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54 Cards in this Set

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Anatomy & Physiology of the
Urinary System
Kidney
Ureter
Bladder
Urethra
Kidney
-Filtration
-Reabsorption
-ureter
-Bladder
Bladder
-Reservoir
-Organ of excretion
-Rugae
-250-450 ml
Urethra
Female?
Male?
-Female-1 1/2- 2 1/2
-Male 6 1/2- 8
Micturition
-storage
-voiding
Kidneys:
Time of development?
Composition & volume of?
-Embryonic development same time as ears
-Composition & volume of body fluids
Kidneys:
functions?
(4)
-Water balance
-Electrolyte balnace
-Acid-base balance
-Eliminate waste
Inspection procedures:
Male?
Female?
Always provide privacy, wear gloves, drape
to expose urethral meatus
Male: Compress glans tip to open urethral
meatus
– Centered at tip
– s/s of infection or ulceration
Female: – Spread labia, irregular slit-like opening
– midline above vagina
– s/s infection, discharge, swelling
Normal Voiding Patterns
How many x per day?
How many cc over 24hrs?
How many cc an hour?
Voiding times Increased with?
How many cc/24hrs to maintain life?
* 4-5x/day
* 1500cc/24hrs
* 60cc/hr
* voiding times: increased fluid in= increased fluid out
* 900cc/24hr output to maintain life
Abnormal patterns?
Anuria
none or very little--less than 100cc/24hrs
Abnormal Patterns:
Dysuria
-Difficulty in voiding
-May have pain or burning
Abnormal Patterns:
Oliguria
-Scant--100-500cc or 3ml/hr/24hrs
Abnormal Pattens:
Frequencey
Increased incidence of voiding
Abnormal Patterns:
Polyuria-diuresis
-Excessive output--greater than 2500cc/day
Abnormal Patterns:
Dialysis
-Hemodialysis
-Peritoneal dialysis
Abnormal Patterns:
Nocturia
-Frequency at night
Abnormal Patterns:
Urgency
-Feeling of must void NOW!
Abnormal Patterns:
Enuresis
-Not incontinence
-nocturnal enuresis- bedwetter
Abnormal Patterns:
Rentention
-Inability to void- Urine is present
*physical
*Psychological
*Meds (Box 47-1 pp1260)
Abnormal Patterns:
Incontinence
-Total
-Functional
-Stress
-Urge
-Overflow
Independent Nursing Actions:
Bladder Training
-Postpone voiding @ urge- lengthen times b/w
Independent Nursing Actions:
Habit Training
-Regular timed voiding
-Voids with urge also
Independent Nursing Actions:
Prompted Voiding
-Used with habit training
-Remind and attempt to void
Independent Nursing Actions:
Pelvic Muscle exercise
-Kegal exercise Pg. 1271
Normal Characteristics of Urine:
Amount? Color? Clarity? Odor? Sp.Gr.? pH? %water and % solutes?
amount: 60-120 cc/hr
color: yellow
clarity: clear
odor: aromatic
sp.gr.: 1.010-1.025
pH: 4.5-6.0
98% water
4% solutes
Urine: Consituents
Organic (6)
-urea
-Uric acid
-Creatinine
-Hippurc acid
-Indican
-Nitrogen
Urine: Consituents
Inorganic (7)
-Ammonia
-Sodium chloride
-Traces of iron
-Phosphorus
-Sulfur
-Potassium
-Calcium
Abnormal consituents:
Urine
-Blood (hematuria)
-glucose (glucosuria)
-acetone (acetonuria)*simple ketone
-protein (proteinuria)
-gross bacteria
-pus
-stones
-casts
-bile
Micturition: physiology
-urine from ureter to bladder
-bladder elastic
-stretch receptors triggered
-miturition center: to spinal cord unconscious
Micturition: physiology
-Brain connectors: to brain-unconscious
-urethral pressure increases
-storage-Sympathetic: outlet tightens & bladder relaxes
-voiding-parasympathetic: outlet opens & bladder contracts
Factors affecting Micturition
Developmental
*Developmental
-Infant:spinal reflex
-Toddler:conditioned reflex to training
-Age 5+: conscious inhibition
-Elderly: decreased muscle tone, capacity, concentration
Factors affecting Micturition
diet & fluid intake
-diet & fluid intake
intake=output
caffine & ETOH
Color & pH
Factors affecting Micturition
Initial urge
-Initial urge
Delayed
larger amounts
loss of tone
Factors affecting Micturition
Lifestyle
-lifestyle
gender
privacy
plumbing
traumatic experience
Factors affecting Micturition
Medications
-Medications
diuretics
pyridium
vitamins
antibiotics
Factors affecting Micturition
Muscle tone
-catheter
Factors affecting Micturition
Activity level
-Activity Level
self help
elderly
Factors affecting Micturition
Psychological Stressors
Psychological stressors
stress
blood pressure
perfusion
urine
Factors affecting Micturition
Pathology
-Pathology
disease
Diagnostic Procedures
-UA
-C&S
-IV Pyelography
-Retrograde Pyelography
-CT Scan
-Ultrasonography
-Cystoscopy
The nurse as a role model
-empties regulary
-responds to urge
-drinks 8-10 glasses of water
-responds to changes
-promotes wellness
Nursing Diagnosis R/T Urinary Elimination
*Urinary function as problem
Urinary function as problem
-incontinence
-retention
Nursing Diagnosis R/T Urinary Elimination
*Urinary function as etiology
Urinary function as etiology
-anxiety
-impaired skin integrity
-sleep pattern disturbance
-social isolation
Generalized outcomes
-urinary output
-empty bladder
-skin integrity
-Identify
-achieve
-demonstrate
Describe Nursing Interventions: Independent
Independent
-fluids
-diet
-I&O
-Maintain normal patterns
-hygeine
training/retraining client
Describe Nursing Interventions: Dependent
Urge
Anticholinergic-Ditropan
-inhibits bladder cont. & increase capacity
Describe Nursing Interventions: Dependent
Stress
Alpha-adrenergic-Sudafed
-Internal sphincter resistance
Beta-adrenergic-Inderal
-Outlet resistance
Hormone-estrogen
-Internal sphincter resistance
DHIC
-bladder overactive but ineffective emptying
Describe Nursing Interventions: Dependent
Urge/Stress
Antidepressant-Tofranil
-Increase internal sphincter & capacity
Describe Nursing Interventions: Dependent
Overflow
Choliergic-Urecholine
-complete bladder emptying, decreased capacity
Alpha-adrenergic-Dibenzyline
-decreased outlet resistance
Describe Nursing Interventions: Dependent
Antibiotic
Bactrim
-infection
Dependent Interventions
Urinary flow devices
Urinary flow devices
-external
-other
-urinary catheterization
Incontinence: requirements for urine control
-G.U. integrity
-Cognitive ability
-Mobility
-Motivation
Incontinence: Common impediments
-UTI
-Fecal impaction
-dehydration
-medications
-illness
-confused
Incontinence: Possible interventions
-proveide adequate intake
-NPO 2hrs prior to HS
-void prior to bed
-privacy/ comfort
-establish schedule
-briefs at night
-keep record
-kegel exercises
-prevent UTI's
-prevent fecal impaction