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68 Cards in this Set
- Front
- Back
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explain the pathophys of urination (what causes urination to happen and what muscle contracts/relax)
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bladder stretch send signals in sacral spinal cord so then PNS will stimulate detrusor muscle to contract and int ureth sphincter to relax. Now brain understands the need to void and instruct ext urethral and perineal muscle to relax while abs to contract, dissapating urge to void
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What factors affect the freq of urination? (10)
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1.age (young and old may be incontinent, old may have retention)
2. Mobility 3. Cognitive problems 4. Pyschosocial factors 5. Foods and fluid 6. Activity 7. Muscle tone 8. Diseases 9. Surgical/diagnostics 10. Meds |
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Why do young people have urination problems? When is bladder controlled?
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Can't concentrate urine and reabsorb water. At 6 weeks, infant can conc urine and reabsorb water. No bladder control under 2-5yrs old
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Why do old people have urination problems?
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1. Loss of glomeruli with decreased GFR
2. Decreased renal flow and CO 3. Decreased ability to concentrate urine 4. mobility 5. cognition problems 6. Disease process (like BPH) |
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what psychosocial factors affect urination? (5)
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1. Privacy
2. Time 3. Abnormal positioning 4. Needs assist, can be embarassing with opp. sex 5. anxiety and stress |
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How does alcohol affect urination?
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inhibits ADH so will have increased urine
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what 4 foods can cause odor in urination?
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1.asparagus
2. beets 3. onions 4. garlic |
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how can indwelling catether affect urination?
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damages urethral sphincter or loosen bladder tone
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List 3 activity factors that can affect urination?
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1. prolonged immobility
2. childbirth 3. low levels of estrogen after menopause (estrogen must help keep urinary wall strong?) |
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List 4 diseases that cause decrease UOP that is responsible for renal blood flow
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1. HF
2. dehydration 3. hypovolemia 4. hemorrhage |
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what 2 diseases affect the kidneys that incr. or decreases UOP?
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renal failure or glomuronephritis
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2 disease that cause urine retention
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BPH and stones
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what does spinal injury cause in urination? CVA?
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spine-urinary incontinence
CVA-may retain (dunno) |
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3 diseases that can cause weakness that affect urination
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-parkinsons
-rheumatoid -degenerative joint disease |
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febrile condition causes increased or decreased UOP
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decreased
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Who is the most important in checking for urine retention and how long must wait before must insert a foley?
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post op. If more than 6 hrs.
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How does a cystosopy affect urination?
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urethra may swell after a foley removal causing diff. peeing and urine retention
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What diagnostic tests will affect urination?
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-cytoscopy
-TURP -Anesthesia -OR or stress of OR |
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How does cytoscopy affect urination?
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urethra may swell after removal and thus may cause urination retention
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how does TURP affect urination?
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cause hematuria or clot that may cause urine retention or spasm
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What does stress from OR cause?
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decreased UOP due to increased ADH
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What meds affect urination?
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1. Diuretics
2. Anticholinergics: 3. Antihypertensives (urine retention 4. cholinergics: stimulates destrusor muscles to contract causing urination 5. alpha adrenergic blocker: decreases s/s of BPH by relaxing smooth muscle 6. Nephrotoxics |
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Name drugs that can cause urine to change color?
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rifampin: reddish orange
pyridium: orange dilantin: pink/red |
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When do pt retain urine?
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when bladder gets distended then destrusor muscles lose ton causing no stretch signals to spinal cord therefore voiding reflex is no activated and the bladder doesn't contract
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What causes pt to overflow?
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increased pressure opens (external urethral sphincter opens. It can be caused by:
-urethral obstruction -surgical trauma -childbirth -meds |
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what are 5 incontinence types?
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-stress
-reflex -urge -functional -overflow |
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How is stress incontinence caused and what are interventions to it?
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-caused by involuntar loss of sm. urine due to intra abdominal pressure from coughing, sneeqing, laugh, etc)
Interventions: Kegels, schedule toileting, wt reductions |
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What is reflex incontinence, what causes it, and interventions?
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involuntary loss of urine at predictable times but have no urge to pee, often from spinal injury (think yuko)
interventions: anticholinergic, intermittent cath, credes (massage) |
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What is urge incontinence-cause and interventions?
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invol passage of urine after strong urgency from caffeine, water, ETOH
interventions: anticholinergic, bladder retraining, scheduled toileting, fluid restrictions, rx of UTI |
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Functional incontinence-cause and interventions?
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invol unpredictable passage of urine but pt has normal urinary and nervous syst---can't make it in time. CAN BE DUE TO MOBILITY DEFICIENTS
interventions-cath, environmental, schedule, diaper |
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What is overflow incontinence-causes and interventions?
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vol/invol loss of sm amount of urine from overdistended bladder (could be from spinal cord injury, diabetes, uterine prolapse
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s/s of urinary tract infection
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-burning with urination
-frequency/urgency -hematuria -cloudy urine -flank pain -tenderness -fever -chills with pyelonephritis (sepsis) |
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what is urinary diversions? what is it caused by>
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it is divert flow of urine from kidneys to abs. The 2 types are ileal and kock pouch
causes of this happening is from bladder CA, trauma, radiation injury to bladder |
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what does a ileal conduit do and what must you watch out for?
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it drains urine constantly but you need to wear a pouch.
-may see mucus -check stoma integrit |
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what is a kock pouch and what must you worry about?
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it is a urinary diversion. Requires an intermettent cath for emptying urine.
NO need wear pouch |
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what is a ureterostomy and nephrostomy?
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ureterostomy= 1 or 2 ureters put up to stomach. Need to wear a pouch and watch for skin integrity and if infection runs up kidney
nephrostomy=inserted directly into kidney |
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For someone suffering from urination disorder, ask the following nursing history
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-when do you void?
-how does urine look, changes? -Taking meds/fluids -presence of urinary ostom |
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what do you assess in a person with urinary problems?
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-Check skin turgor
-Mucosa -Auscultate for renal bruit -palpate CVA -feel for distention of bladder -percuss kettle drum -assess urethral meatus for swelling, inflammation |
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What should you assess when you see the urine?
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-color
-clarity -odor -amount -SG |
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glucose, ketones, occult bld--what is normal with this and what is it caused by?
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glucose: not normal, if find glucose then due to diabetes, too high carb diet, or D5W infusion
ketones: not normal in urine, caused by uncontrolled DM, malnourishment, or increased protein occult bld: due to trauma, bladder CA, infection, stones |
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High creatinine and BUN indicate?
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renal failure
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high BUN indicates?
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dehydration
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What is creatinine clearance rate, and when must be done?
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Is a measurement of the rate at which creatinine is removed from blood by kidneys--must do 24 hr urine collection
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how to get urine for urinalysis?
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-discard first urine then save the rest. Put the rest in ice. Take urine for 24 hr
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What does a KUB do? what do you see? How to prepare
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it is a diagnostic test that x-rays the kidneys, ureters, bladder.
-it shows size, shape, symmetry, tumors, calculi -requires no prep |
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what is IVP, what does it look at? How to prep? who is this test contradicted with?
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Will use a dye through IV pyelogram to look at renal tissue, pelvis, outlin of ureter, bladder/urethra.
-Prep: NPO after midnite, bowel prep with laxative and enema -contradicted with pt who are allergic to iodine shellfish, pt with high levels of creatinine and BUN, and pregnant people |
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how do you do a renal scan?
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inject a radioactive isotrope into an IV that also you to visualize kidney
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Describe a CT scan and what does it spot?
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CT scan is painless, noninvasive that can find tumors or obstructions
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In doing a renal biopsy, what can you determine from it and what must be done at the same time?
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determines, nature, extent, or prognosis of renal disease. Also check urine, VS, pressure dressing, and avoid strenuous activity for 2 weeks
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Describe the process of arteriogram and describe what needs to be done in addition to that?
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arteriogram will insert cath into artery and inject dye.
Check: -renal blood flow -VS -pulse distal to cath insertion -note any bleeding -pressure dsg |
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what is cytoscopy and what must be done for it?
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cytoscopy will insert catheter into urethra and allows visualization of urethra, bladder, ureteral canal
To prep: -NPO after midnite -bowel prep -check voiding and patency of cath -note urine color and amt -encourage fluid intake -I&O |
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what stimulates peeing?
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1. assume normal position
2. run water 3. touch with warm water 4. stroke inner thigh 5. Offer cold or warm fluids like coffee 6. Kegel exercises 7. Meds |
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What can you do to promote good catheter care?
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1. handwash before and after
2. increase fluids 3. close drainage with tape 4. Keep bag below bladder level 5. acidify urine (meat, eggs, cranberry) 6. wash area with soap and warm water, pat dry and lotion |
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If person has a catheter but has frequent voiding, dysuria, painful distention, what can you give them?
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Pyridium
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If pt has catheter and they have an inflammed urethra, what can you do for them?
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give a sitz bath
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Specific gravity,what is the norm and what does hi/lo specific gravity mean. 2 abnormal things that can cause an incorrect hi specific gravity
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normal gravity: about low 1. Hi specific=concentratd urine
LO specific=diluted urine Protein and glucose can make it inaccurately hi |
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what are 8 abnormal consituents in urine?
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1. Blood
2. pus 3. albumin 4. glucose 5. ketones 6. cast 7. gross bacteria 8. bile |
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How to take a sterile specimen from indwelling catheter? How much is needed for culture and how much for urinalysis
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take specimen from special port for specimen. Do not use take from the drainage bag.
Culture: needs 3 ml Analysis: 10 ml |
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HOw to collect a sterile specimen from an indwelling catheter?
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-clamp tube below collection port
-wide with antiseptic swab -insert 21-25 gauge needle -take specimen |
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when is a specimen considered positive for UTI?
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either when show signs of UTI or 100,000 organisms/ml
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How to treat a UTI
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-antibiotics
-drink more water -observe urine -dry perineal area from front to back -drink 2 cups before and after sex then void immediately after -take showers -wear cotton underwear -Cranberry juice -estrogen vaginal ring for postmenopausal |
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What are the reasons why people are catheterized? 6 reasons
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1. relieve urinary retention
2. obtain sterile specimen 3. measure postvoid residual 4. obtain specimen if menstrauting/incontinent 5. to empty bladder before/during/after surgery 6. Monitor ill pt |
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what it mean when urine gets foamy when shaken?
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it has protein
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what size catheter for an adult?
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12-14F
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in maintaining care for catheter pt, do what?
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-clean perineal with soap and water, NOT iodine
-ambulate -encourage fluids -do not open drainage system to obtain urine specimen/measure urine |
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how to remove a foley catheter?
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-first deflate balloon
-have pt take deep breaths as you withdraw it -clean perineal |
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who should not have a condom catheter on and what should you do?
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Do not put condom catheter on retracted penis
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how to prepare penis for catheter
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wipe around in circular motion then downwards on shaft
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