Ch 48

Front 1

A person's urinary habits depend on

Back 1

social culture, personal habits, and physical abilities

Front 2

Urinary elimination depends on effective functioning of the

Back 2

upper urinary tract: kidneys and ureters; and the lower urinary tract: urinary bladder, urethra, and pelvic floor

Front 3

Peritoneal cavity

Back 3

The potential space between the parietal and visceral layers of the peritoneum

Front 4

Peritoneum

Back 4

The serous membrane that lines the walls of the abdominal cavity and folds inward to enclose the viscera

Front 5

Viscera

Back 5

The soft internal organs of the body, especially those contained within the abdominal and thoracic cavities

Front 6

The Kidneys are the primary regulators of ______ and ______ ______ balance in the body

Back 6

fluid and acid-base

Front 7

The functional unit of the kidneys are the

Back 7

Nephrons, which filter the blood and remove metabolic wastes

Front 8

In the average adult _____ mL of blood, or about ___ % of the cardiac output, passes through the kidneys every minute

Back 8

1,200 mL; 21%

Front 9

Each kidney contains approximately __________ nephrons

Back 9

1 million

Front 10

Each nephron has a ______, a tuft of capillaries surrounded by Bowman's capsule

Back 10

glomerulus

Front 11

The endothelium of glomerular capillaries is ______, allowing fluid and solutes to readily move across this membrane into the capsule

Back 11

porous

Front 12

______ ______ and ______ ______, are too large to cross the membrane normally

Back 12

plasma proteins and blood cells

Front 13

Glomerular filtrate is similar in compostiion to ______, made up of water, electrolytes, glucose, amino acids, and metabolic wastes

Back 13

plasma

Front 14

From bowman's capsule the filtrate moves into the tubule of the nephron. In the ______ ______ ______, most of the water and electrolytes are reabsorbed.

Back 14

proximal convoluted tubule

Front 15

Solutes such as ______ are reabsorbed in the loop of Henle, but in the same area other substances are secreted into the filtrate, concentrating the urine.

Back 15

glucose

Front 16

In the ______ ______ ______, additional water and sodium are reabsorbed.

Back 16

distal convoluted tubule;

Front 17

In the distal convoluted tubule, additional water and sodium are reabsorbed under the control of ______ such as ______ ______ (ADH), and ______

Back 17

harmones; antidiuretic hormone and aldosterone

Front 18

Diuretic

Back 18

Tending to increase the discharge of urine.

Front 19

Aldosterone is a ______ ______ secreted by the ______ ______ that regulates the ______ and ______ balance in the body.

Back 19

steroid hormone; adrenal cortex; salt and water

Front 20

ADH is released from the ______ ______ when fluid intake is ___ or the concentration of solutes in the blood is ____. More water is reabsorbed in the distal tubule, and less urine is excreted.

Back 20

anterior pituitary; low; high

Front 21

Solute

Back 21

The dissolved matter in a solution; the component of a solution that changes its state

Front 22

When fluid intake is high or the blood solute concentration is low, ADH is

Back 22

suppressed

Front 23

Without ______, the distal tubule becomes impermeable to ______, and more urine is ______.

Back 23

ADH; water; excreted

Front 24

Aldosterone also affects the tubule. When aldosterone is released from the adrenal cortex, sodium and water are ______ in greater quantities, increasing the ______ volume and decreasing ______ output.

Back 24

reabsorbed; blood; urinary

Front 25

Calyx

Back 25

A collecting structure in the kidney.

Front 26

Renal pelvis

Back 26

The middle section of the kidney where urine first collects after filtration from the blood.

Front 27

Once the urine is formed in the kidneys, it moves through the collecting ducts into the calyces of the renal pelvis and from there into the ______.

Back 27

ureters

Front 28

The ureters are ___ cm long and ___ cm in diameter.

Back 28

25 - 30 cm; 1.25 cm

Front 29

The upper end of each ureter is ______ shaped as it enters the kidney.

Back 29

funnel

Front 30

The lower ends of the ureters enter the bladder at the ______ ______ of the ______ of the bladder.

Back 30

posterior corners; floor

Front 31

At the junction between the ureter and the bladder, a flaplike fold of mucous membrane acts as a valve to prevent ______ of urine up the ureters.

Back 31

reflux

Front 32

The urinary bladder is a ______, ______ organ that serves as a ______ for urine and as the organ of ______.

Back 32

hollow, muscular; reservoir; excretion

Front 33

When empty, the urinary bladder lies behind the ______ ______.

Back 33

symphysis pubis

Front 34

In men, the bladder lies in front of the ______ and above the ______ ______.

Back 34

rectum; prostate gland

Front 35

In women the bladder lies in front of the ______ and ______.

Back 35

uterus; vagina

Front 36

Normal bladder capacity is between ___ and ___ mL of urine.

Back 36

300 mL - 600 mL

Front 37

The ______ extends from the bladder to the urinary ______ (opening).

Back 37

urethra; meatus

Front 38

In the adult woman, the urethra lies directly ______ the symphysis pubis, ______ to the vagina, and is between ___ and ____ cm long

Back 38

behind; anterior; 3cm-4cm

Front 39

The urinary meatus is located between the ______ ______, in front of the ______ and below the ______.

Back 39

labia minora; vagina; clitoris

Front 40

The male urethra is aproximately ___ cm long and serves as a passageway for ______ as well as ______.

Back 40

20 cm; semen; urine

Front 41

In both men and women, the urethra has a mucous membrane lining that is ______ with the bladder and the ureters. Thus, an infection of the urethra can extend through the urinary tract to the kidneys.

Back 41

continuous

Front 42

The vagina and the urethra and rectum pass through the ______ ______ which consist of sheets of muscles and ligaments that provide support to the viscera of the pelvis

Back 42

pelvic floor

Front 43

The internal sphincter muscle situated in the proximal urethra and the bladder neck is composed of smooth muscle under ______ control. It provides active tension designed to close the urethral lumen.

Back 43

involuntary

Front 44

The external sphincter muscle is composed of skeletal muscle under ______ control, allowing the individual to choose when urine is eliminated.

Back 44

voluntary

Front 45

The wall of the bladder is made up of four layers. The smooth muscle layers are collectively called the ______ ______.

Back 45

detrusor muscle

Front 46

The ______ at the base of the bladder is a triangular area marked by the ureter openings at the posterior corners and the opening of the urethra at the anterior inferior corner.

Back 46

trigone

Front 47

______, ______, and ______ all refer to the process of emptying the urinary bladder.

Back 47

micturition, voiding, and urination

Front 48

Urine collects in the bladder until pressure stimulates special ______ ______ endings in the bladder wall called ______ ______.

Back 48

sensory nerve; stretch receptors

Front 49

The amount of pressure that stimulates the sensory nerve endings in the bladder is __ to ___ mL

Back 49

50-200mL

Front 50

The stretch receptors transmit impulses to the ______ cord, specifically to the ______ ______ center located at the level of the ______ to ______ sacral vertebrae.

Back 50

spinal; voiding reflex; second to fourth

Front 51

If the time and place are appropriate for urination, the ______ portion of the brain ______ the external urethral sphincter muscle and urination takes place

Back 51

conscious; relaxes

Front 52

If the time and place are inappropriate, the ______ ______ usually subsides until the bladder becomes more filled and the reflex is ______ again.

Back 52

micturition relfex; stimulated

Front 53

Voluntary control of urination is possible only if the ______ supplying the bladder and urethra, the ______ ______ of the cord and brain, and the ______ area of the ______ are all intact.

Back 53

nerves; neural tracts; motor; cerebrum

Front 54

Injury to any of these parts of the nervous system-for example, by a cerebral hemorrhage or spinal cord injury abouve the level of the sacral region-results in intermittent ______ ______ of the bladder.

Back 54

involuntary emptying

Front 55

Elders whos cognition is ______ may not be aware of the need to urinate or able to respond to this urge by seeking toilet facilities.

Back 55

impaired

Front 56

Urine output varies according to fluid intake but gradually increases to ___ to ___ mL a day during the first year.

Back 56

250mL-500mL

Front 57

Infants are born without urinary control. Most will develop this between the ages of ___ to ___.

Back 57

2 and 5

Front 58

Parents need to realize that accidents do occur and the child should never be _______ or ______ for this

Back 58

punished or chastised

Front 59

The kidneys double in size between ages ___ and __ years

Back 59

5 and 10

Front 60

______, which is defined as the involuntary passing of urine when control should be established (about ___ years of age), can be a problem for some school-age children.

Back 60

Enuresis; 5

Front 61

______ ______, or bed-wetting, is the involuntary passing of urine during sleep

Back 61

nocturnal enuresis

Front 62

Bed-wetting should not be considered a problem until after the age of ___.

Back 62

6

Front 63

The excretory function of the kidney ______ with age, but usually not signfificantly below normal levels unless a ______ precess intervenes.

Back 63

diminishes; disease

Front 64

With age, the number of functioning ______ decreases to some degree, imparing the kidney's filtering abilities.

Back 64

nephrons

Front 65

Conditions that alter normal fluid intake and output, such as having ______ or having ______, can compromise the kidney's ability to filter, maintain acid-base balance, and maintain electrolyte balance in elders

Back 65

influnenza; surgery

Front 66

The more noticeable chages with age are those related to the ______.

Back 66

bladder

Front 67

Complaints of urinary ______ and urinary ______ are common in the eldery.

Back 67

urgency and frequency

Front 68

In men these changes are often due to an enlarged ______ ______, and in women they may be due to weakened ______ supporting the bladder or weakness of the ______ ______.

Back 68

prostate gland; muslces; urethral sphincter

Front 69

The capacity of the bladder and its ability to completely empty diminish with ___.

Back 69

age

Front 70

This explains the need for elders to arise during the night to void (______ ______) and the retentions of ______ ______, predisposing the elder to bladder infections.

Back 70

nocturnal frequency; residual urine

Front 71

Conditions which may help stimulate the micturition relfex include ______, normal ______, sufficient ______, and, ocasionally, running ______.

Back 71

privacy; position; time; water

Front 72

Circumstances that do not allow for the client's accustomed conditions may produce ______ and muscle ______.

Back 72

anxiety; tension

Front 73

As a result of anxiety and muscle tension, the person is unable to relax abdominal and perineal muscles and the external urethral sphincter, and voiding is ______.

Back 73

inhibited

Front 74

People may voluntarily suppress urination because of perceived time pressures e.g., nurses often ignore the urge to void until they are able to take a break. This behavior can increase the risk of urinary tract ______.

Back 74

infections

Front 75

The healthy body maintains a balance between the amount of fluid ingested and the amount of fluid ______.

Back 75

eliminated

Front 76

When the amount of fluid intake increases, the output normally ______.

Back 76

increases

Front 77

Certain fluids, such as alcohol, increase fluid output by inhibiting the production of ______ ______

Back 77

antidiuretic hormone

Front 78

fluids that contain caffeine e.g., ______, ______, and ______ ______ also increase urine production.

Back 78

coffee, tea, and cola drinks

Front 79

Food and fluids high in ______ can cause fluid retention because water is retained to maintain the normal concentration of electrolytes.

Back 79

sodium

Front 80

Some foods and fluids can change the color of urine. For example, beets can cause urine to appear ______; foods containing ______ can cause the urine to appear yellower than usual.

Back 80

red; carotene

Front 81

Many medications, particularly those affecting the automomic nervous system, interfere with the normal urination process and may cause ______.

Back 81

retetntion

Front 82

______ e.g., chlorothiazide and forosemmide increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidney into the bloodstream

Back 82

Diuretics

Front 83

Some medications may alter the ______ of the urine

Back 83

color

Front 84

Changes in uringary elimination through the life span fetuses:

Back 84

The fetal kidney begins to excrete urine between the 11th and 12th week of development

Front 85

Changes in uringary elimination through the life span infants:

Back 85

Ability to concentrate urine is minimal; therefore, urine appears light yellow. Because of neuromuscular immaturity, voluntary urinary control is absent

Front 86

Changes in uringary elimination through the life span children:

Back 86

Kidney function reaches maturity between the 1st and 2nd year of life; urine is concentrated effectively and appears a normal amber color; Between 18 and 24 months of age, the child starts to recognize bladder fullness and is able to hold urine beyond the urge to void; At approximately 2 1/2 to 3 years of age, the child can perceive bladder fullness, hold urine after the urge to void, and communicate the need to urinate; Full urinary control usually occurs at age 4 or 5 years; daytime control is usually achieved by age 3 years

Front 87

Changes in uringary elimination through the life span adults:

Back 87

The kidneys reach maximum size between 35 and 40 years of age.

Front 88

Changes in uringary elimination through the life span

Back 88

An estimated 30% of nephrons are lost by age 80. Renal blood flow decreases because of vascular changes and a decrease in cardiac output. The ability to concentrate urine declines. Bladder muscle tone diminishes, causing increased frequency of urination and nocturia (awakening to urinate at night). Diminished bladder muscle tone and contractibility may lead to residual urine in the bladder after voiding, increasing the risk of bacterial growth and infection. Urinary incontinence may occur due to mobility problems or neurologic impairments

Front 89

Anticholinergic and antispasmodic medications, such as ______ and ______ may cause urinary retention.

Back 89

atropine and papaverine

Front 90

Antidepressant and antipsychotic agents, such as ______ and ______ ______ may cause urinary retention.

Back 90

phenothiazines and MAO inhibitors

Front 91

Antihistamine preparations, such as ______ (actifed and sudafed)may cause urinary retention.

Back 91

pseudoephedrine

Front 92

Antihypertensives, such as ______ (apresoline) and ______ (aldomet) may cause urinary retention.

Back 92

hydralazine and methyldopate

Front 93

Antiparkinsonism druge, such as ______, ______ (artane), and ______ ______ (cogentin)may cause urinary retention.

Back 93

levodopa, trihexyphenidyl and benztropine mesylate

Front 94

Beta-adrenergic blockers, such as ______ (inderal) may cause urinary retention.

Back 94

propranolol

Front 95

Opioids, such as ______ (vicodin) may cause urinary retention.

Back 95

hydrocodone

Front 96

Good muscle ______ is important to maintain the stretch and contractility of the ______ muscle so the bladder can fill adquately and empty completely.

Back 96

tone; detrusor

Front 97

Clients who require a retention catheter for a long period may have poor bladder muscle ______ because continuous drainage of urine prevents the bladder from filling and emptying normally.

Back 97

tone

Front 98

______ muscle tone also contributes to the ability to store and empty urine.

Back 98

Pelvic

Front 99

Diseases of the ______ may affect the ability of the nephrons to produce urine

Back 99

kidneys

Front 100

Kidneys may virtually stop producing urine altogether, a condition known as ______ ______.

Back 100

renal failure

Front 101

Heart and circulatory disorders such as ______ failure, ______, or ______ can affect blood flow to the kidneys, interfering with urine production.

Back 101

heart, shock, or hypertension

Front 102

If abnormal amounts of fluid are lost through another route e.g., ______ or ______ ______, water is retained by the kidneys and urinary output falls

Back 102

vomiting or high fever

Front 103

Processes that interfere with the flow of urine from the kidneys to the urethra affect urinary ______.

Back 103

excretion

Front 104

A urinary stone (______) may obstruct a ureter, blocking urine flow from the kidney to the bladder.

Back 104

calculus

Front 105

Hypertrophy of the ______ ______, a common condition affecting older ______, may obstruct the urethra, impairing urination and bladder emptying.

Back 105

prostate gland; men

Front 106

Some surgical and diagnostic procedures affect the passage of urine and the urine itself. The urethra may swell following a ______, and surgical procedures on any part of the urinary tract may result in some postoperative bleeding; as a result, the urine may be red or pink tinged for a time.

Back 106

cystoscopy

Front 107

______ ______ can affect the passage of urine because they decrease the client's awareness of the need to void.

Back 107

spinal anesthetics

Front 108

Surgery on structures ______ to the urinary tract can also affect voiding because of swelling in the lower abdomen.

Back 108

adjacent

Front 109

Although people's paterns of urination are highly individual, most people void about ___ to ___ times a day.

Back 109

5 to 6

Front 110

People usually void when they first ______ in the morning, before they go to ______, and around ______.

Back 110

awaken; bed; mealtimes

Front 111

______ (or ordiuresis) refers to the production of abnormally large amounts of urine by te kidneys, often several liters more than the client's usual daily output.

Back 111

polyuria

Front 112

Polyuria can follow excessive fluid intake, a condition known as ______,

Back 112

polydipsia

Front 113

Polyuria may be associated with diseases such as ______ ______ , ______ ______ , and ______ ______ .

Back 113

diabetes mellitus, diabetes insipidus, and chronic nephritis

Front 114

The terms ______ and ______ are used to describe decreased urinary output.

Back 114

oliguria and anuria

Front 115

______ is low urine output, usually less than ___ mL a day or ___ mL an hour for an adult.

Back 115

Oliguria; 500mL or 30mL

Front 116

______ can cause excessive fluid loss, leading to intense thirst, dehydration, and weight loss.

Back 116

Polyuria

Front 117

Although oliguria may occur because of abnormal fluid losses or a lack of fluid intake, it often indicates impaired ______ ______ to the kidney or impending ______ ______ and should be promptly reported to the primary care provider.

Back 117

blood flow; renal failure

Front 118

Restoring renal ______ flow and ______ output promptly can prevent renal failure and its complications.

Back 118

blood and urinary

Front 119

______ refers to a lack of urine production.

Back 119

Anuria

Front 120

______ refers to a lack of urine production.

Back 120

Anuria

Front 121

Should the kidneys become unable to adequately function, some mechanism of filtering the blood is necessary to prevent ______ and ______.

Back 121

illness and death

Front 122

Artifical filtering is done through the use of renal ______ , a technique by which fluids and molecules pass through a semipermeable membrane according to the rules of ______ .

Back 122

dialysis; osmosis

Front 123

Artifical filtering is done through the use of renal ______ , a technique by which fluids and molecules pass through a semipermeable membrane according to the rules of ______ .

Back 123

dialysis; osmosis

Front 124

The two most common methods of dialysis are ______ and ______ dialysis.

Back 124

hemodialysis and peritoneal

Front 125

In ______ , the client's blood flows through vascular catheters, passes by the dialysis solution in an external machine, and then returns to the client

Back 125

hemodialysis

Front 126

In ______ dialysis, the dialysis solution is instilled into the abdominal cavity through a catheter, allowed to rest there while the fluid and molecules exchange, and then removed through the catheter.

Back 126

peritoneal

Front 127

Both hemodialysis and peritoneal dialysis must be performed at ______ ______ until the client's kidneys can resume the filtering function.

Back 127

frequent intervals

Front 128

Frequency, nocturia, urgency, and dysuria often are manifestations of underlying conditions such as a ______ ______ ______ .

Back 128

urinary tract infection

Front 129

Enuresis, incontinence, retention, and neurogenic bladder may be either a ______ or the ______ problem affecting urinary elimination.

Back 129

manifestation; primary

Front 130

Polyuria

Back 130

Ingestion of fluids containing caffeine or alcohol; prescribed diuretic; presence of thirst, dehydration, and weight loss

Front 131

Oliguria, anuria

Back 131

Decrease in fluid intake; signs of dehydration; presence of hypotension, shock, or heart failure; history of kidney disease; sighs of renal failure such as elevated blood urea nitrogen (BUN) and serum creatinine, endema, hypertension

Front 132

Frequency or nocturia

Back 132

Pregnancy; increase in fluid intake; urinary tract infection

Front 133

Urgency

Back 133

presence of psychologic stress; urinary tract infection

Front 134

Dysuria

Back 134

urinary tract inflammation, infection, or injury; hesitancy, hematuria, pyuria (pus in the urine), and frequency

Front 135

Enuresis

Back 135

Family history of enuresis; difficult access to toilet facilities; home stresses

Front 136

Incontinence

Back 136

Bladder inflammation or other disease; difficulties in independent toileting (mobility impairment); leakage when coughing, laughing,sneezing; cognitive impairment

Front 137

Retention

Back 137

Distended bladder on palpation and percussion; associated signs, such as pubic discomfort, restlessness, frequency, and small urine volume; recent anesthesia; recent perineal surgery; presence of perineal swelling; medications prescribed; lack of privacy or other factors inhibiting micturition

Front 138

______ is voiding two or more times at night e.g., nocturia x 4.

Back 138

Nocturia

Front 139

______ is the sudden strong desire to void. There may or may not be a great deal of urine in the bladder, but the person feels a need to void immediately.

Back 139

urgency

Front 140

Urgency accompanies psycologic stress and irritation of the ______ and ______.

Back 140

trigone and urethra

Front 141

Urgency is also common in people who have poor ______ ______ control and unstable ______ ______ . It is not a normal finding.

Back 141

external sphincter; bladder contractions

Front 142

Dysuria means voiding that is either ______ or ______.

Back 142

painful or difficult

Front 143

______ means voiding that is either painful or difficult.

Back 143

Dysuria;

Front 144

Dysuria can accompany a ______ (decrease in caliber) of the urethra, urinary ______ , and injury to the ______ and ______ .

Back 144

stricture; infections; bladder and urethra

Front 145

Often clients with dysuria will say they have to ______ to void or that ______ accompanies or follows voiding. The burning may be described as severe, like a hot poker, or more subdued, like a sunburn.

Back 145

push; burning

Front 146

With ______ ______ often, the burning may be described as severe, like a hot poker, or more subdued, like a sunburn. The burning may be described as severe, like a hot poker, or more subdued, like a sunburn. (a delay and difficulty in initiating voiding) is associcated with dysuria.

Back 146

urinary hesitancy

Front 147

Enuresis is ______ urination in children beyond the age when voluntary bladder control is normally acquired, usually ___ or ___ years of age.

Back 147

involuntary; 4 or 5

Front 148

______ enuresis often is irregular in occurrence and affects boys more often than girls.

Back 148

Nocturnal

Front 149

______ (daytime) enuresis may be persistent and pathologic in origin. I affects women and girls more frequently.

Back 149

Diurnal

Front 150

Urinary incontinence, or involuntary urination, is a ______, not a disease. It can have a significant impact on the client's life, creating physical problems such as ______ ______ and possibly leading to ______ problems such as embarrassment, isolation, and social withdrawal.

Back 150

symptom; skin breakdown; psychosocial

Front 151

Many factors can contribute to acute or ______ incontinence, including polyuria, exposure to irritants, infection, urinary retention, use of pharmaceuticals, stool impaction or constipation, atrophic urethritis or vaginitis, restricted obility or dexterity, psychologic conditions, and delirium or acute confused state.

Back 151

reversible

Front 152

There are different types of chronic incontinence, each having a different etiology, including ______, ______, ______, ______ with ______, and ______ ______.

Back 152

stress, urge, reflex, retention with overflow, and functional incontinence

Front 153

Nursing management of incontinence includes implementing ______ bladder programs,______ of urine, and ______ skin care.

Back 153

individualized; containment; meticulous

Front 154

Although incontinence is experienced in some elders, it is ______ a normal consequence of aging and can often be treated.

Back 154

not

Front 155

If a client describes incontinence a thorough ______ and ______ is indicated.

Back 155

history and assessment

Front 156

When emptying of the bladder is impaired, urine accumulates and the bladder becomes overdistended, a condition known as ______ ______.

Back 156

urinary retention

Front 157

Overdistention of the bladder causes poor contractility of the ______ ______, further impairing urination.

Back 157

detrusor muscle

Front 158

Common causes of urinary retention include ______ ______ (enlargement), ______ and some ______.

Back 158

prostatic hypertrophy; surgery; medications

Front 159

Clients with urinary retention may experience overflow voiding or incontinence, eliminating ___ to ___ mL of urine at frequent intervals. The bladder is firm and distended on palpation and may be displaced to one side of midline

Back 159

25 to 50 mL

Front 160

Impaired neurologic function can interfere with the normal mechanisms of urine eliimination, resulting in a ______ ______.

Back 160

neurogenic bladder

Front 161

The client with a ______ ______ does not perceive bladder fullness and is unable to control the urinary sphincters. The bladder may become ______ and distended or ______, with frequent involuntary urination.

Back 161

neurogenic bladder; flaccid; spastic

Front 162

A complete assessment of a clinet's urinary function includes the following:

Back 162

Nursing history; physical assessment of the genitourinary system, hydration status, and examination of the urine; relating the data obtained to the results of any diagnostic tests and procedures

Front 163

The nurse determines the client's normal voiding pattern and frequency, ______ of the urine and any recent ______, and past or current problems with ______, the presence of an ______, and factors influencing the elimination ______.

Back 163

appearance; changes; urination; ostomy; pattern

Front 164

Complete physical asssessment of the urinary tract usually includes percussion of the ______ to detect areas of tenderness.

Back 164

kidneys

Front 165

Physical asssessment of the urinary tract includes palpation and percussion of the ______.

Back 165

bladder

Front 166

If the client's history or current problems indicate a need for it, the ______ ______ of both male and female clients is inspected for swelling, discharge, and inflammation.

Back 166

urethral meatus

Front 167

Normal urine consists of ___% water and ___% solutes.

Back 167

96%; 4%

Front 168

______ ______ include urea, ammonia, creatinine, and uric acid.

Back 168

Organic solutes

Front 169

______ ______ include sodium, chloride, potassium, sulfate, magnesium, and phosphorus.

Back 169

Inorganic solutes

Front 170

______ ______ is the most abundant inorganic salt.

Back 170

Sodium chloride

Front 171

Normally, the kidneys produce urine at a rate of approximately ___mL per hour or about ____mL per day.

Back 171

60mL; 1,500mL

Front 172

______ ______ is affected by many factors, including fluid intake, body fluid losses through other routes such as perspiration and breathing or diarrhea, and the cardiovascular and renal status of the individual.

Back 172

Urine output

Front 173

Assessment Interview: Voiding pattern ?'s:

Back 173

How many times do you urinate during a 24-hour period? has this pattern changed recently? Do you need to get out of bed to void at night? How often?

Front 174

Assessment Interview: Discription of urine and any changes ?'s:

Back 174

How would you describe your urine in terms of color, clarity (clear, transparent, or cloudy), and odor (faint or strong)?

Front 175

Assessment Interview: Urinary elimination problems ?'s:

Back 175

What problems have you had or do you now have with passing your urine? Passage of small amounts of uring? voiding at intervals that are more frequent? Trobule getting to the bathroom in time or feeling an urgent need to void? Painful voiding? Difficulty starting urine stream? Frequent dribbling of urine or feeling of bladder fullness associated with woiding small amounts of uring? Reduced force of stream? Accidental leakage of uring? If so, when does this occur e.g., when coughing, laughing, or sneezing; at night; during the day? Past urinary tract illness such as infection of the kidney, bladder, or urethra; urinary claculi; surgery of kidney, ureters, or bladder?

Front 176

Assessment Interview: Factors influencing urinary elimination ?'s:

Back 176

Medications. Do you take any medications that could increase urinary putput or cause retention of urine? Note specific medication and dosage. Fluid intake. What amount and kind of fluid do you take each day e.g., six glasses of water, two cups of coffee, three cola drinks with or without caffeine? Environmental factors. Do you have any problems with toileting e.g., mobility, removing clothing, toilet seat too low, facility without grab bar? Stress. Are you experiencing any major stress? If so, what are the stressors? Do you think these affect your urinary pattern? Disease. Have you had or do you have any illnesses that may affect urinary function, such as hypertension, heart disease, neurologic disease, cancer, prostatic enlargement or diabetes? Diagnostic procedures and surgery. Have you recently had a cystoscopy or anesthetic?

Front 177

Normal urine output in 24 hours (adult) ______ - ______ mL

Back 177

1,200 - 1,500 mL

Front 178

Urine outputs below __ mL per hour may indicate low ______ volume or ______ malfunction and must be reported.

Back 178

50 mL; kidney

Front 179

To measure urine output instruct the client to keep urine separate from ______ and to avoid putting ______ ______ in the urine collection container.

Back 179

feces; toilet paper

Front 180

After measuring fluid output, rinse the urine collection and measuring containers with ______ water and store appropriately.

Back 180

cool

Front 181

To measure urine output, calculate and document the total output at the end of each ______ and at the end of __ hours on the client's chart.

Back 181

shift; 24 hrs

Front 182

Urinary ______ and urinary tract ______ are possible consequences of incomplete bladder emptying

Back 182

stasis; infection

Front 183

______ urin is measured to assess the amount of retained urine after voiding and determine the need for interventions e.g., medications to promote detrusor muscle contraction.

Back 183

Residual

Front 184

To measure residual urine, the nurse ______ or bladder ______ the client after voiding. The amount of urine voided and the amount obtained by catheterization or bladder scan are ______ and ______.

Back 184

measured and recorded

Front 185

An indwelling ______ may be inserted if the residual urine exceeds a specified amount.

Back 185

catheter

Front 186

Blood levels of two metabolically produced substances, ______ and ______, are routinely used to evaluate renal function. Both are normally eliminated by the ______ through filtration and tubular secretion.

Back 186

urea and creatinine; kidneys

Front 187

______, the end product of protein metabolism, is measured as ______ ______ ______ (BUN).

Back 187

Urea; blood urea nitrogen

Front 188

______ is produced in relatively constant quantities by the muscles. The creatinine clearance test uses 24 hr urine and serum creatinine levels to determine the glomerular filtration rate, a sensitive indicator of renal function.

Back 188

Creatinine

Front 189

NANDA diagnostic label: ______ ______ ______.

Back 189

Impaired Urinary Elimination

Front 190

Definitions of NANDA Incontinence Diagnoses: Functional Urinary Incontinence -

Back 190

Inability of usually continent personto reach toilet in time to avoid unintentional loss of urine.

Front 191

Definitions of NANDA Incontinence Diagnoses: Reflex Urinary Incontinence -

Back 191

Involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached.

Front 192

Definitions of NANDA Incontinence Diagnoses: Stress Urinary Incontinence -

Back 192

Sudden leakage of urine occurring with activities that increase abdominal pressure.

Front 193

Definitions of NANDA Incontinence Diagnoses: Total urinary Incontinence -

Back 193

Continuous and unpredictable passage of urine.

Front 194

Definitions of NANDA Incontinence Diagnoses: Urge Urinary Incontinence -

Back 194

Involuntary passage of urine occurring soon after a strong sense of urgency to void

Front 195

Problems of urinary elimination also may become the etiology for other problems experienced by the client:

Back 195

Risk for Infection; Low Self-Esteem or Social Isolation; Risk for Impaired Skin Integrity; Self-Care Deficit; Risk for Deficient Fluid Volume or Excess Fluid Volume; Disturbed Body Image e.g., ostomy; Deficient Knowledge e.g., new ostomy; Risk for Caregiver Role Strain

Front 196

Examples of overall goals for clients with urinary elimination problems:

Back 196

Maintain or restore a normal voiding pattern; Regain normal urine output; Prevent associated risks such as infection, skin breakdown, fluid and electrolyte inbalance, and lowered self-esteem; Perform toilet activities independently with or without assistive devices; Contain urine with the appropriate device, catheter, ostomy appliance, or absorbent product

Front 197

______ agents reduce urgency and frequency by blocking muscarinic receptors in the detrusor muscle of the bladder, thereby inhibiting contractions and increasing storage capacity.

Back 197

Anticholinergic

Front 198

______ agents are useful in relieving symptoms associated with woiding in clients with ______ bladder and ______ neurogenic bladder, and ______ urinary incontinence.

Back 198

neurogenic; reflex; urge

Front 199

Monitor for constipation, dry mouth, urinary retention, blurred vision, and mental confusion in the elderly; symptoms may be ______ related.

Back 199

dose

Front 200

After Administration of drugs, keep primary care provider informed of expected responses to ______ e.g.,effect on urinary frequency, urge incontinence, nocturia, and bladder emptying.

Back 200

therapy

Front 201

When administering drugs, start with ______ doses to clients over 75 yrs.

Back 201

small

Front 202

______ is contraindicated in clients with urinary retention, gastrointestinal motility problems (partial or complete GI obstruction, paralytic ileus), or uncontrolled narrow-angle glaucoma.

Back 202

Oxybutynin

Front 203

Clients with increased fluid requirements are those who have ______, who are experiencing abnormal fluid losses through ______, gastric ______, ______, or wonnd ______.

Back 203

diaphoresis; vomiting; suction, diarrhea; drainage

Front 204

Clients who are at reisk for urinary tract infection or urinary calculi (stones) should consume ______ to ______ mL of fluid daily.

Back 204

2,000 to 3,000 mL

Front 205

______ urine and ______ urination reduce the risk of urinary tract infection as well as stone formation.

Back 205

Dilute; frequent

Front 206

Increased fluid intake may be contrainindicated for some clients such as people with ______ failure or ______ failure. For these clients, a fluid restriction may be necessary to prevent fluid ______ and ______.

Back 206

kidney; heart; overload and edema

Front 207

The rate of ______ ______ ______ (UTI) is greater in women than men because of the short urethra and its proximity to the anal and vaginal areas.

Back 207

urinary tract infection

Front 208

___ are the most common type of nosocomial infection found in long-term care facilities.

Back 208

UTIs

Front 209

Instruct the client to respond to the urge to ______ as soon as possible; avoid urinary retention.

Back 209

void

Front 210

Emphasize the importance of drinking ___ to ___ 8 ounce glasses of water daily.

Back 210

8 to 10

Front 211

Teach ffemale clients about pelvic ______ exercises to strengthen perineal muscles.

Back 211

muscles

Front 212

Teach the client to promptly ______ any of the following to the ______ ______ ______: pain or burning on urination, changes in urine color or clarity, malodorous urine, or changes in voiding patterns e.g., nocturia, frequency, dribbling.

Back 212

report; primary care provider

Front 213

Instruct female clients to wipe from ______ to ______ (from the urinary meatus toward the anus) after voiding, and to discard toilet paper after each swipe.

Back 213

front to back

Front 214

For clients with an indwelling catheter or urinary diversion, emphasize the importance of maintaining a generous fluid intake (___ to ___ quarts daily).

Back 214

2.5 to 3 quarts

Front 215

When a client is on meds, inform the client and family about any expected changes in urine color or odor associated with ______ ______.

Back 215

prescribed medications

Front 216

For clients taking meds that may damage the kidneys e.g., aminoglycoside antibiotics, stress the importance of maintaining a generous ______ intake while taking the medication.

Back 216

fluid

Front 217

Suggest increasing intake of potassium-rich foods when taking a potassium-depleting diuretic such as ______.

Back 217

furosemide

Front 218

Teach thte client about dietary changes to promote urinary function, such as consuming ______ juice and foods that V the urine to reduce the risk of repeated urinary tract infections or forming calcium-based urinary stones.

Back 218

cranberry; acidify

Front 219

Instruct clients with ______ or ______ to limit their intake of cafffeine, alcohol, citrus juices, and arificial sweeteners because these are bladder irritants that may increase incontinence.

Back 219

stress; incontinence

Front 220

Make appropriate referrals to ______ health agencies, community agencies, or social services for assistance with resources.

Back 220

home

Front 221

______ ______, which requires that the client postpone voiding, resist or inhibit the sensation of urgency, and void according to a timetable rather than according to the urge to void. The goals are to gradually lengthen the intervals between urination to correct the client's frequent urination, to stabilize the bladder, and to diminish urgency.

Back 221

Bladder training

Front 222

Bladder training may be used for clients who have bladder ______ and urge ______.

Back 222

instability; incontinence

Front 223

Delayed voiding provides larger voided ______ and longer ______ between voiding

Back 223

volumes; intervals

Front 224

In bladder training, to inhibit the urge-to-void sensation, the nurse instructs the client to practice deep, slow ______ until the urge diminishes or disappears.

Back 224

breathing

Front 225

With ______ training, there is no attempt to motivate the client to delay voiding if the urge occurs.

Back 225

habit

Front 226

______ voiding suplements habit training by encouraging the client to try to use the toilet (prompting) and reminding the client when to void.

Back 226

prompted

Front 227

______ exercises, help to strengthen pelvic floor muscles and can reduce or eliminate episodes of incontinence.

Back 227

Kegel

Front 228

Skin that is continually moist becomes ______ (oftened).

Back 228

macerated

Front 229

Urine that accumulates on the skin is converted to ______ , which is very ______ to the skin.

Back 229

ammonia; irritating

Front 230

Because both skin irritation and maceration predispose the client to skin ______ and ______, the incontinent person requires ______ skin care.

Back 230

breakdown and ulceration; meticulous

Front 231

In bladder training, when the client find that voiding can be controlled, the intervals between voiding can be ______ slightly without loss of continence.

Back 231

lengthened

Front 232

In bladder training encourage fluids between the hours of ______ and ______.

Back 232

0600 and 1800

Front 233

Avoid excessive consumption of citrus juices, carbonated beverages (especially those containing artificial sweeteners), alcohol, and drinks containing caffeine because these ______ the bladder, increasing the risk of ______.

Back 233

irritate; incontinence

Front 234

All ______ increase the excretion of waste from the body.

Back 234

diuretics

Front 235

While bladder training schedule ______ early in the morning

Back 235

diuretics