Urinary Elimination and Incontinence
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| Where are the kidneys? | Lie on either side of vertebral column behind peritoneum - Left higher than right because of position of liver.
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| How much of CO does kidneys receive? | Highly vascular; receive about 25% of cardiac output
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| 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
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| 3 causes of kidney failure | intrarenal, postrenal, prerenal
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| Intrarenal | anything that directly damages the kidney tissue (drugs like vancomicine),
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| 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
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| Prerenal | affects blood flow to kidneys - Decreased blood flow to and through the kidney
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| Renal corpuscle | responsible for filtration – 125 mL/minute or about 20% is filtered through our glomerulus
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| lasix works here | Loop of Henle –– water reabsorption
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| 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.
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| Diseases that cause irreversible damage to kidney tissue result in | end-stage renal disease (ESRD).
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| Kidneys also affect Calcium & Phosphate regulation by | producing substance which converts vitamin D into active form
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| Calcium binds to | phosphate
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| Urine production should be a minimum of | one half ml/kg/hour (30 ml/ hr for 132
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| Proteinuria | sign of renal injury or infection - presence of large proteins in the urine (proteinuria) is a sign of glomerular injury.
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| Pressure within the bladder is usually | low, even when partly full, a factor that protects against infection.
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| 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.
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| Adult bladder can store up to | 600ml - urge to void felt at 150-200ml – 50 – 100 in a child.
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| When bladder full it | Expands and extends above symphysis pubis - Not palpable unless distended.
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| Length of urethra | In women 4-6.5 cm long, in men 20cm
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| What are 5 disease conditions which may affect renal function or urine elimination? | diabetes, multiple sclerosis, BPH (benign prostate hypertopy), Alzheimer’s, dementia
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| 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.
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| reflex incontinence | Damage to the spinal cord above the sacral region causes loss of voluntary control of urination
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| 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
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| End stage renal disease | do not produce urine so all the fluid backs up in body - uremic syndrome
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| uremic syndrome | increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome.
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| 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
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| Dialysate | sterile electrolyte solution instilled into peritoneal cavity by gravity via surgically placed catheter - remains in cavity & then drained out removing wastes
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| 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.
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| Epidurals affect bladder how? | relax the bladder and cause urinary retention.
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| 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.
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| pyridium turns urine | orange (and it stains)
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| Anesthetics and narcotic analgesics slow the | glomerular filtration rate, reducing urine output & impair sensory & motor impulses traveling between the bladder, spinal cord, & brain
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| Cystoscopy | water used to distend bladder -allows visualization of bladder mucosa & urine - retained which can increase chance of UTI.
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| Decreased blood flow to kidneys results in | decreased ability to conserve Na, dilute and/or concentrate urine & excrete acid load
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| 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.
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| BPH - benign prostatic hypertrophy | Results in hesitancy, retention, slow stream & UTI’s –residual in the bladder. Dribbling and up at night.
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| 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
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| 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
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| 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.
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| Contenent urinary diversions | illeal conduit – ureters are implanted into the intestines
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| Urinary retention | urine accumulation due to inability of bladder to fully empty - stress, urethral obstruction, childbirth, postop patients due to anesthesia.
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| Symptoms would be discomfort, low output, distended bladder - In the suprapubic area below umbilicus | urinary retention
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| Urinary Tract Infections – UTI | bacterial infection, can be caused by catheterization, hygiene, urinary retention – symptoms would be dysuria (pain), fever
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| Urinary incontinence | involuntary leakage of urine - Can occur when you have a disruption of muscle tone during trauma like surgery or childbirth.
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| Functional incontinence | urge to void but did not make it in time – bladder gets overfull and you leak – can occur during work
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| Overflow incontinence | lost sensation to urinate and it over flows and causes leaking of urine.
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| Reflex incontinence | associated with spinal cord injury because they have lost sensation to urinate.
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| Stress incontinence | sneezing, lifting, etc. Increased intra-abdominal pressure causes leaking.
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| Urge incontinence | urine output after strong urgency to void – prostate problems
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| 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.
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| Anuria | no urine is produced
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| Nocturia | awakening to void one or more times at night - often a sign of renal alteration.
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| Hematuria | Irritation to bladder & urethral mucosa results in blood-tinged urine
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| Dysuria | pain or burning during urination (dysuria) as urine flows over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the infection worsens.
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| Polyuria | excessive output of urine
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| Bacteriuria | bacteria in the urine - leads to spread of organisms into the kidneys & possibly leads to bacteremia or urosepsis (bacteria in the bloodstream)
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| Cystitis | irritated bladder (cystitis) causes a frequent and urgent sensation of the need to void.
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| Pyelonephritis | infection spread to the upper urinary tract (kidneys—pyelonephritis), flank pain, tenderness, fever, and chills are common.
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| BUN & Creatinine indicative of | renal function
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| Cystitis is usually marked by | urinary frequency and irritation.
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| The cloudiness of urine is usually indicative of | bacterial presence.
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| A renal stone presents with | pain and hematuria.
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| Clients should avoid fluids for __before bedtime to prevent nocturia. | 2 hours
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| The Foley catheter drainage bag should be below the level of the bladder to prevent | urinary reflux, which can lead to infection.
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| 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.
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| A client undergoes ultrasonography of a kidney. The nurse providing postprocedure care remembers that | There are no special precautions that must be taken.
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| 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
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| 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
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| beverages that are diuretics | tea, coffee,cola - alcohol inhibits the release of antidiuretic hormone, thus increasing water loss in urine.
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| When catheterization is performed at home by the client only | clean technique is required
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| __ acidify the urine, which creates an inhospitable environment for pathogens | Prunes, cranberry juice, and whole-grain breads – grapefruit is not
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