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93 Cards in this Set

  • Front
  • Back
what four urinary tract organs contribute to the process of urinary elimination?
kidneys, ureters, bladder, and urethra
what organ acts as the primary regulator of fluid and acid-base balance in the body?
the kidney
the functional unit of the kidneys
in the average adult, how much blood flows through the kidneys each minute?
1200ml of blood, or about 21% of the cardiac output
how many nephrons are in each kidney
each kidney contains approximately 1 million nephrons
what is the tuft of capillaries called which are found within each nephron?
a glomerulus
the structure that surrounds each glomerulus is called what?
Bowman's capsule
where is water and electrolytes reabsorbed by the capillaries in the kidney (after the Glomerular capsule)
in the proximal convoluted tubule
what happens in the loop of Henle in the nephron?
solutes such as glucose are reabsorbed and other substances are secreted into the filtrate
where does antidiuretic hormone (ADH)and aldosterone affect water and sodium reabsorption? (part of nephron)
in the distal convoluted tubule
at what part of the bladder does the ureters enter it?
at the posterior corners of the floor of the bladder
where in is the bladder located when empty?
behind the symphysis pubis
what is the detrusor muscle?
the smooth muscle layers in the wall of the bladder
what is the trigone?
the triangular area of the base of the bladder formed by the posterior inferior openings of the ureters and the anterior inferior opening of the urethra
when full, where might the dome of the bladder be palpated?
above the symphysis pubis, and at some times as high as the umbilicus
how long is a woman's urethra?
about 1.5" long
the male urethra is how long?
about 8" long
how are the sphincter muscles controlled?
the internal sphincter muscle is under involuntary control whereas the external sphincter muscle is under voluntary control
why are women more prone to UTIs than men?
because of their short urethras and because of the proximity of the urinary meatus to the vagina and anus
what are the special sensory nerves located in the bladder wall called?
stretch receptors
how much urine is needed to gather in the bladder before the stretch receptors to become stimulated?
this occurs when the bladder holds between 250 and 450 ml of urine for adults

in children the same thing happens between 50 and 200ml
where is the voiding reflex center located which controls the involuntary relaxation of the internal sphincter
at the level of the second to fourth sacral vertebrae
if you delay voiding for some time after the stimulation of the stretch receptors, what usually happens?
the micturition reflex usually subsides until the bladder becomes more filled and the reflex is stimulated again
what is necessary for conscious control of micturition to exist?
the nerves supplying the bladder and urethra, the neural tracts of the cord and brain, and the motor area of the cerebrum need to all be intact for this to exist
urine output for a 1 year old should be about how much?
how many times does an infant urinate per day?
up to 20 times/ day
at what age do children develop urinary control?
between the ages of 2 and 5 years old
the kidneys double in size during which ages?
between 5 and 10 years old
what is enuresis
the involuntary passing of urine when control should be established
when should control be established for children
about 5 years of age
what effect does aging have on kidney functioning?
the excretory function of kidney diminishes with age, but usually not significantly below normal levels unless a disease process intervenes
a decrease in kidney functioning places a person at a greater risk of what? (when taking medications)
toxicity from medications
what usually causes the common urinary urgency associated with older people?
in men, these changes are often due to an enlarged prostate gland and in women to weakened muscles supporting the bladder or weakness of the urethral shincter...the capacity of the bladder and its ability to completely void also decrease
what predisposes older people to bladder infections?
residual urine remaining in the bladder as a result of incomplete voiding
how does food high in sodium cause a person to retain fluid?
water is retained in order to maintain normal concentration of electrolytes
what physiological changes occur in elders r/t renal functioning?
-30% of nephrons are lost by age 80
-renal blood flow decreases because of vascular changes and a decrease in cardiac output
-the ability to concentrate urine declines
-bladder muscle tone diminishes, increases frequency of urination and nocturia
-diminished bladder muscle tone and contractibility may lead to residual urine in the bladder after voiding, increasing risk of bacterial infection
-urinary incontinence due to mobility problems or neurologic impairments
the kidneys reach maximum size at what age?
between 35 and 40
kidney functioning reaches maturity at what age?
usually between the first and second year of life
how might an indwelling catheter affect bladder functioning?
clients who require a retention catheter for a long period may have poor bladder muscle tone because continuous drainage of urine prevents the bladder from filling and emptying normally
urine output below 30 ml/hour may indicate what?
it may indicate low blood volume or kidney malfunction and must be reported
normal urine consists of what?
96% water
4% solutes

organic solutes=urea, ammonia, creatinine, uric acid.

inorganic solutes= sodium, cloride, potassium, sulfate, magnesium, and phosphorus
how is residual urine measured?
by catheterizing the client immediately after voiding. the amount voided and the amount obtained by catheterization are recorded
what is the end product of protein metabolism called?
what is the general diagnostic label for urinary elimination approved by NANDA?
impaired urinary elimination
what are the subcategories for "impaired urinary elimination"?
-functional urinary incontinence
-reflex urinary incontinence
-stress urinary incontinence
-total urinary incontinence
-urge urinary incontinence
-urinary retention
what are ketones? what's the normal concentration of ketones in the urine?
ketones are the end product of the breakdown of fatty acids. they are not normally found in the urine.
how much fluid should clients who are at risk for UTIs or urinary calculi consume?
2000 to 3000 ml of fluid per day
is urinary incontinence a normal part of aging?
what is "credes's maneuver"?
using manual pressure on the bladder to promote bladder emptying.
when should someone use crede's maneuver?
it is not advised without a physician or nurse practitioner's order and is used only for clients who have lost and are not expected to regain voluntary bladder control.
an infection of the urethra may lead to what?
a bladder infection which then may lead to a kidney infection
what does "tortuous" mean?
having or making twists and turns
what does "dysuria" mean?
voiding that is either painful or difficult
what does "urinary hesitancy" mean?
a delay and difficulty in initiating voiding
what is oliguria?
a low urine output, usually less than 500ml/day or 30ml/hr
what is anuria?
a lack of urine production
what are the two most common types of dialysis?
hemodialysis and peritoneal dialysis
is urinary incontinence a disease or symptom?
a symptom
what problems can be caused by urinary incontinence?
physical problems such as skin breakdown;

psychosocial problems such as embarrassment, isolation, and social withdrawal
what are some risk factors for developing urinary incontinence?
-a history of UTIs, surgery, or trauma
-multiple vaginal births
-musculoskeletal, endocrine, or neurological disorders
4 factors R/T polyuria
-ingesion of fluids cotaining caffeine or alcohol
-prescribed diuretic
-presence of thirst, dehydration, and weight loss
-Hx of DM, diatebetes insipidus, or kidney disease
5 factors R/T oliguria or anuria
-decrease in fluid intake
-signs of dehydration
-presence of hypotension, shock, or heart failure
-Hx of kidney disease
-signs of renal failure such as elevated BUN and serum creatinine, edema, hypertension
2 factors R/T frequency or nocturia
-increase in fluid intake
2 factors R/T urgency
-psychological stress
6 factors R/T dysuria
-infection or injury
3 factors R/T enuresis
-family Hx of enuresis
-difficult access to toilet facilities
-home stresses
4 factors R/T incontinence
-bladder inflammation or other disease
-difficutlties in independent toileting (mobility impairment)
-leakage when coughing, laughing, sneezing
-cognitive impairment
which beverages should not be consumed in excess during bladder training because they irritate the bladder?
-citrus juices
-carbonated beverages (especially those with artificial sweeteners)
-drinks with caffeine
which type of catheter should be used for long-term use (2-3 months)?
silicone catheters
what size catheter is typically used for children?
#8 or #10
what size catheter is typically used for adults?
#14 , #16 , #18 (for men)
who typically requires a larger catheter, men or women?
what length should the catheter be for use on women as compared to those used on men?
22 cm for women
40 cm for men
what size balloons should be used for a child's catheter?
3 mL balloon
what size balloon should be used for an adult in order to optimize urine drainage?
5 mL balloon
this size balloon is often used to achieve hemostasis of the prostatic area following a prostatectomy
30 mL balloon
how long can you leave a plastic catheter in?
only for short periods (eg 1 week or less) because they are inflexible
why might a bladder irrigation be carried out?
to wash out the bladder or to apply a medication
why is the closed method of catheter or bladder irrigation preferred?
because its associated with a lower risk of UTI
when might an open method of bladder or catheter irrigation be required?
for clients who develop blood clots and mucous fragments that occlude the catheter and when it is undesirable to change the catheter
what is a urinary diversion?
a surgical rerouting of urine from the kidneys to a site other than the bladder
when are urinary diversions usually created?
when the bladder must be removed
what is a cutaneous ureterostomy?
when the ureters are brought directly to the skin to form small stomas
what is the disadvantage of a cutaneous ureterostomy?
it creates a direct access for microorganisms to reach the kidneys
what is the most common type of urinary diversion?
the ileal conduit or ileal loop
what is a ileal conduit (or ileal loop)
when a segment of the ileum is removed and the intestinal ends are reattached. one end of the segment is closed with sutures to create a pouch and the other end is brought out through the abdominal wall to create a stoma. the ureters are implanted into the ileal pouch.
what are the advantages of an ileal conduit (as compared to a cutaneous ureterostomy?
-the mucous membrane of the ileal pouch provides some protection from organisms
-the larger stoma is easier to fit with an appliance than ureterostomies
what is "the Kock pouch" or continent ileal bladder conduit? *note* "the Kock pouch" is also used to mean a continent vesicostomy
it uses a portion of the ileum to form a resevoir for urine. nipple valves are created which close as the bladder fills with urine. the client empties the pouch by inserting a clean catheter approximately every 4 hours. Between catherizations, a small dressing is worn over stoma.
what is a continent vesicostomy or "Kock pouch"? *note* "kock pouch" is also used to mean a continent ileal bladder conduit.
the ureters remain intact and the bladder is sutured to the abdominal wall, forming a stoma
what must be noted and documented when caring for someone with a urinary diversion?
I/O, urine color, odor, clarity, and the condition of the stoma and surrounding skin.
what problems might a client experience due to a urinary diversion?
problems with body image and sexuality
what is commonly found in the urine of someone with a urinary diversion?
mucous shreds
before applying a condom catheter, what should be assessed about the client's elimination pattern?
the nurse determines when the client experiences incontinence because some clients may require it only at night