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foundations exam 2
urinary elimination
| Question | Answer |
|---|---|
| urinary system includes | kidneys, ureters, bladder, urethra |
| Act of Urination | Micturition, Voiding |
| Process of emptying the bladder | Detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra Muscles of perineum and external sphincter relax Muscle of abdominal wall contracts slightly Diaphragm lowers, micturition occurs |
| Factors Affecting Micturition | developmental considerations, fluid and flood intake, psychological variables, activity and muscle tone, pathological conditions, medications |
| developmental considerations affecting micturition | toilet training, effects of aging |
| Pathologic Condition | UTI, AKI, CKD, ESRD |
| developmental considerations affecting micturition: toilet training | children 2-3 years old enuresis |
| developmental considerations affecting micturition: effects of aging | Nocturia Increased frequency Urine retention and stasis Voluntary control affected by physical problems |
| Diseases Associated With Renal Problems | Congenital urinary tract abnormalities Polycystic kidney disease Urinary tract infection Urinary calculi Hypertension Diabetes mellitus Gout Connective tissue disorders |
| Medications that have effect on Urine Production and Elimination | nephrotoxic drugs, diuretics, cholinergic medications, analgesics and tranquilizers |
| nephrotoxic drugs | capable of causing kidney damage |
| diuretics | prevent reabsorption of water and certain electrolytes in tubules |
| cholinergic medications | stimulate contraction of detrusor muscle, producing urination |
| analgesics and tranquilizers | suppress CNS, diminish effectiveness of neural reflex |
| anticoagulants effect on urine color | red urine, hematuria |
| diuretics effect on urine color | pale yellow urine |
| Pyridium effect on urine color | orange to orange-red urine Phenazopyridine: a urinary tract analgesic |
| The antidepressant amitriptyline or B-complex vitamins effect on urine color | green or blue-green urine |
| levodopa effect on urine color | brown or black urine |
| Nursing History | Usual patterns of urinary elimination Recent changes in urinary elimination Aids to elimination Present or past occurrence of voiding difficulties Presence of urinary diversion |
| Physical Assessment of Urinary Functioning: kidneys | Palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment |
| Physical Assessment of Urinary Functioning: bladder | Palpate or use a bedside scanner |
| physical Assessment of Urinary Functioning: urinary orifice | Inspect for signs of infection, discharge, or odor |
| Physical Assessment of Urinary Functioning: skin | Assess for color, texture, turgor, and excretion of wastes |
| Physical Assessment of Urinary Functioning: urine | Assess for color, odor, clarity, and sediment |
| Additional Assessment Techniques | measuring urinary output routine urinalysis |
| measuring urinary output is different based on whether | Continent patients Incontinent patients Indwelling catheter |
| routine urinalysis | Clean-catch or midstream specimen Sterile specimen Urinary diversion specimen 24-hour specimens |
| Indications for Use of an Ultrasound Bladder Scanner | Urinary frequency Absent or decreased urine output Bladder distention Inability to void Postvoid residual (PVR) urine Establishing intermittent catheterization schedules |
| External Urine Collection Device female | purewick |
| External Urine Collection Device male | condom catheter |
| where should the urinary collection bag hang | below the bladder so that gravity brings the urine down |
| types of urethral catheters | Intermittent urethral catheters (straight catheters) Indwelling urethral catheter (retention or Foley catheters) |
| Intermittent urethral catheters (straight catheters) | Used to drain the bladder for short periods |
| Indwelling urethral catheter (retention or Foley catheters) | Used when a catheter is to remain in place for continuous drainage Designed using an inflated balloon so that it does not slip out of the bladder |
| collecting a sterile urine specimen | check slide 21 |
| 24-Hour Urine Specimens | Initiate a collection at a specific time (which is recorded) by asking the patient to empty the bladder. The collection should be in an ice bath. Discard this urine and then collect all urine voided for the next 24 hours. |
| what can you do to help remind a pt not to discard their urine | Post a sign on the patient’s bathroom door |
| Urinary functioning as the problem | Incontinence Pattern alteration Urinary retention |
| promoting urinary elimination | maintaining regular voiding habits promoting fluid intake strengthening muscle tone assisting with toileting |
| patient at risk for UTIS | sexually active people with female genitalia people who use diaphragms for contraception postmenopausal people people with indwelling urinary catheter in place people with diabetes mellitus older adults |
| Types of Urinary Incontinence | transient mixed overflow functional reflex total stress |
| transient | appears suddenly and lasts 6 months or less |
| mixed | urine loss with features of two or more types of incontinence |
| overflow | overdistention and overflow of bladder |
| functional | caused by factors outside the urinary tract |
| reflex | emptying of the bladder without sensation of need to void |
| total | continuous, unpredictable loss of urine |
| stress | involuntary loss of urine related to an increase in intra-abdominal pressure |
| reasons for catheterization pt 1 | Relieving acute urinary retention Obtaining a sterile urine specimen Accurate measurement of urinary output in critically ill patients To help heal sacral or perineal wounds in incontinent pts |
| reasons for catheterization pt 2 | Emptying the bladder before, during, or after select procedures and before certain Dx exam Providing improved comfort for end-of-life care Prolonged pt immobilization |
| Types of Catheters | Intermittent urethral catheters Indwelling urethral catheter Suprapubic catheter |
| Actual or Potential Health Problems and Needs | Urinary retention Urinary frequency Impaired urination Infection risk Total urinary incontinence Altered body image perception Altered skin integrity risk Knowledge deficiency Toileting ADL deficit Deconditioning |
| Expected Outcomes When Removing an Indwelling Catheter | cath will be removed w/o difficulty and with min. pt discomfort pt voids w/o discomfort post cath removal pt voids a min. of 250 mL of urine within 6-8hrs of cath removal pts skin remains clean, dry, and intact, w/o evidence of irritation or breakdown |
| what should the pt verablize | their understanding of the need to maintain adequate fluid intake |
| Administering Continuous Closed Bladder or Catheter Irrigation are not recommended unless | obstruction is anticipated |
| when is obstruction anticipated | Obstruction might occur with bleeding after prostate or bladder surgery Sediment or debris or blood clots might block the catheter preventing flow of urine out of the catheter |
| when is Continuous Closed Bladder or Catheter Irrigation used | Used when continuous irrigation with solution is needed to restore or maintain patency of the drainage system |
| Irrigations might also be used to | instill medications that will act directly on the bladder wall |
| takeaways from this presentation | Catheters harbor bacteria Insertion site needs cleaned and dried at least twice per day Try to minimize the dwell time |
Created by:
leh195