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Chapters 15, 20, 22, & 49

What technique is used when catching a midstream urine specimen? Clean
What are the two ways to collect a sterile urine specimen? Straight Catheter & Indwelling Catheter
Does a straight catheter stay place or get removed after specimen is collected? Removed
How do you maintain sterile technique when collecting urine from indwelling catheter? Clamp hose 30 mins prior to collecting, clean port w/alcohol, use needle to withdrawal urine
What is residual urine? Urine that is left in the bladder after voiding
How do you check for residual urine? Have patient void, wait 10 min, then collect specimen using a straight catheter.
What amount is considered residual urine? < 50mL of urine
What test can be performed to check for renal function and urine composition? 24 hour urine collection
What is not collected during a 24 hour urine collection? First void
What do you do if urine is accidentally discarded or contaminated? Restart the 24 hour test the next day
What is the best way to notify all staff that a 24 hour urine collection is being done? Note on bathroom door and bedside table
What is the function of fluid (water) in the body? Provide extra cellular route to deliver nutrients to the cells and carry waste products from the cells
What provides a medium in which chemical reactions, or metabolism can occur with in the cell? Fluid (Water)
What acts as a lubricant for tissues, aids in the maintenance of acid-base balances, and assist in heat regulation via evaporation Fluid (Water)
What does the percentage of body weight that is water depend on? Age, Intake, & Output
What percentage of body weight is water in a premature infant? 90%
What is the normal daily loss of fluid equated to? Normal daily equated
What is the approximate daily water intake & output? 2500mL
How does fluid leave the body? Kidney's, lungs, skin & GI tract
How is water loss replenished? Ingestion of liquids, foods, by metabolism of food, and body tissues
What does intake include? All fluids entering the body
What are examples of fluids entering the body? Liquids taken orally, consumed in food, foods that assume a liquid consistency at room temperature, tube feedings, parenteral feedings, IV fluids, CBI, blood components, and TPN
What does output include? All fluids leaving the body
What are examples of fluids leaving the body? Urine, diarrhea, vomitus, NG suction, chest tube drainage, drainage from surgical wounds, and drainage collected in surgical receptacles (JPeg, Davol, Hemovac)
What do you use to measure output from surgical receptacles or bags? Graduated Container (DO NOT USE measurements from bags)
What plays an extremely important role in fluid balance? Kidney's
What happens when kidney's are not functioning properly? Body has great difficulty regulating fluid balance
What is Glomerular Filtration Rate (GFR)? Rate at which the nephrons filter blood
What is normal GFR? 125mL/min or 180L/day
How much output of urine does normal GFR lead to? 1-2L/day
How much does 1L of fluid equal in kg? 1kg (2.2lb)
What does weight change of 1kg reflect? Loss or gain of 1L of body fluid
What is urinary elimination? Maintaining adequate urinary drainage
What are the 12 types of catheters? Coude, Foley, Malecot, Pezzer, mushroom, Robinson, whistle-tip, cystostomy, vesicostomy, suprapubic, and texas
Why is a coude catheter selected? Ease of insertion when enlargement of the prostate is suspected
How is a foley catheter designed? With a balloon near the tipe to be inflated after insertion, holding the catheter in the urinary bladder for continuous drainage
What is a ureteal catheter? Long and slender to pass directly into the ureter
Where are suprapubic catheters placed? Introduced through the abdominal wall above the symphysis pubis. They are used to divert urine flow from urethra to treat injury to bony pelvis, urinary tract, or surrounding organs, strictures, or obstructions
What is the typical size for an adult catheter? 16 French
What is the other name for a Texas catheter? Condom catheter - is not a catheter, but a drainage system connected to the external male genetalia
Why is a texas catheter used? Minimize skin irritation from urine
What technique is used for self-catheterization? Clean
Why would someone use self-catheterization? Patient experience spinal cord injury or other neurological disorders that interfere with urinary elimination
What does intermittent self-catheterization promote for a patient? Independent function
When is perineal care & cleaning of the first two inches of a catheter done? Every 8 hours
What should normal urine NOT have in it? Albumin, glucose, erythrocytes, ketones, or leukocytes
What is the pH range for normal urine? 4.0-8
What color is normal urine? Yellow/clear
What is normal urine clarity? Clear
What does lower urine specific gravity indicate? Hydration
What does higher urine specific gravity indicate? Dehydration
What could albumin in the urine indicate? Renal disease, increased BP, or toxicity of the kidney cells from heavy metals
What could glucose in the urine indicate? High glucose levels
What do erythrocytes in the urine indicate? Infection, tumors, or renal disease
What do ketones in the urine indicate? Too many fatty acids are oxidized
What is found in the urine when there is an infection in the urinary tract? Leukocytes
What characteristic are in abnormal urine? Amber or orange, cloudy
At what age do kidneys have a 50% loss of filtering? 70
What occurs at age 70? Bladder loses tone, perineal muscles relax, and incomplete emptying of the bladder
What is the most objective way to check for residual urine? Bladder scanner
What can improve urinary incontinence? Kegel exercises & bladder training
What is urinary retention? Inability to void
What may increase with urinary retention? Risk of infection
What is insensible fluid loss? That which can not be directly measured, such as fluid loss during respiration and perspiration
What is the composition of urine? 95% water, remainder is nitrogenous wastes and salts
What is the normal urine specific gravity? 1.003 - 1.030
Normal urine is sterile, but what happens to it when it reaches room temperature? Rapidly decomposes and smells like ammonia as a result of the breakdown of urea
What are signs of dehydration? Tenting, dry cracked tongue & lips, sunken eyes, decrease in urine volume, increase in urine specific gravity, low BP, weak rapid pulse, dyspnea, respiration's rapid & shallow (pediatric pt. will have sunken fontanel)
What are signs of over-hydration? Cool, pale, moist skin, puffy eyes, distention of jugular vein, edema of extremities, frequent/moist bm, light colored urine, high BP, labored breathing with exertion, pink & frothy sputum
Can involuntary incontinence be permanent or temporary? Both
What are secondary causes to urinary incontinence? Infection, loss of sphincter control, sudden change in pressure in the abdomen
What is involuntary loss of urine? Leaking with coughing, sneezing, or lifting
What are the ways to medically manage involuntary incontinence? Treat underlying cause, surgical repair of bladder, temporary or permanent catheter, bladder training, kegel exercises, avoiding caffeine & spicy foods, and meticulous skin care to reduce risk of skin impairment
What is functional incontinence? Inability to get to the bathroom to urinate
When does overflow incontinence occur? When bladder is distended, preventing it from emptying normally
What is the most common cause of overflow incontinence in males? Enlarged prostate
What is stress incontinence? Increased abdominal pressure that causes urine to leak out of the bladder
What is urge incontinence? Over active bladder - inability to keep urine in the bladder long enough to get to the bathroom
What are symptoms and triggers to urge incontinence? Frequent urination day/night, urine leakage, hearing water run, drinking liquid, or washing hands, or typing this study stack!
What happens with a neurogenic bladder? There is a loss of voluntary voiding control, which results in urinary retention or incontinence
What is the cause of neurogenic bladder? Lesion of the nervous system that interferes with normal nerve conduction to the urinary bladder, often happens with spinal cord injury
What are the clinical manifestations of neurogenic bladder? Infrequent voiding, incontinence, diaphoresis, flushing, nausea prior to reflux incontenence
What are the nursing interventions to neurogenic bladder? Antibiotics (urecholine), intermittent catheterization, and bladder training
What does bladder training involve? Developing the muscles of the perineum to improve control over voiding
What are the ways to retrain the bladder? Kegel exercises, reduce fluid intake before bedtime, put patient on toilet every 2hr schedule during the day
When can bladder training begin? When catheter is in place
How is bladder training completed while catheter is in place? Clamp is placed and removed on catheter at prescribed times
What important to maintain urinary function? Limit caffeine intake, monitor fluid intake, have prostate checked, and monitor emotions
Why does caffeine increase urination? Diuretic effects
What does more fluid intake equal? More fluid output
What happens when a male has an enlarged prostate? Lead to difficulty in voiding
What type of emotions can cause frequency in urination? Fear, anxiety, and excitement
Why is a straight catheter used? To obtain a specimen when patient is unable to void
Why is an indwelling catheter inserted and left in place? For continuous drainage
When is a three way indwelling catheter used? After surgery to prevent occlusion of the catheter with blood clots
What is a non-invasive way to prevent skin irritation on a male? Use a texas catheter
Why must you never use tape to secure a texas catheter? It is likely to limit circulation to the penis, which can lead to necrosis of the skin and penis
A texas catheter should be pain free, what do you do if patient experiences pain? Remove the catheter
What are the steps to collecting a midstream (clean catch) specimen? Patient cleans perineum, starts to void, stops midstream, places specimen cup to collect specimen, restarts to void to get specimen, stops to remove cup, finishes voiding
What are the steps to collecting a regular urine sample? Patient cleans perineum and urinates in specimen cup
What is a "wee-bag"? Small bag used to collect urine specimens from infants and small children who are not potty-trained. (You may need to assist parent with perineum care)
What is a urolithiasis? Kidney stone
What is the least common type of bladder irrigation (BI) and why? Open bladder irrigation, because of the increased incidence of infection
What makes the open bladder irrigation have an increased incidence of infections? The tubing is connected to sterile solution, and then disconnected to irrigate, then reconnected to solution and disconnected to irrigate. These steps are repeated until irrigation is complete
What is the most common type of bladder irrigation (BI)? Continuous Bladder Irrigation (CBI)
What are the steps to completing CBI? 3000mL of irrigation solution is hung next to bedside, it is connected to a three-way foley and irrigation process begins
When is CBI typically used? Following prostate surgery
What is the formula for calculating urine output with CBI? Total output-CBI infused= urine output
What is the type of urostomy that creates a urinary diversion? Ileal conduit
Describe an ileal conduit? Ureters are implanted into a loop of the ileum that is isolated & brought to the surface of the abdominal wall, a drainage bag (urostomy bag) is fitted over the stoma to contain constant drainage of urine
What is very important when caring for a patient with a urostomy? Skin care around the stoma
How is the kock pouch created? By implantation of the ureters into a segment of the small intestine that has been surgically removed from the rest of the bowel & anastomosed to the abdominal wall
How is urine flow controlled with a kock pouch? With a nipple-like valve that prevents leakage
How often must a kock pouch be drained & how is it done? Every 4-6 hrs. / By inserting a catheter through the valve
Why must the kock pouch be drained at regular intervals? To minimize the re-absorption of waste materials from the urine and reflux into the catheters
Nocturia Excessive urination at night
Oliguria Diminished capacity to form & pass urine (less than 500mL in 24hr period) result is that the end products of metabolism cannot be excreted efficiently
Anuria Urinary output of less than 100-250mL in 24 hr period
Retention Inability to void even in the presence of an urge to void
Dysuria Painful or difficult urination
Residual Urine Urine remaining in the urinary tract & bladder after voiding
Incontinence Inability to control urination or defecation
Polyuria Excretion of an abnormally large quantity of urine
Diuresis Secretion & passage of large amounts of urine
Hematuria Blood in the urine
Renal Failure Characterized by the kidney's inability to remove wastes, concentrate urine, and conserve or eliminate electrolytes
Urgency (urinary) An immediate unstoppable urge to urinate, due to a sudden involuntary contraction of the muscular wall of the bladder
Created by: tandkhopkins
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