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69 Cards in this Set
- Front
- Back
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True or False: Each Nephron contains a glumerulus |
True |
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True or False: If there has been damage to the nephrons the glomerulus rate will be off and this will show by the numbers in water, glucose, electrolytes, creatinine, iris acid, amino acids. |
True |
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Can determine if kidneys are sensitive when we tap on the back |
True |
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Glomelular filtration look at water, glucose, protein, Uric acid, creative, and electrolytes. |
True |
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Are large proteins typically filtered out? |
No |
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Know abnormalities What shouldn’t be there and how bad is it when it’s there |
Note |
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Kidneys are responsible for producing Erthropoietin which helps to stimulate RBCs production |
True |
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Micturation |
happens when the brain gives the bladder permission to empty, the bladder contracts, the urinary sphincter relaxes and urine leaves through the urethra |
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Normal liters of urine on a daily basis |
Usually 1 to 2 liters of urine is produced every day; 1 ml/kg/hr |
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Function of Kidneys |
filter by-products of metabolism from the blood |
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Function of Ureters |
allow for urine to pass from the kidneys to the bladder |
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Function of Bladder |
distends and holds urine until there is a urge to void |
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Function of Urethra |
urine travels from the bladder through the urethra and passes outside via the urethral meatus. It is stabilized by a group of muscles called to pelvic floor muscles |
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Kidney location |
Lie behind the peritoneum against the deep muscles of the back |
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Function of Nephron |
remove waste from blood and have a major role in fluid and electrolyte balance |
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True or False: Large proteins and blood are not usually filtered through the glomerulus unless injury to the glomerulus |
True |
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What percentage of urine is reabsorbed |
Not all filtered material is excreted as urine (only 1%), 99% is reabsorbed |
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Where is Erythropoietin produced? |
in the kidneys |
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Function of the lower part of the ureters |
The lower part of the ureters compress during micturation which prevent backflow of urine to the ureters |
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True of False: The female urethra is about 3 to 4 cm and 18 to 20 cm in am male |
True |
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Process of bladder function |
The bladder fills and stretches Then sends message to the spinal cord return signals come to the bladder either to prevent contraction (sympathetic stimulation) or, if the timing is right, for contraction to occur (parasympathetic stimulation) resulting in urinary sphincter relaxing and bladder contraction to occur |
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Factors influencing urination |
Anxiety, trauma, medications, alcohol, anesthetics, and more |
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What is : the inability to empty the bladder, may be partially emptied Can stretch the bladder and cause discomfort After several hours can void (but not fully) Postvoid residual (PVR) is the amount of urine left in the bladder after voiding Can have incontinence with retention (overflow incontinence) bladder pressure exceeds sphincter control |
Urinary retention |
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What is the MOST COMMON heath-care acquired infection |
UTI |
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What thing might indicate a UTI |
Bacteriuria Dysuria Pyelonephritis Cystitis |
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What is Bacteriuria |
bacteria in the urine (does not always indicate a UTI) |
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What is Dysuria |
pain with urination |
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What is Pyelonephritis |
(significant upper UTI) which can become life threatening if enters the blood stream This is seen through prescence of Bacteremia Urosepsis. |
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What is Cystitis |
bladder irritation (frequency, spasms, urgency, incontinence, foul-smelling urine, suprapubic tenderness) |
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What is Urinary incontinence |
Involuntary loss of urine |
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What are the different types of urinary incontinence? (SUMOCF) |
Stress Urge Mixed Overactive bladder Chronic retention Functional |
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Urinary incontinence Stress Type |
occurs with any effort or exertion |
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Urinary incontinence Urge Type |
leaking occurs |
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Urinary incontinence Mixed Type |
has both stress and urgency |
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Urinary incontinence Overactive Type |
bladder occurs with urinary urgency, often accompanied by increased urinary frequency |
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Urinary incontinence Chronic retention Type |
(overflow) leakage with overfull bladder |
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Urinary incontinence Functional Type |
Factors contributing to access (usually no bladder pathology) |
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When is urine diverted to the outside of the bladder? |
When the bladder has been removed through a surgery known as Cystectomy. |
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Where is a catheter inserted |
in the pouch of the ileocecal valve (creates a 1 way valve in the pouch) |
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What is orthotopic neobladder |
ileal pouch to replace the bladder |
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Ileal conduit or ureterostomy |
permanent. Transplants the ureters into a closed-off part of the ileum and bringing out the other end through the abdominal wall. There is no sensation or control and requires the drainage (effluent) to be collected in a pouch. |
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Nephrostomy |
small tubes tunneled through the skin into the renal pelvis Used as drains when the ureters are obstructed |
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The urinary tract is sterile and requires |
The urinary tract is sterile and requires maintaining asepsis involving procedures in this area Perineal hygiene is essential Invasive procedures require sterile technique |
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Effect of pregnancy on the urinary tract |
Pregnancy can cause changes, increased urination and shirking bladder capacity |
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Urinary tract for Children |
The neurological system is not well developed until 2-3 years of age Young children are not able to associate the filling sensation with the urge to urinate. Once they can, toilet training can occur They can, however, continue to have nocturnal enuresis |
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What is nocturnal enuresis? |
Children who wet the bed at night without waking from sleep |
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Considerations in the elderly |
Many factors contribute to incontinence Need to be reminded to void frequently Investigate new causes of incontinence Provide interventions towards self care and continence (toileting schedule) Perform exercises for pelvic muscles to improve stress incontinence *need to maintain adequate hydration, thirst decreases with aging May need to decrease intake 2 hours prior to bed Men may have enlarged prostates, need to monitor patterns |
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Physical Assessment of Urinary tract |
Detailed history including signs and symptoms, severity, onset and duration and any predisposing factors Physical assessment Kidneys can become inflamed and tender resulting in flank pain (can be noted with percussion of the costovertebral angle “CVA tenderness” Bladder rests below the symphysis pubis, when full can be palpated and may be tender Perineal skin examined for damage, burning or itching |
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What to look for Intake and output which measurement requires intervention |
Evaluates bladder emptying, renal function and fluid and electrolyte balance Changes in urine can be indicator of kidney dysfunction Below 30ml/hr x 2 hours requires intervention No voiding more than 6 hours despite fluid requires intervention |
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Color, Odor, Clarity |
Color Should be straw color May be more concentrated in the morning Blood in the urine (hematuria) is NOT a normal finding Dark amber urine can occur form high concentrations of bilirubin seen in liver disease Odor May smell like ammonia The more concentrated, the stronger the odorFoul smelling urine may indicate an UTI Some foods can impact smell (asparagus) Clarity Should be clear (may turn cloudy after remaining in container over time) Cloudy urine can indicate infection |
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Genitalia may have drainage or inflammation. |
Labia majora should be evaluated for swelling, redness, tenderness, scratching or lesions Labia minor should be pink and moist (can be less so in post-menapausal women) The meatus should not be swollen or red for either male or female Penis should not have redness or irritation Retract the foreskin (if present) |
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Urine samples |
Needs to be sent to the lab without delay A ‘clean catch’ should be midstream to obtain a specimen free of bacteria Sterile specimens can be obtained via catheter |
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Urinalysis |
pH (4.6 to 8) Protein (up to 8mg/100ml) Glucose (not usually present) Ketones (not usually present) Blood (occult; when erythrocytes, hemoglobin, myoglobin is present) Specific gravity (1.0053 to 1.030) determines how concentrated the urine is Low: overhydration, inadequate ADH secretion High: dehydration, decreased renal blood flow, increased ADH secretion RBC (up to 2)WBC (0-4) Bacteria (not usually present) Casts (not usually present) if present, indicates renal disease Crystals (not usually present) if present can indicate risk for stones. May indicate presence of gout uric acid crystals |
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Testing for Urinary Table 46.5 |
Abdominal x-ray (KUB) will evaluate the structures of the urinary system Computerized axial tomography scan (CT) is used to identify abnormal structures Additional prep is required as per protocol Intravenous pyelogram (IVP) Provides an outline of the urinary tract with the use of contrast Helpful in identifying stones, tumor and other obstructions Make sure no allergy to dye Must make sure remains adequately hydrated afterwards Ultrasound Sound waves used to identify abnormalities in structures Patient requires a full bladder to perform Cystoscopy Provides a picture of the bladder |
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Testing for Urinary Table 46.5 (Cont'd) |
BUN and Creatinine Blood Urea Nitrogen comes from the breakdown of protein in the foods we eat As kidney function decreases, the BUN level rises 7 to 20 Creatinine is a waste product that comes from normal wear and tear on muscles of the body As creatinine rises, kidney disease progresses 1.2 women 1.4 men Glomerular Filtration Rate (GFR) Tests how well the kidneys are removing wastes and excess fluid from the blood Many factors are considered (age, weight, gender) Normal is above 90 |
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Urinary System diagnoses |
Functional urinary incontinence Stress urinary incontinence Urge urinary incontinence Reflex incontinence Risk for infection Toileting self-care deficit Impaired skin integrity Impaired urinary elimination Urinary retention |
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Planning (Figure 46-7) |
Figure 46-7 provides a good overview of the nursing process, including the planning phase Good hygiene, interventions that assist with normal micturation, performing skills needed for voiding |
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Intervention |
Health Promotion Promote normal micturation to prevent problems Create a private environment to prevent delays Maintain adequate hydration Promote complete bladder emptying Assist females to the squatting position or standing for a male Promote relaxation and stimulate bladder contractions (running water) Attempt a second void Create a schedule for voiding if needed Prevent infection Adequate hydration Perineal hygiene Regular voiding periods Wipe from front to back! Avoid bubble baths, tight clothes |
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Urinary catheterization |
Placement of a tube through the urethra into the bladder to drain urine Size is based on the French Scale (FR) which correlates to the catheter diameter Most indwelling area size 14 to 16 Fr. Larger sizes increase risk of trauma There is a balloon that varies in size May be intermittent or indwelling Short term use (after surgery) or Long term Single lumen for straight catheterization Double lumen for indwelling catheter Triple lumen for continuous bladder irrigation (CBI) |
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Urinary catheter drainage |
Keep intact unless absolutely necessary Specimens may be collected without opening the system Always hang the bag below the level of the bladder Never let the bag touch the floor If ambulating, have below the level of the bladder (a leg bag can be used) |
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Catheter care, skill 46-3 |
Requires regular perineal hygiene to reduce CAUTI Secure catheter to prevent movement and pulling Refer to skill 46-3 Empty the drainage bag when ½ full Irrigating catheter Done with closed drainage system to prevent UTIUsed to prevent clots following genitourinary surgery After catheter removal need to monitor voiding |
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Bladder scan |
Measures postvoid residual Follow facility protocol Measure 10 minutes after voiding Need to select gender on device (women with hysterectomy should be entered as male) Palpate the pubic bone and apply gel to midline abdomen (2.5cm-4mc above symphysis pubis) |
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Suprapubic catheter |
Inserted above the symphysis pubis through the abdominal wall to the bladder Site should be cleaned daily Monitor for inflammation |
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Find in textbook |
If a patient has a urinary diversion: With continent urinary reservoir Teach how to self-catheterize With external pouch, should be changed every 4-6 days |
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External Catheter |
Condom catheter that fits over the penis Allow for 2.5 to 5 cm space between the tip of the penis and the end of the catheter If tape is used, should fit snug not tight and should not wrap around |
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Obtaining samples |
In addition to what has been mentioned; clean area with cleanser and wipe from front to back, using a fresh towelette each time(left, right, center) going from least contaminated areaHold labia apart and obtain midstream collection (30-60ml)For a man, clean penis using circular movements from center to outside |
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Catheter Insertion |
Place in dorsal recumbent position Position lighting for best visualization Supplies are typically in kit provided Drape perineum Cleanse urethral meatus For female spread labia use cotton ball or swab 1 at a time Clean labia and urinary meatus from clitoris towards anus(left, right, center) |
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Safety Guidelines for Nursing Skills |
Follow principles of surgical and medical asepsis as indicated Identify patients at risk for latex allergies Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine. |
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Continuing Care |
Pelvic floor muscle training (PFMT) Kegal exercises (Box 46-8) Toileting schedules Scheduled every 2-3 hours not based on urge to void Quick flicks 3-5 followed by 10 sustained contractions 3-4 times/day Bladder retraining Can help with urgency and frequency Intermittent catheterization Skin care |
