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Urinary Elim
T2-Urinary Elim Lecture - FI
| Question | Answer |
|---|---|
| How does urinary elimination occur? | Through the function of the kidneys, ureters, bladder, and urethra |
| What factors affect Urination? | Disease conditions, Sociocultural, Psychological, Fld Balance, Surgical, Meds, Diagnostic exams |
| What Pathological (Disease) conditions affect urinary elimination? | DM, MS, RA, Chronic diseases, Acute renal disease, Febrile, Spinal cord injuries |
| What Sociocultural Factors can affect urinary elimination? | Cultural and gender norms vary on privacy or publicness, Social expectation influence what time (school) |
| What Psychological factors can affect urinary elimination? | Anxiety and stress affect a sense of urgency and increase the frequency of urination |
| How can Fluid intake affect urinary elimination? | Caffeine and alcohol increase UOP |
| How can Surgical procedures affect urinary elimination? | Stress reponse to surgery reduces amt of urinary output to increase circulatory fl vol. Anesthetics and pn-killers slow filtration rate and reduce UOP. Local trauma during lower abd and pelvic surg sometimes obstructs urine flow, indwelling caths necess |
| How do Meds affect urinary elimination? | Diuretics prevent reabsorption of H2O and increases UOP. Some drugs change color or urine and affect ability to relax and empty bladder. |
| How do Diagnostic exams affect urinary elimination? | Cystoscopy causes localized edema of urethral passageway and bladder sphincter spasm, resulting in urinary retention and passing of red/pink urine. |
| Name urinary disorders | Urinary retnetion, Lower UTI, Urinary Incontinence |
| What is Urinary Retention? | Bladder is unable completely empty so urine accumulates in bladder |
| What will eventually develop from Urinary Retention? | Retention c overflow - Pressure in the bladder builds so that external urethral sphincter is unable to hold back urine. Sphincter opens to allow a small vol of urine to escape |
| What causes Urinary Retention? | Obstruction, Inflammation, Swelling, Anxiety, Meds |
| What is residual urine? | Urine left in bladder after urination. |
| How much residual urine is normal? | 100cc |
| What is bladder distention? | Then the bladder is full, it expands up into a dome and pushes above the symphysis pubis. Grealy distended bladder may reach the umbilicus. |
| How do UTIs occur? | Microorgs enter urethra resulting in bacterial spread, causing inflammation of bladder muscle |
| What are UTI nosocomial infections? | UTIs that are of hospital-acquired. |
| What are the characteristic symptoms of a UTI? | Dysuria, Urgency, Frequency |
| What is dysuria? | Burning during urination |
| Why are females more susceptible to UTIs? | Bc of the shorter urethra |
| What is Urinary Incontinence? | Loss of control over voiding which can be temporary or permanent |
| What are the types of Urinary Incontinence? | Total, Functional, Stress, Urge, Reflex |
| What is Acute Urinary Incontinence? | Reversible Urinary Incontinence |
| What is Chronic Urinary Incontinence? | Not reversible urinary incontinence |
| Describe Total Urinary Incontinence | Total uncontrollable and continuous loss of urine. Unpredictable. Constant dribble. No bladder distention bc urine doesn't collect in bladder |
| What causes Total urinary incontinence? | Neuropathy of sensory nerves, Trauma or disease of spinal nerves or urethral sphincter |
| What are the symptoms of Total Urinary Incontinence? | Constant flow of urine at unpredictable times |
| What Tx is avail for Total Urinary Incontinence? | Not may Tx |
| What is Reflex Urinary Incontinence? | Involuntary loss of urine occurring at somewhat predictable intervals when pt reaches specific bladder vol. (Bladder fills but no urge to void, so voids) |
| What causes Reflex Urinary Incontinence? | Upper spinal cord injury or disease involoving area above reflec arc, blocking cerebral awareness. Lower spinal cord injury blocking impulses to reflex arc. |
| What are the symptoms of Reflex Urinary Incontinence? | Lack of awareness of bladder filling, No urge to void, Uninhibited bladder contraction or spasm at regular intervals |
| What is Stress Urinary Incontinence? | Involuntary loss of urine caused by increased intraabdominal pressure |
| What causes Stress Urinary Incontinence? | Coughing, laughing, vomiting, lifting with a full bladder |
| What are the symptoms of Stress Urinary Incontinence? | Dribbling of urine with increased intraabdominal pressure |
| Who is primary affected by Stress Urinary Incontinence? | Women |
| What Tx is avail for Stress Urinary Incontinence? | Kegal exercises, bladder suspension |
| What Tx is avail for Reflex Urinary Incontinence? | Catheter |
| What is Functional Urinary Incontinence? | Environmental obstructions, sensory, motor, or cognitive deficit results where pt can't get to br in time |
| What are symptoms of Functional Urinary Incontinence? | Strong urge to void with loss of urine before reaching br |
| What Tx is avail for Functional Urinary Incontinence? | Alter environment so pt can go to br before voiding |
| What is Urge Urinary Incontinence? | Involuntary voiding after strong sense of urgency to void |
| What causes Urge Urinary Incontinence? | Decreased bladder capacity, Prostated enlargement, ETOH, Caffeine, Increased Fld intake |
| What are the symptoms of Urge Urinary Incontinence? | Urinary urgency, Abnormal frequency, Bladder contracture, Nocturia, Voiding in small or large amts |
| What Tx is avail for Urge Urinary Incontinence? | Treatment of infection, Drug therapy |
| What Nursing Processes are in the Assessment of Urinary Elimination? | Nursing Hx, Physical Assessment, Assessment of Urine, Diagnostic Exams (NPAD) |
| During the Assessment of Urinary Elimination, what is included in the Nursing Hx? | Pattern of Urination, Symptoms of Urinary Elimination, Factors Affecting Urinary Alterations |
| How do you assess for Patterns of Urination? | Ask the pt about daily voiding patterns - Freq and times of day, normal vol, Hx or recent changes. |
| What does nocturia indicate? | Renal or cardiovascular disease |
| How do you assess for Symptoms of Urinary Elimination? | Ask Pt about presence of Urinary Alteration symptoms, such as Urgency, Dysuria, Freq, Hesitancy, Polyuria, Oliguria, Nocturia, Dribbling, Hematuria, Rention, or Residual Urine |
| What is the minimum urinary production? | 30 mL/hr |
| What are the common symptoms of Urinary Alterations | Polyuria, Oliguria, Nocturia, Dysuria, Rention, Residual Urine, Freq, Urgency, Dribbling, Hematuria, Hesitancy (PONDRRFUDHH) |
| What does Polyria mean in terms of Common Symptoms of Urinary Alterations? | Voiding large amount of urine |
| What does Oliguria mean in terms of common symptoms of Urinary Alterations? | Diminished urinary output in relation to fl intake (scant amt of urine production) |
| What does Nocturia mean in terms of common symptoms of Urinary Alterations? | Excessive urination at night |
| What does Dysuria mean in terms of common symptoms of Urinary Alterations? | Pnful or difficultly urinating |
| What does Residual Urine mean in terms of common symptoms of Urinary Alterations? | Urine remaining in the bladder after voiding. >100 mL |
| What does Retention mean in terms of common symptoms of Urinary Alterations? | Accumulation of urine in bladder c inability to void |
| What does Frequency mean in terms of common symptoms of Urinary Alterations? | Voiding a frequent intervals |
| What does Urgency mean in terms of common symptoms of Urinary Alterations? | Feeling of the need to void immediatly |
| What does Dribbling mean in terms of common symptoms of Urinary Alterations? | Leakage of urine despite voluntary control or micturition (eg. Stress Incontinence) |
| What does Hematuria mean in terms of common symptoms of Urinary Alterations? | Presence of blood in urine |
| What does Hesitency mean in terms of common symptoms of Urinary Alterations? | Difficulty in initiating urination |
| What factors can affect urination? | Age, Meds, Urinary diversion, Sensory restrictions (blind), Environmental barriers, Mobility status, Past Illness, Major Surgery, Personal Habits, Fld intake (AMUSE MPMPF) |
| What is continent urinary diversion (CUR)? | Surgical diversion of the drainage of urine froma diseased of dysfunctional bladder. Pt uses cath to drain pouch |
| During the Assessment of Urinary Elimination, what is included in the Physical Assessment? | Assessment of Skin and Mucosal Membranes, Kidneys, Bladder, Urethral Meatus |
| Why do you assess the Skin and Mucosal Membranes in the Physical Assessment of Urinary Elimination? | To see if hydration is adequate |
| What increased the risk for skin breakdown? | Urinary incontinence, Fld imbalance, Electrolyte disturbances |
| How do you assess the Kidneys during the Physical Assessment for Urinary Elimination? | Flank pn develops, palpate for tenderness by gently precussing the costovertebral angle |
| What do you note when assessing the bladder during your PA? | Bladder distention. Upon light palpation, pt feels tenderness or pn |
| What should you note when assessing the Urethral Meatus during a PA? | Discharge, inflammation. Drainage indicated infection. Note color and consistency of drainage. |
| What does Assessment of Urine involve? | Noting I/O, Characteristice of Urine, Specimen collection, Common Urine tests. |
| What should you do to track I/O? | Measure I/O to monitor fl and electrolyte balance. Doc all fld intake-NPO, water for taking meds, fl in foods, Enteral feedings, Parenteral flds (IV, blood components, nutrition). Measure all UO c graduated container (bedpan, urinal, nuns hat, cath bag) |
| What is a Urometer? | Attached to cath drainage tubing and measures small urine vol on regular basis. HOlds 100-200 mL |
| What are the characteristics of Urine? | Color: Pale straw to amber. Clarity: Transparent at time of voiding but becomes cloudy. Odor: Ammonia odor. More concentrated or longer stands, stronger the odor. |
| What pt would have freshly voided urine appear cloudy? | Pts with renal disease bc of P concentration, Could be result of bacteria |
| What are the types of Specimen collection? | Random, Timed, Sterile, Mid-Stream (Clean voided) |
| What is a Timed Urine Specimen? | Involves collection of urine over specified amt of time, 24 hrs. Make sure last voiding is closest to end of time period. Let everyone know. |
| What is a Sterile Urine Specimen? | Has to be taken from catheter, so must put one in pt if they don't have one |
| What is a Mid-Stream/Clean-Voided Urine Specimen? | Pt wipes with sterile disinfectant wipes. During midstream, collect urine. Less contaminents. Standard U/A |
| What are the common urine tests? | U/A, Urine culture, Specific gravity |
| Describe a Urine culture Urine test | Req a sterile sample of urine. |
| Describe Specific Gravity Urine test | Use urinometer and cylinder. Pour specimen into cylinder and suspend urinometer in it. Concentration of dissolved sub in urine determines depth at which urinometer will float. High specific gravity=concentrated urine. Low grav=diluted urine. 1.005-1.030 |
| What type of techniques are used in the Diagnostic Examinations during Assessment of Urinary Elimination? | Invasive and Noninvasive |
| What are noninvasive techniques that can be used to in diagnostic exams of the urinary system? | Xrayx, Flat plate, KUB, IV Pylogram, CT scan |
| What are invasive techniques that can be used to in diagnostic exams of the urinary system? | Cystoscopy, Endoscopy, Arteriogram/Angiogram |
| What is a cystoscopy? | Looks for inflammation, masses. Cystoscope inserted through urethra. Pnful so pt is under general or local anesthesia with sedation |
| What is an Arteriogram or Angiogram? | Invasiv radiographic procedure c radiopaque contrast material that outlines the vascular supply to the kidneys |
| What is the normal pH values in U/A? | 4.5-8.0 |
| Through assessment of pt's urinary function IDs defining charact that support actual or at-risk elimination probs. From then, you can give a possible: | Nursing Diagnosis |
| In the Nursing Process, the Planning stage establishes: | Pt-centered goals and outcomes in collaboration with the pt and family. Set priorities, Continuity of care |
| During the Assessment of Urinary Elimination, what is included in the Implementation phase? | Promotion of Normal Voiding, Promotion of Complete Bladder Emptying, Prevention of Infection, Promoting Comfort, Maintenance of Skin Integrity (NCPCM) |
| How do you Promote Normal Voiding? | Provide privacy, Kegal exercises and situps, Manual bladder compression/Crede's Compression, Cath, Bladder reconditioning |
| Describe Crede's Compression | Helps stimulate micturition and manually expels urine when bladder tone is reduced. When urine in bladder, Crede's causes sensation of bladder fullness. Also promotes bladder emptying by relaxing urethral sphincter |
| Describe Bladder Reconditioning | Clamp cath so urine accumulates in bladder to get bladder used to expanding/contracting. Then unclamp |
| How long is max amt of time before pt should have voided? | Within 8 hrs |
| How do you promote bladder emptying? | Strengthening Pelvic Floor muscles, Crede's Compression, Drug therapy |
| Name cath alternatives | Suprapubic cath and Condom Cath |
| What is a Suprapubic catheter? | Inserted surgically into the bladder through the lower abdomen above the symphysis pubis. Sometimes used in older males who req long-term alternative to urinary cath. Risk for UTI, spread of infection to kidneys req removing cath. |
| What is a Condom Catheter? | Perfect for incontinent or comatose male pts who still have complete and spontaneous bladder emptying. Poses little risk for infection. Must remove daily to check for skin irritation. |
| What are advantages of Suprapubic cath? | Void naturally when cath is clamped and is more comfortable |
| How do you Prevent Infection regarding Urinary Assessment? | Urine pH=4-8 (strive for acidity-meat,eggs, cranberry juice), Void @ regular intervals, Good hygienve, Cath care, Void after sex, Showers instead of bath, Prevent breaks in indwelling cath unless intermittent irrigation |
| How do you Promote Comfort when dealing with Urinary Elimination? | Pt is clean and dry, If they have Dysuria, give pt Sitz baths |
| How do you Maintain Skin integrity regardin Urinary Elimination? | Clean and dry to prevent maserate of skin, wash c mild soap and water if incontinent |
| What is urinary reflux? | Abnormal backward flow of urine. Infection will likely develop |
| What are the outcomes you are striving for during Evaluation? | Pt has ability to urinate voluntarily s dysuria, urgency or freq. Urine is amber color, clear, s abnormal constituents, Within normal range of pH and specific gravity |
| What is cystitis? | Inflammation of the bladder |
| An adult pt hasn't voided in 8 hrs and complains about a continued perception of the urge to urinate. Your inital action is to: | Palpate the pt's bladder |
| Identification of a "2+ hematuria" in female pt c UTI indicates: | Irriation of the bladder mucosa from the pathogen |
| When applying a condom cath, it is important to secure the cath to penile shaft in such a manner that the _____ circulation is not impaired and urine is able to flow out. | Penile |
| When a pt c an indwelling cath c/o discomfort in the bladder, you first: | Check the patency of the tube |
| Maintaining a Foley cath drainage bag in the dependent position prevents: | Urinary reflux |
| The purpose of instructing the pt to begin and discard the initial stream of urin when obtaining a mid-stream urine specimen is to: | Allow the initial urine to wash bacteria from external genitalia |
| How long s urinating before the pt is at risk for cystitis? | More than 8 hrs |
| When collecting a 24-hour urine specimen, you: | Discard the first voided specimen in the 24-hour period |
| A routine U/A is ordered for pt. If you cannot send the specimen to lab immediately, you: | Refrigerate the specimen |
Created by:
mcwilliams05
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