Nurs 4935 Test 2: Urinary Elimination

Front 1

True or false.
using pelvic floor muscles (contracting) can stop urine flow

Back 1

true

Front 2

Bladder holds approximately how much urine?

Back 2

600mL

Front 3

Urinary diseases are classified as either
prerenal
or
postrenal

Back 3

Prerenal= decreased blood flow to and through the kidney.
renal= disease condition involving the renal tissue
postrenal= obstruction in the lower urinary tract that prevents flow from the kidneys

Front 4

What are some diseases that affect any aspect of renal function?

Back 4

DM, BPH, Parkinson's disease, degernative joint disesae, Alzhiemers, MS,

Front 5

Nocturia

Back 5

is the urge to void that awakens one at night.

Front 6

Anuria

Back 6

is when the kidneys produce no urine.

Front 7

Polyuria

Back 7

is an excessive output of urine.

Front 8

Oliguria

Back 8

is a decreased urinary output in spite of adequate fluid intake.

Front 9

End stage Renal Disease (ERD)

Back 9

irreversible damage done to kidney tissue

Front 10

Uremic syndrome
Increase in nitrogenous wastes in the blood

Back 10

an increase in nitrogenous wastes in the blood.

it is composed of electrolyte abnormalties, nausea, vomiting, coma, headache and convulsions.

Front 11

renal replacement theories include (3)

Back 11

hemodyalysis - an external machine has a membrane and it uses diffusion, osmosis, and ultrafilterign to clean the blood after which it is put back into the body through a vascular entry (goretex graft, AV fistula,hemodyalysis catheter.
peritoneal dyalisis- an indirect method of cleaning the blood with the pertineum (semi permeable membran) it uses diffsusion and osmosis to do so.
organ transplant-

Front 12

What is apparent in a pt. with bladder retention.

What will happen in the long run if retention is not successfully dealt with?

Back 12

Bladder distention is apparent. They are able void urine but only a little bit 2 to 3 times an hour and eventually overflow will occur.

Front 13

UTI's are commonly caused by what bacteria?

Back 13

E. coli
Bacteuria (bacteria in urine)
Bacteremia (bacteria in blood)
women are more susceptible to UTI (shorter urethra to bladder distance and close proximity to anus)

Front 14

dysuria
cystitits
hematuria
pyelonephritis

urosepsis

Back 14

burning during urination
irritation to bladder
irritation to bladder and the urethral mucosa
if infection spreads to kidneys (flank pain, tenderness, fever, and chills.)

overarching term for a urinary tract infection

Front 15

Urostomies

Types of diseases when a urostomy may be done

Where urostomies commonly occur?

Back 15

Urinary Diversions

This can be necessary because of trauma, cancer, radiation, fistula, or chronic cystitis.

The types of diversion include ileal loop or conduit, continent pouch, or nephrostomy.

Front 16

Urinary incontinence can be temporary or permanent and continuous or intermittent. UI can affect any age, but is very prevalent in the elderly. Causes can be ....(3)

Back 16

problems with movement
removing clothing,
mental incapacity

Front 17

Urinary Assessment
P
C haracter
I/0 30+mL/hr or >2500/day
S/S of infection
S/S of incontinence
A nuria
F unctional status
M edications

Box 45-3 Nursing assessment questions to ask
Table 45-1 common types of urinary alterations

Back 17

Patterns of urination—Frequency? Nocturia? Pain?
Character of urine—Color? Blood? Clarity/Oliguria?
I&O—Urine amt? (30+mL/hr); Polyuria ? (>2500mL/day)
Signs/Symptoms of infection?
Signs/Symptoms of incontinence
Anuria—cessation of the production of urine
Functional status—can patient get to bathroom?
Medications—Diuretics?

Front 18

Physical Assessment

skin and mucosal linings
bladder
kidneys
urethra meatus

Back 18

assess for hyrdation by testing turgor and looking for moisture

A distended bladder will feel tender, maybe the urge to urniate and/or a bit painful on palpation (above symphisis pubis) percussion produces a dull tone.

flank pain may occur with infection or inflammation

observe for discharge, inflamation, or lesions

Front 19

Assesment of Urine
I/O
Color
Clarity
Odor

Back 19

pale straw color is normal, be sure to note any hematuria Urine will be more concentrated in the morning. Medications can change the color as can beets, rhubarb, or blackberries. Dark amber urine is the result of bilirubin from liver disease.

this is normally transparent
should smell like ammonia normally A sweet or fruity odor is seen with diabetes mellitus or starvation.

SPECIMENS can be voided or midstream, sterile or timed, random, clean

Front 20

A 2 hour output of less than how much is a cause for concern

Back 20

30mL

Front 21

Incontinence can be a sign of what

Back 21

infection

Front 22

Urine Tests and Diagnostic Examinations

Table 45-3 for normal values of tests

Back 22

Urinalysis (U/A)—nonsterile specimen pH, protein, ketones, blood, RBCs, WBCs, Bacteria, Casts, Crystals,
Specific gravity Specific gravity is the weight or degree of concentration of a substance compared with an equal volume of water(normal=1.0053-1.030)

Culture & Sensitivity (C&S)—sterile specimen. A urine culture requires a sterile or clean voided urine sample. It will take 24 to 48 hours to indicate the findings of bacterial growth. The test for sensitivity will determine which antibiotic will be most effective.


Noninvasive examination—CT, IVP, U/S, Urodynamic evaluation
Invasive examination—Cystoscopy , Angiography

Front 23

Urine testing will sometimes require specific indications

Back 23

Remember that each examination has a specific indication and use, bowel preparation and client education. Some exams will require a signed consent form. Some will require injection of a dye. You will need to assess the client’s sensitivity to the dye.

Front 24

implementation

inserting catheters

Back 24

Catheterization can be intermittent or indwelling. Box 45-7 presents indications for catheterization. You need an order to insert a catheter. You must use sterile aseptic technique. (Review Chapter 34: Infection Control). In the nursing skills lab, you will learn how to insert both straight and indwelling catheters.

Front 25

What needs to be done to avoid infection with catheterization?

Back 25

To prevent infection, it will be necessary to maintain a closed system. The sites for breakage in the system are the drainage bag, spigot, bag juncture, and junction of the tube and bag. Box 45-9 presents tips for preventing infection in catheterized clients.

Front 26

Blood, pus, or sediment can collect in the tubing and cause bladder distention and buildup of urine.
What is used to prevent and alleviate this problem?

Back 26

Catheter irrigations and instillations can be used to maintain the patency of an indwelling urinary catheter.

Front 27

Alternatives to an indwelling catheter include
suprapubic catheter
condom catheter

Back 27

Suprapubic needs to be surgically placed and has the same sort of maintenance guidelines as indwellinggs

condom catheters are used for some male clients. (box 45 -10

Front 28

For catheter implementation
teach and promote...

Back 28

independence in caring for themselves with catheter, keeping the catheter clean