Ch. 33
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| show | 1 - 2 L/day, 95% h2O, 5% solutes (electrolytes and urea, uric acid, creatinine, ammonia)
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| show | nephrons remove waste from blood and regulate water/electrolyte concentrations
Glomerulus - site of urine formation
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| show | protein in urine, not supposed to be there. If present then faulty glomerulus
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| show | urination, voiding. Adult urinates 150-200mL/day, child 50-100.
Ext sphincter relaxes, detrusor muscle contracts
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| show | physiological, psychosocial conditions, diagnosticor treatment-induced
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| show | 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 | show 🗑
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| What is urinary retention? | show 🗑
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| What is over flow incontinence | show 🗑
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| What is residual urine | show 🗑
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| show | 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) | show 🗑
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| show | prevent reabsorption of h2o, incr. urination
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| show | 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 | show 🗑
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| What is total urinary incontinence and cases and symptoms | show 🗑
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| Functional urinary incontinence | show 🗑
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| show | incr abd pressure cause leaks
Cause: cough/laugh/vomit, obesity, 3rd trimester, weak muscles
Sx: dribbling, urgency, freq.
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| show | 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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| show | 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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| show | Catheter Associated UTI's, assoc. morbidity, prolong hospitilizations, mortality
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| show | sterile insertion technique
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| show | bladder scanner, toileting schedule
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| show | renal or cardiovascular disease or cystitis
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| show | 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 | show 🗑
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| show | painful or difficult urination, bladder inflammation, trauma of urethra
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| what is polyuria | show 🗑
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| What is oliguria | show 🗑
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| show | blood in urine, neoplasms of kidney, glomerular disease, kidney/bladder infections, caliculi
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| show | 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 | show 🗑
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| show | 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? | show 🗑
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| show | 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... | show 🗑
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| Normal Urinalysis values | show 🗑
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| What do you keep/discard when collecting 24 hr sample | show 🗑
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| Noninvasive Procedures Abdominal Roentgenogram | show 🗑
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| show | view entire urinary system, IV injection of radiopagque dye
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| Noninvasive procedures Computerized Axial Tomography | show 🗑
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| Invasive procedures Endoscopy | show 🗑
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| Invasive procedures Urodynamic Testing | show 🗑
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| show | Stress: if px loses urine after sneeze/cough
Urge: strong urge before incontinence
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| show | putting pressure on suprapubic area to relieve urinary retention
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| show | px edu, promote normal micturition and bladder emptying, prevention of infection, promote skin integrity and comfort
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| show | Bethanochol - incr bladder contraction and improve emptying
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| show | phenoxybenzamine improve emptying
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| show | propantheline - reduce incontinence by blocking contractility of bladder
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| show | indwelling, Foley- until pxt voids completely
intermittent- single use (5-10min)
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| show | 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 | show 🗑
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| show | q8h, remove secretions/encrustation at site, cleanse first 4 inches of tube, going away from urethra
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| show | if no voiding 6-8 hrs after removal, need to put back in
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| show | 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 | show 🗑
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