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Diseases and Conditions that can effect micturation:
- Diabetes Mellitus and Multiple Sclerosis can = decreased bladder tone or inhibit bladder contractions
- Benign Prostatic Hyperplasia= increased retention and incontinence
- Alzheimers= forget how to urinate
- Patients with Heart failure: blood is not circulating effectively and my not reach kidneys
- Diseases that hinder movement like parkinsons or degenerative joint disease
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What Psychological factors influence Urination?
anxiety and emotional stress can increase urination frequency
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Nocturia
Awakening to void one or more times at night
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Polyuria
an excessive output of urine
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Oliguria
A decreased output of urine despite normal intake
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Anuria
No urine is produced (usually in severe kidney disease)
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Diuresis
- *think diuretic
- increased urine formation
- -can happen due to intake of caffeine
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How does Anesthesia affect urine output?
Can cause incontinence because when "under" everything is slowed. Also there is usually a catheter in place which drains the bladder. A patient should urinate within 8 hours after procedure.
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What medications effect Urine output?
- -Diuretics prevent reabsorption of water and certain electrolytes to increase urine output (Lasix)
- - The use of antihistamines (e.g., diphenhydramine) often causes urinary retention.
- -Some meds change the color of urine (pyridium)
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After a procedure, why might the urine be pink?
trauma to the urethra or bladder mucosa
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Urinary Diversion
temporary or permanent bypass of the bladder and urethra as the exit routes for urine
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Stoma
- an artificial opening
- usually on a patient with a urinary diversion; urine drains to the outside of the body through the stoma
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Urinary Retention
an accumulation of urine resulting from an inability of the bladder to empty properly
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What is dribbling? and Why might this be occuring
Dribbling is the voiding of 25-60 mL and can occur 2-3 times an hour. This is usually due to progressed retention and overflow. The external urethral sphincter is unable to hold back the urine so it opens to allow the bladder pressure to fall just enough to let it regain control.
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Bacteriuria
Bacteria in the urine
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Urosepsis
- aka Bacteremia
- Bacteria in the bloodstream
- Can occur from bacteruria that spreads to the kidneys
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Dysuria
pain or burning during urination
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Cystitis
Irritated bladder
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Urinary Incontinence
involuntary leakage of urine that is sufficient enough to be a problem. can be continuous or intermittent.
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What is an incontinent urinary diversion?
- The ileal 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
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What is a continent urinary diversion?
Reservoir  : provides urinary storage in a leakproof pouch. The portion of the ileum connected to the abdominal wall acts as a continent nipple, requiring intermittent catheterization for emptying.
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Nephrostomy
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.
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Fun Fact! (aka i couldn't figure out how to make a question outta this cuz my brain is fried!) Any invasive procedure of the urinary tract, such as catheterization, requires sterile technique. Procedures such as perineal care or examination of the genitalia require medical asepsis, including proper hand hygiene.
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nocturnal enuresis
voiding at night and not waking up
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What is important in the stimulation of the micturation reflex?
- Privacy
- Sitting (female) or standing (male)
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Adequate fluid intake is....?
2000 mL a day
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What do Kegel Exercises promote?
The strengthening of pelvic floor muscles
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Crede's Method (pronounced kra- dayz)
a method for emptying a flaccid (haha you said flaccid) bladder. A method of applying pressure over the symphysis pubis to expel the urine periodically. This method is sometimes used therapeutically to initiate voiding of bladder retention for persons with paralysis following spinal cord injury
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What is the normal color of urine?
Straw to Amber colors
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Under what circumstance would a persons urine look like a Guinness Beer? (brown and viscous with a frothy white head)
Liver failure
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Who is most susceptible to UTI?
Post trauma patients, post surgery patients, any patient with a catheter, postpartum patients, patients with kinked or obstructed catheters.
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What are some simple ways to prevent UTI?
- Hand washing
- Good hygiene before and after sex
- Good Fluid Intake (2000 mL/day)
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Total Urinary Incontinence
Patient has no control over bladder at all. (ie spinal cord injury, paralysis)
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Functional Urinary Incontinence
- environmental factor that prohibits a patient from making it to the BR or getting to BR.
- (elderly client who can’t get buttons done in time) (an Immobile patient who can't make it to the BR fast enough) (obstical course in front of your bathroom... haha jk but really.)
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Stress Urinary incontinence
Involuntary leakage of urine during increased abdominal pressure in the absence of bladder muscle contraction. Usually happens in older women and postpartum ie voiding while laughing, coughing,
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Urge Urinary Incontinence
Involuntary passage of urine after a strong sense of urgency to void. happens more often than every 2 hours
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Mixed Urinary Incontinence
Combination of urge urinary incontinence and stress urinary incontinence signs and symptoms
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Reflex Urinary Incontinence
Involuntary loss of urine at intervals without sensation of urge to void.
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