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NURS 106 Exam 2
Urinary Elim (W & VL) NURS 106 Exam 2
| Question | Answer |
|---|---|
| What 6 factors play a role in urinary health? | personal hygiene, age, nutrition, stress, sexual activity, medications |
| What do the kidneys do? | filter metabolic wastes, toxins, excess ions, H20, regulate blood volume, blood pressure, electrolyte, pH, and acid base balance |
| What are the secondary functions of the kidneys? | production of erythropoietin, secrete enzyme renin and activate vitamin D |
| What part of the kidneys form urine? | the functional unit: the nephrons |
| What is the glomerular filtration rate? | amount of filtrate formed by the kidneys in 1 min. |
| ADH does what? | It causes the distal convoluted tubules and collecting ducts to reabsorb more water into the blood - due to decreases in fluid in the body. |
| What does aldosterone do? | increases re-absorption of water and sodium back into the blood |
| What two hormones help maintain normal blood volume and and pressure when the fluid in the body decreases? | ADH and Aldosterone |
| When there is too much water in the body what occurs? | ADH is suppressed and urine becomes more dilute and water continues to be eliminated until urine returns back to normal |
| What organ transports urine? | ureters |
| How does the ureters move urine toward the bladder? | peristaltic waves |
| What can an average normal bladder store of urine? | 500 mL - but can distend when needed to a capacity twice that amount |
| Can you palpate an empty bladder? | No - but you can palpate a full or distended bladder in the suprapubic region |
| How long is the average female urethra? | 3 - 4 cm or 1.5 inches |
| How long is the average male urethra? | 20 cm or 8 inches |
| How does urinary elimination occur? | the internal urethral sphincter relaxes when 200-450ml of urine activates the voiding reflex center from stretch receptors in the bladder and the detrusor muscles contract.. but can be temp. stopped by the external urethral sphincter. |
| How much urine does the kidneys produce in an hour? | 60 mL per hour |
| How much urine does the kidney produce in a day | 1500 mL (fluctuate from 1000 mL - 2000 mL) |
| What is the normal specific gravity range? | 1.002 to 1.028 |
| How much urine does newborn kidney's produce? | 15-60 mL per kilogram of body weight |
| Define enuresis | occasional wetness and is normal in children even in early school years |
| Define nocturnal enuresis | bed wetting and is considered normal until age 6 |
| Define nocturnal frequency | urinate during the night |
| What conditions can lead to leakage of urine? | enlarged prostate gland, weakened pelvic muscles from child bearing, lost of bladder elasticity |
| Define urinary stasis | delaying of urination, stoppage of flow |
| What personal environmental factors affect urination? | lack of time, lack of privacy, loss of dignity, cultural influences, |
| What substances increase urine production? | caffeine, chocolates act as diuretics or large amounts of alcohol which blocks ADH |
| what causes water retention? | high salt diet |
| What are thiazide diuretics? | treat high blood pressure reducing amt of sodium and water in the body and dilates blood vessels |
| What are loop acting diuretics? | they cause the kidney to excrete more urine by reabsorbing less water - this reduces amt of water in the body decreasing BP |
| Meds that have significant interaction with diuretics | digoxin, antidepressants, other high blood pressure meds |
| Common side effects of diuretics? | weakness, muscle cramps, skin rash, increased sensitivity to sunlight, dizziness/lightheaded, joint pain |
| Define nephrotoxic | damaging to the kidneys |
| What meds are nephrotoxic | long term or high doses of aspirin and ibuprofen |
| Define renal calculi | kidney stones or tumors which obstructs normal flow of urine |
| How does an hypertrophic prostate affect urinary system? | it is either benign or cancerous and can interfere with flow of urine |
| How does cardiovascular and metabolic disorders affect the urinary system? | decrease blood flow through the glomeruli and impair filtration |
| Neurogenic bladder | occurs due to impaired neurological function, the person cannot perceive when their bladder is full or control urinary sphincters |
| what does a systemic infection with a high fever cause in the urinary system? | results with the kidneys reabsorbing and retaining water |
| To assess urinary elimination what data will you need? | nursing history, physical examination, diagnostic and lab reports |
| When a pt indicates distress regarding urination, incontinence with activity and decreasing oral liquids to control incontinence post prostatectomy surgery, what is the nursing diagnosis? | Stress urinary incontinence due to disruption of urinary sphincter and related pelvic muscles |
| Acute Renal Failure (ARF) | an acute rise in the serum creatinine level of 25% or more. May be caused by inadquate blood flow to kidneys, injury to kidneys, obstruction of outflow |
| Anuria | absence of urine - when output is less than 100ml in 24 hours |
| dysuria | painful or difficult urination maybe associated with infection or partial obstruction or meds that trigger urinary retention |
| End stage renal disease ESRD AKA chronic renal failure | a permanent rise in serum creatinine levels associated with loss of kidney function and must be treated with dialysis or transplantation |
| Frequency | need to urinate at short intervals |
| Hematuria | blood in the urine may due to trauma, kidney stones, infection or menstruation |
| Oliguria | urine output of less than 400 ml in 24 hours |
| nephropathy | a broad term meaning disease of the kidney |
| nephrotoxic | a substance that damages kidney tissue (ex include: lead, nonsteroidal anti-inflammatory drugs) |
| Nocturia | frequent urination after going to bed may be caused by excessive fluid intake as well as UTI or cardiovascular problems |
| Pyuria | pus in the urine (WBC) maybe caused by lesions or infection of the urinary tract |
| urgency | a sudden almost uncontrollable need to urinate |
| Can you delegate bedside urine testing to unlicensed assistive personnel? | Yes, if you know that they have the knowledge and skill to perform the procedure.Have the UAP report the results and keep the sample in case a repeat test is deemed necessary. |
| What is a refractometer | Determines specific gravity. It measures the extent to which the beam of light changes directions when it passes through urine. If concentration of solids is high, the light is refracted more |
| Urinometer or hydrometer | measures specific gravity if body floats in liquid the concentration of dissolved substances is high and low if it sinks |
| Name some urinary nursing diagnosis | impaired urinary elimination, urinary incontinence (functional, reflex, stress, total, urge), risk for urge urinary incontinence, urinary retention, risk for UTI, readiness for enhanced urinary elimination |
| UTI is typically due to what microbe? | Esherichia coli or e.coli |
| Urethritis | infection limited to urethra |
| Cystitis | when bacteria travels up the urethra into the bladder causing bladder infection |
| Pyelonephritis | when infection moves from bladder to the ureters or kidneys |
| What are the risks for UTIs? | Sexually active women, women who use spermicidal contraceptive gel, older women due to loss of estrogen, men with enlarged prostates, kidney stones, anyone with or has an indwelling cath, people with DM, people with history of UTIs |
| What are the signs for a UTI? | urinary freq, urgency, foul smelling urine, pyuria, dysuria, hematuria, edema, chills, fever, back pain, nausea and vomiting, bladder spasms |
| Urinary retention | inability to empty the bladder completely |
| Etiologies for urinary retention | obstruction, inflammation, swelling, neurological problems, meds, anxity |
| Can fecal impaction cause an obstruction in urination? | Yes |
| Define urinary incontinence (UI) | lack of voluntary control over urination |
| Is incontinence a normal change that occurs with aging? | HELL NO its a myth |
| Urge incontinence | involuntary loss of urine associated with strong urge to void or overactive bladder |
| stress incontinence | involuntary loss of urine with increased intraabdominal pressure (less than 50 mL of urine). Activities that produce it is exercise, laughing, coughing, sneezing, lifting. |
| Mixed incontinence | combo of urge and stress |
| overflow incontinence | loss of urine in combination with a distended bladder |
| functional incontinence | involuntary loss of urine in the absence of urinary system injury or nervous system problem. It is when the person usually can't get to the toilet in time. |
| transient incontinence | short term incontinence that is expected to resolve spontaneously |
| unconscious reflex incontinence | loss of urine when person does not realize the bladder is full and has no urge to void. A CNS disorder and multisystem problems are the common cause. It is involuntary loss of urine at somewhat predictable intervals when a specific volume is reached. |
| Enuresis | familial, involuntary urination after 5 to 6 years of age |
| Nocturnal enuresis | bed wetting, typically if bladder training was never achieved (primary), or if control was established and then lost (secondary) |
| Incontinence nursing interventions | kegel exercises, |
| urostomy? | urinary diversion - a surgical procedure that create an opening for elimination of urine |
| How does urostomy work? | urine does not go through urethra, instead it passes the bladder and is expelled through a stoma or ostomy. Voluntary control is lost. |
| Hydronephrosis | distention of the kidneys with urine from obstruction of the ureter |
| cutaneous ureterostomy | reroutes ureters directly to surface of abdomen forming a sm stoma |
| ileal conduit or brickers loop or ileal loop | most common, small piece of ileum removed with blood and nerve supply and is made into a stoma. |
| continent urostomy or ileal bladder conduit or kock pouch | urine drains from the ureters to surgically created ileal pouch, the stoma on the abdomen contains a nipple valve to keep urine from leaking and a cath is used to drain the urine |
| what is the general goal of urinary elimination? | to comfortably void 1500 mls of light yellow urine in 24 hours |
| what are nursing activities for pt's with elimination problems | promoting normal urination, preventing UTIs, managing urinary retention, managing incontinence, caring for pt's with urinary diversion |
| How much should pt's drink a day? | 8 to 10 large glasses or 3000 mls of fluid a day unless health problems limit there intake |
| Crede's maneuver | apply manual pressure over the bladder to promote emptying |
| post void residual volume | urine that remains in the bladder after pt voids |
| When performing a male cath what must u do to the penis | elevate the penis so that it is perpendicular to the body |
| what should you always check before performing catheterizations | whether the pt has any latex or iodine allergies |
| straight cath | single lumen tube inserted for immediate drainage of the bladder to obtain sterile urine specimen or measure post void residual vol or to relieve temp bladder distention |
| indwelling cath | is for continuous bladder drainage and is usually a double lumen tube one for drainage and the second to inflate a balloon near the tip of the cath |
| when is a triple lumen indwelling cath is used | when pt requires intermittent or continuous bladder irrigation |
| suprapubic cath | used for continuous urine drainage when urethra must be bypassed after gynecological surgery or when there is a prostatic obstruction, it is inserted through an incision above the symphysis pubis |
| What position should the pt be when inserting a cath? | dorsal recumbent position if women cannot assume this position try sims or lateral position |
| Name some nursing goals for pt's with indwelling caths | prevent UTI, maintain free flow of urine, prevent transmission of infection, promote normal urine production, maintain skin and mucosa integrity |
| Name some nonpharmacological treatment options for urinary issues? | life style mods, bladder training, scheduled voiding, pelvic floor muscle rehabilitation, vaginal weight training, biofeedback and supportive interventions |
| pessary or intravaginal support device | insert in the vagina that prevents pelvic organ prolapse, which may trigger UI |
| anti incontinence devices | devices that reduce the incident of urinary incontinence or provide a pathway for urine flow |
| Enuresis | occasional wetting |
Created by:
lydia.koo
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