Urinary Elimination
Help!
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| How much urine can a normal bladder hold? | 600 mL
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| Within a normal 24 hour day, a person will void how much? | 1,500-1,600 mL
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| How does the kidney change when you age? | 20-30% decrease in size and weight between the ages of 30-90; after the age of 70, a person loses 30% of the glomeruli function
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| For women who are menopausal what would increase their risk of urinary incontinence? | Using hormone replacement therapy
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| What are the effects of an enlarged prostate? | hesitancy, urine retention, slowing of the urinary stream and bladder infections
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| When assisting a pt using a bedpan, what are two key points to keep in mind? | Give plenty of privacy (by closing curtains) but stay close by to provide assistance as needed.
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| When is one time of the day that you can almost always anticipate your patient needing to void? | When they first wake up.
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| What are the gender specific differences when voiding? | Women prefer to sit on the toilet and men prefer to stand.
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| What are some psychological problems concerning voiding? | 1) Anxiety and emotional stress may cause a sense of urgency and increased frequency of urination. 2)Paruresis
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| Paruresis | Inability to urinate in public restrooms or in situations where others may be aware of the person voiding.
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| What are some other terms you could use when refering to paruresis? | Shy bladder syndrome, bashful bladder, bladder shyness
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| What is wrong with a person's urinary tract that caused the paruresis? | Nothing is physically wrong with the urinary system, it's not a physical condition
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| What are some treatment plans to consider with a pt that suffers from paruresis? | Have men use a stall instead of a urinal, flushing toilet first to help start stream, distracting thoughts, psychotherapy,hypnosis, self-catheterization
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| Poor control of voiding can result from... | Muscle wasting caused by immobility, stretching of muscles during childbirth, menopausal muscle atrophy, traumatic damage to muscle, and prolonged use of indwelling catheter.
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| What ways does the body excrete fluids? | urine, feces, and insensible water loss (perspiration and respiration)
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| Polyuriaa | An excessvie output of urine
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| Oliguria | Urine output that is decreased despite normal intake
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| How can oliguria occur? | perspiration, diarrrhea, vomiting, kidney disease, edema
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| Diuresis | Increased urine formation
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| What foods can cause diuresis? | Coffee, tea, cocoa, sodas, all drinks that contain caffeine and foods that contain a high fluid content.
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| Diaphoreses | Excessive sweating
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| How do anesthesia and narcotic analgesics affect urine output? | May alter the glomerular filtration rate reducing urine output, pts recovering from anestesia and deep analgesics often do not sense bladder fullness and spinal anesthetics increase the risk of urinary retention.
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| Diuretics prevent the reabsorption of | water and certain electrolytes to increase urine output.
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| What are the types of drugs that can cause urine retention? | antichlinergics, antihistimines and antihypertensives.
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| Aldomet | antihypertensive ddrug
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| Which meds can change the color of urine? | Pyridium will change the color to appear bright orange or rust colored. Chemotherapy drugsmay change the color of the urine and can be toxic to the kidneys or the bladder.
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| Urinalysis | general examination of urine to sestablish baseline information or provide data to establish a tentative diagnosis.
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| Urine culture | aka Clean catch-midstream. Confirms suspected UTI and identifies the causative organ
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| Cytoscopy | Involves the direct visualization of urinary structures
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| What affect will cytoscopy have on the patient? | Pt will often have urinary retention and may pass red or pink urine b/c of the trauma to the urethral or bladder mucosa.
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| When performing a nursing assessment for elimination status, what questions would you ask to establish a pattern of urination? | Average number of times a day that you void, usual time at voiding, and have there been any recent changes?
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| urgency | feeling a need to void immediately (STAT) :)
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| Dysuria | painful or difficult urination
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| Frequency | voiding at frequent intervals (less than every 2 hours)
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| Hesitancy | difficulty initiating urination
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| Polyuria | voiding large amounts of urine
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| Oliguria | diminished urinary output relative to intake
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| Nocturia | excessive or frequent urination at night time
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| Dribbling | leaking of urine despite voluntary contol
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| Hematuria | blood in the urine
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| Retention | accumulation of urine in the bladder with the inability of the blader to empty fully.
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| Residual urine | volume of urine remaining after voiding (greater than 100mL)
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| What are some other factors affecting urination? | nutrition intake, medications, exposure to cleaning solvent, pesticides or other nephrotoxic agents, sensory or motor deficits, personal habits, past illnesses that increase the risk of urinary alterations, family Hx of alterations, urinary diversion
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| When performing a physical examination (focused on voiding), what aspects do you want to focus on? | Skin and mucosal membranes, kidneys and bladder, urethral meatus and urine assessment.
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| What are you going to focus on when you are assessing the skin and mucosal membranes? | hydration status and skin breakdown due to urinary incontinence
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| What are you going to focus on when you are assessing the kidneys? | Assess for flank tenderness by percussing the costovertebral angle; auscultation also performed to detect the presence of renal artery bruit
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| What are you going to focus on when you are assessing the bladder? | bladder distention, bladder is not percussible until it contains 150mL of urine, if the bladder is full dullness will be heard above the symphysis pubis.
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| What are you going to focus on when you are assessing the urethral meatus? | discharge,inflammation, or lesions
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| What are you going to focus on when you are assessing the urine? | I&O, characteristics of urine, urine testing, specimen collection
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| What are the common urine tests? | urinalysis, specific gravity and urine culture
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| Stress incontinence | Leakage of small amount of urine caused by sudden increase in intra-abdminal pressure.
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| What are some causes of stress incontinence? | coughing, laughing, and exercise, number and difficulties of childbirth, weak pelvic musculature, incompetent bladder outlet, obesity
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| Urge incontinence | Involuntary urine loss that occurs due to detrusor muscle over-activity
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| What are some causes of urge incontinence | symptoms of urinary tract infection; frequency, dysuria, hematuria, and nocturia, urgency of micturation, alcohol and caffeine intake and increased fluid intake
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| Overflow incotinence | occurs b/c of over-distention of the detrusor muscle
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| What are some causes of overflow incotinence? | under-active detrusor muscle secondary to drugs, fecal impaction and diabetes, prostate enlargement, uterine prolapse
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| Reflex incontinence | Occurs as a result of neurologic impairment of the central nervous system
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| What are some causes of reflex incontinence? | involuntary loss of urine occurring at somewhat predictable intervals, unawareness that bladder is filling, and lack of urge to void.
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| Functional Incontinence | Involuntary unpredictable passage of urine in persons with intact urinary and nervous system.
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| What causes functional incontinence? | caused by a change in environment, sensory, cognitive, or mobility deficits, the pt has a fully functioning urinary tract but cannot make it to the bathroom in time due to physical or cognitive disabilty
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| Cytoscopy | A thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder
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| Urodynamic studies | Investigation of bladder function and control of micturition under quasi-physiological condition, various techniques used to measure pressure in the bladder and the flow of urine.
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| Urinar flow rate | measure of urine flow rate
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| Cystometrogram | evaluates detrusor muscle function/evaluat bladder tone
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| Electromyography | Assesses sphincter and perineal muscles
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| voiding pressure flow | detects outlet obstruction or determines "leak point pressure"
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| videourodynamics | Anatomic imaging
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| Proactive stress testing | pt coughs vigorously while examiners observe for leakage
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| Post void residual | catheterization or bladder scan immediately following voiding
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| What are the normal findings with a post void residual exam? | 50 mL or less
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| What can you ask the patient to keep track of (at home)? | Fluid intake and output and keep a urinary diary
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| What is some general advice that you could give to a person who is having minor incontinence problems? | lose weight, decrease fluid intake and Kegel exercises.
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| Kegel | Pelvic floor exercises-the practice of stopping the flow of urine (the pt does not need to be in the middle of urinating to perorm this exercise)
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| Biofeedback | use of special vaginal or rectal probes
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| Electrical stimulation | use of very low voltage, used with urge and stress incontinence
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| vaginal cones | Cones are different sizes and weight to strenghthen muscle tone.
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| What types of drugs can you give to treat urinary incontinence that occurs with increased intra-abdominal pressure? | Anticholinergic drugs
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| pseudoephedrine/Sudafed | beta adrenergic with anticholinergic effects
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| What medications can you use to treat urinary incontinence due to over-distention of the bladder? | None; the only treatment is a foley catheter
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| How would you define severe urinary retention? | accumulation of urine in the bladder that you are unable to empty. 2,000-3,000 mL
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| What are the symptoms of urinary retention? | suprapubic pressure, discomfort, tenderness, restlessness, diaphoresis, and retention overflow (25-60 mL)
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| What are some causes of urinary retention? | Urethral obstruction, surgical trauma, alteration in motor and sensory innervation, medication side effects, medications, and anxiety
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| Burch colposuspension | Surgical procedure to correct the position of the bladder and urethra neck.
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| Marshall-Marchetti-Krantz | Similar to the Burch Procedure. Surgical approach requires a wide abdominal incision; surgeon then elevates the urethra and bladder neck using sutures.
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| Sling procedure | Surgical procedure that involves making an incision above the pelvic bone and removes a layer of the fasci. The piece of muscle fiber is then attached under the urethra and bladder. The sling compresses the urethra back to its original position.
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| What drugs cause urinary retention? | tricyclic antidepresents-Tofranil, elavil
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| What drugs have a side effect of urinary retention? | Opioids, beta-adrenergic receptor and calcium channel blockers
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| Indwelling catheter | Urethral catheterization requires a physician’s order. The nurse must use strict sterile technique when inserting a catheter.
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| Intermittent catheterization is used to check | residual urine
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| Intermittent catheterization | In and out catheterization; a straight-single use catheter is introduced long enough to drain the bladder (5 to 10 minutes).
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