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FONDATION OF NURSING

exam 2 CHAP 37

QuestionAnswer
KIDNEY Urinary systems-filtration, reabsorption, & excretion, fluid and electrolyte balance
Kidneys and ureters? –Filter and excrete waste–Regulate fluid balance
URETHRA LONG IN MALE, SERVE AS A PROTECTIVE MECHANISM (It is about 5 1/2 to 6 1/4 in (13.7 to 16.2 cm) PRONE 2 INJURY-CATHETER 6-8IN SHORT IN WOMEN-PRONE TO INFECTION *(is about 1 1/2 to 2 1/2 in (3.7 to 6.2 cm) long HELP EXCRETE URINE FROM BLADDER TO EXTERIOR
BLADDER The urinary bladder is a smooth muscle sac that serves as a temporary reservoir for urine. AUTONOMIC BLADDER- BLADDER NO LONGER CONTROLLED BY THE BRAIN DUE INJURY OR DISEASE
MICTURITION 30ML/HR OR 360/DAY OR 240/DAY THE PROCESS OF EMPTYING THE BLADDER VOIDING-PEEING- UNVOLONTARY REFLEX- DESIRE TO VOID @ 150-250ML IN ADULT FIST URINE IS NOT FRESH
INCONTINENCE: UNVOLONTARY CONTROL OF VOIDING-Strong psychological factors =fear, Being on bedrest, having dementia, and having difficulty walking to the bathroom = involuntary urination. MEN USE URINARY SHEATH CONDOM / FEMALE CATHETER (LAST RESORT) CONTINENCE: VOLUNTARY CONTROL OF VOIDING
URINARY RETENTION 50> IN BLADDER=ISBAR LIKE ANURIA, URINE IS NOT CMPLTY EXCRETED FROM THE BLADDER. FACTORS AFFECTING: MEDICATIONS, ENLARGED PROSTATE OR VAGINAL PROLAPSE, URINATING Q3-4H INCREASE RISK OF UTI AND KIDNEY SORDER. STAGMINATION OF URINE IN BLADDER=ALKALINE-FAVORS BACTERIA GROWTH
ENURESIS INCONTINENCE AT NIGHT- Continued incontinence of urine past the age of toilet training is termed-Nocturnal enuresis (nighttime bedwetting)
NOCTURIA CONTANST VOIDING AT NIGHT- YOU CAN GET UP The diminished ability of the kidneys to concentrate urine-
DYSURIA PAIN @ VOIDING
POLYURIA EXCESSIVE VODING = THIRST-HUNGRY DIIABETES
PUYURIA PUS IN URINE=PRESENCE OF ANY UTI(BURNING, FREQUENCY, FOULSMELL- CLOUDY RINE)
ANURIA DECREASE OUTPUT <50 Oliguria: 24-hour urine output is less than 400 mL
GLYCOSURIA GLUCOSE IN URINE=DIABETES
DEVELOPEMENTAL CONSIDERATION WITH AGING =URINARY RETENTION Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, Decreased bladder contractility may lead to urine retention and stasis, Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weak
FOOD AND FLUID INTAJE DEHYDRATION MAKES KIDNEY REABSORB FLUID=CONCENTRATED AND DECREASED AMOUNT OF URINE. FOOD HIGH IN NA RETAINT H2O DARK AMBER PEE HYDRATED KIDNEY EXCRETE MORE=INCREASED AND DILUTE URINE ALCOHOL (DIURETIC) SUPPRESS ADH = INCREASED AMOUNT OF URINE
PSYCHOLOGICAL VARIABLES COULD BE PERCEIVED AS A PRIVATE ACT- NEEDING A BEDPAN COULD CAUSE ANXIETY/ EMBARRASSEMENT. STRESS COULD INTERFERE W, ABILITY TO RELAX PERINEAL MUSCLE+EXTER. URETHRAL SPINCTER.
Activity and muscle tone DECRSD MUSCLE TONE AFTER CHILDBEARING, MUSCLE ATROPHY DUE TO DECRSD ESTROGEN(MENOPAUSE) AND MUSCLE DAMAGE FROM TRAUMA REGULAR EXERCISE=INCRSD METABOLISM+ OPTIMAL URINE PRODUCTON AND ELIMINATION IMMOBILITY=DCRSD BLADDER AND SPHNCTER=POOR URINARY CONTROL
Pathologic conditions (enlarged prostate) Renal failure is a condition in which the kidneys fail to remove metabolic end products from the blood and are unable to regulate fluid, electrolyte, and pH balance. DISEASES RELATED 2 RENAL: HBP, DIABETES(INCRSD OUTPUT) , UTI, URINARY CALCULI (KIDNEY STONE REDUCE PHYSICAL A CTIVITY :ARTHRITIS Parkinson’s disease, and degenerative joint disease, may interfere with toileting COGNITIVE DEFICIT INTERFERE W/ ABILITY T
Medications PhenaZOPYRIDYUM UTI MED=ORANGE RED PARKISON IRION=BROWN, BLACK AMNOGLYCOSIDE=AFFECT RENAL SOME DRUGS ARE NEPHROTOXIC I.E IBUPROFEN& ASPIRIN ANICHOLENERGIC: Sedatives and tranquilizers may diminish awareness of the need to void . Anticoagulants (blood in the urine), =pink or red color. Diuretics = pale yellow. amitr (elavil) green-blue
CHILDREN ? OLDER? 2-3 OR 2-5 OR WHEN THEY CAN HOLD URINE FOR 2 HOURS OR Recognize the feeling of bladder fullness Communicate the need to void and control urination until seated on the toilet. DECREASE IN NEPHRON AND BLADDER TONE AND CONTRACILITY
PREGANCY CONSTIPATION, UTI, BLADDER PRESSURE
NURSING PROCESS ASSESS =INFO + PHYSICAL AND COMBINE TO UNDERSTAND PT ROBLEM PALPITATION OF KIDNEY- PALPITATE BLADDER=USE BEDSIDE SCANNER URETHRAL OFFICE=INSPECT SIGN OF INFECTION, DISCHARGE OR ODOR ASSESS= COLOR, TEXTURE, TURGOR AND EXCRETION WASTE URINE=COLOR, ODOR, SCLARITY, EDIMENT NORMAL= CLEAR-ODOR LESS-PH 5-6- SP, GRAV
SPECIFIC GRAVITY MINIMUM DRINK 64 OZ/DAY 8 GLASS H20 OVER HYDRATED-DILUTED BELOW 1.0053 NORMAL RANGE 1.0053-1.03 DEHYDRATED-CONCENTRATED ABOBE 1.030 URINE SGRAV. 1.015-1.25
PROMOTE NORMAL VOIDING FOLLOW A SCCHEDULE . FLUID INTAKE(64OZ/DAY) STRENGTHEN MUSCLE TONE=KEGEL EXERCISE TO DECREASE INCONTINENCE. PT CONTRACT PERINEAL AND ABD. MUSCLES 10 TIMES, Q10SECS Q1H (HOLDING AND SQEEZING IN) URGE TO VOID- WARM H20 ON FINGER/ IN BEDPAN PRIVACY- HELP
PATIENT AT RISK FOR UTI URINARY RETENTION WOMEN PRONE W/ SHORTER URETHRA OLDER WOMEN NURSES MENOPAUSE PREGNANCY PT ON ANTICHOLENERGIC URINARY CATHETER PEE AFTER NTERCOURSE TO FLUSH OUT BACTERIA
MEASURE URINE OUTPUT STRICT INTAKE/OUTPUT=EXACT AMOUNT INTAKE=OUPUT
URINE SAMPLE COULD BE STERILE(MID-STREAM) OR REGULAR CLEAN URETHRA-START URINATE-MIDWAY-STOP AND URINATE IN CUP-THEN CONTINUE URINATING IN TOILET ERADICATED BACTERIA
CATHETER? 12 to 16F gauge; 5-mL or 10-mL BALLON smallest appropriate indwelling urinary catheter. STERILE COMES FROM BLADDER PT GOING IN SURGERY AUTONOMIC DIS=HIGH BLOOD PRESSURE=STROKE INDWELLING CATHETER= CONTINUOUS DRAIN-STERILE, SWAB W/ ALCOHOL-SHAKE PEE IN CORD AND CLIMP-PT MUST VOID 6-8 AFTER REMOVAL ON THEIR OWN=BLADDER SCAN IF 100>, THEN USE NATURAL OR MED STIMULANTS INTERMITTNT URETHRAL CATHETER(STRAIGHT)- USE STERILE TECHNIQUE
24H URINE SPECIMEN SEE THE EXTEND OF KIDNEY DAMAGE FROM RENAL FAILURE URINE STAY IN ICE- ICE MUST COVER JAR FOR 24H FROM STARTING TIME. GET THE FIRST URINE AND DUMP IT=DOCUMENT=get the urine after the first one
URINARY RETENTION CHECK POSITION SCANNER PRESS SCANNER AIM SCANNER HEAD..COCCYX VERIFY SCREEN CROSSBARS W/IN RANGE OBSERVE & RECORD BLADDER SCALE HELP SEE POST VOID RESIDUAL. SHOULD BE <50. MORE THAN 50, REDO IT AGAN AND LET MD KNOW INTRO-SITU-BAC-ASS-REC(ISBAR) NON-INVASIV ASSESSMENT=ULTRASOUND=-PUT GEL, RUB AROUND ABDOMEN AND WILL SEE URINE AMOUNT
CONDOM (USE FOR INCONTINENCE-UNVOLUNTARY LOSS OF URINE URINE BREAKS DOWN SKIN SUPRAPUBIC CATHETER-BEST FOR LONG CONTINUOUS DRAINAGE (LESS UTI AND SEPSIS) STOMA PULLED U ON TOP OF ABDOMEN
WHAT IS urinary diverstion? MONITOR INTAKE/OUTPUT=FLUID BALANCE '' RETURN OF INSTSTINAL FUNCTN AND PERISTALISIS CLEAN SKIN AROUND STOMA=PURPLE-BLUE=LACK O2-ISCHEMIA WATCH MUCUS FOR NORMAL FINDG ENCOURAGE PT TO CARE 4 STOMA REROUTE URINE = DISEASE DEFECTIVE BLADDER, URETHERS, URETHRA TEMPORARY OR PERMENTLY = STOMA PREFFERED TO CATHERTERIZE STOMA=COULD BE SWOLLEN PALE STOMA=ANEMIA NORMAL=MOIS AND DARK PINK-RED
URINE CULTURE REQUIRES 3ML ROUTINE ANALYSIS REQUIRES 10ML NONSTERILE SPECIMEN
RECOMMENDATION? 8-10 8OZ OF H20 DAILY; 2 8OZ B4 AND AFTER SEX TO FLUSH OUT BACTERIA DRY PERINEAL AFTER VOIDG / DEFECATION COTTON SCROTCH UNDERWEAR SHOWER
Fever and diaphoresis = kidneys to conserve body fluids=urine is concentrated and decreased in amount. HEART FAILURE RETAIN BODY FLUID=CONCENTRATE URINE AND DECREASE OUTPUT
ASEPSIS-ABSENCE OF VIRUSES, BACTERIA, MICROORGANISMS IN SURGICAL SITE SEPSIS-PRESENCE OF VIRUSES, BACTERIA AND MICROORGANISMS IN BLOOD, SURGICAL SITE IRRIGATION: The flushing of a tube, canal, or area with solution. Natural irrigation: INCREASE FLUID BY PT INTAKE IS PREFERRED.
ROUNDED SHELF OF BEDPAN SHOULD NE PLACED UNDER CLIENT BUTTOCKS CLEAN CATCH? STERILE SPECIMEN SAMPLE-
TYPES OF INCONTINENCES? TRANSIENT, STRESS,MIXED, OVERFLOW, FUNCTIONAL, REFLEX, TOTAL
STRESS=INVOLUNTARY LOSS OF URINE=INCREASE IN ABDOMINAL PRESSURE=COUGHING, SNEEZING, LAUGHING, OTHER PHYSICAL ACTIVITIES (CHILDBIRTH, MENOPAUSE, OBESITY STRAINING CHRONIC CONSTPTN= URINE LOSS) MIXED=LOSS OF URINE W/FEAURES OF 2> TYPES OF INCONTINENCES. OVERFLOW=CHRONIC RETENTION OF URINE-OVERDISTENTION/ OVERFLOW OF BLADDER.UNDERREACTIVE OR ABSENT EMPTYING SIGNAL =BLADDER FILLS=DIBBLING OCCURS DUE TO 2 FECAL IMPCTION/ NEUROLOGIC CONDITNS-DRUG
FUCNTIONAL=INABILITY 2 REACH TOILET B/C ENVIROM. BARRIERS, PHYSICAL LIMITATIONS, LOSS MEMORY, DISORIENTATION. REFLEX= EMPTYING BLADDER W/O SENSATION OF NEED OF VOIDG=SPINAL CORD INJURY TOTAL INCONTINENCE=CONTINUOUS AND UNPREDICTABLE LOSS OF URINE, FROM SURGERY, TRAUMA, PHYSICAL MALFORMATION=URINE CANT BE CONTROL DUE TO ANATOMIC ABNORMALITY TRANSIENT=6MNTHS<=CONFUSIION SECONDARY TO ACUTE ILLNESS, DIURETIC, IV
Created by: Seka_nurse
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