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21 Cards in this Set
- Front
- Back
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What are the developmental factors affecting voiding?
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Developmental Factors
• Ability to micturate (control urination) – 18 – 24 months old • Aging impairs micturition – Disease processes • Reaching toilet • Balance • Unable to get up from toilet |
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What are some factors affecting voiding in older adults?
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Older Adults:
– Kidney function decreases – Urgency and frequency common – Loss of bladder elasticity and muscle tone leads to: • Nocturia • incomplete emptying |
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What are some factors that influence urine output?
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• Personal factors- lack of time, privacy, loss of dignity, cultural influences
• Hydration – Caffeine-increased diuresis – Alcohol-inhibits release of ADH • Medications – Diuretics increase urine output – Anticholinergics inhibit free flow of urine – Nephrotoxic (damage to the kidney) • Surgical procedures of reproductive & urinary tract can affect ability to pass urine • Anesthetics can decrease BP & glomerular filtration |
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What are some factors affecting urinary elimination?
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Pathological Conditions:
• Bladder/kidney infections • Kidney stones • Hypertrophy of the prostate (male) • Mobility problems • Alteration in cognition • Decreased blood flow through glomeruli • Neurological conditions • Communication problems |
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What are the risks for lower urinary tract infection (UTI) – bladder?
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Risks
• Indwelling catheters • Wiping back to front • Holding urine too long • Synthetic undies, Hose, • Tight clothing • People with diabetes • Intercourse |
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What are the signs and symptoms of a UTI?
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• Frequency
• Urgency • Burning, pain (dysuria) • Cloudy urine (WBCs) • Blood in urine (hematuria) |
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What is urinary retention and what are the causes?
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• Inability to empty bladder completely
• Causes: o Obstruction – fecal impaction, stones, scar tissue o Inflammation & swelling from infection or surgery o Neurological conditions that affect nerve innervation to bladder o Medications – anesthesia o Anxiety |
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What are nursing implementations for someone with urinary retention?
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• Assess for risk factors such as prostatic hypertrophy, medications with anticholinergic effects (valium, benadryl)
• Monitor I&O • Inspect & palpate for bladder distention • Place in normal voiding position, run water, Crede’s manuever (if ordered)(using manual pressure over bladder) • Measure post void residual (<100 mL) |
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What are facts and risk factors for urinary incontinence?
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• ½ of 1.5 million Americans who live in nursing homes are incontinent
• Incontinence is not a normal change with aging • Risk factors: • Men (BPH), Women (childbirth) • – Obesity, diabetes |
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What are the different types of urinary incontinence?
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• Functional –from Physical or Psycho causes
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What are some nonpharmacological interventions to manage urinary incontinence?
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• Strengthening Pelvic Floor Muscles
• Kegel (Teaching: client pg 1300) • Bladder Training, goal is for pt to hold greater volumes of urine & increase interval between voidings. Initially • void every 2 hours then increase to every 4-6 hrs. Teach distraction & relaxation strategies • Habit training or scheduled voiding – involves timed voiding. To keep dry, have ct. void at regular intervals • Perineal skin care – cleanse skin after each episode, use barrier creams |
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What are some other ways to manage urinary incontinence?
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• Supportive interventions – BSC, raised toilet seats, bedpans, urinals, gait & strength training
• Anti-incontinence devices – pessary or intravaginal support device, indwelling catheter (used as last resort), bed alarm, condom catheter(for men), bed alarm (wakens pt if incontence occurs) • Pharmacological- Estrogen, anticholinergics • Surgical –bladder suspension, prostrate resection |
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What are some implementations to promote normal urination?
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– Stimulating Micturition reflex
– Provide privacy – Assist with positioning – Facilitate toileting routines – Promote adequate fluids- 3000 mL daily – Assist with hygiene –perineal care |
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What are some important aspects of catheter care?
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– Prevent UTI by keeping drainage tube and collection bag a closed system
– Maintain free flow of urine – Provide catheter care by cleaning catheter with washcloth using soap water in downward motion – Provide perineal hygiene and secure tubing to the leg |
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What are some diagnostic tests used to assess urinary function?
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• Urinalysis,– “dipstick”, measures pH, specific gravity, protein glucose
• Specific Gravity (1.010-1.025) • Urine Culture (sterile specimen) • BUN (8-20 mg/dl) • Creatinine (0.5-1.1mg/dl) |
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What are some nursing diagnoses for the urinary system?
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• Altered urinary elimination
• Body image disturbance • Urinary Incontinence, stress • Urinary Incontinence , urge • Urinary Incontinence , reflex • Urinary Incontinence , functional • Self-care deficit, toileting • Skin integrity, impaired • Urinary retention • Lack of knowledge |
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What are the following types of altered urination?
• Urgency • Dysuria • Frequency • Hesitancy • Polyuria • Olguria, anuria • nocturia |
Urgency – sudden, strong desire to void
Dysuria – painful or difficult voiding Frequency – voiding more than 4-6 times/day Hesitancy – delay & difficulty in inititiating voiding Polyuria – production of abnormally large amts of urine Oliguria – low urine output Anuria – lack of urine output Nocturia – voiding 2 or more times a night |
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What are the different ways to collect urine?
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Urine Collection
• Voided urine – ambulatory patients who go to bathroom put specimen “hat” over toilet & instruct pt. • Midstream clean catch – cleanses perineal area with towlette front to back, starts urinating then stops, then goes into speciman cup • Sterile – catherize or remove sample from indwelling catheter • 24 hour urine- to begin have pt void and record the time. Collect all urine from this time |
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What are some ways to develop outcomes in managing urinary problems?
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• Were client expectations met?
• Ex. remains dry between voidings at night • Questions to ask, Are scheduled toileting times appropriate? Is access to toilet a problem? Are mobility aids needed, walker, elevated toilet seat, grab bars. Is he taking a diuretic, should continence aids like condom catheter, or absorbant pads be considered or used? |
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What information would need to be collected during a nursing history?
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Elimination patterns
• Daily voiding patterns • Frequency and times • Volume and appearance • Nighttime voiding |
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What is being looked at in assessing urine?
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• Assessment of Urine
– Measure fluid intake and output (I/O) – Observe universal precautions – Residual urine (less than 100 mL after voiding) • Characteristics of urine – Color, pale, straw, amber, dark red – Odor, more concentrated, stronger odor – Clarity, transparent |
