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66 Cards in this Set

  • Front
  • Back
The kidneys filter and excrete blood constituents that are not needed and retain those that are.
Fluid and Electrolyte Balance
The nephrons maintain and regulate fluid balance through the mechanisms of selective reabsorption and secretion of water, electrolytes, and other substances.
Regulation of BP
Kidneys help maintain the composition and volume of body fluids.
Urinary incontinence
Any involuntary loss of urine that causes such a problem
Autonomic bladder
People whose bladders are no longer controlled by the brain because of injury or disease void by reflex only. This also occurs during infancy
Urinary retention
occurs when urine is produced normally but is not excreted completely from the bladder. Fx include: meds, an enlarged prostate, or vaginal prolapse.
Continued incontinence of urine past the age of toilet training
urination during the night
Blood in the urine
24 hour urine output is less than 50 mL
Painful or difficult urination
increased incidence of voiding
Presence of sugar in the urine
Scanty or greatly diminished amount of urine voided in a given time; 24-hour urine output is less than 400 mL
Excessive output of urine (diuresis)
Protein in the urine; indication of kidney disease
Pus in the urine; urine appears cloudy
Stoppage of urine production; normally the adult kidneys produce urine continously at the rate of 60-120mL/hr
Strong desire to void
Changes with the Aging Process
Decrease nephrons
Decrease muscle tone & contractility
Decrease ability to reabsorb Na+, Cl- , & water
Decrease bladder capacity
Increase ↑size of prostate
Decrease muscle tone
Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination
Decrease in nephrons
The diminished ability of the kidneys to concentrate urine may result in Nocturia
Decrease Contractility
May lead to urine retention and stasis, which increase the likelihood of urinary tract infection
Pathologic conditions
Neuromuscular disorders, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time.
Factors affecting urinary elimination
1. Nocturia
2. Enuresis
3. Alcohol
4. Caffeine
5. Fever
6. Medication
Caffeine-containing beverages have a diuretic effect, increasing urine production
Fever and diaphoresis (profuse perspiration)
Results in body fluid conservation by the kidneys. Urine production is decreased, and the urine is highly concentrated.
Assessment: Kidneys
The kidneys are normally well protected by considerable fat and connective tissue, making palpation difficult. This requires deep palpation and should be practiced only under the supervision by an advanced practitioner.
Assessment: Bladder
Palpate or bedside scanner is another way to assess the bladder.
Assessment: Urethral meatus
Inspect the urethral orifice for any signs of inflammation, discharge, or foul odor. In females, its a slit-like opening below the clitoris and above the vaginal orifice. In males, its at the tip of the penis.
Assessment: Skin
Because problems with urinary functioning may result in disturbances in hydration and excretion of body wastes, assess the skin carefully for color, texture, and turgor.
Urine Studies
1. Blood studies

2. Urinalysis (Table 37-1)

3. Clean catch/Midstream

4. 24-hour
Blood studies
a. BUN: 10-20 mg/dL (17-18 mg/dL; Taylor)
b. Creatinine: male 0.6-1.2 mg/dL; female 0.5-1.1 mg/dL (0.4-1.5 mg/dL; Taylor)
Urinalysis Color
A freshly voided specimen is pale yellow, straw-colored, or amber, depending on its concentration
Urinalysis Odor
Normal urine smell is aromatic. As urine strands, it often develops an ammonia odor because of bacterial action
Urinalysis Turbidity
Fresh urine should be clear or translucent; as urine strands and cools, it becomes cloudy.
Urinalysis PH
The normal PH is about 6, with a range of 4.6-8
Urinalysis Specific Gravity
This is a measure of the concentration of dissolved solids in the urine. The normal range is 1.015 to 1.025
Urinalysis Constituents
Organic constituents of urine include urea, uric acid, creatinine, hippuric acid, indican, urene pigments, and undetermined nitrogen.
Inorganic constituents are ammonia, sodium, chloride, traces of iron, phosphorus, sulfur, potassium, and calcium.
Clean-catch or midstream specimen
This means that the patient voids and discards a small amount of urine, continues voiding into the container, removes container and continues voiding, then discards the last amount of urine in the bladder
24 hour
urine collected in 24 hours
Diagnostic Tests
1. KUB
3. Renal ultrasound
4. Invasive
a. Cystoscopy
b. Biopsy
Nursing Responsibilites
Nurses are responsible for preparing the patient for the procedure and giving appropriate aftercare. Explaining the procedure helps reduce the patient's anxieties.
Functional Urinary Incontinence
Altered environment; Sensory, cognitive, or mobility defecits
Urinary Retention
High urethral pressure caused by weak detrusor; inhibition of reflex arc; strong sphincter
Pattern alteration
Some patients report urinating on demand in no apparent pattern. Others have inflexible patterns that have developed over the years and become anxious if these are interrupted.
Urinary functioning as the etiology
1. Acute pain
2. Anxiety
3. Caregiver role strain
4. Risk for infection
Acute Pain
Acute pain related to bladder spasms, dysuria, urinary retention, cancer of the bladder, diagnostic procedures
Related to incontinence, diagnostic procedures
Caregiver Role Strain
related to incontinence of family member
Risk for infection
Related to indwelling urinary catheter
Impaired Urinary Elimination Causes
1. Causes/Predisposing factors
a. Post-surgical/Anesthesia
b. Indwelling catheter
c. BPH (benign prostatic hypertrophy)
d. Fecal impaction/chronic constipation
Impaired Urinary Elimination Clinical Manifestations
a. Bladder distention  overflow
b. Frequency
c. Urgency
UTI Causes
a. Nosocomial
b. Inadequate perineal hygiene
UTI Clinical Manifestations
a. Classic triad:
• Dysuria
• Frequency
• Urgency

• fever, chills, n/v, malaise
• hematuria
• Urine: cloudy
Stress Incontinence
cause by Increase in intra-abdominal pressure
Urge Incontinence
abrupt and strong desire to void
Mixed Incontinence
s/s of urge & stress
Functional Incontinence
Inability to get to the toilet
Reflex Incontinence
emptying of the bladder without sensation of need to void
Total Incontinence
continuous loss of urine
VII. Promoting Health 37-1
A. Promoting Normal Urination

B. Maintaining Normal Voiding Habits

C. Care of patient with an indwelling catheter
A. Anticholinergic / Urinary antispasmodic
1. Action:
a. Relax smooth muscles of the urinary tract
b. overactive bladder contractions
c. bladder capacity

2. Uses
a. Overactive bladder
b. Urge incontinence
c. Frequency

3. Side Effects
a. Headache
b. Insomnia
c. Drowsiness
d. Dizziness
e. Alter mental status
f. Blurred vision
g. Dry mouth GI distress
h. Urinary retention & hesitancy

4. Medications
a. oxybutynin (Ditropan, Ditropan XL)
b. Tolterodine (Detrol, Detrol LA)
B. -Adrenergic blocker (antagonists)
1. Action
a. Relax smooth muscle improving urine flow
b. urethral sphincter resistance to urinary outflow

2. Uses: urine flow and symptoms of BPH

3. Side Effects
a. Impotence, libido ~ Procar
b. Dizziness
c. Hypotension
d. Headache
e. Diarrhea and nausea

4. Medications
a. Terazosin (Hytrin)
b. alfuzosin (UroXatral)
c. finasteride (Proscar)
d. tamsulosin (Flomax)
C. Antibiotics
1. Action: prevent bacteria synthesis and destroy bacterial actions

2. Uses: treat UTI

3. Side Effects
a. GI distress
b. Rash

4. Medications
a. Nitrofurantois (Macrodantin, Macrobid)
b. Ciprofloxacin hydrochloride (Cipro)
c. Co-trimoxazole (Bactrim)
D. Urinary tract analgesic: Phenazopyridium (Pyridium)
1. Action: local anesthetic effect

2. Use: relieve pain or irritation associated with UTI

3. Side effects
a. headache
b. Vertigo
c. Nausea
d. GI distress