N210 Week-3 Lecture Elimination & Fluid Balance

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  1. b. Dizziness
    • c. Arthritis
    • d. Parkinson's disease
    • e. Degenerative joint disease
    • 7. Cognitive deficits and certain psychiatric problems can interfere with a person's ability to desire to control urination voluntarily
    • 8. Fever and diaphoresis (profuse perspiration) result in body fluid conservation
    • a. Urine production is decreased, and highly concentrated
    • 9. Congestive heart failure can lead to fluid retention and decreased urine output
    • 10. High blood glucose levels, such as diabetes mellitus, may lead to an increase of urine output secondary to an osmotic diuretic effect
    • F. Medications
    • 1. Nephrotoxic (capable of causing kidney damage) prescription and nonprescription drugs can effect urine production and elimination
    • a. Example: The antibiotic named gentamicin
    • 2. Abuse of analgesics (aspirin or ibuprofen) can cause nephrotoxicity
    • 3. Diuretics (commonly used in hypertension and other disorders) can cause moderate to severe increases production and excretion of dilute urine
    • 4. Cholinergic medications stimulate contraction of destrusor mucle and produce urination
    • 5. Some analgesics and tranquilizers supress the CNS, interfering with urination by diminishing the effectiveness of the neural reflex
    • 6. Certain drugs change the color of urine
    • a. Anticoagulants, may cause hematuria (blood in the urine) leading to a pink or red color
    • b. Diuretics can lighten the color of urine to pale yellow
    • c. Phenazopyridine (Pyridium), a urinary tract analgesic, can cause orange or orange-red urine
    • d. The antidepressant amitriptyline (Elavil) or B-complex vitamins can turn urine green or blue-green
    • e. Levodopa (L-dopa), an antiparkinson drug, and injectable iron compunds can lead to brown or black urine
  2. 4. Perform the following assessment techniques: determine the presence of select abnormal urine constituents, determine urine specific gravity, and assist with diagnostic test and procedures (1272)
    • Determine the Presence of Select Abnormal Urine Constituents (1272)
    • 1. Protein
    • 2. Blood
    • 3. Glucose
    • 4. Ketone Bodies
    • 5. Bacteria
    • Determine the Urine Specific Gravity (1272)
    • 1. Assess the patient’s urine for color, odor, clarity and sediment (if any)
    • 2. Monitor the pH and Specific Gravity (a measure of the density of urine compared with the density of water) of the urine
    • A. Normal Range — 1.015-1.025
    • B. High Specific Gravity (Concentrated Urine) =Dehydration
    • C. Low Specific Gravity (Diluted Urine) =Over-hydration
    • Assist w/Diagnostic test and Procedures (1277)
    • REFER TO PAGE 1278 for thorough breakdown
    •  Urodynamic Studies
    •  Cystoscopy
    •  Intravenous Pyelogram
    •  Retrograde Pyelogram
    •  Renal Ultrasound
    •  CT Scan
    •  Renal Biopsy
  3. 7. Describe nursing interventions that can be used to manage urinary incontinence effectively. (Taylor pg. 1286)
    • A. Noninvasive, low-risk behavioral interventions are the first line of therapy (medications or exercise)
    • B. Community settings are ideally suited for using many of these interventions
    • C. Nurses can identify patients who are incontinent and use these techniques or refer them to nurse or advanced practice continence experts in the community
    • D. All nurses must be familiar with education about incontinence
    • E. Surgical intervention is considered if behavioral and pharmacologic measures prove ineffective
    • F. Patient often turns to absorbent products for protection because they absorb or contain urine leakage.
    • G. Nursing skills and creativity can help patients become continent again before surgery
  4. 8. Describe nursing interventions that can prevent the development of urinary tract infections. (Taylor pg. 1283-1284)
    • A. Short-course antibiotic regimen (1 large dose vs. 3 or 7 days of smaller doses) usually eradicates infections of the lower urinary tract; longer antimicrobial therapy is required for upper UTIs.
    • B. Patient education can help prevent UTI recurrence by teaching the patient about measures that promote health and decreases the severity and incidence of UTIs is a major nurse responsibility
    • C. Tell them to
    • 1. Drink 8-10 oz of water daily
    • 2. Observe urine for color, amount, odor, and frequency
    • 3. Dry parineal area after urination or defecation from the front to the back
    • 4. Drink two glasses of water before and after sexual intercourse and void immediately after intercourse
    • 5. Take showers rather than baths
    • 6. Wear underwear with a cotton crotch, and avoid clothing that is tight and restrictive on the lower half of the body
    • 7. Drink 10 oz of cranberry or blueberry juice daily because they contain bacteriuria (bacteria in the urine) by inhibiting bacteria from adhering to the bladder wall and urinary catheters
  5. c. Provide care for urinary diversion and know when to notify MD
    • d. Develop a plan to modify any factors that contribute to urinary problems
    • e. Correct unhealthy urinary habits
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N210 Week-3 Lecture Elimination & Fluid Balance
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