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Urinary elimination

3802 final

How many mL's of urine does the bladder usually hold? 600 ml's of urine
Within a 24 hr day, how many ml's can an individual void? Between 1,500-1,600 mL per day
What happens to the aging r/t anatomic changes with urinary issues? Anatomnic changes occurs within the kidney; 20-30% decrease in size and weight between the ages of 30-90 years of age.
What happens to the kidney after 70 years? 30% of the glomeruli have lost their function
When is urinary incontinence higher? For menopausal women who use hormone replacement therapy.
Since men's prostate enlarges as they age what type of complications are associtated with the enlargement? hesitancy, retention, and slows urinary stream and more bladder infections.
What should a nurse do if the pt prefers privacy while voiding? The nurse should PREVENT INTERRUPTION
What should the nurse do when placing the patient on the bedpan or bedside commode? Close the curtains and allow the patient some privacy. Provide the patient the nurse-call button for easy and accessible reach. Nurse should remain close-by in case the patient needs some assistance.
When do pt's usually having a need to void? When they first awaken so the nurse needs to be accessible to meet the needs of the Pt.
What kind of effect does anxiety have on the urinary system? It over stimulates the individuals nervous system and clamps the sphincter shut.
What are the treatment plans for abnormal urinary elimination? men using stall rather than urinal, flushing toliet first to help start stream, distracting thoughts, psychotherapy, hypnosis, and self-catheterization.
Concerning muscle tone, what can cause poor control of voiding? muscle wasting caused by immobility, stretching of muscles during childbirth, menopausal muscle atrophy, and traumatic damage to muscle.
How can prolonged use of indwelling catheter cause urinary problems? Continuous drainage of urine through an indwelling catheter causes loss of bladder tone and/or damage to the urethral sphincter.
What is Oliguria? Can occur from losses of what? urine output that is decreased despite normal intake; perspiration, diarrhea, or vomiting (may occur with kidney disease)
Diuresis increased urine formation
What types of drinks and foods cause diuresis? Drinks: coffee, tea, cocoa, cola drinks that contain caffeine. Foods: that contain high fluid content (fruits and vegetables).
What happens to pt's who become extremely diaphoretic (sweating) loses a large amnt of fluids through insensible water loss, will this increase or decrease urine production? DECREASE
How does anesthesia and narcotic analgesics alter urine formation? They alter the glmoerular filtration rate = reducing urine output. These pharmacologic agents impair the sensory and motors traveling between the bladder, spinal cord, and brain.
Why is an indwelling catheter inserted prior to a surgical procedure requiring anesthesia? Pt's recovering from anesthesia and deep analgesics often do not sense bladder fullness.
How do spinal anesthetics increase the risk of urinary retention? Because of the inability of the bladder muscles and sphincters to respond.
How can the lower abdominal and pelvic structures impair urination? Due to local trauma to the surrounding tissue.
Diuretics prevent reabsorption of water and certain electrolytes to increase urine output
1. Sudafed 2. Aldomet 3. Furosemide/Lasix 4. Atropine....classify each med 1. Sudafed = antihistamine 2. Aldomet = anti-hypertensive 3. Furosemide/Lasix = diuretic 4. Atropine = anti-cholinergic
Which medications (and their categories) will cause urinary rentention? anticholinergics (Atropine), antihistamine (Sudafed), anti-hypertensive (Aldomet)
What color does pyridium change the urine? Bright orange to rust
How does cancer chemotherapy drugs effect the urine? They may change the color of the urine and can be toxic to the kidneys or bladder.
A urinalysis is a general examination of urine to establish baseline information or provide data to establish a _______ diagnosis? tentative
What is important when obtaining a urine culture (what is required of the specimen)? A clean catch midstream urine specimen
Cystoscopy involves direct visualization of urinary structures; pt's often have urinary rentention following the procedure and may pass red or pink urine because of the trauma to the urethral or bladder mucosa.
urgency is defined as? feeling of a need to void immediately
dysuria painful or difficult urination
frequency is defined as? voiding at frequent intervals, less than 2 hours
hesitancy is defined as? difficultyu initating urination
Polyuria voiding large amnts of urine
Oliguria diminished urinary output relative to intake
Dribbling leakage of urine despite voluntary control of urine
Residual Urine Volume of urine remaining after voiding (greater than 100 mL)
Where do you assess flank tenderness? By percussing the costovertebral angle
What can be detected by auscultating the kidneys? The presence of renal artery bruit.
During bladder distention the bladder cannot be percussable until it contains how much fluid? 150 mL of urine
What does the bladder sound like if it is full and where is this sound heard at? Dullness is heard above the symphysis pubis
What should be inspected if urethral meatus is suspected? Inspect to note the presence of discharge, inflammation, or lesions.
What is stress incontinenece and the etiogology behind it? Stress incontinence is leakage of small amnt of urine caused by sudden increase in intra-abdominal pressure. Etiology: coughing, laughing and exercise, weak pelvic musculature, incompetent bladder outlet, and obesity.
What is urge incontinence and it's etiology? Involuntary urine loss occurs due to detrusor muscle overactivity; Symptoms of UTI, frequency, dysuria, hematuria, & nocturia, urgency of micturition, urge incontinence(spontaneous, uncontrolled loss), alcohole/caffeine ingestion, increa fluid intake.
What's overflow incontinence and the etiology? Occurs b/c of over-distention of the detrusor muscle. Etiology: under-active detrusor muscle secondary to drugs; fecal impaction; diabetes; men: prostate enlargement; women: uterine prolapse
What is reflex incontinence? What is the etiology for it? result of neurological impairment of the CNS; i.e. spinal cord injury; stroke; parkinson's disease; multiple sclerosis. Eti: involuntary loss of urine occuring @ somewhat predictable intervals, unawareness of bladder filling, lack of urge to void
What's functional incontinence and its etiology? Involuntary, unpredictable passage of urine in persons with intact urinary and nervous system. Etiology: Caused by change in environment, sensory, cognitive, or mobility defects.
This is an example of which type of urinary incontinence? The Pt has a fully functioning urinary tract, but cannot make it to the bathroom in time due to physical or cognitive disability i.e. maybe the Pt's suffering from arthritis or Alzheimers Dx. Functional incontinence
What are urodynamic studies? Name all five. Investigation of bladder function & control of micturition under quasi-physiological conditions; measure pressure in the bladder and the flow of urine. The 5 are: urinary flow rate, cystometrogram, electromyography, voiding pressure flow, & videodynamics
What is urinary flow rate? measure of urine flow rate
Cystometrogram Evaluates detrusor muscle function/evaluate bladder tone
Electromyography assess spincter and perineal muscles
Voiding pressure flow? Detects outlet obstruction or determines "leak point pressure"
Videodynamics Anatomic imaging
Provocative stress testing Pt coughs vigorously while examiners observe for leakage
Post Void Residual (PVR) Catheterization or bladder scan immediately following voiding
What is considered an abnormal finding indicative of a bladder problem? Large amnt of residual urine
What is considered a normal finding for urinary problems (how much urine in the bladder)? 50 mL or less of urine (increases with age)
What is the diagnosis if the Pt's bladder studies reveal a normal capacity (450 mL's), and filling profile? Stress incontinence
What are Kegel exercises and the point behind practicing them? Pelvic floor exercises to practice stopping onselfs from urinating
What is biofeedback when r/t to urinary problems? Use of special vaginal or rectal probes
What is electrical stimulation and what urine disorder is this used for? Use of very low voltage; used with urge and stress urinary incontinence
What are vaginal cones? Cones are different sizes and wt's used to strengthen muscle tone.
Urinary incontinence due to detrusor over-activity is the dx. What type of drug would be appropriate for this dx to help fix the urinary problem? What type of urinary incontinence? Alpha-adrenergic drugs like Enablex, Detrol, and Detrol LA.
Name which type of urinary incontence this is and the appropriate type and specific med to help this problem: Urinary incontinence that occurs coincident with increased intra-abdominal pressure. Anti-cholinergic drugs- pseudoephedrine (Sudafed). Type: Stress urinary incontinence
What type of urinary incontinence is this? What meds are approp?: Urinary incontinence due to over-distention of the bladder. Overflow urinary incontinence. No meds effectively treat this condition; the only way to treat is w/ a foly catheter.
Burch colposuspension? Surgical procedure to correct the position of the bladder and urethra neck.
Marshall-Marchetti- Kranz? Surgical approach by making a wide abd incision; surgeon elevates urethra and bladder neck using sutures.
Sling procedure? Incision above pelvic bone & removes layer of fasci (tissue that covers muscle fibers). The piece of muscle fiber is attached under the urethra & bladder. Sling compresses urethra back to its original position.
Urinary rentention? accumulation of urine in the bladder due to inability to empty bladder.
What amnt of urine is considered severe accumulation with urinary rentention? 2,000 to 3,000 mL of urine
What are the symptoms of urinary rentention? suprapubic pressure, discomfort, and tenderness; restlessness; diaphoresis; and rentention overflow of 25-60 mL of urine
What are the physiological causes of urinary retention? urethral obstruction, surgical trauma, anxiety, and alteration in motor and sensory innervation.
Which medications (and their types) will cause urinary rentention from THEIR SIDE EFFECTS? Opioids like Morphine sulfate, beta-adrenergic receptors like Metoprolol and Lopressor, and Ca Channel blockers like Cardizem and Procardia.
Which medication causes urinary rentention (not from it's side effect but the purpose of the med)? Name the category of drug as well. Tri-cyclic anti-depressants like Tofranil and Elavil
Since intermittent catheterization is one way to manage urinary retention, what is the proper way to use this method? In & out catheterization; straight-single use catheter is introduced long enough to drain the bladder (5-10 mins). When the bladder is emptied the nurse immediately withdraws the catheter.
What type of urine is intermittent catheterization used for? To check residual urine- catheter inserted immediately after the Pt has voided to check the amnt of residual urine left in the bladder.
What is important to know about an indwelling catheter? requires a physicians order; nurse must use strict sterile technique when inserting a catheter.
What is the purpose of a prostatectomy when r/t urinary problems? surgery to correct destruction
Created by: jalvarez1210