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Urinary Elimination

Ch. 33

QuestionAnswer
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