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54 Cards in this Set
- Front
- Back
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Anatomy & Physiology of the
Urinary System |
Kidney
Ureter Bladder Urethra |
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Kidney
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-Filtration
-Reabsorption -ureter -Bladder |
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Bladder
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-Reservoir
-Organ of excretion -Rugae -250-450 ml |
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Urethra
Female? Male? |
-Female-1 1/2- 2 1/2
-Male 6 1/2- 8 |
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Micturition
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-storage
-voiding |
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Kidneys:
Time of development? Composition & volume of? |
-Embryonic development same time as ears
-Composition & volume of body fluids |
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Kidneys:
functions? (4) |
-Water balance
-Electrolyte balnace -Acid-base balance -Eliminate waste |
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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 |
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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 |
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Abnormal patterns?
Anuria |
none or very little--less than 100cc/24hrs
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Abnormal Patterns:
Dysuria |
-Difficulty in voiding
-May have pain or burning |
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Abnormal Patterns:
Oliguria |
-Scant--100-500cc or 3ml/hr/24hrs
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Abnormal Pattens:
Frequencey |
Increased incidence of voiding
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Abnormal Patterns:
Polyuria-diuresis |
-Excessive output--greater than 2500cc/day
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Abnormal Patterns:
Dialysis |
-Hemodialysis
-Peritoneal dialysis |
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Abnormal Patterns:
Nocturia |
-Frequency at night
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Abnormal Patterns:
Urgency |
-Feeling of must void NOW!
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Abnormal Patterns:
Enuresis |
-Not incontinence
-nocturnal enuresis- bedwetter |
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Abnormal Patterns:
Rentention |
-Inability to void- Urine is present
*physical *Psychological *Meds (Box 47-1 pp1260) |
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Abnormal Patterns:
Incontinence |
-Total
-Functional -Stress -Urge -Overflow |
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Independent Nursing Actions:
Bladder Training |
-Postpone voiding @ urge- lengthen times b/w
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Independent Nursing Actions:
Habit Training |
-Regular timed voiding
-Voids with urge also |
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Independent Nursing Actions:
Prompted Voiding |
-Used with habit training
-Remind and attempt to void |
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Independent Nursing Actions:
Pelvic Muscle exercise |
-Kegal exercise Pg. 1271
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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 |
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Urine: Consituents
Organic (6) |
-urea
-Uric acid -Creatinine -Hippurc acid -Indican -Nitrogen |
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Urine: Consituents
Inorganic (7) |
-Ammonia
-Sodium chloride -Traces of iron -Phosphorus -Sulfur -Potassium -Calcium |
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Abnormal consituents:
Urine |
-Blood (hematuria)
-glucose (glucosuria) -acetone (acetonuria)*simple ketone -protein (proteinuria) -gross bacteria -pus -stones -casts -bile |
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Micturition: physiology
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-urine from ureter to bladder
-bladder elastic -stretch receptors triggered -miturition center: to spinal cord unconscious |
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Micturition: physiology
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-Brain connectors: to brain-unconscious
-urethral pressure increases -storage-Sympathetic: outlet tightens & bladder relaxes -voiding-parasympathetic: outlet opens & bladder contracts |
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Factors affecting Micturition
Developmental |
*Developmental
-Infant:spinal reflex -Toddler:conditioned reflex to training -Age 5+: conscious inhibition -Elderly: decreased muscle tone, capacity, concentration |
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Factors affecting Micturition
diet & fluid intake |
-diet & fluid intake
intake=output caffine & ETOH Color & pH |
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Factors affecting Micturition
Initial urge |
-Initial urge
Delayed larger amounts loss of tone |
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Factors affecting Micturition
Lifestyle |
-lifestyle
gender privacy plumbing traumatic experience |
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Factors affecting Micturition
Medications |
-Medications
diuretics pyridium vitamins antibiotics |
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Factors affecting Micturition
Muscle tone |
-catheter
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Factors affecting Micturition
Activity level |
-Activity Level
self help elderly |
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Factors affecting Micturition
Psychological Stressors |
Psychological stressors
stress blood pressure perfusion urine |
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Factors affecting Micturition
Pathology |
-Pathology
disease |
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Diagnostic Procedures
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-UA
-C&S -IV Pyelography -Retrograde Pyelography -CT Scan -Ultrasonography -Cystoscopy |
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The nurse as a role model
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-empties regulary
-responds to urge -drinks 8-10 glasses of water -responds to changes -promotes wellness |
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Nursing Diagnosis R/T Urinary Elimination
*Urinary function as problem |
Urinary function as problem
-incontinence -retention |
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Nursing Diagnosis R/T Urinary Elimination
*Urinary function as etiology |
Urinary function as etiology
-anxiety -impaired skin integrity -sleep pattern disturbance -social isolation |
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Generalized outcomes
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-urinary output
-empty bladder -skin integrity -Identify -achieve -demonstrate |
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Describe Nursing Interventions: Independent
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Independent
-fluids -diet -I&O -Maintain normal patterns -hygeine training/retraining client |
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Describe Nursing Interventions: Dependent
Urge |
Anticholinergic-Ditropan
-inhibits bladder cont. & increase capacity |
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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 |
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Describe Nursing Interventions: Dependent
Urge/Stress |
Antidepressant-Tofranil
-Increase internal sphincter & capacity |
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Describe Nursing Interventions: Dependent
Overflow |
Choliergic-Urecholine
-complete bladder emptying, decreased capacity Alpha-adrenergic-Dibenzyline -decreased outlet resistance |
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Describe Nursing Interventions: Dependent
Antibiotic |
Bactrim
-infection |
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Dependent Interventions
Urinary flow devices |
Urinary flow devices
-external -other -urinary catheterization |
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Incontinence: requirements for urine control
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-G.U. integrity
-Cognitive ability -Mobility -Motivation |
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Incontinence: Common impediments
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-UTI
-Fecal impaction -dehydration -medications -illness -confused |
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Incontinence: Possible interventions
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-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 |
