Urinary Elimination

Front 1

Strong peristaltic waves attempt to move the obstruction (ie. renal calculus) into the bladder, resulting in Pain, this is referred to as ?

Back 1

-RENAL COLIC

Front 2

Disease Conditions:
1. PRERENAL
2 RENAL-
3. POSTRENAL-

Back 2

1. decrease blood flow to & through the kidney (dehydration, hemorrhage)
2. condition of the renal tissue
3. obstruction in the lower urinary tract, prevents urine flow from kidneys(ie. bld clot, stones, tumors)

Front 3

Normal adult urine output?

Back 3

1,500-1,600 mL /day

-an output of < than 30 mL/hr indicates possible renal alterations

Front 4

What is the function of Renin?

Back 4

-functions as an enzyme to convert angiotensinogen (synthesized by liver) into angiotension I
-Angiotension I is converted to angiotension II in the lungs

Front 5

Client w/ chronic alterations in kidney function do not make sufficient amounts _______.

Back 5

acitve Vitamin D
-prone to develop renal bone disease

Front 6

Kidneys affect _______ and _____ regulation by producing a substance that converts Vitamin-D into its active form

Back 6

calicum
phosphate

Front 7

PRERENAL alteration:

Back 7

-decreased blood flow to & through the kidney

Ie. dehydration, hemorrhage (both causing decreased urine output)

Front 8

RENAL alteration:

Back 8

-diease condition of the renal tissue

ie. DM

Front 9

POSTRENAL

Back 9

-caused by an obstruction that prevent blood flow
-urethra narrows
ie. blood clot, kidney stone, turmors

Front 10

Name conditions that would hender or make it difficult for a client to reach the toilet

Back 10

-Parkinsonism, Degenerative joint disease, arthritis
sensory deficit (blindness)
alzheimer's -Dementia

Front 11

Peritoneal dialysis:

Back 11

can be done at home, q 6 hours
-sterile technique

Front 12

DIURESIS:

Back 12

increased urine formation

-promoted by coffee, tea, cocoa, coke which promote urine formation

Front 13

Urine output that decreases despite normal intake :

Back 13

OLIGURIA
-occurs when fluid is lost via other means (diarrhea, perspiration, vomiting)

Front 14

What drug class causes an increase in urine output?

Back 14

-diuretics

Front 15

Drug Class: causes urinary retention:

Back 15

-Anticholinerics: atropine, Robinal
-antihistamines

Front 16

Meds that change color of urine
1. Pyridium:
2. amitriptyline :
3. Levodopa:

Back 16

1. bright orange to rust
2. green/blue
3. brown to black
-chemo drugs changes color of urine

Front 17

Urised
1. action
2. side effects
3. pt teaching
4. usual dose`

Back 17

1. relieves lower urinary tract discomfort caused by inflammation or diagnostic procedures; cystitis (inflammation of the bladder and ureters), urethritis (inflammation of the urethra), and trigonitis (inflammation of the mucous membrane of the bladder)
2. Acute urinary retention (in men with an enlarged prostate), blurry vision, difficulty urinating, dizziness, dry mouth, flushing, rapid pulse, skin rash
3. blue to blue-green color to urine / Do not take antacids or antidiarrheal medicines, such as loperamide, 1 hour before or after you take Urised.
4. 2 tablets taken 4 times a day.

Front 18

Pyridium
1. action
2. side effects
3. special teaching
4. usual dosage

Back 18

1. urinary tract analgesic/ symptomatic relief of pain, burning, urgency, frequency
2. Headache, rash, pruritus
3. urine orange in color
4. two 100mg tabs tid or 1 200mg tab tid

Front 19

URINARY RETENTION:

Back 19

-accumulation of urine in bladder as a result of the inability of the bladder to empty

Front 20

Symptoms of Urinary retention:

Back 20

1. feelings of pressure, discomfort
2. tenderness over symphysis pubis
3. restlessness, diaphoreses
4 distended bladder (can hold 2 to 3 L of urine)

Front 21

What are causes of urinary retention?

Back 21

1. urethral obstruction R/t prostate enlargement
2. fecal impaction
3. 3-9 mos pregnant
4. urethral stricture (narrowing of urethra or ureters (males)
5. urethral edema after child birth or abd surgery
6. post-catheter removal ( if don't urinate will have to put cath back in)
7. spinal cord trauma or disease
9. emotional anxiety, muscle tension (retain urine)

Front 22

UROSEPSIS:

Back 22

bacteria in the blood stream

Front 23

RESIDUAL URINE:

Back 23

retained; how much urine is left in the bladder after urination (>100mL)
-ask pt to void, input cath, drain bladder = residual amt

Front 24

1. PYELONEPHRITIS:
2. S/S?

Back 24

1.infection that spreads to the kidney (upper urinary tract)
2. flank pain, tenderness, fever & chills

Front 25

HAI:

Back 25

health care associated infection: results from catheters or surgical manipulation

Front 26

S/S of UTI?

Back 26

dysuria, frequency, urgency, hematuria, cloudy or concentrated urine
**as sx get worse: fever, chills, N/V

Front 27

CYSTITIS:

Back 27

irriated bladder
causes: a freq and urgent sensation of the need to void

Front 28

-loss of control over voiding
-incompetent or weak external urethral sphincter
-can be intermittent or continuous

Back 28

URINARY INCONTINENCE

Front 29

Nursing Dx for urinary incontinence:

Back 29

-disturbed body image (young adult)
-impaired skin intergity (older adult)

Front 30

Onset of Lasix (po)

Back 30

1 hour

Front 31

What leads to STRESS incontinence?
-How is it managed?

Back 31

-childbirth,
-gravity weakening the pelvic floor, allowing prolaspe of the bladder
-pelvic floor (Kegel) exercises

Front 32

What are signs/ symptoms of STRESS incontinence?

Back 32

loss of urine with increased laughing, sneezing, or lifting w/ a full bladder

Front 33

1. Involuntary passage of urine after a strong sense of void
2. S/S
3. interventions:

Back 33

1. URGE incontinence
2. urinary urgency, w/ frequency (> than q 2 hrs), bladder spasm or contraction
3. antimuscarinic agents, bladder training, kegal, stop smoking, loose wt

Front 34

S/S of Functional incontinence:

Back 34

1. urge to void that causes loss of urine before reaching appropriate receptacle
2. clothing modifications (buttons), environmental alterations, scheduled toileting, absorbent prodents

Front 35

Is urniary incontience treatable?

Back 35

YES

Front 36

NEPHROSTOMY:

Back 36

-tube placed directly into the Renal pelvis(kidney(s)) for urinary drainage
ie. pt w/ kidney stones (9mm), that are blocking the ureters

Front 37

Transureterostomy:

Back 37

-bring both ureters together and have 1 stoma (bag)

Front 38

iLLEAL loop or conduit

Back 38

md takes a short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed short segment of intestine is placed at the skin surface to create the stoma. The ureters, which normally carry urine from the kidneys to the bladder, are then attached to the other end of the segment of intestine. The urine travels through the newly formed ileal conduit and the stoma into an external collecting poucH
-red stoma (know its made out of bowel)

Front 39

URETEROSTOMY:

Back 39

1 or both ureters to abd surface

Front 40

Color of urine for a dehyrated pt?

Back 40

-dark & concentrated

assess: skin turgor & mucus membranes

Front 41

Urine is bright red, where is the bleeding?

Back 41

bleeding is low: bladder or urethra

Front 42

Urine is a darker red, where is the bleeding?

Back 42

-bleeding is higher: ureters or kidneys

Front 43

Dark amber -colored urine (coffee/tea color) maybe indicative of what 2 diseases?

Back 43

-liver
gallbladder

Front 44

nighttime voiding w/o awakening?

Back 44

-NOCTURNAL ENURESIS

Front 45

1. What is the clarity of high protein urine (renal disease)?
2. thick & cloudy urine:

Back 45

1. fresh urine will appear: formy or cloudy

2. bacteria (foul odor)

Front 46

stagnant urine smell?

Back 46

-ammonia odor (repeatedly incontinent clients)

Front 47

Smell of urine that is high in glucose:

Back 47

-fruity, sweet b/c of acetone

Front 48

C & S

Back 48

-Sterile tech! -can be delegated
clean voided, midstream specimen, clean catch (all mean the same thing)
-sterile cup
-sterile specimen (from port of cath)

Front 49

Normal specfic gravity?

Back 49

1.010 (well hydrated) -1030

> than 1.030 = dehydration (urine is dark, wt is heavy) increased HR

Front 50

Normal range of urine pH?

Back 50

4.6-8.0
slightly acidic 6-7 (?)
7 neutral
> 7 is alkaline
acidic pH helps protect against bacterial growth (meats, whole grain breads, cranberry juice)

Front 51

When is PROTEIN seen in the urine?

Back 51

-renal disease
glomeruli damage
(not normal to see protein in the urine)

Front 52

When are KETONES seen in the urine

Back 52

dehyrdation, starvation, excessive ASA usage
-Ketone= end product of fat metabolism (not normal to see in urine)

Front 53

Blood(rbc) in urine:

WBC in urine:

Back 53

1. -normal up to 2 RBC
-> amts indicate renal disease/ trauma/ stones/ uti
2. 0-4 low, maybe seen in females

Front 54

IVP:

Back 54

(intravenous pyelogram): assess for SHELL fish allergy
-signed Consent - bowel prep
-iv access -increase fluids
-Late allergic reaction: RASH
-Stat reaction: give steroid/benadryl
-anaphaytic: wheezing, SOB
(views collectings ducts, renal pelvis, ureters, bladder, urethra)

Front 55

What abnormal lab values indicate a client can not receive IV dye?

Always assess for what allergy before admin IV dye

Back 55

high BUN, creatine

-SHELLFISH

Front 56

CT scan:

Back 56

-images of selected planes of the body (cross sections)
-view turmors, obstructions
-if pt is on I & O: include the amt of constast (liquid or IV)for CT scan

Front 57

Dx exam that detemines the shiz, shape, symmetry & location of the kidneys:

Back 57

-KUB

Front 58

Dx Exam: Direct visualization of the interior of the bladder & the urethra
-inserted through the urethra into the bladder:

Back 58

-Cystoscopy: invasive, painful
risk of bladder perforation if pt not relaxed and cooperative

Front 59

Retrograde Pyelogram:

Back 59

use of Cystoscopy: Md injects contrast to get a good pic of kidney & ureters

Front 60

Dx exam: Procedure determines bladder muscle function

Back 60

(Urodynamic Testing)
-Cystometrogram (CMG): (use cystoscopy)
evaluates causes of urinary incontinence
-pt must be awake for the test

Ie. cystoscopy w/ CMG (need consent for both procedures)

Front 61

Procedure used to visualize renal arteries & their branches to detect narrowing or occlusion:

Back 61

ARTERIOGRAM / ANGIOGRAPHY
-catheter placed in Femoral artery & moved up to the level of renal arteries
-contrast injected (shellfish allergy)
-done in radiology by radiologist
-post op: check for bleeding, apply pressure for 15-20 mins after removing 18 g IV, check pedal pulse

Front 62

Procedure that determines nature, extent and prognosis of renal disease

Back 62

-Renal Biopsy: renal tissue is examined under microscope
2 methods: 1. percutaneous(closed): done in pt's room
2. Surgical(open) done during surgery
-Nurses watch for: bleeding, hematoma, V/S

Front 63

What is the amt of fluid volume intake for a person w/ normal renal function & no heart disease:

Back 63

Daily intake: 2000-2500mL

Front 64

What is the average daily intake of fluids that is adequate unless the client has a hx of UTIs

Back 64

1200-1500mL

Front 65

Crede's compression or Maneuver:

Back 65

-manual bladder compressions (push down right over bladder area, will help push urine out: do after a pt is catherized

Front 66

What foods are high in acid?

Back 66

Acidifying Urine:
-meats -eggs
-whole grains -cranberries
-cranberries -prunes
-high doses of Vit-C

Front 67

DRUG THERAPY
1. increase bladder contraction & improve bladder emptying
2. stimulates PNS nerves to increase bladder wall contraction & relax the sphincter

3.

Back 67

1. cholinergic drug (diarrhea)
2. Urecholine

Front 68

Drug Therapy
1. for a spastic bladder caused by irritation or hyperactivity of the detrusor:
2. dribbling or overflow incont. seen in men w/ prostatic enlargemnet can be treated w/:

Back 68

1. anti-cholinergic (Vesicare, Ditropan): reduce incontinence
2. adrengic blocker (Hytrin)

Front 69

Flomax:

Back 69

alpha-adrenergic blocker
-relaxes prostatic smooth muscle
-treats dribbling or overflow incontinence seen in men w/ prostatic enlargement
-used w/ BPH

Front 70

2 ways to assess a distened bladder

Back 70

1. palpation : distened bladder is palpable (not normal), feel smooth round mass, tender to touch
2. Percussion:dull sound heard, indicates full bladder

Front 71

Coude Catheter:

Back 71

-male w/ prostate enlargement
-less traumatic during insertion b/c it's stiffer & easier to control past the prostate gland

Front 72

Indications for catheterization:
1. relief of discomfort of Bladder Distention, Provision of Decompression,
-assessment of Residual urine

Back 72

1. INTERMITTENT:
-assessment of residual urine
-long term mangement w/ spinal cord injuries, neuromuscular degeneration or incompetent bladders

Front 73

catheter size:
1. female
2. male

Back 73

1. 14 or 16 french
2. 16 or 18 french
** use ONLY Sterile H20**
saline w/ crystallize
(larger the # larger the tube)

Front 74

Indications for Catheterization:
SHORT-TERM Catheterization

Back 74

-obstruction to urine outflow (ie. prostate enlargement, surgical repair of bladder, urethra & surrounding structures , measurement of urinary output in critically ill clients (ie. pt w/ CHF is taking Lasix keep up w/ I & O)

Front 75

How often is a long term indwelling catheter changed?

Back 75

q month

Front 76

Plastic catheter are only used for ________.

Back 76

-only for intermittent use

Front 77

How long are Latex catheters used?

Back 77

use up to 3 weeks, be aware of allergies
(Retention/foley catheter)

Front 78

What are Pure Silicon or teflon catheter best used for?

Back 78

-long-term (2 to 3 mos) b/c of less encrustation at the urethral meatus

Front 79

Empty urinary drainage bag q ____ hours?

Back 79

8

Front 80

Patient teaching: Removing Foley catheter

Back 80

- dysuria (1st few voids)
-fluids up to 3000mL/day if not contraindicated

Front 81

Why would a nurse have an order to irrigate a catheter?

Back 81

-clear a blockage
causes: mucus, thromi, pus, sediment
-sterile NS, irrigant solution
-**subtract amt of irrigate solution used to irrigate cath from output

Front 82

*What is the difference b/w instillation and irrigations solutions?

Back 82

-instillations: remain in the bladder for a specfic amt of time, then drained: ie. antibiotic or chemo (urologist instills)

Front 83

________ incontinence benefits from habit training?

Back 83

-functional
improves voluntary control over urination