elimination
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| bladder capacity of the infant | from 50cc-250 cc.
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| specific Gravity of their urine is around | 1.008
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| what color is an infants urine | PALE YELLOW, straw-colored—almost odorless
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| an infants Patterns of voiding | should void within 48 hours after birth, then 5-25X/24 hr, or 25 mL/kg/day
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| Infection in newborns is usually due to | structural problems, such as Obstructions or Malformations, and infection due to proximity of urethra to anus in female infants.
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| Preschoolers capacity of the bladder increases to | ~250 mL
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| Urinary control usually occurs between the ages of | 2-5. This should NEVER be a punitive process
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| Girls MUST be taught to wipe from | front to back
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| The #2 cause of infection in children is | UTI
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| School Age children The size of the child’s kidney | Doubles
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| from age 5-10 voiding _____ times per day | 6-8
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| enuresis | “involuntary urination after control should be established”
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| Nocturnal Enuresis | episodes of bed wetting
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| Elders Bladder tone: | Bladder more fibrous (Less elastic)
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| Nephrons begin to diminish after the age of | 40—if otherwise healthy,
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| no functional issues until | 80’s or 90’s, but renal function of 85-yr-old only 50% of 30-yr-old!
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| Salt: Causes the body to and why | retain fluid Why….to maintain homeostasis normal concentration of Na+ and KCL.
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| Fluids that contain caffeine | increase urine production
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| Intake. Alcohol _________ output (diuretic) but also _______ the body by _________ the production of ___ | increases dehydrates inhibiting ADH
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| Beets may cause your urine to have a ___ cast | Red
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| Asparagus makes your urine smell really ___ | Bad
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| Foods high in carotene can deepen the _______ color. | Yellow
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| Loop diuretics | work in the Loop of Henle by blocking reabsorption of sodium & chloride
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| Thiazide diuretics | work on the distal tube to block sodium reabsorption & increase potassium & water excretion
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| Potassium-sparing diuretics | work in the distal tubule to allow sodium excretion, while restoring much of the K+ to the body, avoiding the potassium depletion seen with other types of diuretics Also miscellaneous diuretics carbonic anhydrase inhibitors & osmotic diuretics
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| when on diuretics you need to watch for: | hydration & electrolyte balance, vital signs (especially for hypotension d/t fluid loss), BUN, creatinine, electrolytes, & other pertinent values. Avoid salt substitutes with K+-sparing diuretics
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| _____makes your urine Orange | AZO Also pyridium
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| Some chemo drugs can cause what color of urine. | red or green
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| It is important to know which Medications cause | retention.
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| what medications can cause retention | Sudafed, Benadryl, atropine, B/P meds, opioids
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| Changes in the client’s ____ system especially the _______ can affect the production of urine | renal nephrons
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| spme surgeries can cause | Swelling, anesthesia, Post-Op Bleeding, Sometimes spinal anesthesia may alter a patient’s ability to feel the need to void.
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| Pelvic muscle tone affects | urination—poor in pts who have had catheters recently, or for longterm
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| Polyuria | Diuresis –May be several liters more than usual output.
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| Polydipsia | This is often associated with Diabetes and Nephritis.
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| Polydipsia can lead to: | dehydration & Weight Loss
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| Anuria | No urine production; almost always due to renal disease
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| Oliguria | Low output < 30 mL/hr, or 500 mL/24 hours hours in adult
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| Polyuria can: | ↑thirst, dehydration, wt loss
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| Dialysis: Hemodialysis | is the exchange of body wastes across a semipermeable membrane via vascular catheters;
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| Peritoneal Dialysis | Fluids are instilled into the abdomen & the fluid & molecules exchange, then drain out through an abdominal catheter.
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| Nocturia | > 2 times at night
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| Frequency | > 6 times per day (UTI, Diabetes, Pregnancy, Stress)
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| Urgency | --“Gotta go NOW”, from irritation, poor sphincter control, bladder spasms, stress
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| Dysuria | Pain or burning with urination (UTI, stricture, or stone accompanied by Hesitancy
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| Hesitancy | Difficulty starting urinary stream
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| Neurogenic Bladder | Incontinence, overfilling, or incomplete emptying of bladder
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| Intake and Output | Change in I & O is a significant indicator of fluid alterations or kidney disease
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| Order: | Will read I & O- measure everything that goes in and everything that comes out
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| Measurement red flag is | hourly- an output of less than 30 ml for more than 2 hours
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| Volume: | 1200-1500 Less than 1200;
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| Color | clarity: Straw to Amber Transparent
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| Bad colors are | Dark cloudy, Orange, red or brown thick or obvious sediment
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| Odor: | Faint aromatic; some foods change the smell of urine such as asparagus
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| Bad odor | Offensive smell Urine high in glucose may have a sweet smell:
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| pH | 4.5-8.0 the pH may indicate the client’s diet or state of nutrition.
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| Ketone bodies | None; Presence of Ketones is highly indicative of uncontrolled diabetes or starvation;
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| Specific gravity | 1.010-1.025 –density compared to water (1.0) The higher the concentration the higher the SG
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| Color: Renal Bleeding | dark red (older blood)
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| Color Bladder bleeding | bright red
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| Color High concentration- | dark amber
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| why do we need to Get specimens to lab ASAP or refrigerate | Clear at time of voiding- May become cloudy as it sits
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| Renal disease | may look cloudy or foamy due to the high protein conc
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| Bacteria- | thick and cloudy
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| Odor of stagnant urine | Stagnant urine has ammonia odor-common with incontinence.
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| Cystoscope | Use conscious sedation to decrease anxiety-direct examination for structural abnormalities (going into bladder with a light and camera)
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| Noninvasive Procedures | KUB (kidneys, ureters, bladder x-ray) -IVP (intravenous pyelogram—dye) -CT scan -Renal scan - Ultrasound (like radar)
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| Retention | Urinary retention may be due to poor contractility of the bladder, changes in outflow: Prostate enlargement, medications, and surgery
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| Functional: | Inability of Continent people to reach the toilet in time—can’t respond to need to void—dementia, impaired mobility, diuretics, sedation, depression, regression (physical, environmental, psychosocial causes)
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| Reflex: | Urine loss occurs when a certain volume is reached
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| Stress: | Urine loss with increased abd. Pressure (cough, sneeze, lifting, laughing) decreased urethral resistance, weak muscles & weak urethra
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| Total: | Complete inability to hold urine; loss of control in all situations & positions
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| Urge: | Inability to hold urine after the urge to void is noticed—”overactive bladder”—strong urge to void—detrusor muscle hyperactive
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| Overflow (with retention): | can’t empty bladder—frequent loss of small amounts urine (25-50 mL)
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| D.I.A.P.E.R.S. | D- Delirium I- Infection A- Atrophic P- Psychological E-Endocrine R- Restricted Mobility. S- Stool
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| Congenital disorders: epispadias | (absence upper wall urethra),
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| Congenital disorders: meningomyelocele | (neural tube defect; spinal cord protrudes through vertebral column
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| Acquired disorders: | CNS system, spinal cord trauma; stroke
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| Chronic disorders: | MS, Parkinson’s disease
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| Tofranil | control smooth muscles of bladder neck for mild stress incontinence
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| estrogen therapy | post-menopausal atrophic vaginitis
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| oxybutynin-Ditropan | urge incontinence—drugs to inhibit detrusor muscle contractions, ↑ bladder capacity anticholinergic
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| tolterodine—Detrol | antimuscarinic agents
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| Ditropan & Detrol | can be taken once or twice daily & have fewer side effects than other anticholinergic agents. Contraindicated for pts with glaucoma (increased pressure in eyes). Urinary retention is potential side effect
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| Fluid intake of at least | 1.5-2L/day; better to be 2-3 L daily, but ↓ in evening
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| ↓ consumption of beverages containing (all bladder irritants) | caffeine citrus juices, artificial sweeteners with NutraSweet & ↓ alcohol
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| Use behavioral techniques such as | scheduled toileting, habit training, bladder training (↑’ing intervals gradually to ↑ capacity. Resist urge to void more freq (to 300 mL/void)
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| When bladder contains 250-450 mL, signal to | CNS of need to void. Can consciously inhibit this urge (as nurses often do at work)
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| Voluntary urinary retention | failure to respond by voiding when bladder contains > 300 mL can stretch detrusor muscle & cause loss of muscle tone, and can lead to overfilling.
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| Continent Stoma | Kock Pouch Neobladder
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| incontinent stoma | Ureterostomy Nephrostomy Vesicostomy Ileal conduit
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| Ureterostomy | Bringing the end of one or both ureters to the abdominal surface
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| Catheterization: | Introducing a rubber or plastic tube through the urethra and into the bladder
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| Intermittent Catheterization: | Relief of discomfort Obtaining sterile specimen Assessment of residual Long-term management
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| Indwelling Catheterization: | Obstruction of urine outflow Surgical repair of urinary tract Measurement of strict U/O Bladder irrigation Severe retention
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| Kegel exercise | Strengthening Pelvic Floor Muscle-
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| Bladder Retraining- | Increase interval between voids
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