Flashcards
Urinary Elimination
Cards in this deck (54)
- 1What is the nurses' role in urinary elimination?1. Assess urinary tract function
2. Provide support for bladder emptying/improving/gaining continence
3. Minimize infection risk
4. Educate on bladder health - 2Urinary elimination depends on the coordinated functions of which parts of the body?kidneys, ureters, bladder, urethra, urinary sphincter, CNS
- 3General role of kidneys in urinary eliminationfilter waste from blood
- 4General role of ureters in urinary eliminationtransport urine from kidneys to bladder
- 5General role of bladder in urinary eliminationholds urine until excess volume triggers urge to urinate
- 6General role of CNS in urinary eliminationsends message to micturition centers that ok to void because in appropriate place to urinate
- 7General role of urinary sphincter in urinary eliminationrelaxes causing bladder to contract and urine eliminated
- 8What is the purpose of the kidneys related to urinary elimination?1. Regulate fluid & electrolyte balance: remove waste from blood, filter it, reabsorb/excrete it
2. Produce hormone erythropoietin to stimulate production & growth of RBC's
3. Convert Vit D into its' active form for calcium absorption
4. Control BP, blood volume, & renal blood flow through renin-angiotensin system - 9Hematuria/ProteinuriaA result of glomerular injury; glomerulus can't filter blood or protein because too large; if found in urine indicates injury
- 10What would cause anemia in a pt w/chronic kidney condition?Because kidneys are not functioning properly, pt is not producing enough erythropoietin so not enough RBC's are being produced
- 11Why would a pt with kidney issues be hypertensive?inadequate production of renin-angiotensin & aldosterone(ADH) stimulation in adrenal cortex causing improper balance of vasodilation & vasoconstriction w/water retention
- 12Why would a pt w/kidney issues have electrolyte imbalance?wastes are not being filtered and excreted properly
- 13Possible causes of distention in kidney related issuesbackflow of urine through ureters and kidney pelvis usually caused by obstruction; ex: kidney stone
- 14Possible causes of backflow of urine from bladder into ureters and kidneysinfection, pregnancy (fetus pushes against bladder reducing capacity causing feeling of fullness) ***normally when bladder is filling pressure is low preventing backflow***
- 15Who is more at risk for UTI? Why?Females because urethra is shorter making it closer to perineal area that's contaminated w/bacteria
- 16What are the 3 most common urinary elimination issues?1. urinary retention
2. UTI
3. urinary incontinence - 17What is urinary retention?It's the inability to empty the bladder due to bladder pressure exceeding sphincter's ability to prevent urine from passing
- 18Name the 2 types of urinary retention.1. Acute onset- pain, tenderness over symphysis pubis, restlessness, diaphoresis; can have 0 output over several hours or frequency, urgency, void small amts/incontinent small amts
2. Chronic- symptoms over time of decreased voiding amts, straining to void, frequency, urgency, incontinence, sensation of incomplete bladder emptying - 19UTI1. most common healthcare-acquired infection
2. E. coli most common cause
3. increased risk w/indwelling catheter, instrumentation of urinary tract, urinary retention, urinary & fecal incontinence, poor perineal hygiene
4. upper UTI- kidneys; pyelonephritis; can lead to sepsis
5. lower UTI- bladder, urethra - 20Symptoms of lower UTIburning/pain w/urination, bladder irritation that presents as urgency, frequency, incontinence,suprapubic tenderness, foul-smelling cloudy urine, delirium/altered mental status in elderly, hematuria, can spread to upper urinary tract
- 21Symptoms of upper UTIfever, chills, diaphoresis, flank pain
- 22urinary incontinence*common in men & women 40+
*older adults
*70% of nursing home pts
types:
1.urge/urgency-involuntary leakage assoc. w/urgency
2. stress-assoc. w/effort or exertion like sneezing/coughing
3. mixed- stress + urgency UI types both present
4. chronic retention- caused by overfull bladder
5. functional- interference w/toilet access
6. transient- caused by medical conditions, usually treatable - 23What are urinary diversions?-surgical procedures to divert urine out of body via stoma (opening in abd. wall)
-can be temporary/permanent & continent/incontinent - 24Name 2 types of continent urinary diversions.1. continent urinary reservoir- storage pouch made from part of ileum & colon, catheter inserted into stoma to empty urine, pts must cath pouch 4-6 x daily for rest of lives
2. orthotopic neobladder-pouch replaces bladder, can void via urethra using Valsalva technique - 25Name 2 types incontinent urinary diversions.1. ureterostomy- permanent, no sensation/control of urine, collected in pouch
2. nephrostomy- drains renal pelvis when ureter obstructed - 26Micturition in infants & childrennot able to assoc. sensation of filling w/urge to void until 2-3 y/o, can't effectively concentrate urine, urine is light yellow/clear, excrete large volumes of urine, 13-18 lb infant 400-500 mL output daily
- 27Name one way a nurse can advocate for pt w/urinary elimination problems.can suggest non-invasive alternatives to catheterization like bladder scanner or voiding schedule
- 28Important points to watch for in assessment of pt w/urinary elimination problems1. pt's understanding of their urinary problem and treatment expectations; always ask what they expect from their care
2. cultural and gender differences like gender preference in urination position & cultural preferences in which gender is acceptable to provide care w/elimination
3. assess pt's level of health knowledge about their condition BEFORE educating them; limited knowledge causes poor treatment outcomes - 29What should the nursing history of a pt w/urinary elimination problems include?1. review of elimination patterns
2. symptoms of changes in voiding
3. assessment of factors affecting normal urination - 30Nursing History: Urination Patterns-Ask frequency & times of day, normal void volume, history of recent changes
-common urination times when wake up, after meals, before bed
-people void avg 5+ times daily - 31Nursing History: Changes in Urination-ask about symptoms related to urination changes
-does anything happen before/aggravate symptoms
-what does pt do when symptoms occur - 32Which cultures prefer same-gender care?Iranian, Jewish Orthodox, Korean, Hindu, Vietnamese
- 33What do Hindu and Muslim cultures require regarding hygiene during care?left hand-unclean procedures & handling of secretions
- 34Physical assessment of kidneysGently percuss costovertebral angle(formed by spine & 12th rib) for tenderness caused by inflamed/infected kidneys
- 35Physical assessment of bladder-look for swelling of lower abdomen
-gently palpate lower abdomen for fullness; will feel like smooth, round mass
-further assess w/bladder scanner or ultrasound if bladder overfull - 36Physical assessment of genitalia, urethral meatus, & perineal skin-observe labia for swelling, redness, tenderness, rashes, lesions, evidence of scratching
-observe urethral meatus for drainage and lesions, discomfort; document color, consistency, odor of any drainage
-observe penis for redness/irritation; retract foreskin of uncircumcised pt but return foreskin to avoid causing dangerous swelling
-observe perineal skin exposed to moisture minimum 1x daily; more if incontinence ongoing - 37Physical assessment of pt w/indwelling catheter-assess urinary meatus for catheter related damage
-signs of inflammation & discharge that could indicate infection
-catheter can erode thru meatus to vagina or glans/shaft of penis - 38What does assessment of urine include?input & output, characteristics of urine: color, clarity, odor
- 39What does I & O assessment tell you about pt's condition?output indicator of kidney & bladder function, changes could be caused by fluid imbalance, kidney dysfunction, decreased blood volume
- 40What should be included in I & O measurement?Intake: all oral liquids, semi-liquids, enteral feedings, parenteral fluids
Output: urine, vomitus, gastric drainage tubes, wound drains, any fluid that leaves the body - 41What should a nurse do if a postop pt's output falls below 30 mL/hr?Assess for blood loss & immediately contact doctor
- 42What does a catheterized post op pt's output provide a measure of?indirect measurement of circulating blood volume
- 43What should the nurse do if pt has an extreme increase/decrease in output?-output less than 30 mL/hr for 2+ consecutive hours: assess further & contact provider
-polyuria- assess further & contact provider - 44Proper procedure for emptying catheter drainage bagsfollow standard precautions, make sure drainage tube reclamped and secured
- 45What is the normal color for urine?pale straw to amber color
- 46hematuria-blood in the urine
-never normal
-dark red urine: kidneys/ureters bleeding
-bright red urine: bladder/urethra bleeding - 47What are other causes of abnormal urine color?-urinary analgesic: bright orange
-eating beets, rhubarb, blackberries: red
-high bilirubin concentrations in liver disease pts: dark amber like tea - 48What action should the nurse take if unexpected urine color changes occur?report to provider
- 49urine clarity-transparent in normal urine at time of voiding
-kidney disease: cloudy because of protein concentration
-thick & cloudy: bacteria & WBC's present - 50urine odor-normal=ammonia odor
-foul odor=UTI
-foods like asparagus & garlic can change urine odor - 51Correct way to label urine specimensname, date, collection type
***get to lab w/in 2 hrs of collection or preserve according to lab protocol - 52What is an important part of problem-focused nursing diagnoses?-identifying the cause/related factor
-for risk diagnoses, select correct risk factors
-allows intervention choices to treat/modify cause/risk factor for resolution of diagnoses - 53What is a general goal for pts with urinary issues?normal urinary elimination but individual goals can differ; can be long/short term goals
- 54What is the difference between independent and collaborative interventions?independent- nurses use own judgment like teaching pt self care
Collaborative- prescribed by provider & carried out by nurse like med admin
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- Nursing Flashcards on Urinary Elimination, created by Georgie Duff on 18/10/2017.
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- Georgie Duff
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