-
What does the process of urination depend on for effective functioning?
- Upper urinary tract
- Lower urinary tract
- Cardiovascular system
- Nervous system
-
What does the upper urinary tract include?
-
What does the lower urinary tract include?
- bladder
- urethra
- pelvic floor
-
How does the nervous system play a role in the effective functioning of the urinary sytem?
A pt needs sensation that bladder is full.
-
What are some developmental factors influencing urinary elimination?
2 yr. old child getting toilet trained vs. 5 yr. old child
-
What are some psychosocial factors influencing urinary elimination?
- Fear of sound of toilet flushing
- Bring male child to woman's bathrm, what age is appropriate?
- Bathroom not clean enough affects ability to go
- Need quiet or total privacy to go
-
What are some fluid balance factors influencing urinary elimination?
- Not enough intake.
- Or not enough output.
-
What are some medication factors influencing urinary elimination?
- Some meds could increase output.
- Some meds can interfere with elimination.
-
How does muscle tone affect urinary elimination?
If muscle tone is poor, the sensation to void becomes poor as well.
-
What are some pathologic conditions that can influence urinary elimination?
- Kidney stones
- Swelling can interfere
-
What are some surgical and diagnostic procedures that can influence urinary elimination?
- Anesthesia
- spinal anesthesia
-
What is an example of a disease that can affect urinary elimination?
Prostatic Hyperplasia, which is an enlarged prostate.
-
Normal voiding is every...
Q2-6 hrs
-
Frequency will vary based on...
- fluid consumption
- bladder capacity
- availability of toilet
- magnitude of insensible fluid loss
- sweat excretion
- temp of room
-
At what age does voluntary control of our urinary system start?
18-24mo.
-
During our growth and development what do we require to express our needs?
- verbal communication skills: "potty, pee, tinkle, piddle"
- comfortability with language, some pts don't know "void" meaning
-
In growth and development of a person, what do we need to recognize?
- Recognition of sensation of bladder filling
- Hold urine 1-2hrs
-
List the different psychosocial factors influencing urinary elimination?
- Privacy
- European countries have communal toilets
- Men stand, women sit
- Rural areas may not have indoor plumbing
- May need distraction to relax, running water
- Anxiety can cause urgency or prevent bladder emptying > catherize, which then causes fear
-
What are all the fluid balance factors?
- Diuresis
- Caffeine, Alcohol
- Dehydration
-
What does diuresis cause?
increased urine excretion
-
What effect does caffeine and alcohol have on fluid balance?
Decreases ADH which causes increased fluid loss
-
How does dehydration affect fluid balance?
The body attempts to retain fluid so output decreases, and concentration increases.
-
What are the benefits of an accurate I&O and daily wt? Which one is better?
- I&O will show a few days trend.
- Daily wt shows day to day and r/t to fluid changes.
Daily wt is the BEST overall indicator.
-
When the kidneys produce an abnormally large amount of urine, what is this called?
Polyuria
-
When there is low urine output < 500cc/day, therefore 20.8cc/hr (30cc/hr is normal), what is this called?
Oliguria
-
This is a lack of urine production, what is this called?
Anuria
-
What are the different classes of meds that affect the urinary system?
- Diuretics
- Anticholinergics & decongestants
- Anesthesia
-
These meds increase urine output by preventing reabsorption of water and electrolytes. What kind of meds are these?
Diuretics
-
These meds cause urinary retention. They also dry secretions, but retain urine.What are these meds known as?
Anticholinergics and decongestants
-
These meds can slow glomerular infiltration. They cause changes in the color of the urine from orange to green or blue, to black or brown. What are these meds called?
- Anesthesia (esp. epidural)
- Opioid analgesics
-
How do weak abdominal and perineal muscles affect a pt?
They can impair bladder contraction and/or urethral control.
-
What happens to the muscles of women after childbirth, menopause, and elderly ppl?
Muscle wasting
-
What else can decrease muscle tone?
Long term indwelling catheter use
-
What are all the pathologic conditions that can affect urinary elimination?
- Kidney disease/kidney stones
- Protein or blood cells
- Heart or circulatory disorders
- Blocked flow
- Spinal anesthetics
-
What are the two types of UTI?
-
What organ does cystitis affect?
bladder
-
What organ does pyelonephritis affect?
Kidney
-
What are s/s of cystitis?
- freq
- urgency
- suprapubic pain
- dysuria
- hematuria
- fever
- confusion in elderly
- darker blood
-
What are the s/s of pyelonephritis?
- flank pain
- dysuria
- pain @costovertebral angle
- bright red blood
plus s/s of cystitis
-
What kind of teaching and prevention could a nurse do for someone with a UTI?
- Drink more fluids
- Showers are better than baths
- Perineal cleansing "front to back"
- Voiding after intercourse
- Anti-Microbial Therapy
- No scented toilet paper
- No perfumes, etc to perineal area
- Empty bladder regularly
-
How would a UTI be medically diagnosed?
- Dipstick for Leukocyte Esterase and Nitrates
- UA/ C&S
- High risk for older adults
-
What would Tx be for UTI?
- Anti-Mircobials
- Increase fluid intake
- Prevention
-
What are all the factors concerning surgical procedures that can affect urinary system?
- Stress > decreased ADH secretion
- Lower abdomen and perineal surgery causes edema > interferes with voiding
- Anesthesia
-
In older adults what do we watch out for?
- Arteriosclerosis
- Nephrons
- Illness or surgery
- Decreased renal function
- Decreased bladder function
- Menopause
-
This decrease in blood flow impairs renal function. What is this called?
Arteriosclerosis
-
What happens to our nephrons as we age?
Decrease
-
Why does illness or surgery affect urinary system?
It takes longer to return to normal functioning
-
This increases the risk for med toxicity of meds that are excreted via kidneys. What is this called?
Decreased renal function
-
This increases the risk of nocturnal frequency. What is it?
Decreased bladder capacity
-
What does menopause do for women's urinary system?
- The urethra is affected by decreased levels of estrogen which cause atrophic changes.
- The changes increase risk of infection and urinary incontinence.
-
How do we promote and maintain normal voiding pattern in our pts?
- Increase intake (no juice if diabetic)
- Offer BRP - less risk for incontinence
- Being ambulatory increases circulation
- Foley tubing is below the bladder
- Privacy
- Washing hands
- Perineal care
-
What would we ask to fill out history of pt?
- Voiding pattern
- Freq
- Urinary appearance
- Recent changes
- Past/current problems with urination
- Meds
-
What would we do for the physical assessment?
- Percussion of kidneys
- Inspect urethral meatus for swelling, discharge, and inflammation
- Inspect skin for color, texture, turgor, edema, and excoriation
- Bladder scan
-
What does BUN stand for? What does it do?
Blood Urea Nitrogen- the excretion of urea, indicates glomerular function and hydration status
-
What does creatinine levels tell us?
Creatinine is a byproduct of muscle metabolism. The level indicates kidneys ability to excrete.
-
A BUN level >20 means
- serious, glomerular is not working well
- dehydration, excessive protein intake
- impaired renal function
-
How can we get a false result of BUN level?
r/t hydration status, didn't drink enough water
-
A low BUN means...
- Overhydration
- liver damage
- malnutrition
-
What is GFR? What does this indicate?
Glomerular Filtration Rate– better indication of kidneys than BUN/creatinine
-
-
What is the normal GFR level?
60-120
-
0-15 GFR is...
Kidney Failure
-
15-60 GFR is...
Kidney Disease
-
How do we find the GFR, what tests do we need? What is this test called?
- 24 hr urine
- Serum creatinine levels
-
What produces creatinine?
Muscles produce relatively constant quantities.
-
When there is renal impairment what happens to serum creatinine and urinary clearance?
- Serum creatinine goes up
- Urinary clearance goes down
-
Someone with unilateral kidney disease, what happens to creatinine clearance?
A decrease is not expected if other kidney is healthy
-
What race makes a difference when it comes to GFR?
African Americans
-
How do we obtain urine specimen for culture and sensitivity?
- "Clean Catch" specimen
- Cleanse perineal area with soap and water
- Midstream urine into sterile container– females: spread labia, males: penis doesn't touch container
-
What characteristics do we look for in a U/A?
-
If a U/A has been sitting for a long time then what is the odor like?
ammonia
-
Diabetics U/A has a _______odor.
fruity
-
A urine specimen that has a malodorous odor means...
UTI
-
If a U/A test pos for protein, what does this mean?
Renal disease
-
If a U/A tests pos for glucose, what does this mean?
Diabetes
-
If a U/A tests pos for ketones?
Diabetes
-
What is normal specific gravity?
1.005-1.025
-
What is the specific gravity of water?
1.000
-
If specific gravity of water is low what does this mean?
Diluted urine
-
If specific gravity of urine is high, what does this mean?
Urine is concentrated
-
Even if Nitrites and Leukocyte esterase test pos we still need_________ to confirm UTI.
Culture of bacteria
-
The longer the U/A sits...
the higher the pH, altering results
-
"Bed wetting", involuntary control past age of normal development
Eneuresis
-
If one voids >2x/night means
Nocturia
-
This is the desire to go
Urgency
-
Secondary eneuresis is...
normal urinary elimination then bed wetting started.
-
What are the characteristics of a neurogenic bladder?
- Impaired neuro function
- Unable to perceive bladder fullness
- Unable to control the urinary spincters
- Bladder becomes flaccid / distended / spastic with freq involuntary urination
-
Emptying of the bladder is impaired
Urine accumulates
Bladder distends
What are these all characteristic of?
Urinary Retention
-
How do we assess urinary retention?
Palpate bladder
-
How do we assess for bladder distention?
- Palpation
- Percussion
- Bladder scan
-
What do we palpate for bladder distention?
Bladder is firm, and may be to one side of midline
-
What kind of percussion do we listen for bladder distention?
Dull sound represents fluid (bowel sounds have an air sound)
-
How do we decrease catherization?
Bladder scanning
-
What risks do we take when we do urinary catherization?
- Trauma
- Indwelling vs. intermittent catheter
- Duration of use
-
What kind of trauma can result from catherizing?
Alteration in skin integrity
-
The longer a catheter is in the urinary system, then...
the higher the risk for infection
-
What nursing interventions will we take for our pt with an indwelling catheter?
- Encourage po
- I&O
- Ensure foley bag is below bladder
- Assure patency
- Avoid tension on tubing
- Prevent contamination
- Observe flow Q2-3H
- Patient teaching– involve pt about reason for increasing fluids
-
When we collect a specimen from the foley catheter what do we do?
- Wash hands
- Gloves
- Scrub the hub, 15-20sec with alcohol, air dry
- Clamp/kink tubing (5-10min)
- Syringe into port
- Unclamp
- Transfer to sterile container
- Patient label
-
In order to d/c an indwelling catheter, what do we do?
- Doctor's Order
- Duration of use, how long used?
- Document
-
How long is normal for a pt to void after having a foley catheter?
- 6-8 hrs
- >8 hrs could mean urinary retention
-
What is a suprapubic catheter?
Inserted surgically thru abdominal wall directly into the bladder
-
This is a surgical re-routing of urine from the kidneys to a site other than the bladder, what is this called? What are the 2 categories?
Urinary Diversion
- Incontinent– urostomy
- Continent– neobladder with intestine + pt empties
-
What are some Nursing Dx?
- Impaired Urinary Elimination
- Dysfunctional in Urine Elimination
-
What are the interventions for maintaining normal elimination?
- Promoting fluid intake
- Assisting with toileting
- Maintaining normal voiding habits (establish baseline)
- Preventing UTI's
-
What kinds of nursing management can we do for urinary incontinence?
- Individual bladder program– offer BRP Q2H / pelvic muscle exercises
- Meticulous skin care
- Containment of urine (condom catheter– leave 1" to promote urine flow)
-
What are the benefits of kegel exercises?
- Strengthen pelvic floor muscles
- Reduce or eliminate episodes of stress incontinence (coughing, laughing, sneezing, lifting)
-
How do we do a kegel exercises?
- Sit or lie in a comfortable position
- Contract and relax pelvic muscles 3-5 sec
- 10x/3x a day, increasing to 10 sec hold
-
How do we identify our pelvic muscles?
- You can stop urine midstream
- Tightening anal sphincter as if to hole a bm
-
What's the purpose behind the condom catheter?
- Collect urine and control urinary inc
- To permit pt physical activity while controlling urinary incontinence
- Prevent skin irritation as a result of urine inc
-
After applying a condom catheter what should the nurse do?
Check the penis for adequate circulation 30 min after applying (1" space)
-
Even in a healthy elder this urinary elimination change can occur....why?
The amt of urine retained after voiding increases because of decrease in muscle tone.
|
|
