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45 Cards in this Set
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Rate of urine production |
The kidneys produce urine at a rate of approximately 50 to 60 ml per hour (1500 ml per day) |
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Factors affecting urinary output |
-quantity the of fluids the patient drinks -ability of the heart to circulate the blood -adequate kidney functioning -ability of the patient to void -may be low if the individual is sweating excessively or vomiting and diarrhea -may be reduced due to high fever |
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Measuring fluid intake |
Record all fluids the patient drinks or receives intravenously, include: -oral fluids -semiliquid foods -ice chips -IV fluids -tube feedings -irrigations instilled |
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Measuring fluid output |
Include: -urine output -gastrointestinal fluid loss (e.g., emesis) -feces -drainage (e.g., suction devices or wounds) |
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Normal ranges for blood urea nitrogen (BUN) and creatinine |
BUN: 8-20 mg/dl Creatinine: 0.5-1.1 mg/dl Levels may be increased in: -renal failure -impaired renal perfusion -kidney infection or inflammation -kidney obstruction -dehydration -excessive protein intake -use of total parenteral nutrition (TPN) Levels may be decreased in: -inadequate protein intake -malabsorption syndromes -liver disease |
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Blood urea nitrogen (BUN) |
A measure of the amount of urea in the blood. Urea forms in the liver as the end product of protein metabolism, circulates in the blood, and is excreted through the kidney in urine. The BUN, determined by a blood test, is directly related to the metabolic function of the liver and the excretory function of the kidneys. |
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Creatinine |
A substance formed from the metabolism of creatine, commonly found in blood, urine, and muscle tissue. It is measured in blood and urine test as an indicator of kidney function. The numbers decrease in elderly patients because of a smaller muscle mass. |
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Emesis |
To expel the contents of the stomach through the esophagus and out of the mouth. Also called emesis, vomitus, the material expelled. |
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When to total I&Os |
You will usually total the I&O at the end of each shift as well as for each 24-hour period. In extensive care units, you may measure I&O hourly. Explain to the client, family members, and all caregivers that intake and output are being monitored. Posting a sign at the bed side or on the door to the room is a helpful reminder. When possible, have the client assist you with monitoring. |
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Indwelling urinary catheter |
Also known as a Foley or a retention catheter. It is a flexible tube that is inserted through the urethra into the bladder. It is held in place by a balloon that is inflated in the bladder above the detrusor muscle. |
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Freshly voided specimen |
To collect a freshly voided sample, collect the urine in the same manner as when you are measuring I&O. Pour the urine into the specimen container labeled with the patient's name, the date, and time of collection. |
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Clean catch specimen |
The client must cleanse the genital before voiding and collect a sample in midstream because initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum. |
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Clean catch specimen |
The client must cleanse the genital before voiding and collect a sample in midstream because initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum. |
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Sterile urine specimen |
A sterile urine specimen aids in determining the presence of a urinary tract infection. You can obtain a sterile urine specimen by inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter. Never disconnect a catheter from the drainage tube to obtain a sample. Interrupting the system creates a portal of entry for pathogens thereby increasing the risk of contamination. |
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Acute renal failure (ARF) |
An acute rise in the serum creatinine level of 25% or more. May be caused by inadequate blood flow to the kidney, injury to the kidney glomeruli or tubules, or obstruction of kidney outflow. |
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Anuria |
The absence of urine, often associated with kidney failure or congestive heart failure. This term is used when urine output is less than 100 milliliters in 24 hours. |
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Dysuria |
Painful or difficult urination. May be associated with infection or partial obstruction of the urinary tract as well as medications that trigger urinary retention. |
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End stage renal disease (ESRD) |
A chronic rise in serum creatinine levels associated with lost of kidney function that must be treated with dialysis or transplantation. Also known as chronic renal failure (CRF). |
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Enuresis |
Involuntary loss of urine |
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Frequency |
The need to urinate at short intervals |
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Hematuria |
Blood in the urine. Maybe due to trauma, kidney stones, infection, or menstruation. |
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Oliguria |
Urine output of less than 400 ml in 24 hours. For pediatric patients, oliguria is less than 0.5 - 1.0 milliliters per kilogram per hour (ml/kg/hr) |
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Nephropathy |
A broad term meaning "disease of the kidney" |
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Nephrotoxic |
A substance that damages kidney tissue. Some antibiotics (gentamicin, tobramycin, and amikacin), non-steroidal anti-inflammatory drugs, lead, and contrast media have the potential to be in nephrotoxic |
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Nocturia |
Frequent urination after going to bed. May be caused by excessive fluid intake as well as a variety of urinary tract and cardiovascular problems. |
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Nocturnal enuresis |
Involuntary loss of urine while asleep. |
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Micturition |
To start the stream of urine; to urinate; release urine from the bladder. |
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Pessary |
An incontinence device that is inserted into the vagina to reduce organ prolapse or pressure on the bladder |
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Polyuria |
Excessive urination. May be caused by excessive hydration, diabetes mellitus, diabetes insipidus, or kidney disease. |
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Proteinuria |
The presence of protein in the urine. May be a sign of infection or kidney disease. |
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Pyuria |
Pus in the urine. May be caused by lesions or infection in the urinary tract. |
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Urgency |
A sudden, almost uncontrollable need to urinate. |
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Routine urinalysis (RA) |
Urinalysis requires a freshly voided sample. - dipstick testing can determine pH and specific gravity and the presence of protein, glucose, ketones, and occult blood in the urine. Commercially prepared kits contain a reagent designed to detect a specific substance. - specific gravity is an indicator of urine concentration. Can be measured with a reagent strip but a refractometer can give precise and accurate measurements. A Refractometer measures the extent to which a beam of light changes direction when it passes through the urine. If the concentration of solids is high, the light is refracted more. |
-Bedside testing (dipstick) - specific gravity |
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Color of urine |
A freshly voided sample is pale yellow to deep amber. Urine becomes lighter in color and and may even be clear if fluid intake is high or urine output is excessive. Urine becomes dark in color as it becomes more concentrated with decreased fluid intake or excessive fluid loss. Color is also affected by diet and medications. |
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PH of urine |
5.0-9.0, with an average of 6.0 Indicates kidneys' ability to help maintain balanced hydrogen ion concentration in the blood. The pH increases (more alkaline) if the client eats dairy products or citrus fruits or has a vegetarian diet. The pH decreases (more acidic) if the client eats a high protein diet or consumes cranberry juice. |
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Specific gravity of urine |
1.001- 1.035 This is a reflection of the kidneys' ability to concentrate urine. Specific gravity rises with limited fluid intake or dehydration. It may also rise with kidney disease. Specific gravity decreases as fluid intake increases. |
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Clarity of urine |
A freshly voided sample should be translucent. If the urine sits for a period of time, it will become cloudy. Cloudiness in a freshly voided sample indicates the presence of other constituents in the urine. These may include bacteria, red blood cells (RBCs), WBCs, sperm, prostatic fluid, or vaginal discharge. |
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Odor of urine |
Fresh urine is aromatic. Certain foods such as garlic, onions, and asparagus, may give urine a distinctive odor. Bacteria will give urine an ammonia like odor. A sweet syrup odor may indicate a congenital metabolic disorder. |
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Protein of urine |
<20 mg/dl Proteinuria is the most common indicator of renal disease. Protein is increased in diabetic nephropathy, glomerulonephritis, nephrosis, and toxemia of pregnancy. May be increased in benign proteinuria secondary to stress or physical exercise. |
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Glomerulonephritis |
An inflammation of the glomerulus of the kidney, characterized by proteinuria, hematuria, decreased urine production, and edema. |
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Glucose in urine |
Should be negative Glucose is found in the urine with elevated blood sugars and diabetes. |
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Ketones in the urine |
Should be negative. Presence of ketones indicates impaired carbohydrate metabolism. Ketones may be detected with diabetes, fever fasting, high protein diets, starvation, vomiting, or the post anesthesia period. |
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Hemoglobin of urine |
Negative on dipstick If RBCs are assessed via microscopic exam: < 5 per high-power field. Hemoglobin may be detected with infection of the urinary tract, disease of the bladder, glomerulonephritis, pyelonephritis, nephrolithiasis, hemolytic reactions, or trauma. It also may be present in samples from women who are currently menstruating. |
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Bilirubin in urine |
Should be negative. Increased bilirubin occurs with liver disease. |
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Urobilinogen in urine |
Up to 1 mg/ dl Increase is found in cirrhosis, heart failure, liver disease, infectious mononucleosis, malaria, and pernicious anemia. |
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