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bladder capacity of the infant from 50cc-250 cc.
specific Gravity of their urine is around 1.008
what color is an infants urine PALE YELLOW, straw-colored—almost odorless
an infants Patterns of voiding should void within 48 hours after birth, then 5-25X/24 hr, or 25 mL/kg/day
Infection in newborns is usually due to structural problems, such as Obstructions or Malformations, and infection due to proximity of urethra to anus in female infants.
Preschoolers capacity of the bladder increases to ~250 mL
Urinary control usually occurs between the ages of 2-5. This should NEVER be a punitive process
Girls MUST be taught to wipe from front to back
The #2 cause of infection in children is UTI
School Age children The size of the child’s kidney Doubles
from age 5-10 voiding _____ times per day 6-8
enuresis “involuntary urination after control should be established”
Nocturnal Enuresis episodes of bed wetting
Elders Bladder tone: Bladder more fibrous (Less elastic)
Nephrons begin to diminish after the age of 40—if otherwise healthy,
no functional issues until 80’s or 90’s, but renal function of 85-yr-old only 50% of 30-yr-old!
Salt: Causes the body to and why retain fluid Why….to maintain homeostasis normal concentration of Na+ and KCL.
Fluids that contain caffeine increase urine production
Intake. Alcohol _________ output (diuretic) but also _______ the body by _________ the production of ___ increases dehydrates inhibiting ADH
Beets may cause your urine to have a ___ cast Red
Asparagus makes your urine smell really ___ Bad
Foods high in carotene can deepen the _______ color. Yellow
Loop diuretics work in the Loop of Henle by blocking reabsorption of sodium & chloride
Thiazide diuretics work on the distal tube to block sodium reabsorption & increase potassium & water excretion
Potassium-sparing diuretics work in the distal tubule to allow sodium excretion, while restoring much of the K+ to the body, avoiding the potassium depletion seen with other types of diuretics Also miscellaneous diuretics carbonic anhydrase inhibitors & osmotic diuretics
when on diuretics you need to watch for: hydration & electrolyte balance, vital signs (especially for hypotension d/t fluid loss), BUN, creatinine, electrolytes, & other pertinent values. Avoid salt substitutes with K+-sparing diuretics
_____makes your urine Orange AZO Also pyridium
Some chemo drugs can cause what color of urine. red or green
It is important to know which Medications cause retention.
what medications can cause retention Sudafed, Benadryl, atropine, B/P meds, opioids
Changes in the client’s ____ system especially the _______ can affect the production of urine renal nephrons
spme surgeries can cause Swelling, anesthesia, Post-Op Bleeding, Sometimes spinal anesthesia may alter a patient’s ability to feel the need to void.
Pelvic muscle tone affects urination—poor in pts who have had catheters recently, or for longterm
Polyuria Diuresis –May be several liters more than usual output.
Polydipsia This is often associated with Diabetes and Nephritis.
Polydipsia can lead to: dehydration & Weight Loss
Anuria No urine production; almost always due to renal disease
Oliguria Low output < 30 mL/hr, or 500 mL/24 hours hours in adult
Polyuria can: ↑thirst, dehydration, wt loss
Dialysis: Hemodialysis is the exchange of body wastes across a semipermeable membrane via vascular catheters;
Peritoneal Dialysis Fluids are instilled into the abdomen & the fluid & molecules exchange, then drain out through an abdominal catheter.
Nocturia > 2 times at night
Frequency > 6 times per day (UTI, Diabetes, Pregnancy, Stress)
Urgency --“Gotta go NOW”, from irritation, poor sphincter control, bladder spasms, stress
Dysuria Pain or burning with urination (UTI, stricture, or stone accompanied by Hesitancy
Hesitancy Difficulty starting urinary stream
Neurogenic Bladder Incontinence, overfilling, or incomplete emptying of bladder
Intake and Output Change in I & O is a significant indicator of fluid alterations or kidney disease
Order: Will read I & O- measure everything that goes in and everything that comes out
Measurement red flag is hourly- an output of less than 30 ml for more than 2 hours
Volume: 1200-1500 Less than 1200;
Color clarity: Straw to Amber Transparent
Bad colors are Dark cloudy, Orange, red or brown thick or obvious sediment
Odor: Faint aromatic; some foods change the smell of urine such as asparagus
Bad odor Offensive smell Urine high in glucose may have a sweet smell:
pH 4.5-8.0 the pH may indicate the client’s diet or state of nutrition.
Ketone bodies None; Presence of Ketones is highly indicative of uncontrolled diabetes or starvation;
Specific gravity 1.010-1.025 –density compared to water (1.0) The higher the concentration the higher the SG
Color: Renal Bleeding dark red (older blood)
Color Bladder bleeding bright red
Color High concentration- dark amber
why do we need to Get specimens to lab ASAP or refrigerate Clear at time of voiding- May become cloudy as it sits
Renal disease may look cloudy or foamy due to the high protein conc
Bacteria- thick and cloudy
Odor of stagnant urine Stagnant urine has ammonia odor-common with incontinence.
Cystoscope Use conscious sedation to decrease anxiety-direct examination for structural abnormalities (going into bladder with a light and camera)
Noninvasive Procedures KUB (kidneys, ureters, bladder x-ray) -IVP (intravenous pyelogram—dye) -CT scan -Renal scan - Ultrasound (like radar)
Retention Urinary retention may be due to poor contractility of the bladder, changes in outflow: Prostate enlargement, medications, and surgery
Functional: Inability of Continent people to reach the toilet in time—can’t respond to need to void—dementia, impaired mobility, diuretics, sedation, depression, regression (physical, environmental, psychosocial causes)
Reflex: Urine loss occurs when a certain volume is reached
Stress: Urine loss with increased abd. Pressure (cough, sneeze, lifting, laughing) decreased urethral resistance, weak muscles & weak urethra
Total: Complete inability to hold urine; loss of control in all situations & positions
Urge: Inability to hold urine after the urge to void is noticed—”overactive bladder”—strong urge to void—detrusor muscle hyperactive
Overflow (with retention): can’t empty bladder—frequent loss of small amounts urine (25-50 mL)
D.I.A.P.E.R.S. D- Delirium I- Infection A- Atrophic P- Psychological E-Endocrine R- Restricted Mobility. S- Stool
Congenital disorders: epispadias (absence upper wall urethra),
Congenital disorders: meningomyelocele (neural tube defect; spinal cord protrudes through vertebral column
Acquired disorders: CNS system, spinal cord trauma; stroke
Chronic disorders: MS, Parkinson’s disease
Tofranil control smooth muscles of bladder neck for mild stress incontinence
estrogen therapy post-menopausal atrophic vaginitis
oxybutynin-Ditropan urge incontinence—drugs to inhibit detrusor muscle contractions, ↑ bladder capacity anticholinergic
tolterodine—Detrol antimuscarinic agents
Ditropan & Detrol can be taken once or twice daily & have fewer side effects than other anticholinergic agents. Contraindicated for pts with glaucoma (increased pressure in eyes). Urinary retention is potential side effect
Fluid intake of at least 1.5-2L/day; better to be 2-3 L daily, but ↓ in evening
↓ consumption of beverages containing (all bladder irritants) caffeine citrus juices, artificial sweeteners with NutraSweet & ↓ alcohol
Use behavioral techniques such as scheduled toileting, habit training, bladder training (↑’ing intervals gradually to ↑ capacity. Resist urge to void more freq (to 300 mL/void)
When bladder contains 250-450 mL, signal to CNS of need to void. Can consciously inhibit this urge (as nurses often do at work)
Voluntary urinary retention failure to respond by voiding when bladder contains > 300 mL can stretch detrusor muscle & cause loss of muscle tone, and can lead to overfilling.
Continent Stoma Kock Pouch Neobladder
incontinent stoma Ureterostomy Nephrostomy Vesicostomy Ileal conduit
Ureterostomy Bringing the end of one or both ureters to the abdominal surface
Catheterization: Introducing a rubber or plastic tube through the urethra and into the bladder
Intermittent Catheterization: Relief of discomfort Obtaining sterile specimen Assessment of residual Long-term management
Indwelling Catheterization: Obstruction of urine outflow Surgical repair of urinary tract Measurement of strict U/O Bladder irrigation Severe retention
Kegel exercise Strengthening Pelvic Floor Muscle-
Bladder Retraining- Increase interval between voids
Created by: ED.