305 Urinary Elimination

Front 1

What is normal adult urine output?

Back 1

1500-1600 ml/day >30 ml/hr

Front 2

What are the functions of the Kidneys?

Back 2

Urinary output
Production of erythropoietin
JG cells to stimulate retention of water through angiotenision/aldosterone.
Produce E2 a vasodialtor

Front 3

True or False:
Urine is not sterile

Back 3

False:
Urine is sterile

Front 4

Renal Colic

Back 4

Strong peristaltic waves that attempt to move obstruction (renal calculus-kidneystone) into bladder

Front 5

Function of Bladder

Back 5

stores and excretes urine

Front 6

What does damage to spinal chord above sacral region cause?

Back 6

reflex incontinence (no sensation to void).

Front 7

What does enlarged prostate cause?

Back 7

bladder over-activity

Front 8

Who are more prone to UTI's

Back 8

Women

Front 9

What diseases cause problems with urination?

Back 9

DM
MS
BPH (Benign prostate hyperplasia)
Alzheimer's
Degenerative joint disease
Parkinson's

Front 10

Oliguria

Back 10

decrease output despite input (fluid loss by persperation, diarrhea, vomiting –kidney Fevers make concentrated urine. Stress

Front 11

Anuria

Back 11

no urine produced (severe kidney disease)

Front 12

ESRD

Back 12

endstage renal damage cause uremic syndrome: increase nitrogen marked fulid and electrolyte abnormalities, nausea, vomiting, headache coma

Front 13

Polyuria

Back 13

excessive amount of urine output. >2000-2500 mL/day

Front 14

Diuresis

Back 14

excessive amount of urine output. >2000-2500 mL/day

Front 15

Nocturia

Back 15

Awakening to void one or more times at night (sign of renal alteration)

Front 16

Urinary Retention

Back 16

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.

Front 17

Urinary Residual

Back 17

Retained urine that becomes more alkaline and is ideal for microorganism growth.

Front 18

Risks for UTI's

Back 18

• 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

Front 19

Bacteriauria

Back 19

bacteria in the urine spreads to kidneys and leads to bacermia or urosepsis.

Front 20

Urospeis

Back 20

bacteria in the bloodstream

Front 21

Dysuria

Back 21

pain during urintation, lower UTI’s if worsens then fever, chills, nausea, vomiting and malaise develop.

Front 22

Cystitis

Back 22

irritated bladder causes frequent and urgent sensation of the need to void.

Front 23

Hematuria

Back 23

blood tinged urine caused by irritation to bladder and erthral mucosa

Front 24

Nursing interventions to promote Urinary elimination

Back 24

• Promote normal micurition
• Stimulate micturition reflex
• Maintain elemination habits
• Maintain adequate fluid intake
• Promote complete bladder emptying
• Prevent infection
• Acidifying urine

Front 25

Color of normal urine

Back 25

pale, straw colored to amber

Front 26

Dark red urine

Back 26

Bleeding from kidneys or ureters

Front 27

Bright red urine

Back 27

Bleeding from bladder

Front 28

Orange urine

Back 28

Pyridium

Front 29

Cloudy or Foaming urine

Back 29

Protein in urine

Front 30

Thick and cloudy

Back 30

Bacteria in Urine

Front 31

Urgency

Back 31

Feeling of need to void immediately

Full bladder, bladder irritation or inflammation from infection, overactive bladder, psychological stress

Front 32

Dysuria

Back 32

Painful or difficult urination

Bladder inflammation, trauma or inflammation of urethral sphincter

Front 33

What is considered frequent urination? What causes it?

Back 33

Voiding at frequent intervals (>2 hr)

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

Front 34

Hesitancy

Back 34

Difficulty initiating urination

Prostate enlargement, anxiety, urethral edema

Front 35

Polyuria

Back 35

Voiding large amounts of urine

Excess fluid intake, diabetes mellitus or insipidus, use of diuretics, postobstructive diuresis

Front 36

Oliguria

Back 36

Diminished urinary output relative to intake (usually 400 mL/24 hr)

Dehydration, renal failure, UTI, increased ADH secretion, congestive heart failure

Front 37

Nocturia

Back 37

Voiding one or more times at night

Excessive fluid intake before bed (especially coffee or alcohol), renal disease, aging process, prostate enlargement

Front 38

Dribbling

Back 38

Leakage of urine despite voluntary control of urination

Stress incontinence, overflow from urinary retention (e.g., from BPH)

Front 39

Incontinence

Back 39

Involuntary loss of urine

Multiple factors: unstable urethra, loss of pelvic muscle tone, fecal impaction, neurological impairment, overactive bladder

Front 40

What is Hematuria? What causes hematuria?

Back 40

Blood in the urine

Neoplasms of the kidney or bladder, glomerular disease, infection of kidney or bladder, trauma to urinary structures, calculi, bleeding disorders

Front 41

What is Urinary Retention? What causes it?

Back 41

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)

Front 42

What is Residual Urine? What causes it?

Back 42

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

Front 43

Explain Random (routine urinalysis)

Back 43

Collect during normal voiding, from an indwelling catheter or urinary diversion collection bag. Use a clean specimen cup.

Front 44

What is necessary for a Clean-voided or midstream (culture and sensitivity)

Back 44

A sterile specimen cup.

Front 45

How do you obtain a Sterile specimen (culture and sensitivity) for client with indwelling catheter.

Back 45

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

Front 46

What do Timed urine specimens measure? How is it obtained?

Back 46

(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.

Front 47

Normal value of urine pH

Back 47

(4.6-8.0)

pH of urine will indicate acid-base balance. An acid pH helps protect against bacterial growth. Urine that stands for several hours becomes alkaline.

Front 48

Normal value of urine Protein

Back 48

(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.

Front 49

Normal value of Glucose in urine

Back 49

none

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.

Front 50

Normal value of Ketones in Urine

Back 50

(none)

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.

Front 51

What indicates a positive test for occult blood?

Back 51

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.

Front 52

What does a urinalysis of Specific gravity measure?

Back 52

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.

Front 53

Normal RBC's in urine

Back 53

(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.

Front 54

Normal WBC's in urine

Back 54

(0-4 per low-power field)

Greater numbers indicate urinary tract infection.

Front 55

Normal value of bacteria in urine

Back 55

(none)

Bacteria indicate urinary tract infection. (Client do not always have symptoms.)

Front 56

Normal value of casts in urine

Back 56

(none)

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.

Front 57

What are crystals in urine?

Back 57

Crystals are result of food metabolism. Excess crystals such as uric acid or calcium phosphate result in renal stone formation.

Front 58

When is Intermittent Catheterization indicated?

Back 58

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

Front 59

When is Short-Term Indwelling Catheterization indicated?

Back 59

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

Front 60

When is Long-Term Indwelling Catheterization indicated?

Back 60

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

Front 61

Catheter sizes for Children, women and men.

Back 61

Generally, children require an 8 to 10 Fr, women require a 14 to 16 Fr, and men require a 16 to 18 Fr

Front 62

What determines the catheter material?

Back 62

Expected duration of catheterization

Front 63

What are plastic catheters suited for?

Back 63

Plastic catheters are suitable only for intermittent use due to their inflexibility.

Front 64

What are latex catheters suited for?

Back 64

Latex catheters are recommended for use up to 3 weeks. Be aware of allergies.

Front 65

What are silicon or Teflon catheters suited for?

Back 65

Pure silicon or Teflon catheters are best suited for long-term use (2 to 3 months) because of less encrustation at the urethral meatus

Front 66

What are the Balloon sizes of catheters?

Back 66

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

Front 67

Why don't you use saline to inflate the balloon?

Back 67

Use only sterile water to inflate the balloon because saline will crystallize, resulting in incomplete deflation of the balloon at the time of removal.

Front 68

Odors of Urine

Back 68

Stagnant urine smells of ammonia
Fruity, sweet d/t DKA

Front 69

What does the care of a catheter require?

Back 69

Maintaining a closed system
Perineal care form the meatus down the catheter tubing
Ensuring the collection bag is below the level of the bladder

Front 70

List the signs or symptoms of UTI’s.

Back 70

a. pain or burning during urination (dysuria)
b. fever & chills
c. nausea & vomiting
d. malaise
e. hematuria
f. flank pain
g. tenderness

Front 71

Ileal loop or conduit

Back 71

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.

Front 72

Nephrostomy

Back 72

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.

Front 73

Primary urinary structures that the nurse would assess.

Back 73

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.

Front 74

Identify foods that can increase urine acidity

Back 74

Meats, eggs, whole-grain breads, cranberries, and prunes increase urine acidity.

Front 75

Fluid intake of patients with catheters

Back 75

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.

Front 76

Why use Irrigations and instillations in catheters?

Back 76

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

Front 77

Suprapubic catheterization

Back 77

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.

Front 78

Condom catheter

Back 78

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.