Fund 4 Exam...urinary Elimination

Front 1

Kidney

Back 1

removes waste : uric acid, urea, creatinine, excess fluid and electrolytes.
Maintains homeostatic composition and volume of fluids

Front 2

Ureters

Back 2

transport urine from kidney to bladder

Front 3

Bladder

Back 3

sterile reservoir for urine.
detrusor muscle- layers of smooth involuntary muscles.
Controlled by the Autonomic nervous System.
Bladder capacity 500-1000 ml

Front 4

Urethra

Back 4

transports urine from the bladder to outside the body.Has internal and external sphincters.
Internal--smooth muscle/involuntary
External--skeletal muscle/voluntary

Front 5

Micturition

Back 5

process of emptying bladder

Front 6

200 - 300 ml..

Back 6

the volume which the bladder holds until it stimulates stretch receptors in the bladder wall, therefore signals the need to void.

Front 7

PSNS (parasympathetic nervous system)

Back 7

Helps
Contraction--detrusor and abdominal wall muscles
Relaxation--perineum, internal and external urinary sphincters

Front 8

SNS (sympathetic nervous system)

Back 8

Inhibits
Contraction--internal urinary sphincter
Relaxation--detrusor muscle

Front 9

Normal urinary patterns

Back 9

4-6 x's a day/every 3-4 hours while awake.
60 ml/hr
average 250-500 ml/void ..normal 1500-1600 ml/daily
normally painless
Continence

Front 10

Continence

Back 10

ability to hold urine

Front 11

Abnormal urinary Pattern

Back 11

Frequency- decrease # of voids (greater than every 2 hours)
Small amounts 50-100 ml/void
**IF LESS THAN 30 ml/hour or LESS THAN 240 ml/ PER 8 HOUR>..NOTIFY MD!!!!

Front 12

Anuria

Back 12

less than 50 ml per 24 hours
the absence of urine

Front 13

Oliguria

Back 13

Less than 400 ml per 24 hours
Infrequent urination

Front 14

Polyuria

Back 14

greater than 2500 ml

Front 15

Nocturia

Back 15

awakening during the night to void..> 2 times

Front 16

Urinary Retention

Back 16

incomplete bladder emptying

Front 17

Incontinence

Back 17

involuntary loss of urine

Front 18

Dysuria

Back 18

difficulty urinating, painful and burning

Front 19

Hesitancy

Back 19

delay or difficult in having to void

Front 20

Urgency

Back 20

strong, sudden urge to void immediately

Front 21

Dribbling

Back 21

leakage after the void

Front 22

Enuresis

Back 22

wetting the bed

Front 23

Normal specific gravity in urine..

Back 23

1.010 - 1.025

Front 24

Normal pH in urine..

Back 24

4.6 - 8.0 (usually a 6)

Front 25

Cloudy urine with odor...

Back 25

Infection

Front 26

Glycosuria

Back 26

sugar in urine

Front 27

Hematuria

Back 27

blood in urine

Front 28

Proteinuria

Back 28

presence of protein in urine

Front 29

Pyuria

Back 29

presence of pus

Front 30

medications that affect urination

Back 30

Diuretics (increase UOP)
Anticholinergics and antihistamines (urinary retention)
Narcotics (incontinence or retention)

Front 31

Bladder distension

Back 31

an empty bladder cant be palpated or percussed.

Front 32

CVAT (costo-vetebral angle tenderness)

Back 32

sudden distention of the renal capsule...can be checked by a slight hit on the back.

Front 33

I & O's (intake)

Back 33

*Oral fluids
-all liquids
-foods that become liquid @ room temp
-record ice chips as 1/2 volume of chips
*Tube feedings and flushes
*IV fluids and flushes
*Blood transfusions

Front 34

I & O's (output)

Back 34

*Urine-main one
Emesis (vomit)
Gastric suction
Draining wounds/ bleeding
Diarrhea
*Insensible loss
-skin
-lungs
-feces

Front 35

Examples of Urinalysis tests

Back 35

Dip stick
UA
Urine culture and sensitivity (C&S)
24- hour urine
KUB (kidney urine bladder)
IVP
Serum blood tests

Front 36

Routine Urinalysis

Back 36

clean, non sterile specimen
30 ml of urine needed

Front 37

Urine Culture and Sensitivity (C&S)

Back 37

ordered to identify microorganism causing UTI
Collection MUST BE STERILE

Front 38

Clean catch or mid stream specimen

Back 38

do not collect the first 30 ml
collect mid stream into specimen cup
*sterile sample from a female may need to be obtained by I&O catheterization

Front 39

Collecting urine from an indwelling catheter

Back 39

clamp catheter tubing 3" below collection port
Allow urine to accumulate
clean port with alcohol
Draw out 20 cc with 21-25g needle / 10-20 cc syringe
**NEVER COLLECT FROM DRAINAGE BAG**

Front 40

Collection 24 hour urine specimen

Back 40

post signs
ask pt to empty bladder
ALL URINE MUST BE COLLECTED.
needs to be refrigerated

Front 41

IVP (intravenous pyleogram)

Back 41

Contrast dye is given IV
Serial xrays are taken of the KUB
--Before
--Assess for allegies to contrast dye, iodine, shellfish
--NPO p midnite
--laxatives given to remove stool and pt. empties bladder
**AFTER--
--decrease fluids unless it is contraindicated (dye is nephrotoxic)
--Assess for reaction to the dye (rash, N/V, SOB)
--Assess fo adequate UCP

Front 42

Serum Blood tests

Back 42

BUN
Creatinine
*KIDNEY FUNCTION TESTS*

Front 43

BUN test

Back 43

(blood urea nitrogen) end product of protein metabolism (can be affected by many other factors)

Front 44

Creatinine test

Back 44

end product of skeletal muscle metabolism(not usually affected by other factors). will be PROBLEM with the KIDNEYS

Front 45

Types of Urinary incontinence

Back 45

Stress (also called activity-related UI)
Urge (aka overactive bladder)
Mixed (stress urge UI)
Overflow
Reflex (aka neurogenic)
Functional
Transient

Front 46

Stess Incontinence

Back 46

Involuntary loss of urine due to increase abdominal pressure. Ex: laughing, crying, sneezing, coughing.
Interventions--
--kegel exercises

Front 47

kegel exercises

Back 47

aka pelvic floor muscle training
--strengthens muscle tone of pelvic floor and urinary sphincter
--stronger muscles increase continence

Front 48

Urge incontinence

Back 48

involuntary loss of urine associated with abrupt and strong desire to void (overactive bladder)

Front 49

Overflow incontinence

Back 49

involuntary loss of urine associated with over distention of the bladder.
--could be obstruction (prostate enlargement)
--could be medication
*interventions*
-correct underlying cause
-I&O catheterizations

Front 50

Reflex Incontinence

Back 50

involuntary loss of urine at some-what predictable intervals when specific bladder volume is reached.
*cause*
--paralyzing spinal cord injury affecting C1-S2

Front 51

Functional Incontinence

Back 51

involuntary loss of urine due to physical or cognitive imparements
-not able to get to the potty because of imparements
*causes*
-dementia
-neuromuscular deficit
-impaired physical mobility

Front 52

transient incontinence

Back 52

temporary reversible due to delirium etc...

Front 53

UTI

Back 53

Urinary tract infection
infection of wither the upper or lower urinary tract
*Diagnosis*
-Urine C&S
*Risk factors*
-women
-sexually active women
-post menopausal women
-indwelling catheter ***
-Diabetes
-Urinary retention
--elderly pts. (especially men)

Front 54

S/S of UTI

Back 54

fever chills N/V
dysuria, bladder spasms
cloudy, foul smelling urine
Confusion/Elderly

Front 55

Urinary retention

Back 55

inability to urinate or to sufficiently empty bladder.

Front 56

PVR (post void residual)

Back 56

the amount of urine remaining in the bladder immediately after voiding
-measured by I&O cath or ultrasound
-adequate bladder emptying (<50ml)

Front 57

Urinary catheters

Back 57

device used to empty the bladder or to collect urine of an incontinent pt.

Front 58

Types of catheters

Back 58

condom caths
suprapubic cath
straight (intermittent, I&O) cath
indwelling (foley) cath

Front 59

Condom Catheter

Back 59

rubber sheath with adhesive strips connected to drainage bag

Front 60

Suprapubic catheter

Back 60

surgically placed into the bladder through the abdominal wall
**assess pt for infection**

Front 61

Straight catheter

Back 61

also called intermittent or I &O caths
--Single Lumen catheter
--can be performed by pts. at home as a clean non sterile procedure
--hospitalized pt.- sterile procedure

Front 62

Indications for use of a straight catheter

Back 62

to obtain sterile urine specimen
relief bladder distention/urinary retention

Front 63

Indwelling catheter

Back 63

aka Foley
2-3 Lumens (ports)
Usually 16 Fr
drains urine to collection bag
inflates balloon to hold catheter in place
delivery of meds or irrigation fluids

Front 64

Indications for use of Indwelling catheters..

Back 64

surgical pt.
very strict I&O's
cant urinate

Front 65

Urinary catheters and UTI's

Back 65

Catherization inhibits defense mechanisms
Indwelling foley catheters can quickly become colonized with bacteria
50% of pt. become infected within 1 week
50% of all Nonocomial infections are UTI's

Front 66

Catheter irrigation

Back 66

requires MD order
purpose is to flush blood clots, instill medication into bladder, maintain cath ppatency
--sterile procedure with sterile solution
--intermittent irrigation through catheter port
--continuous irrigation with a 3 way foley
--Open irrigation (not recommended)

Front 67

Urinary catheter removal

Back 67

Deflate bulb
ask pt. to take a deep breath
document
Instruct pt to measure next void
--increase fluids
--may experience dysuria for the 1st cople of voids
--S/S of UTI's
IF PT HAS NOT VOIDED....CALL MD WITHIN 8 HOURS

Front 68

Urinary Diversions

Back 68

surgical construction of a permanent, alternate route for urinary elimination,
Urine is eliminated by either I&O cath or by a collection device/ pouch
--Assess stoma
---color...dark pink..red and moist
---skin integrity/bleeding
Mucus is normal finding if intestine is used