Urinary Elimination Nursing Fundamentals Craven Chapter 41

Front 1

Structures within the Urinary tract include:

Back 1

1) Kidneys-where urine is formed
2) ureters- connect the kidney with the bladder
3) bladder-stores urine
4) urethra-enables urine to leave body

Front 2

The functional unit of the kidney is called:

Back 2

the nephron

Front 3

The nephron consists of:

Back 3

glomerulus, Bowman's capsule, proximal convoluted tubules, loop of Henle, distal tubule, collecting duct.

Front 4

Characteristics of the ureters

Back 4

narrow (1.25cm), smooth muscle tubes that serve as passageways for urine to flow from the kidneys to the bladder.

Front 5

Location of bladder

Back 5

Women-in front of the uterus and vagina.

Men-in front of rectum and above prostate gland.

Front 6

bladder is composed of 3 layers, collectively the 3 layers are called

Back 6

detrusor muscle

Front 7

Autonomic nervous innervation affects smooth muscle control of the

Back 7

internal sphincter

Front 8

Sympathetic impulses cause the ________ to contract, keeping urine in the bladder

Back 8

sphincter

Front 9

Parasympathetic nerve stimulation results in contraction of the ________ muscle and relaxation of the _______ _______, which causes urination

Back 9

detrusor muscle

internal sphincter

Front 10

Kidneys major function is to:

Back 10

regulate the volume and composition of the body's extracellular fluid (ECF)

Front 11

urine formation occurs by the process of:

Back 11

filtration, reabsorption, and secretion

Front 12

Filtration begins at the:

Back 12

glomerulus.

Front 13

the process of excreting urine from the body, including urination, voiding, and _________.

Back 13

micturition

Front 14

Emptying of the bladder usually occurs when

Back 14

250-400mL of urine stretches or distends the bladder.

Front 15

This reaction of bladder stretch, leading to bladder contraction and perceived need to void, is called the ______ ______ , and involuntary spinal cord reflex

Back 15

micturition reflex

Front 16

When the external ________, a skeletal muscle, is contracted in a closed position, the person can voluntarily delay voiding

Back 16

sphincter

Front 17

Emptying the bladder also involves contraction of abdominal muscles and relaxation of ______ ______ muscles

Back 17

pelvic floor

Front 18

In adults the average amount of urine per void is approximately 250-400 mL. All but ____ to 10mL or urine is typically emptied from the bladder

Back 18

5mL

Front 19

Catherized clients should drain a minimum of _____mL of urine per hour.

Back 19

30mL

Front 20

Urine output of less than 30mL/hour may indicate:

Back 20

inadequate blood flow to the kidneys

Front 21

The color of urine ranges from light yellow, to a dark yellow, to a dark yellow brown called

Back 21

amber

Front 22

Urine may be dark amber or orange-brown if it is very concentrated secondary to

Back 22

decreased fluid intake

Front 23

Medications can also alter urine's color.

Back 23

effects of meds on urine

Front 24

Urine may appear cloudy, dark-reddish brown, or streaked with blood when a women is

Back 24

menstruating

Front 25

Normal urine clarity is

Back 25

transparent

Front 26

Freshly voided urine should appear:

Back 26

clear, without sediment

Front 27

Urine draining from an indwelling catheter should appear clear and without sediment in the tubing, it may contain occasional _______ _____.

Back 27

mucus shreds

Front 28

Urine that has been sitting unemptied in a urinal or collecting device for an hour or longer may normally appear:

Back 28

cloudy secondary to separation or settling of urinary constituents.

Front 29

The odor of freshly voided urine is typically described as

Back 29

aromatic.

Front 30

collected urine that has been sitting for a long period of time will have a ________ odor

Back 30

strong ammonia scent

Front 31

How often per day do people void, and how much fluid in 24 hour period?

Back 31

void 6-8 x per day
1200-1500mL in 24hours
minimum of 200mL and no more than 500mL per void.

Front 32

In later middle age, men experience altered urinary elimination related to:

Back 32

prostatic hypertrophy

Front 33

women experience altered urinary elimination related to

Back 33

weakened perineal muscles

Front 34

As a result of cardiovascular changes that occur with aging, most older adults experience decreased

Back 34

perfusion of the kidneys

Front 35

Over time, owing to decreased arterial perfusion, kidney function progressively decreases; the kidneys become a less effective regulator of the body's

Back 35

ECF

Front 36

The ureters, bladder, and urethra lose some ______ ______ with aging

Back 36

muscle tone

Front 37

_______ is night time urination, is one of the most common reasons for interrupted sleep in the adult population, especially older adults

Back 37

Nocturia

Front 38

Women's risk of developing urinary incontinence is ___X that of men's/

Back 38

2x
related to decreased estrogen levels, and weakened perineal muscles.

Front 39

Older men may experience urinary hesitancy and difficulty starting urine stream, related to:

Back 39

prostatic hypertrophy

Front 40

ADH-antiduretic hormone, plays significant role in the reabsorption of water in the:

Back 40

tubules of the nephron

Front 41

the name "antidiuretic" implies the function of ADH, which is to prevent _______, or water excretion

Back 41

diuresis

Front 42

ADH is secreted by the ________ and released by the posterior pituitary in the brain.

Back 42

hypothalamus

Front 43

Increased ______ _______ stimulates the release of ADH.

Back 43

plasma osmolarity

Front 44

When ADH is present, the distal tubule of the nephron becomes more:

Back 44

permeable to water

Front 45

Release of ADH causes the kidney to

Back 45

reabsorb more water, thus producing a more concentrated urine.

Front 46

When fluid intake increases

Back 46

ADH release is suppressed.

Front 47

In the absence of ADH, the renal tubules become relatively

Back 47

impermeable to water, and little water is reabsorbed, producing an increased volume of dilute urine.

Front 48

When a person loses a great deal of body fluid, the kidneys increase reabsorption of water from the glomerular filtrate to maintain proper osmolarity of the ECF.

Back 48

This "water saving" to regulate concentration of solutes in the ECF results in decreased urine output.

Front 49

Alcohol and caffeine-containing fluids, irritate the bladder and contain a

Back 49

diuretic that can increase urine output when they are ingested in large quantities.

Front 50

Body position and voiding

Back 50

men/women find it difficult when not in natural position. This alters voiding pattern, so voiding becomes more frequent, but with less volume.

Front 51

Cognitions impairment interferes with person's ability to maintain urinary continence.

Back 51

Alzheimer, brain tumor, CVA, can reduce ability to perceive bladder fullness or to delay voiding until at toilet.

Front 52

medications or serious illness can cause temporary confusion called ______ especially in older adults. Disturbs urinary pattern

Back 52

delirium

Front 53

How can stress and anxiety effect urinary pattern?

Back 53

person can experience strong urge to urinate. Also, muscles may become tense that he or she cannot relax the perineal muscles, and voiding is inhibited.

Front 54

Privacy and urination

Back 54

some people can not relax muscles, provide as much privacy for elimination as possible.

Front 55

Structural abnormalities can cause urinary obstruction

Back 55

tumors, or tumors that press against the urinary tract, renal stones, and prostatic enlargement.

Front 56

Obstruction can also occur when clients have catheters or nephrostomy tubes in place that become

Back 56

kinked or plugged

Front 57

__________distention of the kidneys pelvis with urine secondary to the increased resistance caused by obstruction to normal urine flow.

Back 57

hydronephrosis

Front 58

Unrelieved hydronephrosis can cause:

Back 58

renal cell atrophy and necrosis, which can cause permanent kidney damage

Front 59

Effects of Urinary stasis

Back 59

stagnant urine proximal to the obstruction provides a good growth medium for microorganisms, fostering the development of UTI's.

Front 60

UTI's are usually caused by microorganisms normally found in the

Back 60

gastrointestinal tract

Front 61

UTI's are of the Enterobacteriacea group and include Escherichia coli, Klebsiella, and Proteus. These organisms gain access via the

Back 61

urethral meatus

Front 62

The most common UTI's are infections of the:

Back 62

urethra (urethritis) or bladder (cystitis). These are classified as LOWER UTI's.

Front 63

What types of infections are classified as upper UTI's?

Back 63

ureters (ureteritis) and kidney and pelvis or tubule system. These are less common, but are more serious, because kidney damage and renal failure may result.

Front 64

Urinary tract is sterile except at the______?

Back 64

urethral meatus

Front 65

Women are more susceptible to UTI's because:

Back 65

short length of their urethras and the proximity of the vagina and anus to the urinary meatus.

Front 66

Men are less susceptible to lower UTI's because of the longer length of the male urethra and also because of the_________

Back 66

antibacterial properties of prostatic secretions.

Front 67

Other factors that increase incidence of UTI's.

Back 67

incorrect wiping, sexual intercourse, procedure that places object into urethra or bladder for diagnostic or therapeutic reasons. Catheter which increases risk.

Front 68

About 1/2 of catheterized clients become infected with UTI within ______ of catheterization.

Back 68

1 week of catheterization

Front 69

How can UTI's disrupt normal pattern of urinary elimination?

Back 69

Voiding becomes painful and more frequent. Experience urgency, Urine becomes abnormal, containing pus (pyuria) and blood (Hematuria).

Front 70

Hypotension and urinary elimination:

Back 70

when arterial blood pressure drops too low, the renal arteries do not have enough pressure to cause glomerular filtration.

Front 71

Neurologic injury and urinary elimination

Back 71

injury by trauma, hemorrhage, or tumor to the frontal lobes of the brain, which control the voluntary nature of voiding can lead to incontinence.

Front 72

_____ occurs when the bladder, as soon as it is stretched to a certain degree, contracts reflexively, resulting in a loss of urine.

Back 72

Reflex voiding: condition is called reflex neurogenic gladder.

Front 73

If reflex arc is injured, the bladder may fill without the bladder stretch contraction mechanism's working, resulting in urinary retention. Condition is:

Back 73

Autonomous neurogenic bladdeer

Front 74

Abdominal and perineal muscles can weaken because of:

Back 74

Obesity, multiple pregnancies, stretching during childbirth, menopausal atrophy due to decreased estrogen, and chronic constipation.

Front 75

A ______ is the protrusion or herniation of the bladder into the vaginal canal.

Back 75

Cystocele; produces symptoms of stress incontinence, frequency, dribbling, and inability to empty the bladder completely.

Front 76

After removal of a catheter, some clients experience

Back 76

dribbling and difficulty with urinary control. This is usually temporary.

Front 77

Urinary elimination & pregnancy

Back 77

growing uterus can exert pressure on the bladder, a common cause of urinary frequency in pregnant women.

Compression of the bladder by the uterus may also lead to obstruction of urinary flow and incomplete emptying of the bladder.

UTI's are more common during pregnancy because of the hormonally related changes in the urinary tract.

Trauma from vaginal delivery causes swelling in the perineal area, which can obstruct the flow of urine and cause urinary retention during the early postpartum period.

Front 78

Postoperative clients should be able to void within _____ hrs after surgery

Back 78

8 hours after surgery

Front 79

Postoperative clients are volume depleted because of limit fluid intake and loss of blood and flood during surgery

Back 79

postoperative problems with urinary elimination.

Front 80

The stress of surgery triggers the release of _____ which decreases urinary output

Back 80

ADH

Front 81

Many medications used to control postoperative pain have urinary retention as a side effect. Especially true when _____ are administered for pain

Back 81

opioids

Front 82

Trauma to tissues during surgery may cause _______ which can obstruct urine flow.

Back 82

edema

Front 83

Anesthesia call also affect

Back 83

urinary elimination. Anesthetic agents slow the glomerular filtration rate, reducing urinary output.

Front 84

______ are medications that increase urine output

Back 84

Diuretics.

Front 85

Commonly used diuretics include:

Back 85

chlorothiazide
hydrochlorothiazide
furosemide
spironolactone
triamterene

Front 86

________ medications may be given to promote voiding

Back 86

Cholinergic medications

Front 87

________ is a type of cholinergic medication to promote voiding because they stimulate contraction of the detrusor muscle

Back 87

Bethanechol

Front 88

______ (an antispasmodic) or _______ (an anticholinergic) may be used to treat urinary urgency and frequency caused by overactive detrusor muscle activity

Back 88

Oxybutynin and tolterodine

Front 89

The risk of urinary retention is increased with medications having anticholinergic effects. Name a few

Back 89

Tricyclic (antidepressants) and antihistamines are examples of such drugs.

Front 90

_______ can decrease the glomerular filtration rate and the sense of bladder fullness

Back 90

Narcotics

Front 91

________ causes urine to turn bright orange

Back 91

phenazopyridine (Pyridium)

Front 92

_______ causes urine to turn blue-green in color

Back 92

amitriptyline

Front 93

A ______ _______ is a surgical procedure in which normal pathway of urine elimination is altered.

Back 93

urinary diversion

Front 94

The urinary diversion may be permanent, as with cancerous conditions that require removal of the bladder which is called a _____

Back 94

cystectomy

Front 95

______ means painful voiding.

Back 95

Dysuria

Front 96

Symptoms of UTI's are:

Back 96

burning sensation during urination.
Any bladder inflammation or trauma or inflammation of the urethra can cause dysuria.

Front 97

_________ is the formation and excretion of excessive amounts of urine.

Back 97

Polyuria. Urine output of more than 2500-3000mL in 24 hrs is considered polyuria. Untreated diabetes insipidus and hyperglycemia can greatly incease urine output. Ingestion of diuretics, caffeine, and alcohol also results in polyuria.

Front 98

________ is the formation and excretion of decreased amounts of urine, or urinary output less than 500 mL in 24 hours.

Back 98

Oliguria. People with renal disease may be oliguric. As the kidney approaches complete failure, the person may become anuric.

Front 99

________ is the formation and excretion of less than 100 mL of urine in 24 hours

Back 99

Anuria

Front 100

________ is the subjective feeling of being unable to delay voiding voluntarily.

Back 100

Urgency. Urgency implies a strong micturition reflex caused by inflammation or infection of the urethra or bladder; incompetent urethral sphincter, weak perineal muscle control, or psychological stress.

Front 101

Voiding at frequent intervals is know as ________

Back 101

Frequency occurs when a person voids more often than normal, without a significant increase in fluid intake. Overactive bladder is often used.

Front 102

Voiding during normal sleeping hours is called ________.

Back 102

Nocturia. Congestive heart failure may also experience nocturia. When lying supine, edema decreases as fluid enters the circulation. Blood flow to the kidneys increases, increasing glomerular filtration and urine output.

Front 103

_______ is blood in the urine; it can be gross (visible on visual examination) or occult (not visible on visual examination)

Back 103

Hematuria. Pathologic causes of hematuria include UTIs, urinary tract tumors, renal calculi, poisoning, and trauma to the urinary mucosa.

Front 104

________ means that the urine contains pus, which is the accumulation of the end products of an inflammatory response.

Back 104

Pyuria. Occurs in the presence of a UTI.

Front 105

________ is the inability to empty the bladder of urine. Person is either unable to perceive feeling of bladder fullness or unable to relax the bladder neck and external urethral sphincter to allow urine to pass.

Back 105

Urinary retention

Front 106

Accumulation of urine in the bladder leads to ______ or urine, which predisposes the person to UTIs and calculi development.

Back 106

Stasis

Front 107

Bladder distention also leads to _______ as the urine backs up into the ureters and renal pelvis.

Back 107

hydronephrosis

Front 108

People at risk for urinary retention include:

Back 108

neurologic impairment, such as spinal cord injury or brain lesions.. Postoperative clients may experience temporary urinary retention until edema subsides and spinal anesthesia wears off.

Front 109

The sudden, involuntary loss of small amounts of urine that accompanies a sudden increase in intra-abdominal pressure is called __________.

Back 109

stress incontinence

Front 110

Factors associated with stress incontinence include:

Back 110

weakening of the pelvic floor muscle, high intra-abdominal pressure, damage to the bladder neck, and side effects of medications.

Front 111

The involuntary loss of urine after a strong feeling of the need to urinate is termed _______ _______.

Back 111

Urge incontinence.

Front 112

Factors associated with urge incontinence include.

Back 112

UTIs, use of diuretics, consumption of fluids that contain caffeine or alcohol, smoking (nicotine), and increased fluid intake. Overdistended bladder.

Front 113

An involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached is called _______ ________.

Back 113

Reflex incontinence. The person is unable to sense bladder fullness b/c of neurologic impairment, and the bladder empties when a certain degree of bladder stretch occurs.

Front 114

Reflex incontinence is seen in clients with:

Back 114

neurologic impairments, such as spinal cord lesion, cerebrovascular accident, or brain tumor.

Front 115

_______ incontinence involves the inability or unwillingness of a person with normal bladder and sphincter control to reach the bathroom in time to void.

Back 115

Functional incontinence. Environmental barriers, disorientation, or physical limitation can contribute.

Front 116

The continuous, involuntary, unpredictable loss of urine from a nondistended bladder is termed _________ incontinence

Back 116

Total incontinence. specific neurologic lesion in the brain or spinal cord, a traumatic or surgical injury to the genitourinary area or spinal cord, and a congential malformation within the urinary tract or spinal cord.

Front 117

__________ is involuntary voiding, with no underlying pathophysiologic origin, after the age at which bladder control is usually achieved.

Back 117

Enuresis.

Front 118

Urine output that exceeds fluid intake may indicate diuresis. Urine output less than fluid intake intake indicates kidney perfussion, loss of body fluids

Back 118

from other sources (vomiting, bleeding, excessive perspiration) or physiologic conservation of body fluids.

Front 119

The absence of voiding during and 8-12 hour period, or frequent voiding of small amounts of urine suggests ______

Back 119

acute urinary retention or urinary retention with overflow voiding.

Front 120

________ an accumulation of white, odorous secretions from sebaceous glands found under the labia minora in women and under the foreskin in men, is normal and does not represent discharge from the urinary meatus

Back 120

smegma

Front 121

Abnormal findings on inspection of the perineum are:

Back 121

reddened, inflamed skin surrounding the urinary meatus and purulent discharge.

Front 122

Percussion: If the bladder is empty or contains less than 150mL, a _____ note will be hear. Percussion over a distended bladder produces a _______ sound.

Back 122

hollow note & duller sound

Front 123

Percussion is more reliable than _____ in evaluating the degree of bladder distention.

Back 123

palpation

Front 124

_____ specimen collection is used when sterile urine is not required.

Back 124

random specimen. Collected in urinal, bedpan, or hat, or directly into a specimen cup. Should not be contaminated with feces or toilet paper. if menstruating, note the findings on the specimen.

Front 125

A ____ ____- or midstream-voided specimen is used when a specimen relatively free from microorganisms is required.

Back 125

Clean-Catch. Sterile specimen cup or sterile bedpan or urinal is used to collect the urine specimen.

Front 126

A _______ urine specimen is required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day.

Back 126

24 hour specimen. urine protein, creatinine, urobilinogen, uric acid, selected hormones. Keep on ice. Preservative is added to prevent breakdown or certain urinary constituents.

Front 127

Specimen from a catheter

Back 127

is sterile. maintain asepsis. If client has indwelling catheter, specimen is obtained using a syringe from a self-sealing port. Do not collect from urine collection bag, it is not considered sterile.

Front 128

Urine Tests are:

Back 128

Specific Gravity, Reagent strips, Urinalysis, Urine Culture and Sensitivity

Front 129

Urine specific gravity test:
Specific gravity is the weight or concentration of urine as compared to water.

Back 129

Normal specific gravity of urine is 1.010 to 1.025 g/mL. A low specific gravity usually is caused by overhydration or a pathologic condition that affects the kidney's ability to concentrate urine. A specific gravity occurs because of fluid volume deficit.

Front 130

Reagent Strips: (dipsticks) are available to measure the amount of certain substances such as glucose, protein, or ketones in the urine.

Back 130

Such strips can also be used to determine urinary pH or the presence of occult blood. Dip strip into urine sample and compare change color.

Front 131

Urinalysis: provides data about the color, turbiddity, pH, and specific gravity of the urine and indicates the presence of protein, glucose, ketones, red blood cells, white blood cells, bacteria, or casts.

Back 131

1st void of morning is preferred because it is more concentrated. Client consumes no fluids during the night.

Front 132

Urine Culture and Sensitivity test; to identify any microorganisms causing a UTI and to determine which antibiotics can kill the organism.

Back 132

Lab can make preliminary identification within 24 hrs. but another 24-48hrs may be necessary to conduct the definitive analytic tests.

Front 133

(BUN) blood test: measures the amount of urea nitrogen in the blood. Diseased kidney are unable to excrete urea adequately, and urea begins to accumulate in blood. Causing BUN to rise

Back 133

Normal BUN is 8-25mg/100mL. Other factors such as high protein intake, fluid deficit, infection, gout, or excessive breakdown of protein stones, can also elevate BUN, it is not a highly sensitive indicator of impaired renal function.

Front 134

Serum creatinine: is a more sensitive indicator of renal function. Damage to a large number of nephrons prevents efficient excretion of creatinine and

Back 134

causes it to accumulate in the blood. An elevated serum creatinine concentration is indicative of impaired renal function.

Front 135

Creatinine clearance-is a combination blood and urine test that measures the rate at which the kidneys clear creatinine from the blood.

Back 135

To compute clearance, measurements of the creatinine level in the blood, the creatinine level in the urine, and the amount of urine produced in a set period (usually 24 hrs) are needed. Decreased creatinine clearance value indicates renal impairment.

Front 136

______ _______ is a noninvasive technology that can estimate the volume of urine in the bladder. Also measures postvoid residual. Avoiding need for in and out catheterization.

Back 136

Bladder Ultrasound (BUS)

Front 137

Radiologic Examination:
(KUB)-Kidney, ureters and bladder

Back 137

KUB is helpful for detecting malformations in the size or shape of the kidneys, ureters, or bladder and the presence of any stones that could obstruct urine flow.

Front 138

Radiologic Examinations:
IVP-Intravenous pyelogram

Back 138

visualizes the urinary system with the use of radiopaque (contrast) dye that is injected intravenously. X-Ray films are taken at set intervals to permit visualization of the dye as the kidneys excrete it, empty it into the ureters, and finally deposit it in the bladder.

Front 139

______ involves insertion of a tube into the bladder for the purpose of direct visualization

Back 139

Cystoscopy

Front 140

Radiopaque dye may be injected into subsequent kidney radiographic studies; this is known as

Back 140

Retrograde pyelogram. After procedure assess for hematuria, urinary retention, dysuria or bladder spasms, and any signs or symptoms of UTI.

Front 141

Urodynamic studies are used to detect abnormalities in bladder function or voiding. These procedures (uroflowmetry, cystometrograms, and urethral pressure profile)

Back 141

measure pressure (in the bladder and urethra and within the abdomen), urinary flow, and striated muscle activity.

Front 142

Adequate water intake serves 2 functions:

Back 142

flushes microorganisms out of the urinary system, thus decreasing the chance of infection or obstruction. Production of large amounts of urine helps to distend and stretch the detrusor muscle, preventing atrophy.

Front 143

Preventing Urinary Tract Infections

Back 143

1) Avoid stagnant urine
2) Void after sexual intercourse
3) Cranberry juice

Front 144

Promoting Optimal Muscle Tone

Back 144

Pelvic floor exercises (Kegel) involve tightening of the perineal and anal muscles. Clients should perform this activity several times per hour.

Front 145

Lifestyle modifications

Back 145

regulating fluid intake, smoking cessation, losing weight, and establishing a good bowel regimen to prevent constipation promote urinary continence.

Front 146

_____ voiding is the continuous use of an unchanged, fixed voiding schedule (every 2hrs). Used with clients with cognitive or physical impairments

Back 146

Timed voiding

Front 147

______ voiding involves the use of regular checks to determine whether the client perceives the urge to void.

Back 147

Prompted voiding

Front 148

_____ _____ schedules voiding times in an attempt to approximate the client's usual voiding pattern. Clients have predictable incontinent episodes

Back 148

Habit retraining

Front 149

____ ____ starts with schedule voidings. Then suppress the urge to void before schedule times. Gradually increased to 4 hours

Back 149

Bladder training
(most successful with cognitively intact clients with good mobility and motivation)

Front 150

An external catheter (Condom Catheter) is sometimes used for male clients who are unable to control voiding.

Back 150

Ischemia or skin breakdown on the penis can be a complication if the condom or sheath is applied incorrectly.

Front 151

Absorbent Products:
Need to change the protective pads or briefs frequently to avoid odor and to prevent skin irritation from prolonged exposure to moisture

Back 151

Client should bathe at least daily. Each time product is changed, perineal area should be cleansed & examined for irritation.

Front 152

Ammonia, a metabolite of urine, is a skin irritant. The process of skin softening caused by continuous moisture or soaking is called _____.

Back 152

maceration

Front 153

If perineal skin is reddened or fragile, apply a barrier cream (often with ____ ____ as the active ingredient or non-sting barrier film.

Back 153

zinc oxide

Front 154

Straight catheterization performed on a routine scheduled basis for a particular client is called _____ ______.

Back 154

intermittent catheterization

Front 155

A straight catheter with only one _________ is used for in-and out intermittent catheterization procedure.

Back 155

lumen

Front 156

When an indwelling catheter is required, a double-lumen catheter known as a _______ is used.

Back 156

Foley. A Foley catheter contains one lumen to remove urine and a second, smaller lumen to inflate a balloon that keeps the catheter from falling out of bladder.

Front 157

The _____ _____ indwelling catheter is inserted when urine must be removed from the bladder and irrigation of the bladder with fluid or medications must also be performed.

Back 157

triple-lumen indwelling catheter

Front 158

A ______ ______ has a curved tip that permits easier insertion, especially as the catheter passes an area of urethral narrowing, such as that caused by prostatic hyperplasia.

Back 158

coude catheter

Front 159

Catheter comes in various sizes:

Back 159

Adult size ranges from 12 to 22 Fr, with sizes 14 ti 18 Fr used most frequently.

Front 160

Catheterization placement positioning

Back 160

men-supine of semi-Fowler's
women-dorsal recumbent position
weak or limited hip mobility-side lying

Front 161

Risks of catheterization

Back 161

gram-negative sepsis, second most common cause of bacteremia linked to hospital deaths. Catheter-associated UTIs are rarely symptomatic and often go untreated. Increase if cath in place longer than 72 hrs.

Manipulation or advancing cath into bladder after it has been placed, increases risk of infection.

Tissue trauma (especially Men)

Front 162

Care of Indwelling catheter:
system should be replaced when it becomes clogged, obstructed, or infected or is painful to client.

Back 162

Empty drainage bag at least every 8 hours and more frequently if necessary, because pooled urine is an excellent growth medium for microorganisms.

Front 163

The drainage collection bag and tubing should remain below the level of the ______ to maintain proper drainage and to prevent pooling or backflow.

Back 163

bladder

Front 164

Cleanse the client's perineal area and the catheter at least _____ to remove normal secretions and after every bowel movement to help prevent infection.

Back 164

daily

Front 165

Clients with indwelling catheters should produce at least _____ mL of urine per hour or 250 mL/8 hours

Back 165

30 mL

Front 166

The purpose of catheter irrigation is to:

Back 166

cleanse the lumen of the catheter to promote patency of the tube.

Front 167

The purpose of irrigation of the urinary bladder include:

Back 167

the instillation of solutions to help remove mucus, blood clots, or other tissue in the bladder and the application of medications to the bladder wall.

Front 168

If catheter becomes encrusted or obstructed, change the entire system, the catheter and the drainage bag

Back 168

Do not disconnect or open the system at the catheter/drainage tube junction.

Front 169

After removal of an indwelling catheter, what should you tell the patient?

Back 169

Not uncommon to experience some dribbling of urine, particularly if catheter was in place for several days.

Front 170

Suprapubic Catheter-a narrow lumen tube with a curl at the distal end that helps prevent the bladder from expelling the catheter. A physician

Back 170

inserts the suprapubic catheter into the client's urinary bladder from and abdominal entry point just above the symphysis pubis.

Front 171

suprapubic catheter is kept in place by sutures as the abdominal entry point or by a form of body retention seal, which is a part of each catheter.

Back 171

Suprapubic catheters are associated with a lower rate of UTIs than long-term indwelling catheters and may be more comfortable for the client.

Front 172

Complications of suprapubic catheters include: obstruction of urine flow from the bladder due to accumulation of sediment or clots in the catheter, and closing of the bladder wall over the catheter tip.

Back 172

small lumen size of the suprapubic cat also increases the incidence of tube kinking & obstruction. The catheter can become dislodged, or trauma to the bladder wall can occur during suprapubic catheter insertion.

Front 173

Nephrostomy Tube

Back 173

placed in the renal pelvis of the kidney to permit outflow of urine and prevent backup of urine in the kidney (Hydronephrosis) which could cause renal damage.

Front 174

Never _____ a nephrostomy tube, because doing so would cause backup of urine that could result in renal damage.

Back 174

clamp

Front 175

Leg bags:

Back 175

leg bags should be cleaned daily, using a dilute (1:10) bleach solution.