Flashcards
Altered urinary elimination
Cards in this deck (89)
- 1What are conditions that may alter urination?--infection (cystitis, pyelonephritis)
--structural barriers (nephrolithiasis, tumor)
--problems with act of urination (incontinence, retention) - 2What three things must be present in order for urination to occur?--functional stretch receptors that sense bladder filling
--intact parasympathetic pelvic nerve to stimulate emptying
--working detrusor muscle - 3What role does the sympathetic nervous system play in urination?Sympathetic STORES
--relaxation of detrusor muscle & contraction of internal urethral sphincter - 4Inhibition of somatic (voluntary) neurons innervating the external urethral sphincter allow urination because of ____; urination is inhibited when these neurons are ____, which contracts the _____.--relaxation of the external urethral sphincter
--stimulated, external urethral sphincter
(relaxation = urination)
(contraction = no urination) - 5In children up to 3 years old, urination is entirely____reflexive
**when the bladder expands, it empties - 6What are the four main types of incontinence?--stress
--urge (overactive bladder)
--mixed stress urge
--overflow/retention - 7in children, incontinence is divided into:nighttime & daytime
- 8Stress incontinence involves leakage due to:increased intra-abdominal pressure without any bladder contraction involved
- 9Hypermobility of the urethra in stress incontinence results from:lack of support from pelvic floor muscles
**more often in women due to changes from pregnancy, childbirth, & obesity - 10Additional causes of stress incontinence (other than urethral hypmermobility) include--internal sphincter dysfunction (like insufficient heart valves...doesn't close properly)
--cystocele - 11In men, the most common cause of stress incontinence is:prostatectomy
- 12Additional causes of stress incontinence beyond urethral hypermobility & prostatectomy include:--pelvic trauma
--obesity
--chronic coughing
--congenital & neurologic disorders - 13sudden intense urge to urinate preceding or occurring just before leakage of urine =urge incontinence
- 14involuntary bladder contractions associated with dysuria, urgency, & nocturia =overactive bladder
**often used synonymously with urge incontinence but slightly different, often occurs along with urge incontinence - 15central nervous system disorders associated with urge incontinence = **altered inhibition of voiding--Parkinson's
--multiple sclerosis - 16List factors that contribute to urge incontinence:--UTI
--bowel problems (constipation)
--bladder irritants
--smoking
--muscle changes in bladder due to aging, nerve-ending damage - 17Inability to empty the bladder results in what type of incontinence?overflow
**due to impaired contractility --OR-- obstruction - 18Impaired detrusor contractility associated with overflow incontinence may be due to:--aging
--muscle damage/fibrosis
--neuropathy
--efferent nerve disorders (multiple sclerosis)
--low estrogen - 19Overflow incontinence due to retention is usually the result of:--BPH
--uterine fibroid - 20Dribbling urine & a weak stream are seen in which type of incontinence?overflow
- 21detrusor muscle areflexia results from:chronic overdistention of bladder due to prolonged postponement of voiding (nurse's bladder)
- 22Functional incontinence involves:no urinary system disorder but, instead, physical or mental impairment that interferes with toileting
- 23Continuous leakage of urine over 24 hour period or intermittent uncontrollable leakage of large volumes of urine =gross total incontinence
- 24In gross total incontinence, the bladder has no:storage capacity
**fistula, anatomic defects, spinal cord or urinary system injury - 25urinary incontinence resulting from a temporary/reversible condition =transient incontinence
- 26Factors that result in transient incontinence =--infection
--atrophic vaginitis
--medications (diuretics/sedatives)
--depression/anxiety/delirium
--high urine output (polydipsia)
--restricted mobility
--fecal impaction
--alcohol, caffeine (diuretics) - 27Incontinence in children occurs after ages ___ when bladder control is expected4 to 5
**nighttime bladder control may occur later--around ages 5 to 7 - 28primary enuresis =child NEVER achieved nighttime bladder control
- 29secondary enuresischild developed nighttime bedwetting after having achieved nighttime bladder control for >6 months
- 30What are possible causes of nighttime enuresis?--high intake of fluids prior to bed
--sleep disorder
--insufficient ADH secretion at night
--reduced response to ADH secretion
--detrusor overactivity (OAB/urge)
**may be due to delay in maturation of CNS or small bladder capacity - 31Secondary enuresis may be due to:stressful event in child's life (divorce, etc.)
**may also have poor bowel & voiding habits - 32Most cases of enuresis resolvespontaneously
- 33nonmonosymptomatic enuresis =enuresis that occurs with other symptoms, such as urgency, hesitancy, or daytime incontinence
- 34children with nonmonosymptomatic enuresis are more likely to have:urinary tract dysfunction (frequent UTI, neurologic disorder)
- 35Daytime incontinence without enuresis may be due to:--overactive bladder
--neurologic disorder (spina bifida) - 36Incontinence in children due to a psychological/behavioral issuechronically distended bladder resulting from failure to empty in timely manner (nurse's bladder)--results in overstretched bladder that becomes hypoactive & unable to contract effectively (like dilated cardiomyopathy)
- 37Risk factors for incontinence:--female
--advanced age
--overweight/obese
--smoking
--other diseases - 38men with prostate issues are more likely to experience:urge & overflow incontinence
- 39Which factors increase women's risk of incontinence?--pregnancy
--childbirth
--menopause
--anatomy of lower urinary tract - 40Incontinence is not normal during any age except duringinfancy
- 41normal postvoid residual =less than 50ml (100 ml for older adults)
- 42with neurogenic bladder, the bladder may become:spastic or flaccid
- 43upper motor neuron lesions (stroke, TBI, multiple sclerosis) that alter CNS urinary control centers generally cause which type of neurogenic bladder?spastic
**micturition reflexes continue to function - 44With spastic types of neurogenic bladder, the detrusor has ____ and may also have bladder-sphincter _____--hyperreflexia
--dyssynergia - 45If the CNS disfunction exists above the pons micturition center, bladder-sphincter dyssynergia _____ & these structures work in _____.--does not occur
--coordination - 46if the CNS lesions is below the pons micturition center but above the sacral area micturition center, coordination between ____ and ___ is absent, causing ____ & subsequent _____.--bladder contraction
--external sphincter relaxation
--bladder-sphincter dyssynergia
--urinary outlet obstruction - 47Conditions associated with bladder-sphincter dyssynergia are:--Guillain-Barre
--multiple sclerosis
--intervertebral disc problems - 48Interruption in sacral area or lower motor neuron activity (sensory/motor peripheral nerve conduction from bladder to spinal cord) results in:flaccid neurogenic bladder
**CNS remains intact, PNS not intact - 49detrusor areflexia with hypotonic or atonic bladder & loss of sensation =flaccid neurogenic bladder
- 50Disorders associated with flaccid neurogenic bladder include:--congenital anomalies (meningomyelocele, cauda equina syndrome)
--peripheral neuropathies (pelvic nerve damage, herpes zoster) - 51symptoms of spastic type neurogenic bladder =overactive bladder symptoms: frequency, urgency, urge incontinence
- 52symptoms of flaccid type neurogenic bladder =--urinary retention
--bladder distention
--stress & overflow incontinence - 53interstitial cystitis often occurs with other pain syndromes, such as:--fibromyalgia
--vulvodynia
--irritable bowel syndrome - 54Bladder neuron sensitivity and central sensitization are ____ in interstitial cystitis, resulting in more pain with less stimuli.increased
- 55What are the most common congenital defects?--reproductive system
--urinary system - 56Upper urinary tract infections involve ____, whereas lower urinary tract infections involve--kidneys (pyelonephritis)
--bladder, urethra (urethritis) - 57because of protein content, ___ is an excellent medium for bacterial growthurine
- 58urinary system mechanisms to prevent infection include:--one-way valves where ureters attach to bladder
--urination (flushes microbes away)
--bladder lining=barrier against microbes
--prostate secretions slow bacterial growth
--periurethral flora (lactobacillus) outcompete other microbes - 59most UTIs involve invasion of the urethral meatus from:perianal bacteria
**direct invasion of kidneys from blood rarely occurs--most commonly in immunocompromised - 60Pyelonephritis is more common in those who:--require frequent medical attention
--have recurrent UTIs
--have contracted an antibiotic-resistant strain - 61Which bacterium most commonly causes UTI?E. coli
- 62Why are women at higher risk for UTI?--shorter, straighter urethra
--seated void prevents complete emptying
--more frequent perineal tissue irritation (sex, tampons, thong underwear, etc.)
--change in periurethral flora with aging
--urethrovesical reflux from bearing-down activities - 63Men are at high risk for ____ UTI due to bacterial ability to "hide" in prostate tissuerecurrent
**in men, defined as return of symptoms several weeks after treatment - 64Recurrent UTI in men requires investigation for:--prostatitis
--anatomic abnormalities - 65Recurrent UTI in women is defined as:more than 2 infections in 6 months
--or--
more than 3 infections in 1 year
**most recurrent infections in women are due to REINFECTION - 66Relapsed UTI is defined asreturn of symptoms ~ 2 weeks after completion of treatment & causative organism is the same
**may require long-term antibiotics - 67____ should be suspected in children with recurrent UTIsvesicoureteral reflux (VUR)
- 68In VUR, the ___ is congenitally short & part of the ureter is abnormally imbedded in ____--ureter
--bladder wall - 69Backward flow of urine from the bladder to the ureters prevents _____ & increases risk of _____ **as with neurogenic bladder or urinary retention from outlet obstruction--complete emptying
--infection - 70recurrent UTIs--particularly pyelonephritis--can result in:renal scarring & kidney failure
- 71Hydronephrosis in utero may be an indication of:vesicoureteral reflux (VUR)
- 72Risk factors for UTI:--BPH
--congenital urinary tract abnormalities
--immobility
--urinary/bowel incontinence
--renal calculi
--decreased cognition
--pregnancy
--impaired immunity
--impaired nerve innervation
-urinary instrumentation
--improper personal hygiene
--use of diaphragm or spermicide
--unlubricated condoms - 73signs/symptoms of simple acute cystitis:--urgency, frequency
--dysuria
--suprapubic pain
--hematuria
--bacteriuria
--cloudy, smelly urine - 74Systemic manifestations (flank pain, fever, costovertebral angle tenderness) accompanying cystitis usually indicatepyelonephritis
- 75Presence of perineal or pelvic pain in men usually indicates:complicated UTI (prostatitis involved)
- 76systemic manifestations of UTI in elderly tend to be ____subtle & non-specific
--altered mental status, falls, functional impairment - 77In this condition, kidneys become grossly edematous, filled with exudate; compression of renal artery may occur, along with abscesses & necrosis, leading to permanent damage:pyelonephritis
- 78Presence of which enzyme in urinalysis indicates UTI?Leukocyte esterase
**indicates pyuria = WBCs release leukocyte esterase - 79Nitrites in urine reflect infection withenterobacteriaceae (E. coli)
**these bacteria convert nitrate to nitrite
**positive nitrite test suggests significant bacteriuria - 80False negative nitrite test may occur if:--urine has not been in bladder long enough to allow conversion of nitrates to nitrites
--pH of urine is acidic (such as with drinking cranberry juice) - 81False positive nitrite test can occur with ingestion of foods, such as____, that turn urine redbeets, phenazopyridine (bladder analgesic)
- 82White blood cell casts indicate:kidney inflammation & thus acute pyelonephritis
- 83Even with false nitrite test, treatment should ____ if history suggests UTI.be initiated
- 84A culture and sensitivity test should be done in patients with _____--complicated UTI
**pyelonephritis, urosepsis
--atypical presentation
--failure to respond to therapy
--recurrent symptoms - 85Treatment of UTI generally involves targeting ____the most common causative organism (E. coli)
- 86When urine contains bacteria with or without pyuria and WITHOUT SYMPTOMSasymptomatic bacteriuria
- 87Most cases of asymptomatic bacteriuria [do/do not] progress, so treatment [is/is not] necessary--do not
--is not
**however, pregnant women, those undergoing urologic intervention, & renal transplant patients SHOULD receive treatment - 88A positive urine culture is defined as:>10 to the 5th colony forming units/ml
**lower counts in presence of pyuria & UTI symptoms may be diagnostic of UTI - 89Strategies to prevent UTI:--increased hydration
--avoiding irritants (bubble baths)
--proper perineal hygiene
--cotton underwear & loose clothing
--not delaying voiding, adequate emptying
--probiotics
--appropriate catheter care
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- Nursing Flashcards on Altered urinary elimination, created by Whitney Willbanks on 03/03/2024.
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- Whitney Willbanks
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