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78 Cards in this Set

  • Front
  • Back
What is normal adult urine output?
1500-1600 ml/day >30 ml/hr
What are the functions of the Kidneys?
Urinary output
Production of erythropoietin
JG cells to stimulate retention of water through angiotenision/aldosterone.
Produce E2 a vasodialtor
True or False:
Urine is not sterile
Urine is sterile
Renal Colic
Strong peristaltic waves that attempt to move obstruction (renal calculus-kidneystone) into bladder
Function of Bladder
stores and excretes urine
What does damage to spinal chord above sacral region cause?
reflex incontinence (no sensation to void).
What does enlarged prostate cause?
bladder over-activity
Who are more prone to UTI's
What diseases cause problems with urination?
BPH (Benign prostate hyperplasia)
Degenerative joint disease
decrease output despite input (fluid loss by persperation, diarrhea, vomiting –kidney Fevers make concentrated urine. Stress
no urine produced (severe kidney disease)
endstage renal damage cause uremic syndrome: increase nitrogen marked fulid and electrolyte abnormalities, nausea, vomiting, headache coma
excessive amount of urine output. >2000-2500 mL/day
excessive amount of urine output. >2000-2500 mL/day
Awakening to void one or more times at night (sign of renal alteration)
Urinary Retention
accumulation of urine resulting in the an inability of the bladder to empty properly, the bladder is unable to respond to micturation reflex. –anticholinergic or antihistamines increase retention.
• Clients dribble, void 2 to 3 times an hour, Assess for bladder distention and tenderness.
• Severe: 2000 to 3000 mL of urine retained, causes: urethral obstruction, surgical or childbirth trauma, alterations in motor and sensory innervations of the bladder, medication side effects, or anxiety.
Urinary Residual
Retained urine that becomes more alkaline and is ideal for microorganism growth.
Risks for UTI's
• Women, older adults increase risk
• Men increased risk for infection-related renal disease
• Kinked, obstructed, or clamped catheter, increase risk of bladder infection.
• Poor perineal hygiene and wiping back to front
bacteria in the urine spreads to kidneys and leads to bacermia or urosepsis.
bacteria in the bloodstream
pain during urintation, lower UTI’s if worsens then fever, chills, nausea, vomiting and malaise develop.
irritated bladder causes frequent and urgent sensation of the need to void.
blood tinged urine caused by irritation to bladder and erthral mucosa
Nursing interventions to promote Urinary elimination
• Promote normal micurition
• Stimulate micturition reflex
• Maintain elemination habits
• Maintain adequate fluid intake
• Promote complete bladder emptying
• Prevent infection
• Acidifying urine
Color of normal urine
pale, straw colored to amber
Dark red urine
Bleeding from kidneys or ureters
Bright red urine
Bleeding from bladder
Orange urine
Cloudy or Foaming urine
Protein in urine
Thick and cloudy
Bacteria in Urine
Feeling of need to void immediately

Full bladder, bladder irritation or inflammation from infection, overactive bladder, psychological stress
Painful or difficult urination

Bladder inflammation, trauma or inflammation of urethral sphincter
What is considered frequent urination? What causes it?
Voiding at frequent intervals (>2 hr)

Increased fluid intake, bladder inflammation, increased pressure on bladder (pregnancy), diuretic therapy
Difficulty initiating urination

Prostate enlargement, anxiety, urethral edema
Voiding large amounts of urine

Excess fluid intake, diabetes mellitus or insipidus, use of diuretics, postobstructive diuresis
Diminished urinary output relative to intake (usually 400 mL/24 hr)

Dehydration, renal failure, UTI, increased ADH secretion, congestive heart failure
Voiding one or more times at night

Excessive fluid intake before bed (especially coffee or alcohol), renal disease, aging process, prostate enlargement
Leakage of urine despite voluntary control of urination

Stress incontinence, overflow from urinary retention (e.g., from BPH)
Involuntary loss of urine

Multiple factors: unstable urethra, loss of pelvic muscle tone, fecal impaction, neurological impairment, overactive bladder
What is Hematuria? What causes hematuria?
Blood in the urine

Neoplasms of the kidney or bladder, glomerular disease, infection of kidney or bladder, trauma to urinary structures, calculi, bleeding disorders
What is Urinary Retention? What causes it?
Accumulation of urine in the bladder, with inability of bladder to empty fully

Urethral obstruction (stricture), decreased sensory activity, neurogenic bladder, prostate enlargement, postanesthesia effects, side effects of medications (e.g., anticholinergics, opioid narcotics)
What is Residual Urine? What causes it?
Volume of urine remaining after voiding (>100 mL)

Inflammation or irritation of bladder mucosa from infection, neurogenic bladder, prostate enlargement, trauma, or inflammation of urethra
Explain Random (routine urinalysis)
Collect during normal voiding, from an indwelling catheter or urinary diversion collection bag. Use a clean specimen cup.
What is necessary for a Clean-voided or midstream (culture and sensitivity)
A sterile specimen cup.
How do you obtain a Sterile specimen (culture and sensitivity) for client with indwelling catheter.
If the client has an indwelling catheter, collect a sterile specimen by using aseptic technique through the special sampling port found on the side of the catheter.

Clamp the tubing below the port, allowing fresh, uncontaminated urine to collect in the tube. After wiping the port with an antimicrobial swab, insert a sterile syringe hub and withdraw at least 3 to 5 mL of urine (check agency policy).

Using sterile aseptic technique, transfer the urine to a sterile container
What do Timed urine specimens measure? How is it obtained?
(for measuring levels of adrenocortical steroids or hormones, creatinine clearance, or protein quantity tests)

Time required may be 2-, 12-, or 24-hour collections. The timed period begins after the client urinates and ends with a final voiding at the end of the time period. The client voids into a clean receptacle, and the urine is transferred to the special collection container, which often contains special preservatives. Each specimen must be free of feces and toilet tissue. Missed specimens make the whole collection inaccurate. Check with agency policy and the laboratory for specific instructions.
Normal value of urine pH

pH of urine will indicate acid-base balance. An acid pH helps protect against bacterial growth. Urine that stands for several hours becomes alkaline.
Normal value of urine Protein
(none or up to 8 mg/100 mL)

Normally protein is not present in urine. It is common in renal disease because damage to glomeruli or tubules allows protein to enter urine.
Normal value of Glucose in urine

Clients with diabetes mellitus often have glucose in urine as a result of inability of tubules to reabsorb high glucose concentrations (>180 mg/100 mL). Ingestion of high concentrations of glucose causes some glucose to appear in urine of healthy persons.
Normal value of Ketones in Urine

Clients whose diabetes mellitus is poorly controlled experience breakdown of fatty acids. End products of fat metabolism are ketones. Some clients with dehydration, starvation, or excessive aspirin usage also have ketonuria.
What indicates a positive test for occult blood?
A positive test for occult blood occurs when intact erythrocytes, hemoglobin, or myoglobin is present. In women, blood in a routine urine specimen may be a result of contamination with menstrual fluid.
What does a urinalysis of Specific gravity measure?
Specific gravity measures concentration of particles in urine. High specific gravity reflects concentrated urine, and low specific gravity reflects diluted urine. Dehydration, reduced renal blood flow, and increased ADH secretion elevate specific gravity. Overhydration, early renal disease, and inadequate ADH secretion reduce specific gravity.
Normal RBC's in urine
(up to 2)

Damage to glomeruli or tubules allows RBCs to enter the urine. Trauma, disease, or surgery of the lower urinary tract also causes blood to be present.
Normal WBC's in urine
(0-4 per low-power field)

Greater numbers indicate urinary tract infection.
Normal value of bacteria in urine

Bacteria indicate urinary tract infection. (Client do not always have symptoms.)
Normal value of casts in urine

Casts are cylindrical bodies whose shapes take on likeness of objects within the renal tubule. Types include hyaline, WBCs, RBCs, granular cells, and epithelial cells. Their increased presence is always an abnormal finding and indicates renal alterations.
What are crystals in urine?
Crystals are result of food metabolism. Excess crystals such as uric acid or calcium phosphate result in renal stone formation.
When is Intermittent Catheterization indicated?
Relief of discomfort of bladder distention, provision of decompression

Obtaining sterile urine specimen when clean-catch specimen is unobtainable

Assessment of residual urine after urination

Long-term management of clients with spinal cord injuries, neuromuscular degeneration, or incompetent bladders
When is Short-Term Indwelling Catheterization indicated?
Obstruction to urine outflow (e.g., prostate enlargement)

Surgical repair of bladder, urethra, and surrounding structures

Prevention of urethral obstruction from blood clots after genitourinary surgery

Measurement of urinary output in critically ill clients

Continuous or intermittent bladder irrigations
When is Long-Term Indwelling Catheterization indicated?
Severe urinary retention with recurrent episodes of UTI

Skin rashes, ulcers, or wounds irritated by contact with urine

Terminal illness when bed linen changes are painful for client
Catheter sizes for Children, women and men.
Generally, children require an 8 to 10 Fr, women require a 14 to 16 Fr, and men require a 16 to 18 Fr
What determines the catheter material?
Expected duration of catheterization
What are plastic catheters suited for?
Plastic catheters are suitable only for intermittent use due to their inflexibility.
What are latex catheters suited for?
Latex catheters are recommended for use up to 3 weeks. Be aware of allergies.
What are silicon or Teflon catheters suited for?
Pure silicon or Teflon catheters are best suited for long-term use (2 to 3 months) because of less encrustation at the urethral meatus
What are the Balloon sizes of catheters?
Balloon sizes range from 3 mL (pediatric) to large postoperative volumes (75 mL). In adults the 5-mL and 30-mL sizes are the most common: The 5-mL size allows for optimal drainage, whereas the 30-mL size is used after prostatectomies to provide hemostasis of the prostatic bed
Why don't you use saline to inflate the balloon?
Use only sterile water to inflate the balloon because saline will crystallize, resulting in incomplete deflation of the balloon at the time of removal.
Odors of Urine
Stagnant urine smells of ammonia
Fruity, sweet d/t DKA
What does the care of a catheter require?
Maintaining a closed system
Perineal care form the meatus down the catheter tubing
Ensuring the collection bag is below the level of the bladder
List the signs or symptoms of UTI’s.
a. pain or burning during urination (dysuria)
b. fever & chills
c. nausea & vomiting
d. malaise
e. hematuria
f. flank pain
g. tenderness
Ileal loop or conduit
The ileal loop or conduit involves separating a loop of intestinal ileum with its blood supply intact. The ureters are implanted into the isolated segment of ileum. The remaining ileum is reconnected to the rest of the digestive tract. The ileal segment is then used as a conduit for continuous urine drainage or fashioned into a continent reservoir.
Some clients have a need for urinary drainage directly from one or both kidneys. In this case a tube placed directly into the renal pelvis. This procedure is called a nephrostomy.
Primary urinary structures that the nurse would assess.
Skin and mucosal membranes-by assessing skin turgor and the oral mucosa you gather data about the client’s hydration status. Observe the perineum for rashes, blistering, irritation, and breakdown.

Kidneys-Nurses learn to palpate the kidneys during abdominal examination.

Bladder-The bladder rests below the symphysis pubis. When distended, it rises above the symphysis pubis at the midline of the abdomen and often extends to just below the umbilicus. Gentle palpation on a distended bladder causes the client to feel the urge to urinate, tenderness, or even pain.

Urethral Meatus- check for discharge, inflammation, and lesions.
Identify foods that can increase urine acidity
Meats, eggs, whole-grain breads, cranberries, and prunes increase urine acidity.
Fluid intake of patients with catheters
All clients with catheters should have a daily intake of 2000 to 2500 mL if permitted. Clients can do this through oral intake or intravenous infusion. A high fluid intake produces a large volume of urine that flushes the bladder and keeps catheter tubing free of sediment.
Why use Irrigations and instillations in catheters?
To maintain the patency of indwelling urinary catheters, it sometimes becomes necessary to irrigate or flush a catheter. Blood, pus, or sediment can collect within tubing and result in bladder distention and the buildup of stagnant urine. Instillation of a sterile solution ordered by the health care provider clears the tubing of accumulated material. For clients with bladder infections, a health care provider often orders antiseptic or antibiotic bladder irrigations to wash out the bladder or treat local infection. In both irrigations, follow sterile aseptic technique
Suprapubic catheterization
involves surgical placement of a catheter through the abdominal wall above the symphysis pubis and into the urinary bladder. The health care provider performs the procedure under local or general anesthesia. The catheter is anchored in place with sutures, a commercially prepared ring seal, or both. Urine drains into a urinary drainage bag. Maintenance of the tubing and drainage bag is the same as for an indwelling catheter.
Condom catheter
The second alternative to catheterization is the condom catheter, which is suitable for incontinent or comatose men who still have complete and spontaneous bladder emptying. The condom is a soft, pliable, latex sheath that slips over the penis. Clients wear it only at night or continuously, depending on the client's needs.