Ch. 33
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| Normal range of urine production and components | 1 - 2 L/day, 95% h2O, 5% solutes (electrolytes and urea, uric acid, creatinine, ammonia)
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| What are the functioning parts of kidneys | nephrons remove waste from blood and regulate water/electrolyte concentrations
Glomerulus - site of urine formation
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| What is proteinuria | protein in urine, not supposed to be there. If present then faulty glomerulus
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| What is micturition? | urination, voiding. Adult urinates 150-200mL/day, child 50-100.
Ext sphincter relaxes, detrusor muscle contracts
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| Three factors affect urination | physiological, psychosocial conditions, diagnosticor treatment-induced
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| Most common urinary problem | inability to store or fully empty urine from bladder from impaired bladder funx, obstruction to urine flow, not voluntarily control
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| What are urinary diversions | urine drains through artificial opening (stoma) on abd wall
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| What is urinary retention? | accumulation of urine in bladder
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| What is over flow incontinence | pxt will void small amts of urine 2-3x hr with no relief of distention or discomfort
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| What is residual urine | urine remains in bladder after urination. Alkaline promotes bacteria
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| Bacteriuria | bacteria in bladder can ascend to kidneys and result in bacteria in bloodstream (bacteremia or urosepsis)
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| What is urinary incontenence (UI) | temporary or permanent loss of control over voiding, multiple childbirths, sedatives, spinal cord injury
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| What do diuretics do for urination? | prevent reabsorption of h2o, incr. urination
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| Two types of urinary diversions | continent urinary reservoir (ureters embedded in reservoir) and orthotopic neobladder(use ileal pouch to replace bladder)
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| four types of urinary incontinence | Total, functional, stress, urge, reflex
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| 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
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| 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
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| Stress urinary incontinence | incr abd pressure cause leaks
Cause: cough/laugh/vomit, obesity, 3rd trimester, weak muscles
Sx: dribbling, urgency, freq.
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| Urge urinary incontinence | involuntary void after strong sense of urgency
Cause: decr bladder capacity, alcohol/caffeine, incr fluid
Sx: urgency, bldr contracture/spasm, nocturia
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| reflex urinary incontinence | involuntary voiding at somewhat predictable intervals
Cause: upper/lower spinal cord injury
Sx: not aware bldr fills, no urge to void
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| What is CAUTI's | Catheter Associated UTI's, assoc. morbidity, prolong hospitilizations, mortality
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| In acute and long term care settings catheters are always done in what technique? | sterile insertion technique
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| alternatives to catheterization | bladder scanner, toileting schedule
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| What could be cause of voiding freq at night? | renal or cardiovascular disease or cystitis
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| 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
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| What is pyelonephritis | kidney infection. with pain, fever, tenderness, pain on percussion
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| What is dysuria | painful or difficult urination, bladder inflammation, trauma of urethra
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| what is polyuria | voiding large amt of urine, excess fluid intake, diabeter, diuretics
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| What is oliguria | diminished output related to fluid intake, dehydration, renal failure, obstruction, incr ADH (antidiuretic hormone)
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| what is hematuria | blood in urine, neoplasms of kidney, glomerular disease, kidney/bladder infections, caliculi
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| 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
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| Assessment of urine - characteristics | color - pale straw to amber, more concentrated in morn. Drugs x color
clarity - transparent
odor - ammonia smell
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| 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
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| What does a urinalysis screen for? | renal disease, metabolic disorders, lower urinary tract alterations, fluid imbalances
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| 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
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| Never collect urine from drainage bags, unless... | Unless specimen is first urine into new sterile bag
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| 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
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| What do you keep/discard when collecting 24 hr sample | Always discard first sample at beg of collection period.
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| Noninvasive Procedures Abdominal Roentgenogram | plain film, KUB(kidney,ureter,bladder), assess gross structures
Useful in visualizing stones/tumors
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| Noninvasive Procedures Intravenous Pyelogram (IVP) | view entire urinary system, IV injection of radiopagque dye
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| Noninvasive procedures Computerized Axial Tomography | visualize abnormal pathological conditions: tumors/masses/lymph nodes
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| Invasive procedures Endoscopy | see organs with telescope/fiberoptic imaging, painful procedure
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| Invasive procedures Urodynamic Testing | Gold standard for assessing bladder fx/dysfx by reproducing bladder sx, study storage and flow thru tract
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| Difference between stress and urge incontinence | Stress: if px loses urine after sneeze/cough
Urge: strong urge before incontinence
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| What is Crede's method | putting pressure on suprapubic area to relieve urinary retention
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| Specific interventions | px edu, promote normal micturition and bladder emptying, prevention of infection, promote skin integrity and comfort
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| Cholinergic drugs | Bethanochol - incr bladder contraction and improve emptying
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| Alpha adrenergic drugs | phenoxybenzamine improve emptying
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| Anticholinergic drugs | propantheline - reduce incontinence by blocking contractility of bladder
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| Types of catheterization | indwelling, Foley- until pxt voids completely
intermittent- single use (5-10min)
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| 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
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| 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
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| Routine catheter care | q8h, remove secretions/encrustation at site, cleanse first 4 inches of tube, going away from urethra
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| Must replace catheter if... | if no voiding 6-8 hrs after removal, need to put back in
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| 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
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| Sites at risk for infection | place of insertion, drainage bag, spigot tube juction, junction of tube and bag
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