Functional incontinence | urge to void but did not make it in time – bladder gets overfull and you leak – can occur during work |
| Overflow incontinence | lost sensation to urinate and it over flows and causes leaking of urine. |
| Reflex incontinence | associated with spinal cord injury because they have lost sensation to urinate. |
| Stress incontinence | sneezing, lifting, etc. Increased intra-abdominal pressure causes leaking. |
| Urge incontinence | urine output after strong urgency to void – prostate problems |
| Oliguria | urine output that is decreased despite normal intake - fluid losses through other means increases (perspiration, diarrhea, or vomiting) - also occurs in early kidney disease. |
| Anuria | no urine is produced |
| Nocturia | awakening to void one or more times at night - often a sign of renal alteration. |
| Hematuria | Irritation to bladder & urethral mucosa results in blood-tinged urine |
| Dysuria | pain or burning during urination (dysuria) as urine flows over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the infection worsens. |
| Polyuria | excessive output of urine |
| Bacteriuria | bacteria in the urine - leads to spread of organisms into the kidneys & possibly leads to bacteremia or urosepsis (bacteria in the bloodstream) |
| Cystitis | irritated bladder (cystitis) causes a frequent and urgent sensation of the need to void. |
| Pyelonephritis | infection spread to the upper urinary tract (kidneys—pyelonephritis), flank pain, tenderness, fever, and chills are common. |
| BUN & Creatinine indicative of | renal function |
| Cystitis is usually marked by | urinary frequency and irritation. |
| The cloudiness of urine is usually indicative of | bacterial presence. |
| A renal stone presents with | pain and hematuria. |
| Clients should avoid fluids for __before bedtime to prevent nocturia. | 2 hours |
| The Foley catheter drainage bag should be below the level of the bladder to prevent | urinary reflux, which can lead to infection. |
| A condom catheter should fit snugly and securely but should not cause constriction that impedes blood flow. It should not be | tight or placed in a dependent position, and should never be secured with tape in a circular pattern, which could impede blood flow. |
| A client undergoes ultrasonography of a kidney. The nurse providing postprocedure care remembers that | There are no special precautions that must be taken. |
| A client is scheduled for an intravenous pyelogram (IVP). Before the test the most important assessment the nurse performs is asking about | Allergies to shellfish - The contrast medium often used for IVP contains iodine |
| Elimination changes that result from obstruction to the flow of urine in the urinary collecting system may cause which of the following? | renal damage, urinary retention, and urinary tract infections |
| beverages that are diuretics | tea, coffee,cola - alcohol inhibits the release of antidiuretic hormone, thus increasing water loss in urine. |
| When catheterization is performed at home by the client only | clean technique is required |
| __ acidify the urine, which creates an inhospitable environment for pathogens | Prunes, cranberry juice, and whole-grain breads – grapefruit is not |
Created by:
Ladystorm