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28 Cards in this Set

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True or false.
using pelvic floor muscles (contracting) can stop urine flow
true
Bladder holds approximately how much urine?
600mL
Urinary diseases are classified as either
prerenal
or
postrenal
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
What are some diseases that affect any aspect of renal function?
DM, BPH, Parkinson's disease, degernative joint disesae, Alzhiemers, MS,
Nocturia
is the urge to void that awakens one at night.
Anuria
is when the kidneys produce no urine.
Polyuria
is an excessive output of urine.
Oliguria
is a decreased urinary output in spite of adequate fluid intake.
End stage Renal Disease (ERD)
irreversible damage done to kidney tissue
Uremic syndrome
Increase in nitrogenous wastes in the blood
an increase in nitrogenous wastes in the blood.

it is composed of electrolyte abnormalties, nausea, vomiting, coma, headache and convulsions.
renal replacement theories include (3)
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-
What is apparent in a pt. with bladder retention.

What will happen in the long run if retention is not successfully dealt with?
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.
UTI's are commonly caused by what bacteria?
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)
dysuria
cystitits
hematuria
pyelonephritis

urosepsis
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
Urostomies

Types of diseases when a urostomy may be done

Where urostomies commonly occur?
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.
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)
problems with movement
removing clothing,
mental incapacity
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
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?
Physical Assessment

skin and mucosal linings
bladder
kidneys
urethra meatus
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
Assesment of Urine
I/O
Color
Clarity
Odor
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
A 2 hour output of less than how much is a cause for concern
30mL
Incontinence can be a sign of what
infection
Urine Tests and Diagnostic Examinations

Table 45-3 for normal values of tests
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
Urine testing will sometimes require specific indications
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.
implementation

inserting catheters
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.
What needs to be done to avoid infection with catheterization?
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.
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?
Catheter irrigations and instillations can be used to maintain the patency of an indwelling urinary catheter.
Alternatives to an indwelling catheter include
suprapubic catheter
condom catheter
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
For catheter implementation
teach and promote...
independence in caring for themselves with catheter, keeping the catheter clean