Urinary Elimination

33. Identify the primary structures that the nurse would assess.

Skin/mucosal membranes, kidneys, bladder, and urethral meatus.

Describe the following characteristics of urine.

34. Color: pale, straw color to amber depending on concentration.

35. Clarity: normal urine appears transparent at voiding.

36. Odor: urine has a characteristic odor. The more concentrated the urine, the stronger the odor.

37. Describe the following types of urine specimens collected for testing.

a. Random: collect during normal voiding, from an indwelling catheter or urinary diversion collection bag.

b. Clean-voided or midstream:

c. Sterile: If the client has a indwelling catheter, collect a sterile specimen by using a aseptic technique through the special sampling port

d. Timed urine: Time required may be 2, 12, or 24 hour collections. The time 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.

Common urine tests include the following. Briefly explain each.

38. Urinalysis: Testing urine with reagent strips (quick screen)

39. Specific gravity: weight/degree of concentration of a substance compare with an equal volume of water. Measures concentration of particles in urine.

40. Urine culture: sterile/clean voided sample being tested for bacterial growth.

41. Briefly explain the purpose of each of the following noninvasive diagnostic examinations.

a. abdominal roentgenogram: determine size, shape, symmetry and location of kidneys

b. intravenous pyelogram (IVP): view the collection ducts and renal pelvis and outline the ureters, bladder and urethra

c. Urodynamic testing: determine bladder muscle function and evaluate causes of urineary incontinence

d. Computerized axial tomography (CT) scan: obtain detailed images of structures within a selected plane of the body

e. Ultrasound: identifies gross renal structures and structural abnormalities in kidney bladder or urinary tract and estimate volume of urine in bladder

42. Explain the purpose of the following invasive procedures.

a. Endoscopy: direct visualization specimen collection and or treatment of the interior of the bladder/urethra

b. Arteriogram: visualizes the renal arteries/branches to detect narrowing or occlusions

Nursing Diagnosis

List the potential of actual nursing diagnoses related to urinary elimination.

43. disturbed body image

Planning

51. List the goals appropriate for a client with a urinary elimination problem.

a. client will void within 8 hours

52. List the techniques that may be used to stimulate the micturition reflex.

a. sound of running water

53. List two interventions for each of the following types of urinary incontinence.

a. Functional: clothing modification environmental alterations

54. Identify substances that can increase urine acidity.

a. Intermittment:

Acute Care

Explain the nursing measures taken to prevent infection and maintain an unobstructed flow of urine in catherized clients.

56. Perineal hygiene: provided three times a day with soap and water to help reduce the number of organisms around the urethra

57. Catheter care: three times a day and after defecation or bowel incontinence

58. Fluid intake: daily intake 2000-2500ml helps flush the bladder and keeps the catheter tubing free of sediment

59. Irrigations and instillations: to maintain patency maybe antiseptic or antibiotic to wash out the bladder treat local infection

Briefly explain the two alternatives to urinary catheterization.

60. Suprapubic catheter: surgical placement through the abdominal wall above the symphysis and into the urinary bladder

61. condom catheter: soft, pliable latex sheath that slips over the penis held in place by tape, self adhesive

62. Pelvic floor exercises (PFEs/Kegel exercises):

Improve strength of pelvic floor effective in treating stress incontinence, overactive bladder

63. Bladder retraining: to reduce the voiding frequency and capacity of the bladder for urge urine incontinence related to overactive bladder

64. Habit training: helps improve voluntary control over urination

65. Self catherization: Clients with chronic disorders (spinal cord injury) Four to six times a day with volumes of 400-500ml

66. Identify how the nurse would evaluate the effectiveness of the interventions utilized.

The nurse will evaluate the effectiveness of nursing interventions through comparison with the outcome goals. Actual outcomes are compared with expected outcomes to determine success or partial success in achieving those outcomes.