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Urinary elimination
3802 final
| Question | Answer |
|---|---|
| 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
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