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Urinary Elim

T2-Urinary Elim Lecture - FI

How does urinary elimination occur? Through the function of the kidneys, ureters, bladder, and urethra
What factors affect Urination? Disease conditions, Sociocultural, Psychological, Fld Balance, Surgical, Meds, Diagnostic exams
What Pathological (Disease) conditions affect urinary elimination? DM, MS, RA, Chronic diseases, Acute renal disease, Febrile, Spinal cord injuries
What Sociocultural Factors can affect urinary elimination? Cultural and gender norms vary on privacy or publicness, Social expectation influence what time (school)
What Psychological factors can affect urinary elimination? Anxiety and stress affect a sense of urgency and increase the frequency of urination
How can Fluid intake affect urinary elimination? Caffeine and alcohol increase UOP
How can Surgical procedures affect urinary elimination? Stress reponse to surgery reduces amt of urinary output to increase circulatory fl vol. Anesthetics and pn-killers slow filtration rate and reduce UOP. Local trauma during lower abd and pelvic surg sometimes obstructs urine flow, indwelling caths necess
How do Meds affect urinary elimination? Diuretics prevent reabsorption of H2O and increases UOP. Some drugs change color or urine and affect ability to relax and empty bladder.
How do Diagnostic exams affect urinary elimination? Cystoscopy causes localized edema of urethral passageway and bladder sphincter spasm, resulting in urinary retention and passing of red/pink urine.
Name urinary disorders Urinary retnetion, Lower UTI, Urinary Incontinence
What is Urinary Retention? Bladder is unable completely empty so urine accumulates in bladder
What will eventually develop from Urinary Retention? Retention c overflow - Pressure in the bladder builds so that external urethral sphincter is unable to hold back urine. Sphincter opens to allow a small vol of urine to escape
What causes Urinary Retention? Obstruction, Inflammation, Swelling, Anxiety, Meds
What is residual urine? Urine left in bladder after urination.
How much residual urine is normal? 100cc
What is bladder distention? Then the bladder is full, it expands up into a dome and pushes above the symphysis pubis. Grealy distended bladder may reach the umbilicus.
How do UTIs occur? Microorgs enter urethra resulting in bacterial spread, causing inflammation of bladder muscle
What are UTI nosocomial infections? UTIs that are of hospital-acquired.
What are the characteristic symptoms of a UTI? Dysuria, Urgency, Frequency
What is dysuria? Burning during urination
Why are females more susceptible to UTIs? Bc of the shorter urethra
What is Urinary Incontinence? Loss of control over voiding which can be temporary or permanent
What are the types of Urinary Incontinence? Total, Functional, Stress, Urge, Reflex
What is Acute Urinary Incontinence? Reversible Urinary Incontinence
What is Chronic Urinary Incontinence? Not reversible urinary incontinence
Describe Total Urinary Incontinence Total uncontrollable and continuous loss of urine. Unpredictable. Constant dribble. No bladder distention bc urine doesn't collect in bladder
What causes Total urinary incontinence? Neuropathy of sensory nerves, Trauma or disease of spinal nerves or urethral sphincter
What are the symptoms of Total Urinary Incontinence? Constant flow of urine at unpredictable times
What Tx is avail for Total Urinary Incontinence? Not may Tx
What is Reflex Urinary Incontinence? Involuntary loss of urine occurring at somewhat predictable intervals when pt reaches specific bladder vol. (Bladder fills but no urge to void, so voids)
What causes Reflex Urinary Incontinence? Upper spinal cord injury or disease involoving area above reflec arc, blocking cerebral awareness. Lower spinal cord injury blocking impulses to reflex arc.
What are the symptoms of Reflex Urinary Incontinence? Lack of awareness of bladder filling, No urge to void, Uninhibited bladder contraction or spasm at regular intervals
What is Stress Urinary Incontinence? Involuntary loss of urine caused by increased intraabdominal pressure
What causes Stress Urinary Incontinence? Coughing, laughing, vomiting, lifting with a full bladder
What are the symptoms of Stress Urinary Incontinence? Dribbling of urine with increased intraabdominal pressure
Who is primary affected by Stress Urinary Incontinence? Women
What Tx is avail for Stress Urinary Incontinence? Kegal exercises, bladder suspension
What Tx is avail for Reflex Urinary Incontinence? Catheter
What is Functional Urinary Incontinence? Environmental obstructions, sensory, motor, or cognitive deficit results where pt can't get to br in time
What are symptoms of Functional Urinary Incontinence? Strong urge to void with loss of urine before reaching br
What Tx is avail for Functional Urinary Incontinence? Alter environment so pt can go to br before voiding
What is Urge Urinary Incontinence? Involuntary voiding after strong sense of urgency to void
What causes Urge Urinary Incontinence? Decreased bladder capacity, Prostated enlargement, ETOH, Caffeine, Increased Fld intake
What are the symptoms of Urge Urinary Incontinence? Urinary urgency, Abnormal frequency, Bladder contracture, Nocturia, Voiding in small or large amts
What Tx is avail for Urge Urinary Incontinence? Treatment of infection, Drug therapy
What Nursing Processes are in the Assessment of Urinary Elimination? Nursing Hx, Physical Assessment, Assessment of Urine, Diagnostic Exams (NPAD)
During the Assessment of Urinary Elimination, what is included in the Nursing Hx? Pattern of Urination, Symptoms of Urinary Elimination, Factors Affecting Urinary Alterations
How do you assess for Patterns of Urination? Ask the pt about daily voiding patterns - Freq and times of day, normal vol, Hx or recent changes.
What does nocturia indicate? Renal or cardiovascular disease
How do you assess for Symptoms of Urinary Elimination? Ask Pt about presence of Urinary Alteration symptoms, such as Urgency, Dysuria, Freq, Hesitancy, Polyuria, Oliguria, Nocturia, Dribbling, Hematuria, Rention, or Residual Urine
What is the minimum urinary production? 30 mL/hr
What are the common symptoms of Urinary Alterations Polyuria, Oliguria, Nocturia, Dysuria, Rention, Residual Urine, Freq, Urgency, Dribbling, Hematuria, Hesitancy (PONDRRFUDHH)
What does Polyria mean in terms of Common Symptoms of Urinary Alterations? Voiding large amount of urine
What does Oliguria mean in terms of common symptoms of Urinary Alterations? Diminished urinary output in relation to fl intake (scant amt of urine production)
What does Nocturia mean in terms of common symptoms of Urinary Alterations? Excessive urination at night
What does Dysuria mean in terms of common symptoms of Urinary Alterations? Pnful or difficultly urinating
What does Residual Urine mean in terms of common symptoms of Urinary Alterations? Urine remaining in the bladder after voiding. >100 mL
What does Retention mean in terms of common symptoms of Urinary Alterations? Accumulation of urine in bladder c inability to void
What does Frequency mean in terms of common symptoms of Urinary Alterations? Voiding a frequent intervals
What does Urgency mean in terms of common symptoms of Urinary Alterations? Feeling of the need to void immediatly
What does Dribbling mean in terms of common symptoms of Urinary Alterations? Leakage of urine despite voluntary control or micturition (eg. Stress Incontinence)
What does Hematuria mean in terms of common symptoms of Urinary Alterations? Presence of blood in urine
What does Hesitency mean in terms of common symptoms of Urinary Alterations? Difficulty in initiating urination
What factors can affect urination? Age, Meds, Urinary diversion, Sensory restrictions (blind), Environmental barriers, Mobility status, Past Illness, Major Surgery, Personal Habits, Fld intake (AMUSE MPMPF)
What is continent urinary diversion (CUR)? Surgical diversion of the drainage of urine froma diseased of dysfunctional bladder. Pt uses cath to drain pouch
During the Assessment of Urinary Elimination, what is included in the Physical Assessment? Assessment of Skin and Mucosal Membranes, Kidneys, Bladder, Urethral Meatus
Why do you assess the Skin and Mucosal Membranes in the Physical Assessment of Urinary Elimination? To see if hydration is adequate
What increased the risk for skin breakdown? Urinary incontinence, Fld imbalance, Electrolyte disturbances
How do you assess the Kidneys during the Physical Assessment for Urinary Elimination? Flank pn develops, palpate for tenderness by gently precussing the costovertebral angle
What do you note when assessing the bladder during your PA? Bladder distention. Upon light palpation, pt feels tenderness or pn
What should you note when assessing the Urethral Meatus during a PA? Discharge, inflammation. Drainage indicated infection. Note color and consistency of drainage.
What does Assessment of Urine involve? Noting I/O, Characteristice of Urine, Specimen collection, Common Urine tests.
What should you do to track I/O? Measure I/O to monitor fl and electrolyte balance. Doc all fld intake-NPO, water for taking meds, fl in foods, Enteral feedings, Parenteral flds (IV, blood components, nutrition). Measure all UO c graduated container (bedpan, urinal, nuns hat, cath bag)
What is a Urometer? Attached to cath drainage tubing and measures small urine vol on regular basis. HOlds 100-200 mL
What are the characteristics of Urine? Color: Pale straw to amber. Clarity: Transparent at time of voiding but becomes cloudy. Odor: Ammonia odor. More concentrated or longer stands, stronger the odor.
What pt would have freshly voided urine appear cloudy? Pts with renal disease bc of P concentration, Could be result of bacteria
What are the types of Specimen collection? Random, Timed, Sterile, Mid-Stream (Clean voided)
What is a Timed Urine Specimen? Involves collection of urine over specified amt of time, 24 hrs. Make sure last voiding is closest to end of time period. Let everyone know.
What is a Sterile Urine Specimen? Has to be taken from catheter, so must put one in pt if they don't have one
What is a Mid-Stream/Clean-Voided Urine Specimen? Pt wipes with sterile disinfectant wipes. During midstream, collect urine. Less contaminents. Standard U/A
What are the common urine tests? U/A, Urine culture, Specific gravity
Describe a Urine culture Urine test Req a sterile sample of urine.
Describe Specific Gravity Urine test Use urinometer and cylinder. Pour specimen into cylinder and suspend urinometer in it. Concentration of dissolved sub in urine determines depth at which urinometer will float. High specific gravity=concentrated urine. Low grav=diluted urine. 1.005-1.030
What type of techniques are used in the Diagnostic Examinations during Assessment of Urinary Elimination? Invasive and Noninvasive
What are noninvasive techniques that can be used to in diagnostic exams of the urinary system? Xrayx, Flat plate, KUB, IV Pylogram, CT scan
What are invasive techniques that can be used to in diagnostic exams of the urinary system? Cystoscopy, Endoscopy, Arteriogram/Angiogram
What is a cystoscopy? Looks for inflammation, masses. Cystoscope inserted through urethra. Pnful so pt is under general or local anesthesia with sedation
What is an Arteriogram or Angiogram? Invasiv radiographic procedure c radiopaque contrast material that outlines the vascular supply to the kidneys
What is the normal pH values in U/A? 4.5-8.0
Through assessment of pt's urinary function IDs defining charact that support actual or at-risk elimination probs. From then, you can give a possible: Nursing Diagnosis
In the Nursing Process, the Planning stage establishes: Pt-centered goals and outcomes in collaboration with the pt and family. Set priorities, Continuity of care
During the Assessment of Urinary Elimination, what is included in the Implementation phase? Promotion of Normal Voiding, Promotion of Complete Bladder Emptying, Prevention of Infection, Promoting Comfort, Maintenance of Skin Integrity (NCPCM)
How do you Promote Normal Voiding? Provide privacy, Kegal exercises and situps, Manual bladder compression/Crede's Compression, Cath, Bladder reconditioning
Describe Crede's Compression Helps stimulate micturition and manually expels urine when bladder tone is reduced. When urine in bladder, Crede's causes sensation of bladder fullness. Also promotes bladder emptying by relaxing urethral sphincter
Describe Bladder Reconditioning Clamp cath so urine accumulates in bladder to get bladder used to expanding/contracting. Then unclamp
How long is max amt of time before pt should have voided? Within 8 hrs
How do you promote bladder emptying? Strengthening Pelvic Floor muscles, Crede's Compression, Drug therapy
Name cath alternatives Suprapubic cath and Condom Cath
What is a Suprapubic catheter? Inserted surgically into the bladder through the lower abdomen above the symphysis pubis. Sometimes used in older males who req long-term alternative to urinary cath. Risk for UTI, spread of infection to kidneys req removing cath.
What is a Condom Catheter? Perfect for incontinent or comatose male pts who still have complete and spontaneous bladder emptying. Poses little risk for infection. Must remove daily to check for skin irritation.
What are advantages of Suprapubic cath? Void naturally when cath is clamped and is more comfortable
How do you Prevent Infection regarding Urinary Assessment? Urine pH=4-8 (strive for acidity-meat,eggs, cranberry juice), Void @ regular intervals, Good hygienve, Cath care, Void after sex, Showers instead of bath, Prevent breaks in indwelling cath unless intermittent irrigation
How do you Promote Comfort when dealing with Urinary Elimination? Pt is clean and dry, If they have Dysuria, give pt Sitz baths
How do you Maintain Skin integrity regardin Urinary Elimination? Clean and dry to prevent maserate of skin, wash c mild soap and water if incontinent
What is urinary reflux? Abnormal backward flow of urine. Infection will likely develop
What are the outcomes you are striving for during Evaluation? Pt has ability to urinate voluntarily s dysuria, urgency or freq. Urine is amber color, clear, s abnormal constituents, Within normal range of pH and specific gravity
What is cystitis? Inflammation of the bladder
An adult pt hasn't voided in 8 hrs and complains about a continued perception of the urge to urinate. Your inital action is to: Palpate the pt's bladder
Identification of a "2+ hematuria" in female pt c UTI indicates: Irriation of the bladder mucosa from the pathogen
When applying a condom cath, it is important to secure the cath to penile shaft in such a manner that the _____ circulation is not impaired and urine is able to flow out. Penile
When a pt c an indwelling cath c/o discomfort in the bladder, you first: Check the patency of the tube
Maintaining a Foley cath drainage bag in the dependent position prevents: Urinary reflux
The purpose of instructing the pt to begin and discard the initial stream of urin when obtaining a mid-stream urine specimen is to: Allow the initial urine to wash bacteria from external genitalia
How long s urinating before the pt is at risk for cystitis? More than 8 hrs
When collecting a 24-hour urine specimen, you: Discard the first voided specimen in the 24-hour period
A routine U/A is ordered for pt. If you cannot send the specimen to lab immediately, you: Refrigerate the specimen
Created by: mcwilliams05