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Urinary Elimination
Ch. 33
| Question | Answer |
|---|---|
| Normal range of urine production and components | 1 - 2 L/day, 95% h2O, 5% solutes (electrolytes and urea, uric acid, creatinine, ammonia) |
| What are the functioning parts of kidneys | nephrons remove waste from blood and regulate water/electrolyte concentrations Glomerulus - site of urine formation |
| What is proteinuria | protein in urine, not supposed to be there. If present then faulty glomerulus |
| What is micturition? | urination, voiding. Adult urinates 150-200mL/day, child 50-100. Ext sphincter relaxes, detrusor muscle contracts |
| Three factors affect urination | physiological, psychosocial conditions, diagnosticor treatment-induced |
| Most common urinary problem | inability to store or fully empty urine from bladder from impaired bladder funx, obstruction to urine flow, not voluntarily control |
| What are urinary diversions | urine drains through artificial opening (stoma) on abd wall |
| What is urinary retention? | accumulation of urine in bladder |
| What is over flow incontinence | pxt will void small amts of urine 2-3x hr with no relief of distention or discomfort |
| What is residual urine | urine remains in bladder after urination. Alkaline promotes bacteria |
| Bacteriuria | bacteria in bladder can ascend to kidneys and result in bacteria in bloodstream (bacteremia or urosepsis) |
| What is urinary incontenence (UI) | temporary or permanent loss of control over voiding, multiple childbirths, sedatives, spinal cord injury |
| What do diuretics do for urination? | prevent reabsorption of h2o, incr. urination |
| Two types of urinary diversions | continent urinary reservoir (ureters embedded in reservoir) and orthotopic neobladder(use ileal pouch to replace bladder) |
| four types of urinary incontinence | Total, functional, stress, urge, reflex |
| What is total urinary incontinence and cases and symptoms | continuous loss of urine, Causes: neuropathy of sensory nerves, disease of spinal nerves or urethral sphincter Sx: constant flow, nocturia, not aware bladder fills |
| Functional urinary incontinence | unpredictable passage of urine in pxt with mental/physical disability. Causes: fistula b/n bladder/vagina, change in env. Sx: strong urge to void, with loss before reaching bathroom |
| Stress urinary incontinence | incr abd pressure cause leaks Cause: cough/laugh/vomit, obesity, 3rd trimester, weak muscles Sx: dribbling, urgency, freq. |
| Urge urinary incontinence | involuntary void after strong sense of urgency Cause: decr bladder capacity, alcohol/caffeine, incr fluid Sx: urgency, bldr contracture/spasm, nocturia |
| reflex urinary incontinence | involuntary voiding at somewhat predictable intervals Cause: upper/lower spinal cord injury Sx: not aware bldr fills, no urge to void |
| What is CAUTI's | Catheter Associated UTI's, assoc. morbidity, prolong hospitilizations, mortality |
| In acute and long term care settings catheters are always done in what technique? | sterile insertion technique |
| alternatives to catheterization | bladder scanner, toileting schedule |
| What could be cause of voiding freq at night? | renal or cardiovascular disease or cystitis |
| Important factors in pxt history for urination | med usage, mobility status, env. barrier, sensory restrictions, past illness, major surgery, urinary diversion, personal habits, fluid intake, age |
| What is pyelonephritis | kidney infection. with pain, fever, tenderness, pain on percussion |
| What is dysuria | painful or difficult urination, bladder inflammation, trauma of urethra |
| what is polyuria | voiding large amt of urine, excess fluid intake, diabeter, diuretics |
| What is oliguria | diminished output related to fluid intake, dehydration, renal failure, obstruction, incr ADH (antidiuretic hormone) |
| what is hematuria | blood in urine, neoplasms of kidney, glomerular disease, kidney/bladder infections, caliculi |
| Measuring I/O for what physiological problems. What is a danerous I/O amount | measure I/O - totaled q8h, key indicator of fluid imbalance, kidney dysfunction, decr blood vol If below 30mL/hr, notify now |
| Assessment of urine - characteristics | color - pale straw to amber, more concentrated in morn. Drugs x color clarity - transparent odor - ammonia smell |
| Collection of urine, steps to follow | label - name, date, time, type of collection Deliver to lab in 1 hr or refrig Draw 3mL for a culture |
| What does a urinalysis screen for? | renal disease, metabolic disorders, lower urinary tract alterations, fluid imbalances |
| how to clean male/female for urine sample | female- clean from meatus to rectum, use sep. wipe each stroke Male- clean meatus in circular motion from center out, 3x discard initial stream |
| Never collect urine from drainage bags, unless... | Unless specimen is first urine into new sterile bag |
| Normal Urinalysis values | pH = 4.6-8.0 Protein = up to 8mg/100mL glucose = not Ketones = not, dehydration/starve blood = up to 2 RBC Specific gravity = 1.01 - 1.03, measures concentration of urine |
| What do you keep/discard when collecting 24 hr sample | Always discard first sample at beg of collection period. |
| Noninvasive Procedures Abdominal Roentgenogram | plain film, KUB(kidney,ureter,bladder), assess gross structures Useful in visualizing stones/tumors |
| Noninvasive Procedures Intravenous Pyelogram (IVP) | view entire urinary system, IV injection of radiopagque dye |
| Noninvasive procedures Computerized Axial Tomography | visualize abnormal pathological conditions: tumors/masses/lymph nodes |
| Invasive procedures Endoscopy | see organs with telescope/fiberoptic imaging, painful procedure |
| Invasive procedures Urodynamic Testing | Gold standard for assessing bladder fx/dysfx by reproducing bladder sx, study storage and flow thru tract |
| Difference between stress and urge incontinence | Stress: if px loses urine after sneeze/cough Urge: strong urge before incontinence |
| What is Crede's method | putting pressure on suprapubic area to relieve urinary retention |
| Specific interventions | px edu, promote normal micturition and bladder emptying, prevention of infection, promote skin integrity and comfort |
| Cholinergic drugs | Bethanochol - incr bladder contraction and improve emptying |
| Alpha adrenergic drugs | phenoxybenzamine improve emptying |
| Anticholinergic drugs | propantheline - reduce incontinence by blocking contractility of bladder |
| Types of catheterization | indwelling, Foley- until pxt voids completely intermittent- single use (5-10min) |
| Indications for intermittent catheter | 1. immed. relief of bladder distention 2. long term mgmt 3. obtain sterile specimen 4. assess for residual urine 5. instill a medication |
| Indications for indwelling/Foley catheter | 1. obstuction to outflow 2. surgical procedures 3. blood clot prevention 4. record O in comatose/critical 5. provide continuous irrigation |
| Routine catheter care | q8h, remove secretions/encrustation at site, cleanse first 4 inches of tube, going away from urethra |
| Must replace catheter if... | if no voiding 6-8 hrs after removal, need to put back in |
| Alternatives suprapubic catheter, condom catheter | surgically inserted in bladder thru abd, short periods, can void naturally Condom catheter - coma, low risk for infection, remove daily |
| Sites at risk for infection | place of insertion, drainage bag, spigot tube juction, junction of tube and bag |
Created by:
palmerag
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