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Urinary Elm P&P
Potter and Perry 7th Edition Chapter 45
| Question | Answer |
|---|---|
| What may be affected by alterations in urinary elimination? | A patient's body image and virtually all body systems? |
| What has to work (4 things) in order to have urinary elimination function properly? | Kidneys, ureter, bladder, and urethra |
| What is the normal amount of urine produced in a day? | 1-2 L |
| What 2 things affect urine production? | Fluid intake, body temperature |
| Urine is usually ____% water and _____% solutes. | 95% water 5% solutes |
| Electrolytes, urea, uric acid, creatinine, and ammonia are examples of what? | Solutes found in urine |
| What is a waste product of muscle metabolism? | Creatinine |
| What is a molecule of major importance in energy production in muscle? | creatine |
| What would increased creatinine levels tell us? | Kidney dysfunction |
| Where are the kidneys located? | On either side of the vertebral column behind the abdominal peritoneum and against the deep muscles of the back, level with the twelfth Thoracic and 3rd lumbar vertebrae. |
| What organs are the initial site of urine formation? | Glomerulus |
| What is a cluster of capillaries that filter water, glucose, amino acids, urea, uric acid, creatinine, and electrolytes from the blood? | Glomerulus |
| Why would protein in the urine indicate glomerular injury? | Becuase protien does not usually filter through the glomerulus. |
| About ____% percent of glomerular filtrate is reabsorbed back into the plasma. | 99% |
| _______, ________, and _________ are secreted into the tubules and become part of the urine. | hydrogen, potassium, ammonia |
| What carries urine from the kidneys to the bladder by peristalsis? | Ureters |
| What prevents urine from returning from the bladder to the ureters? | A small flaplike fold of mucous membrane acts like a valve that covers the juncture between the ureters and the bladder. |
| Where is the bladder in a male? | behind the symphysis pubis when empty and resting on the rectum posteriorly. |
| Where the bladder in a female? | behind the symphysis pubis when empty and resting against the anterior wall of the uterus and vagina. |
| How far up might the bladder extend if greatly distended? | Almost up to the umbilicus. |
| Where is the external urethral sphincter located and what is its function? | about half way down the urethra-permits voluntary control of urine flow. |
| Give three terms for peeing. | urination, micturition, voiding |
| About how much urine does it take to give a person the sensation that they would like to urinate? Adult? Child? | Only a small amount (about 150ml to 200ml in an adult 50-100 ml in a child) |
| What is the name for the condition in which urine drains through an arificial opening in the abdominal wall? | Urinary diversion |
| What are signs and symptoms of urinary retention? | feelings of pressure, discomfort, tenderness over the symphysis pubis, restlesness, and diaphoresis along with absence of urinary output over several hours and a distended bladder |
| In urinary retention the bladder sometimes holds up to _______ml of urine | 1000 ml |
| What is overflow urinary incontinence? | The pressure in the bladder builds till the external sphincter cannot hold it back. Small amounts leak out (25-60 mls) to relieve pressure as often as 2-3 times an hour. |
| How does decreased urine production cause urinary retention? | By filling the bladder gradually so the stretch receptors are not acitvated |
| Urinary tract infections account for _____ to ____ % of nosocomial infections in the US with most directly due to ___________. | 36% - 40%, catheterization |
| Why is bacteriuria almost inevitable with the introduction of a retention catheter? | Because they are a source of injury to the mucosa, thus allowing bacterial invasion. |
| Why is it important to keep catherization to a minimum? | Because bactiuria leads to the spread of organisms to the bloodstream (Urosepsis) and kidneys, especially in severly ill patients. |
| Microorganism are able to get to the urinary tract through the meatus or the blood stream. Which is the most common route of infection? | Urethral meatus. |
| Why are urinary tract infections more common in women than in men? | Because of the proximity of the anus to the urethral meatus and the shorter urethra |
| Why does urinary retention increase the risk of urinary tract infection? | Because normal urine flow produces a flushing action that washes away microorganism. |
| How do microorganism feel about residule urine? | They think it would be a nice place to raise a family. |
| Name 8 signs and symptoms of an urinary tract infection. | Pain and burning with urination, frequency and urgency, fever, chills, N&V, malaise, hematuria, cloudy urine, |
| What are the addtional signs and symptoms associated with pyelonephritis? | fever, flank pain, tenderness, and chills |
| What sign might an older adult with urinary tract infection and accompanying fever display? | An alteration in mental status such as acute confusion. |
| What are the five types of incontinence? | Total, Functional, Stress, Urge, Reflex |
| What kind of incontinence causes a constant flow of uring at unpredictable times and is due to neuropathy of sensory nerves, trauma or disease of spinal nerves or urethral sphincter? | Total |
| What kind of incontinence could be caused by a fistula between the bladder and vagina; change in environment; senory, cognitive, or mobility deficits in which the patient has the urge to void but can not make it to the appropriate receptacle? | Functional |
| What is the difference in total and functional incontinence? | A person with functional incontinence has an intact urinary and nervous system |
| What kind of incontinence happens to women who have had several children when they sneeze? | Stress incontinence |
| What kind of incontinence is a strong urge due to decreased bladder capacity, irritation of bladder stretch receptors, alcolhol or caffiene ingestion, or too much fluid intake? | Urge |
| What kind of incontinence involves involuntary loss of urine occurring at somewhat predictable intervals when the patient reaches a specific bladder volume? | Reflex |
| What is a surgical process that creates a stoma on the outer abdominal wall for continuous urine drainage? | ureterostomy |
| What do you call an urostomy in which an artificial pouch is created that the patient learns to drain with a catheter periodically throughout the day? | Continent urinary diversion |
| What neglected aseptic step is responsible for most nosocomial infections? | lack of handwashing |
| ______ techniques is required for catheterization. | Sterile |
| _______ _________ is required for examination of gentalia or provision of perineal care. | Medical asepsis |
| At approximately what age do neuromuscular and cognitive functions develop to the point that a child is able to begin to control voiding? | 2-3years |
| What 3 things must a child be capable of before they can be successful in potty training? | Recognize the feeling of bladder fullness, hold urine or 1-2 hours, and communicate sense of urgency to parent |
| What is a developmental risk to males especailly after age 40 that may cause problems with urinary elimination? | The prostrate can enlarge and cause partial obstruction of the urethra resulting in inadequate bladder emptying. |
| How do hormonal changes in women increase the risk of urinary infections? | The lack of estrogen causes the urethral mucosa to become thinner, more fragile to injury and infection. |
| How does decrease in perineal muscle tone affect a woman's urinary elimination? | Decreased perineal muscle tone can contribute to increased urgency and stress incontinence. |
| The state in which an individual experiences a loss of urin of less than 50mls occurring with increased abdominal pressure | Stress incontinence |
| The state in which an individual experiences a continous and unpredictable loss of urine | Total urinary incontinence |
| 100mLs or more of urine remaining in bladder after voiding | Residual Urine |
| What procedure would be used to assess the entire urinary system and some of its functions by allowing the physician to see a radiopaque dye as it passes through the system? | Intravenous pyelogram |
| What procedure would be used if the patient were unable to receive IVP dyes? | Renal Scan |
| What kind of exam is used to visualize abnormal pathological conditions such as tumors, obstructions, retroperitoneal masses, and lymph node enlargement? | Computerized Axial Tomography |
| What procedure would be used to assess the entire urinary system and some of its functions by allowing the physician to see a radiopaque dye as it passes through the system? | Intravenous pyelogram |
| What procedure would be used if the patient were unable to receive IVP dyes? | Renal Scan |
| What kind of exam is used to visualize abnormal pathological conditions such as tumors, obstructions, retroperitoneal masses, and lymph node enlargement? | Computerized Axial Tomography |
| Constant, unpredictable flow; Nocturia; Unawareness of bladder fullness | Total urinary incontinence |
| Strong urge, Can’t make it to toilet before voiding | Functional urinary incontinence |
| Dribbling with increased intra-abdominal pressure, urinary urgency, frequency | Stress incontinence |
| Urinary urgency, Abnormal frequency (more often than every 2 hours), Bladder spasm, Nocturia, Small<100ml or large >550ml amounts of voiding | Urge incontinence |
| Lack of awareness of bladder filling, No urge to void, Uninhibited bladder contraction at regular interviews | Reflex incontinence |
| What effects does the GAS have on urinary elimination? | Urinary output decreases due to release of ADH and aldosterone |
| 30 to 50 mL of urine per hour indicates what? | Adequate renal perfusion and kidney function |
| What is the recommended daily amount of fluid intake to prevent urinary tract infections? | 2000mL, or 2 quarts of fluid |
| Where should we clamp the tubing attached to a urinary catheter in order to collect a urine sample? | 2-3 inches below the collection port. |
| What abnormal urinary function could be precipitated by outlet obstruction, decreased bladder tone, neurologic dysfunction, opioids, or trauma? | Urinary retention |
| What abnormal urinary function could be precipitated by infection, inflammation , or injury? | Dysuria |
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Perseverandovercome
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