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Urinary Test #6

Proteinuria presence of large proteins in urine which is a sing of glomerular injury.
Erythropoietin hormone that functions within bone marrow to stimulate red blood cell production and maturation and prolongs life of mature Red Blood Cells.
Renin an enzyme released from juxtaglomerular cells which convert angiotensin I.
Micturation voiding
Renal Calculus kidney stones
Uremic syndrome an increase in nitrogenous wastes in blood, marked fluid and electrolyte abnormalities, nausea, vomiting headache, coma and convulsions
Renal replacement therapies dialysis and organ replacement
Nocturia awakening to void one or more times a night.
Polyuria excessive output of urine
Oliguria urine output decreased despite normal intake of fluid
Anuria no urine
Diuresis increased urine formation
Urinary diversion surgical formation which temporarily or permanently bypasses urethra as exit routes for urine
Urinary tract infection are infections that can happen anywhere along the urinary tract
Dysuria pain or burning during urination
Cystisis irritated bladder
Hematuria irritation to bladder and urethral mucosa results in blood tinged urine
Pylonephritis infection of upper urinary tract where flank pain, tenderness, fever and chills are common symptoms.
Urinary incontinence UI is the involuntary leakage of urine that is sufficient to be a problem. It is either temporary or permanent
Nephrostomy urinary drainage directly from one or both kidneys in which tube is place directly into renal pelvis.
Bacteriuria bacteria in urine
Bacteremia or urosepsis bacteria in blood stream
Urinary frequency bladder loses muscle tone and capacity decreases which leads to voiding more often
Nocturnal enuresis nighttime voiding without awakening
Residual urine retained urine after voiding
meatus opening of urethra
urinalysis a lab test on a urine specimen
specific gravity is weight or degree of substance compared with equal volume of water
catheterization of bladder involves introducing latex or plastic tube through urethra into bladder. Catheter provides continuous flow of urine in clients unable to control micturation or has other obstructions.
pelvic floor exercises also know as Kegel's, improve strength of pelvic floor muscles and consist of repetitive contractions of muscle groups.
Normal physiology of urinary elimination Kidneys lie on either side of the vertebral column behind peritoneum and against deep muscles in back.
Filter of metabolic wastes Blood reaches each kidney by renal artery. The nephron, fuctional unit of kidneys, forms urine. A cluster of blood vessels form capillaries of glomerulus, which is initial site of urine formation. Glomerular capallaries filtrate into Bowman's capsule.
Nephron composed of glomerulus, Bowmand's capsule, proximal convoluted tubule, loop of Henle, distal tubule and collecting duct.
Glomerular capallaries permit filtration of water, glucose, urea, creatinine and major electrolytes into Bowman's capsule.
Regulate fluid level kidneys play a role in fluid and elecrolyte balance. 99% of filtrate is reabsored in plasma with 1% excreted as urine. Less than 30 ml/hr indicates renal alterations.
regulate composition of electrolytes maintains salt and potassium levels in body
assist in acid/base balance kidneys excretes excess acids or bases
regulates blood pressure regulates by renin which converts angiotenigin to angiotensin I which is converted to AII in lungs and this causes vasoconstriction and stimulates release of aldosterone from renal cortex and this causes retention of water which increases blood volume.
Regulates RBCs through erythropoietin whcih functions in marrow to produce RBCs and older RBCs get prolonged life.
Aids in calcium metabolism It activates Vitamin D. Kidneys produces a substance to turn Vitamin D into active form body can use.
Urinary tract/Bladder urinary bladder is hollow distensible, muscular organ that stores and excretes urine. Empty lies flat in pelvic cavity behind symphysis pubis. Bladder expands as it fills. When full can expand above symphysis pubis.
Urinary tract/Ureters are tubular structures that enter the bladder. Urine draining to bladder is sterile. Peristaltic waves cause urine to enter body in spurts not steadily
Urinary tract/ Urethra urine travels from bladder through urethra and passes outside body through urethral meatus. Women are 4 to 6.5 cm long and men are 20 cm or 8 inches
Autonomic Nervous System Functions of the urinary bladder depend entirely on the autonomic nervous system.
Micturation several brain structures influence bladder function, cerebral cortex, thalamus, hypothalamus, and brain stem. All these allow voiding or halt it.
Voiding Bladder normally holds 600 ml of urine. Individuals feel desire to void with smaller amount of 150 to 200 ml for an adult and 50 to 100 ml for child. as bladder walls stretch, sending sensory impulses to micturation center of spinal chord.
Factors affecting urinary elimination/assessment/Disease conditions decreases blood flow to and through the kidney (prerenal) disease condition of renal tissue or obstruction in lower urinary tracts that prevents urine flow from kidneys sometimes alter renal function.
Assessment/Disease conditions Diabetes Melitis and Multiple sclerosis. causes changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation or inabilty to stop contractions.
Uremic syndrome people with end stage renal disease leads to build up of toxins, nitrogenous wastes in blood. Eventually needing renal replacement therapies.
Assessment/ Growth and development infants and young children cannot effectively control urinating. 2 to 3 yrs. know sensations for bladder filing and urination. Many 4 yr olds can have control of external sphincter, which starts potty training.
Assessment/ Growth and development Pregnancy- urinary frequency and UTIs are common, decreased muscle tone. Aging causes impaired micturation and decreased muscle tone.
Assessment/ Growth and development Men beginning at 40 get enlarged prostates which cut off urine flow. Women have changes in urethral mucosa increases risk of UTIs.
Assessment/ Sociocultural Factors It has to do with amount of privacy for each culture. Americans expect privacy and Europeans have communal toilet facilities.
Assessment/ Psychological Factors anxiety prevents being able to void completely, Emotional tension makes it difficult to relax perineal and abdominal muscles.
Assessment/ Fluid Balance kidneys maintain balance of retention and excretion of fluids. an increase in intake of fluids leads to increase of urine production. Coffee, tea and cola increase urine production. Alcohol causes a water loss in urine.
Assessment/ Muscle Tone can affect elimination through urinary retention, it makes bladder unable to respond to micturation reflex.
Muscle Tone/ urinary incontinence a involuntary leakage due to weak mucles. weak abdominal muscles and pelvic floor muscles impair ability of urinary sphincter to maintain tone during increased abdominal pressure.
Surgical procedures/ narcotic analgesics and anesthetics slow glomerular filtration, reducing urine output.
Surgical procedures/Spinal anesthetics causes urinary retention.
Surgical procedures/ Surgery-lower abdomen causes impaired urination from trauma to local tissue.
Medications/ Diuretics prevent water reabsortion and certain electrolytes by increasing urine output.
Medications/ Anticholinergics and Antihistamines cause urinary retention
Medications/ Phenzopyriedine(Pyridium) turns urine orange
Medications/ amitryptyline turns urine green or blue
Medications/Levodopa turns urine black or brown.
Diagnostic Exam/ Intravenous pylogram (IVP) requires limitations on liquids which lower urine output.
Diagnostic Exam/ Direct visualization diagnostic exams cause localized edema of urethral passageways and spasms of bladder sphincter.
Alterations/urinary retention is an accumulation of urine resulting from inability of bladder to empty properly. Bladder is unable to control micturation and empty bladder. Urine collects stretching walls causing discomfort, tenderness and diaphoresis.
Alterations/ Lower urinary tract infections have pain, burning during urination as flows over inflamed tissues. Causes are because in women have shorter urethra and proximity to anus. Older adults, disease or decreased immunity. Poor perineal hygiene. Inadequate hand washing and catheters.
Alterations/Urinary Incontinence is involuntary leakage of urine. 2 kinds stress or urge. older adults have special problems because of physical limitation and environmental barriers.
Alterations/ Urinary diversions urinary stoma to divert the flow of urine directly to abdominal wall because of cancer, trauma, etc.
Nursing History/pattern of urination ask client about daily voiding patterns, including frequency,times of day, normal volume and any recent changes.
Nursing History/ symptoms of urinary alterations assess for urgency, dysuria, hesitancy, frequency, polyuria, oliguria, nocturia, incontinence, hematuria, retention or residual urine.
Factors age, environmental, medication history, fluid balance, current surgical or diagnostic disease conditions. Bowel patterns, fluid balance or urinary diversions.
assessment/ input and output fluid balance with intake and output measurements
assessment/ characteristics/ color normal pale yellow to clear red- bleeding bright orange-pyridium dark amber-bilirubin-liver dysfunction document unusual color or sediment
assessment/ clarity stagnant-ammonia-incontinent sweat odor-acetone-diabetic/starvation
Urine testing/Urinalysis/UA try to make it the first void of morning to ensure uniform concentration of contituents. Normal values:ph-4.6 to 8.0, protein, glucose, ketones, blood-negative is normal, and specific gravity 1.0053-1.030
Urine testing/ CMP/ comprehensive Metabolic Panel blood test that tells current status of kidneys, liver and electrolytes and acid/base balance as well as blood sugar and proteins.
Diagnostic Studies/ KUB? Abdominal roentergenogram X-ray to determin the size shape, symmetry and location of urinary system
Diagnostic Studies/ IVP Intravenous pyelogram veiw collecting ducts and renal pelvis and outline ureters, bladder and urethra. a special intravenous injection converts to dye in urine. Assess for allergies to shellfish and plenty of liquids after to flush dye.
Diagnostic Studies/Renal Scan/CT scan obtains detailed images of structures in body/ Cross sectional which shows tumors and obstructions. Bowel cleansing and shellfish allergies before and liquids afterward.
Diagnostic Studies/Endoscopy goes right into urinary system for an inside view of kidneys, bladder etc.
Diagnostic Studies/Arteriogram an x-ray of arterioles to evaluate their condition.
Diagnostic Studies/ Urodynamics determine bladder function and evaluate causes of urinary incontinence
promoting urinary elimination/stimulating reflex a client's ability to void depends on felling the urge to urinate, being able to control the urethral sphincter and relax during voiding. To relax and stimulate reflex a client needs to be put in normal position. women/sitting;man/standing.
promoting urinary eliminations/maintaining habits clients need to follow normal schedule
promoting urinary elimination/adequate fluid intake average daily intake is 1200 to 1500 mls. Increase fluids clears you out.
promoting urinary elimination/ promote complete bladder emptying always residual urine left in bladder encourage clients to wait until urine stops and attempt to void again
promoting urinary elimination/prevent infection good perineal hygiene Fluids(2000 to 2500 ml)
Catheterization involves a latex or plastic tube through the urethra and into bladder. The catheter provide a continuous flow of urine when client's cannot control voiding or those with obstructions.
What is the function of the kidneys? Kidneys filter waste products of metabolism that collect in the blood. The blood reaches each kidney by a renal (kidney) artery that branches from the abdominal aorta.
Kidneys filter waste products of metabolism that collect in the blood. The blood reaches each kidney by a renal (kidney) artery that branches from the abdominal aorta. The kidneys produce several substances vital to production of red blood cells (RBCs), blood pressure, and bone mineralization. The kidneys are responsible for maintaining a normal RBC volume by producing erythropoietin.
What is considered a normal urinary output? Although output does depend on intake, the normal adult urine output is 1500 to 1600 mL/day.
An abnormal one? (amount?) URINARY OUTPUT An output of less than 30 mL/hr indicates possible renal alterations.
When does a patient feel the need to void? in the morning, 30 minutes after a meal, bedtime.
What is the recommended daily fluid intake? client with normal renal function should have a fluid intake between 2200 and 2700 mL daily. An average daily intake of oral fluids between 1100 and 1400 mL is usually adequate
How would you know if a patient was taking enough fluids this from the urinalysis? Urinary output of 300 mL or greater will occur with each voiding or 30 ml an hour. The color would be clear or pale yellow.
What is a normal specific gravity of urine? (1.0053-1.030)
What would these results be if a person was dehydrated? above 1.030,
Diuretics prevent reabsorption of water and certain electrolytes to increase urine output
anticholinergics (e.g., atropine) or antihistamines causes urinary retention
Phenazopyridine (Pyridium) colors the urine a bright orange to rust
amitriptyline causes a green or blue discoloration,
Urgency Feeling of need to void immediately Full bladder, bladder irritation or inflammation from infection, overactive bladder, psychological stress
Dysuria Painful or difficult urination Bladder inflammation, trauma or inflammation of urethral sphincter
Frequency Voiding at frequent intervals (<2 hr) Increased fluid intake, bladder inflammation, increased pressure on bladder (pregnancy), diuretic therapy
Hesitancy Difficulty initiating urination Prostate enlargement, anxiety, urethral edema
Polyuria Voiding large amounts of urine Excess fluid intake, diabetes mellitus or insipidus, use of diuretics, postobstructive diuresis
Oliguria Diminished urinary output relative to intake (usually 400 mL/24 hr) Dehydration, renal failure, UTI, increased ADH secretion, congestive heart failure
Nocturia Voiding one or more times at night Excessive fluid intake before bed (especially coffee or alcohol), renal disease, aging process, prostate enlargement
Dribbling Leakage of urine despite voluntary control of urination Stress incontinence, overflow from urinary retention (e.g., from BPH)
Incontinence Involuntary loss of urine Multiple factors: unstable urethra, loss of pelvic muscle tone, fecal impaction, neurological impairment, overactive bladder
Hematuria Blood in the urine Neoplasms of the kidney or bladder, glomerular disease, infection of kidney or bladder, trauma to urinary structures, calculi, bleeding disorders
Retention Accumulation of urine in the bladder, with inability of bladder to empty fully Urethral obstruction (stricture), decreased sensory activity, neurogenic bladder, prostate enlargement, postanesthesia effects, side effects of medications
urinary retention signs are bladder distention and absence of urine output over several hours. result of urethral obstruction, surgical or childbirth trauma, alterations in motor and sensory innervation of the bladder, medication side effects, or anxiety
Urinary tract infections/ interventions Monitor the client's I&O carefully, monitor the urine characteristics, and observe for signs of infection, Adequate fluid intake will help to minimize risk of blockage by increasing urine flow, cranberry juice1
nursing interventions and recommendations for a patient with stress urinary incontinence Strengthening Pelvic Floor Muscles. Bladder Retraining Habit Training Promotion of Comfort
correct procedure for collecting a sterile urine specimen Clamp the tubing below the port, allowing fresh, uncontaminated urine to collect in the tube. After wiping the port with an antimicrobial swab, insert a sterile syringe hub and withdraw at least 3 to 5 mL of urine .
promote normal urinary system functioning Maintaining Elimination Habits./Maintaining Adequate Fluid Intake/Promoting Complete Bladder Emptying./Preventing Infection./ Acidifying Urine
Stimulate the micturition reflex normal position for voiding:woman is better able to void in a squatting or sitting position,man voids more easily in the standing position,sound of running water,Stroking the inner aspect of the thigh stimulates sensory nerves.
What are appropriate nursing diagnoses for a patient experiencing a urinary alteration?
Created by: azchic1973