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44 Cards in this Set

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List the factors affecting voiding.
Developmental, Psychosocial, Fluid and Food Intake, Medications, Muscle Tone, Pathologic Conditions, Surgical & Diagnostic Procedures
Examples of developmental factors affecting voiding are:
Infants - have no urinary function until 2-5 years.
Elders - kidney function diminishes with age but more with disease & bladder issues.
Examples of psychosocial factors affecting voiding are:
Privacy, Normal Position, Sufficient Time, etc.
Examples of Fluid & Food Intake factors affecting voiding are:
Increased input directly relates to increased output.
Examples of Medication factors affecting voiding are:
Medications affecting the autonomic nervous system interfere with normal urination process--some may cause retention.
Examples of how muscle tone factors affect voiding:
Muscle tone is necessary to maintain stretch and contractivity of the detrusor muscle. A deficit in muscle tone could result in urine retention.
Examples of how pathologic conditions affect voiding:
Kidney disease, heart and circulatory disorders, shock and hypertension all affect voiding.
Examples of how surgical and diagnostic procedures affect voiding are:
Swelling from a cystoscopy and spinal anesthetics are two examples of procedures that affect voiding.
Define polyuria.
Production of large amounts of urine (diuresis).
Define Oliguria and Anuria.
decreased urine output or lack of urine production. Oliguria is < 500 ml/day.
Altered Urinary Elimination:

Frequency and Nocturia
More than 4-6 x/day. Nocturia is voiding more than 2 x/night.
Altered Urinary Elimination:

Urgency
Psychologic stress and irritation of the trigone and urethra, poor external sphincter control, unstable bladder contractions.
Altered Urinary Elimination:

Dysuria
Painful or difficult voiding (such as in a UTI or injury).
Altered Urinary Elimination:

Enuresis
Involutary urination (after 4-5 years of age)
Altered Urinary Elimination:

Urinary Incontinence
Symptom not a disease -- involuntary urination (at risk for isolation, social withdrawl).
Altered Urinary Elimination:

Urinary Retention
Characterized by over distended bladder from urine accumulation.
Altered Urinary Elimination:

Neurogenic Bladder
Doesn't perceive bladder fullness -- unable to control urinary sphincter because of neurologic deficits.
Nursing History regarding Urinary Elimination:
Normal voiding patterns, frequency, appearance, recent changes, past or current problems with urination, presence of ostomy, factors influencing elimination patterns.
Assessment of Urine:

Measuring Urinary Output
60 ml/hour or 1500 ml/day
Assessment of Urine:

Measuring Residual Urine
Internal Catheter--measure urine during normal voiding and cath immediately following voiding, measure urine collected from cath.
Assessment of Urine:

Diagnostic Tests
BUN (blood, urea, nitrogen) & Creatinine Clearance
Nursing Diagnoses (Urinary Elimination)
functional urinary incontinence, reflex urinary incontinence, stress urinary incontinence, total urinary incontinence, urge urinary incontinence
Home Care Client Assessment (for urinary eliminations concerns)
self-care abilities, current level of knowledge, assistive devices required, physical layout of toileting facilities, home environment factors interfering w/ toileting, urinary elimination problems
Continence (bladder) Training
time table--more control, habit training--scheduled toileting, prompted voiding--prompting and reminding when to void
Pelvic Muscle Exercises
Kegel's--strengthen pelvic floor muscles--control of urinary sphincter
Maintaining Skin Integrity
urine on skin--ammonia--wash w/ mild soap & water. Thekey is clean and dry--skin, clothing, linen--briefs, draw sheets that absorb liquid (sometimes barrier creams)
Managing Urinary Retention
Cholinergic Drugs for bladder contraction, Crede's Maneuver (manual pressure applied to bladder)
Nursing interventions for cath clients
fluids (2500 to 3000 ml/day to help decrease the risk of UTI's), dietary measures (acidity diet--red meat, tomatoes, whole grains, prunes, etc), perineal care (agency policy), changing catheter and tubing (sediment in cath tubing or collection)
Urinary Diversions
Continent--some control--Kock Pouch or Neobladder
Incontinent--produces urine all the time--requires use of external ostomy appliance (ureterostomy, nephrostomy, vesicostomy & ileal conduits)
Clean Voided Specimen
Routine UA -- 10 ml is sufficient
Clean-catch or midstream specimen
Used to identify specific microorganism causing UTI for antibiotic prescription
Timed Specimen
Void before time starts--if any is missed, start again
Concentration & Dilution of Urine, Glucose Metabolism, Specific Constituents (albumin, amylase, creatinine, urobilinogen)
Indwelling/Retention Catheter Specimen
drawn by syringe from self-sealing cath or port
Specific Gravity
measures amount of solute in urine
pH (urine testing)
normal is 4.5 to 8 -- tests for acidity or alkalinity
Glucose (urine testing)
present/not present - tests for diabetes
Ketones (urine testing)
present/not present - ketoacidosis (alcoholics, after fasting, high protein diets)
Protein
glomerulonephritis - protein is usually too large but if the glomerulus is damaged or "leaky" can spill into urine
Occult Blood
can be a sign of UTI or injury
Osmolality
more exact measurement for specific gravity
Fluid Intake
2500 ml/day: 1500 ml/day by liquids and another 1000 ml/day through foods
Fluid Output
urine, perspiration expectoration, watery feces, wound drainage, emesis, NG Tube Drainage
Fluid Volume Deficit
Loss: 2% is mild, 5% is moderate, 8% is severe (weight loss)
Signs: weak, rapid pulse, decreased temp, decreased BP, orthostatic hypotension
Fluid Volume Excess
Gain: 2% is mild, 5% is moderate, 8% is severe (weight gain)
Signs: edema which can lead to heart failure, renal failure, cirrhosis, tachycardia, full-bounding pulse, increased BP, moist crackles in lungs, dyspnea, increased central venous pressure