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Urinary Elm P&P

Potter and Perry 7th Edition Chapter 45

QuestionAnswer
What may be affected by alterations in urinary elimination? A patient's body image and virtually all body systems?
What has to work (4 things) in order to have urinary elimination function properly? Kidneys, ureter, bladder, and urethra
What is the normal amount of urine produced in a day? 1-2 L
What 2 things affect urine production? Fluid intake, body temperature
Urine is usually ____% water and _____% solutes. 95% water 5% solutes
Electrolytes, urea, uric acid, creatinine, and ammonia are examples of what? Solutes found in urine
What is a waste product of muscle metabolism? Creatinine
What is a molecule of major importance in energy production in muscle? creatine
What would increased creatinine levels tell us? Kidney dysfunction
Where are the kidneys located? On either side of the vertebral column behind the abdominal peritoneum and against the deep muscles of the back, level with the twelfth Thoracic and 3rd lumbar vertebrae.
What organs are the initial site of urine formation? Glomerulus
What is a cluster of capillaries that filter water, glucose, amino acids, urea, uric acid, creatinine, and electrolytes from the blood? Glomerulus
Why would protein in the urine indicate glomerular injury? Becuase protien does not usually filter through the glomerulus.
About ____% percent of glomerular filtrate is reabsorbed back into the plasma. 99%
_______, ________, and _________ are secreted into the tubules and become part of the urine. hydrogen, potassium, ammonia
What carries urine from the kidneys to the bladder by peristalsis? Ureters
What prevents urine from returning from the bladder to the ureters? A small flaplike fold of mucous membrane acts like a valve that covers the juncture between the ureters and the bladder.
Where is the bladder in a male? behind the symphysis pubis when empty and resting on the rectum posteriorly.
Where the bladder in a female? behind the symphysis pubis when empty and resting against the anterior wall of the uterus and vagina.
How far up might the bladder extend if greatly distended? Almost up to the umbilicus.
Where is the external urethral sphincter located and what is its function? about half way down the urethra-permits voluntary control of urine flow.
Give three terms for peeing. urination, micturition, voiding
About how much urine does it take to give a person the sensation that they would like to urinate? Adult? Child? Only a small amount (about 150ml to 200ml in an adult 50-100 ml in a child)
What is the name for the condition in which urine drains through an arificial opening in the abdominal wall? Urinary diversion
What are signs and symptoms of urinary retention? feelings of pressure, discomfort, tenderness over the symphysis pubis, restlesness, and diaphoresis along with absence of urinary output over several hours and a distended bladder
In urinary retention the bladder sometimes holds up to _______ml of urine 1000 ml
What is overflow urinary incontinence? The pressure in the bladder builds till the external sphincter cannot hold it back. Small amounts leak out (25-60 mls) to relieve pressure as often as 2-3 times an hour.
How does decreased urine production cause urinary retention? By filling the bladder gradually so the stretch receptors are not acitvated
Urinary tract infections account for _____ to ____ % of nosocomial infections in the US with most directly due to ___________. 36% - 40%, catheterization
Why is bacteriuria almost inevitable with the introduction of a retention catheter? Because they are a source of injury to the mucosa, thus allowing bacterial invasion.
Why is it important to keep catherization to a minimum? Because bactiuria leads to the spread of organisms to the bloodstream (Urosepsis) and kidneys, especially in severly ill patients.
Microorganism are able to get to the urinary tract through the meatus or the blood stream. Which is the most common route of infection? Urethral meatus.
Why are urinary tract infections more common in women than in men? Because of the proximity of the anus to the urethral meatus and the shorter urethra
Why does urinary retention increase the risk of urinary tract infection? Because normal urine flow produces a flushing action that washes away microorganism.
How do microorganism feel about residule urine? They think it would be a nice place to raise a family.
Name 8 signs and symptoms of an urinary tract infection. Pain and burning with urination, frequency and urgency, fever, chills, N&V, malaise, hematuria, cloudy urine,
What are the addtional signs and symptoms associated with pyelonephritis? fever, flank pain, tenderness, and chills
What sign might an older adult with urinary tract infection and accompanying fever display? An alteration in mental status such as acute confusion.
What are the five types of incontinence? Total, Functional, Stress, Urge, Reflex
What kind of incontinence causes a constant flow of uring at unpredictable times and is due to neuropathy of sensory nerves, trauma or disease of spinal nerves or urethral sphincter? Total
What kind of incontinence could be caused by a fistula between the bladder and vagina; change in environment; senory, cognitive, or mobility deficits in which the patient has the urge to void but can not make it to the appropriate receptacle? Functional
What is the difference in total and functional incontinence? A person with functional incontinence has an intact urinary and nervous system
What kind of incontinence happens to women who have had several children when they sneeze? Stress incontinence
What kind of incontinence is a strong urge due to decreased bladder capacity, irritation of bladder stretch receptors, alcolhol or caffiene ingestion, or too much fluid intake? Urge
What kind of incontinence involves involuntary loss of urine occurring at somewhat predictable intervals when the patient reaches a specific bladder volume? Reflex
What is a surgical process that creates a stoma on the outer abdominal wall for continuous urine drainage? ureterostomy
What do you call an urostomy in which an artificial pouch is created that the patient learns to drain with a catheter periodically throughout the day? Continent urinary diversion
What neglected aseptic step is responsible for most nosocomial infections? lack of handwashing
______ techniques is required for catheterization. Sterile
_______ _________ is required for examination of gentalia or provision of perineal care. Medical asepsis
At approximately what age do neuromuscular and cognitive functions develop to the point that a child is able to begin to control voiding? 2-3years
What 3 things must a child be capable of before they can be successful in potty training? Recognize the feeling of bladder fullness, hold urine or 1-2 hours, and communicate sense of urgency to parent
What is a developmental risk to males especailly after age 40 that may cause problems with urinary elimination? The prostrate can enlarge and cause partial obstruction of the urethra resulting in inadequate bladder emptying.
How do hormonal changes in women increase the risk of urinary infections? The lack of estrogen causes the urethral mucosa to become thinner, more fragile to injury and infection.
How does decrease in perineal muscle tone affect a woman's urinary elimination? Decreased perineal muscle tone can contribute to increased urgency and stress incontinence.
The state in which an individual experiences a loss of urin of less than 50mls occurring with increased abdominal pressure Stress incontinence
The state in which an individual experiences a continous and unpredictable loss of urine Total urinary incontinence
100mLs or more of urine remaining in bladder after voiding Residual Urine
What procedure would be used to assess the entire urinary system and some of its functions by allowing the physician to see a radiopaque dye as it passes through the system? Intravenous pyelogram
What procedure would be used if the patient were unable to receive IVP dyes? Renal Scan
What kind of exam is used to visualize abnormal pathological conditions such as tumors, obstructions, retroperitoneal masses, and lymph node enlargement? Computerized Axial Tomography
What procedure would be used to assess the entire urinary system and some of its functions by allowing the physician to see a radiopaque dye as it passes through the system? Intravenous pyelogram
What procedure would be used if the patient were unable to receive IVP dyes? Renal Scan
What kind of exam is used to visualize abnormal pathological conditions such as tumors, obstructions, retroperitoneal masses, and lymph node enlargement? Computerized Axial Tomography
Constant, unpredictable flow; Nocturia; Unawareness of bladder fullness Total urinary incontinence
Strong urge, Can’t make it to toilet before voiding Functional urinary incontinence
Dribbling with increased intra-abdominal pressure, urinary urgency, frequency Stress incontinence
Urinary urgency, Abnormal frequency (more often than every 2 hours), Bladder spasm, Nocturia, Small<100ml or large >550ml amounts of voiding Urge incontinence
Lack of awareness of bladder filling, No urge to void, Uninhibited bladder contraction at regular interviews Reflex incontinence
What effects does the GAS have on urinary elimination? Urinary output decreases due to release of ADH and aldosterone
30 to 50 mL of urine per hour indicates what? Adequate renal perfusion and kidney function
What is the recommended daily amount of fluid intake to prevent urinary tract infections? 2000mL, or 2 quarts of fluid
Where should we clamp the tubing attached to a urinary catheter in order to collect a urine sample? 2-3 inches below the collection port.
What abnormal urinary function could be precipitated by outlet obstruction, decreased bladder tone, neurologic dysfunction, opioids, or trauma? Urinary retention
What abnormal urinary function could be precipitated by infection, inflammation , or injury? Dysuria