NUR 104 Urinary Elimination Ch 31

A nephrostomy tube is a tube placed in the _________ to permit outflow of urine and prevent backup of urine in the kidney (hydronephrosis), which could cause renal damage. (Craven 1042)

renal pelvis of the kidney

Intermittent catheterization involves the introduction and removal of a catheter into the bladder to permit drainage of urine at ___________, usually every _______ hours. (Craven 1042)

routine intervals, 6 to 8

An elevated ______ ______ _______ is indicative of impaired renal function. (Craven 1030)

serum creatinine concentration

Urolithiasis and nephrolithiasis refer to (Pellico 789)

stones (calculi) in the urinary tract and kidney, respectively.

cystectomy

the bladder is surgically removed

Cholinergic medications (e.g., bethanechol) may be given to promote voiding because:

they stimulate contraction of the detrusor muscle.

The stress of surgery _______ ______ ______ __ ______ which decreases urinary output. (Craven 1021)

triggers the release of ADH,

Procedures to treat Urolithiasis and nephrolithiasis:

ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), endourologic (percutaneous) stone removal

Stones are formed in the urinary tract when (Pellico 789)

urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase. "Supersaturation"

Oxybutynin (an antispasmodic) or tolterodine (an anticholinergic) may be used to treat ______ ______ _____ _____ caused by overactive detrusor muscle activity.

urinary urgency and frequency

mictrition

urination

Amitriptyline turns urine _________.

urine blue-green

nocturia

voiding during normal sleeping hours

urinary retention

inability to empty bladder of urine

urinary incontinence

involuntary loss of urine from the bladder

Overflow voiding

manifestations of urinary retention

Reflex voiding occurs when the bladder, as soon as it is stretched to a certain degree, contracts reflexively, resulting in loss of urine. This condition is called reflex ___________. (Craven 1020)

neurogenic bladder

Cystoscopy involves insertion ________ into the bladder for the purpose of ______________. (Craven 1030)

of a tube, direct visualization

hematuria

presence of blood in urine

pyuria

presence of pus in urine

Bladder assessment:

- Inspect the patient's lower abdomen. - In a supine position, a bulge in the central lower abdomen just above the symphysis pubis can be noted if the bladder is distended. - If the bladder contains less than 500 mL, no bulge will be present. - If the bladder holds more than 700 mL, the bulge may be observed extending in the direction of the umbilicus. - It may not be easy to observe a distended bladder in an obese person. (Craven 1027)

Specific questions in relation to voiding

-Do you have any pain or burning with urination? -Have you noticed any pink or reddish color in your urine? -Do you feel you are able to empty your bladder completely every time you urinate? -Do you accidentally lose any urine when you sneeze or cough? -Do you have any difficulty stopping or starting your urinary stream? (Craven 1026)

Treatments to prevent incontinence

-Doing pelvic floor (Kegel) exercises to strengthen your pelvic muscles . -Staying at a healthy weight. -Quitting smoking. Smoking causes coughing, which can make it harder to control your urine.

Characteristics of normal urine

-Volume -Color -Clarity -Color Many factors produce normal variation among different people and at different times for the same person

A pt reports burning with urination. Which question should the nurse ask to best obtain information about patient's dysuria? 1. "Can you tell me more about the problems you are having with urination?" 2. "How would you describe your experience with incontinence?" 3. " What are your usual bowel habits?" 4. "What color is your urine?"

1. "Can you tell me more about the problems you are having with urination?" This open-ended question encourages patient to talk about the problem from a personal perspective. Follow-up questions can be more specific.

When caring for a group of patients with various urinary problems, which of the following should cause most concern? 1. Anuria 2. Dysuria 3. Diuresis 4. Enuresis

1. Anuria The inability to produce urine (anuria) is life-threatening. If the cause is not corrected, the patient will need dialysis to correct flood and electrolyte imbalances and rid the body of waste products Dysuria - may indicate UTI Diuresis - lg amounts urine Enuresis - invol. discharge of urine All of these are of concern, but not as serious as anuria

Which clinical manifestation can a nurse expect when a p/o (postoperative) pt experiences stress incontinence associated with surgery? 1. Decreased urinary output 2. Low specific gravity 3. Reflex incontinence 5. Urinary hesitancy

1. Decreased urinary output During GAT (General Adaptation Syndrome) the posterior pituitary secretes ADH that promotes water reabsorption in the kidney tubules. Also, the anterior pituitary secretes ACTH (adrenocorticotropic hormone) that stimulates the adrenal cortex to secrete aldosterone, which reabsorbs sodium and thus water

Medication effecting urinary function:

1. Diuretics/Antidiuretics: 2. Cholinergic: bethanechol 3. Oxybutynin (an antispasmodic) 4. tolterodine (an anticholinergic) 5. Tricyclic antidepressants 6. antihistamines 7. Opiods

What is the best nursing action to facilitate bladder continence for the patient who is cognitively impaired? 1. Offer toiling reminder q 2 hours 2. Provide clothing that is easy to manipulate 3. Encourage avoidance of fluid between meals 4. Explain need to call for help with toiling q 4 hours

1. Offer toiling reminder q 2 hours A cognitively impaired person may not be abel to receive, interpret, or respond to cues for voiding. Reminding the person to void q 2 hours empties the bladder, which may limit episodes of incontinence

BEST nursing intervention for a pt with urinary incontinence. 1. Providing skin care immediately after soiling 2. Using a deodorant soap when providing skin care 3. Drying the area well after providing perineal care 4. Dusting the perineal area with a light film of cornstarch

1. Providing skin care immediately after soiling As soon as possible after an incontinence episode the pt should receive thorough perineal care with soap and water and the area dried well. This action removes urea from the skin, which can contribute to skin breakdown

2 parts of urine elimination

1. Urine formation 2. Urine excretion

A practitioner orders a urine specimen for culture and sensitivity via a straight catheter for a pt. What should the nurse do when collecting specimen? 1. Use sterile specimen container 2. Collect urine from catheter port 3. Inflate balloon with 10 mL sterile water 4. Have pt void prior to specimen collection

1. Use sterile specimen container A culture attempts to identify the microorganisms present in the urine, and sensitivity study identifies the antibiotics that are affective against the isolate microorganisms. A sterile specimen contact is used to prevent contamination of the specimen by microorganisms outside of the body (exogenous)

Normal volume of urine elimination a day is?

1200 - 1500 mL

What should nurse teach the patient to avoid to prevent diuresis? 1. Narcotics 2. Caffeine 3. Activity 4. Protein

2. Caffeine Drinks with caffeine (coffee, tea, some carbonated bevs) promote the secretion and excretion of large amts. of urine (diuresis)

A nurse is measuring I&O for a patient with a urinary retention catheter. Which equipment is most appropriate to use to accurately measure urine output? 1.Urinal 2. Graduate 3. Large Syringe 4. Urine collection bag

2. Graduate A graduate is a collection container with volume markings usually at 25 mL increments that promote accurate measurements of urine volume

A nurse caring for two patients. One has reflex incontinence , the other has total incontinence. Which characteristic is common to both? 1. Urination following an increase of intra-abdominal pressure 2. Loss of urine w/out awareness of bladder fullness 3. Retention of urine with overflow incontinence 4. Strong, sudden urge to void

2. Loss of urine w/out awareness of bladder fullness Involuntary voiding and a lack of awareness of bladder distention are related directly to both reflex and total incontinence. Reflex incontinence is the predictable, involuntary loss of urine with no sensation of urgency, of the need to void, or bladder fullness. Total incontinence is the continuous unpredictable loss of urine without distention or awareness of bladder fullness.

A pt has a hx (history) of UTI's. What should the nurse include in a teaching plan regarding why 8 oz of cranberry juice daily helps to minimize the occurrence of UTI's? 1. Dilutes bacterial growth 2. Promotes an acidic urine 3. Prevents urinary retention 4. Stimulates hypoactive detrusor muscles

2. Promotes an acidic urine Foods that promote acidic urine (cranberries, prunes, plums, eggs, meat and whole grain breads) create an environment that is not conducive to the growth of bacteria in urine.

Which constituent found in urine indicates the presence of an abnormality? 1. Electrolytes 2. Protein 3. Water 4. Urea

2. Protein Presence of protein in the urine indicates that the glomeruli have become too permeable, which occurs in kidney dz (disease). Most plasma proteins are too large to move out of the glomeruli, and the small proteins that enter the filtrate are reabsorbed by pinocytosis

A patient's urine is cloudy, amber with an unpleasant odor. What problem may the information indicate that requires a focused assessment? 1. Urinary retention 2. UTI 3. Ketone bodies in urine 4. High urinary calcium

2. UTI Urine appears cloudy due to presence of bacteria, WBC's and RBC's. The unpleasant odor is caused by pus in the urine (pyuria)

What should nurse monitor to best assess a pt's renal perfusion? 1. Blood pressure q 15 minutes 2. Urinary output every hour 3. Body weight every day 4. I&O q 24 hours

2. Urinary output every hour Adequate renal function and kidney function are reflected by and hourly urine output of 30 to 50 mL/hr

Urinalysis can be performed on any random specimen of ________ of urine.

20 to 30 mL

When a patient's intake and output is being monitored on a flow sheet, urine output should be within approximately _______ to _____ of intake for any 24-hour period. (Craven 1026)

200 to 300 mL

When do stones normally form

3-5th decade of life

Nurse is performing a a Phys. Assessment on a newly admitted pt. Which problem identified is most associated with urinary incontinence? 1. Chronic pain 2. Reduced fluid intake 3. Disturbed self esteem 4. Insufficient knowledge

3. Disturbed self esteem Disturbed self esteem is the state in which an individual experiences, or is at risk of experiencing, negative self evaluation about self or capabilities. Incontinence may be viewed by a patient as regressing to child-like behavior and has a negative impact on feeling about self

When caring for a pt on bed rest with a urinary retention catheter, what should nurse do? 1. Irrigate tubing to ensure patency 2. Label tubing with date of insertion 3. Ensure tubing is positioned over the leg 4. Position tubing through the side rail of bed

3. Ensure tubing is positioned over leg This prevents pressure of the leg on the drainage tube that interrupt flow of urine from the bladder

While caring for a patient w a condom catheter, which nursing action is MOST important? 1. Provide perineal care q shift 2. Avoiding kinks in collection tubing 3. Ensure velcro strap in snug, not tight 4. Retracting foreskin before catheter applied

3. Ensuring velcro strap is snug, not tight The anchoring device (e.g. velcro, elastic, self-adhesive, inflatable ring) must by snug enough to prevent the condom from falling off but not so tight that it interferes with blood circulation to penis (if foreskin is left in retracted position it can constrict penis, resulting in edema and tissue injury)

You are caring for a debilitated patient with nocturia. Which nursing intervention is PRIORITY when planning pt needs? 1. Encouraging use of bladder training exercises 2. Providing assistance to toilet q 4 hours 3. Positioning a bedside commode near bed 4. Teaching avoidance of fluids after 5 pm

3. Positioning a bedside commode near bed Bedside commode requires less energy than using a bedpan and is safer than walking to BR. Sitting on commode uses gravity to empty bladder fully and prevents urinary stasis.

Which assessment is not common to monitoring BOTH urine and stool? 1. Constituents 2. Urgency 3. Shape 4. Color

3. Shape Only stool can be assessed regarding shape. It is usually tubular in shape. Since urine is liquid, it assumes the shape of the container in which it is collected

When planning nursing care, which factor in a pt's hx places the pt at greatest risk for stress incontinence? 1. Lumbar spinal cord injury 2. Urinary obstruction 3. Six vaginal births 4. Confusion

3. Six vaginal births

A nurse is assessing the urinary status of a patient. Which sign indicates that additional nursing assessments are necessary? 1. Aromatic odor 2. Pale yellow urine 3. Specific gravity of 1.035 4. Output of 50 mL q hours

3. Specific gravity of 1.035 Specific gravity is the measurement of the concentration of dissolved solids in the urine. The expected range is 1.010-1.025. A specific gravity of 1.035 indicates concentrated urine

A patient state "it burns every time I pass urine" The nurse should make the inference that the patient most likely has which of the following? 1. Reflex incontinence 2. Stress incontinence 3. Retention incontinence 4. An infection

4. An infection Burning on urination (dysuria) is associated with mucosal inflammation that occurs with UTI's

Most important nursing intervention to prevent UTI's? 1. Teach female patients to wipe from the back to the front after urinating 2. Instruct patients to use bath powder to absorb perineal perspiration 3. Advise pt to report burning on urination to practitioner 4. Encourage pt to drink several quarts of fluid daily

4. Encourage pt to drink several quarts of fluid daily

A patient states "I have to urinate as soon as I get the urge to go." For which contributing factor should the nurse implement a focused assessment? 1. Anesthesia 2. Full bladder 3. Dehydration 4. UTI

4. UTI The feeling of need to void immediately (urgency) occurs most often when the urinary bladder is irritated. In the adult, the bladder usually holds 600 mL of urine, although the desire to urinate can be sensed when it contains as little as 150-200mL As the volume increases , the bladder wall stretches , ending sensory messages to the sacral spinal cord, and parasympathetic impulses stimulate the detrusor muscle to contract rhythmically. Bladder contractions precipitate nerve impulses that travel up the spinal cord to the pons and cerebral cores, where the pt experiences the need to void

A nurse collects data about a pt regarding risk for stress incontinence. Which is a major factor that contributes to this condition? 1. Decreased bladder capacity 2. Spinal cord disfunction 3. Cognitive impairment 4. Weak pelvic muscles

4. Weak pelvic muscles Stress incontinence is an immediate involuntary loss of urine during an increase of intra-abdominal pressure. It is related to weak or degenerated pelvic muscles and structural supports.

_______ of stone patients are at risk for stones again within _____.

50%, 5 years

Normal BUN is (Craven 1030)

8 to 25 mg per 100 mL

Teaching for a pt required to collect urine for 24 hours

A 24-hour urine specimen is required for accurate measurement of the kidney's excretion of substances (e.g., urine protein, creatinine, urobilinogen, uric acid, selected hormones) that the kidney does not excrete at the same rate throughout the day (Craven 1028) A 24-hour sample usually is started early in the morning, after the patient's first void. Instruct the patient to void until the bladder is completely empty. Discard this voided urine, and note the time as the beginning of the 24-hour period during which all urine will be saved. All voided urine is emptied into the 24-hour collection container, taking care not to splash, because the added preservative can be caustic. The large container should be refrigerated or placed in a bucket of ice during the 24 hours of collection. At the end of the 24 hours, ask the patient to empty his or her bladder, and add this urine to the collection container. (Craven 1028)

A patient has a nursing diagnoses of reflex incontinence related to micturition reflex. You recognize that your patient is which of the following? 1. An older adult who is a new resident at an assisted living facility and recently had an indwelling catheter removed 2. A 45-year-old patient with neurological impairment 3. An obese, 55-year-old, mother of four who is postmenopausal 4. A 52-year-old with an enlarged prostate

A 45-year-old patient with neurological impairment

COMPUTED TOMOGRAPHY (CT) -

A more reliable study for assessing for size and shape of the kidney and the presence of kidney tumors. Can be performed with or without contrast dye.

Bladder Ultrasound (BUS)

A noninvasive technology that can estimate the volume of urine in the bladder (Craven 1027)

Total Urinary Incontinence (NANDA)

A person experiences continuous, unpredictable loss of urine

When the kidneys are diseased, they are unable to excrete urea adequately and urea begins to accumulate in the blood, ________________ (Craven 1030)

causing BUN to rise.

BUS

Bladder Ultra Sound

You are planning post operative care for a 36 year old male that had a successful ileal conduit surgery. His past medical history includes a cystoscopy a two days ago. The next morning, his urine was collected from his drainage bag for inspection and urinalysis. Which of the following would be considered normal findings? Select all that apply. A. Specific Gravity is 1.045 B. Small amounts of mucus in drainage bag C. pH is 6 D. Urine is a blue-green E. All of the above

B. Small amounts of mucus in drainage bag C. pH is 6 D. Urine is a blue-green

Blood test related to urine

BUN Creatinine Tests for kidney disease

Filtration

Begins at the glomerulus. The renal arteries bring blood to the kidneys; the smaller branches of these arteries bring blood to the glomerulus of each nephron. The fluid that is filtered from the glomerulus into Bowman's capsule is called the glomerular filtrate. (Craven 1015)

S/S of Urolithiasis and nephrolithiasis are

Blocked urine flow Distention of renal pelvis and ureter UTI - fever, chills Intense, deep ache in the costovertebral region Nausea, vomiting Diarrhea and abdominal discomfort

A nurse has identified that the patient has overflow incontinence. What is a major factor that contributes to this clinical manifestation? 1. Coughing 2. Mobility deficits 3. Prostate enlargement 4. UTI

C. Prostate Enlargement An enlarged prostate compresses the urethra and interferes with the outflow of urine, resulting in retention. With urinary retention, the pressure within the bladder builds until the external sphincter temporarily open to allow a small volume (25 to 60 mL) of urine to escape (overflow incontinence)

Common Diuretics:

Chlorothiazide, Hydrochlorothiazide, Furosemide, Spironolactone, Triamterene Can Have Fun Surfing Today.

Urine Color

Color of urine ranges from a light yellow, to a darker yellow, to a dark yellow-brown, called amber. The patient's state of hydration affects the color. May be dark amber or orange-brown if it is very concentrated 2* to decreased fluid intake. May appear cloudy, dark reddish-brown, or streak with blood when a woman is menstruating (Craven 1016)

Urine culture or sensitivity

Culture and sensitivity tests can be performed on urine to identify any microorganism causing a UTI and to determine which antibiotics can kill the organism. (Craven 1029)

Reflex Urinary Incontinence (NANDA)

Person experiences involuntary loss of urine, occurring at somewhat predictable intervals when a specific bladder volume is reached

Urge Urinary Incontinence (NANDA)

Person experiences involuntary passage of urine after a strong urge to void

Urinary Retention (NANDA)

State in which a person experiences incomplete emptying of the bladder

Stress Incontinence (NANDA)

State where person experiences loss of less than 50 mL of urine with increased abdominal pressure

Risk factors for stones include:

Dehydration Genetic Disposition Catheterization

Medical management of Urolithiasis and nephrolithiasis:

Determine type to avoid nephron destruction Treat renal or ureteral colic Manage pain (Opiod, NSAIds) Reduce swelling Hot baths or moist heat Increase fluids Diet education

Cons of external catheter device

Dislodgment Leaking - causing skin breakdown

hydronephrosis

Distention of the kidney pelvis with urine secondary to the increased resistance caused by obstruction to normal urine flow. Unrelieved hydronephrosis can cause renal cell atrophy and necrosis, which can cause permanent kidney damage. (Craven 1019)

Anticholinergic effects

Dry mouth, dental caries, blurred vision, constipation, urinary retention.

Urine formation occurs by the processes of

filtration, reabsorption secretion.

A patient is having urine formation issues on his/her glomuerlus, which stage would this apply to? Reabsorbtion Metabolism Filtration Secretion

Filtration

4 factors that have a impact on elimination

Fluid intake Loss of body fluid Nutrition Body position Cognition Psychological issues (Craven 1018)

diuresis

Formation and excretion of large amounts of urine

Anuria

Formation and excretion of less than 100 cc of urine in 24 hours (Craven 1013)

Nephron

Functional unit of the kidney; consists of the glomerulus, Bowman's capsule, proximal convoluted tubules, loop of Henle, distal tubule, and collecting duct (Craven 1015) Each kidney has more than 1 million nephrons and each is capable of forming urine

Clean Catch Method of urine collection

GIRLS AND WOMEN Use two fingers to spread open your labia. Use the first wipe to clean the inner folds of the labia from the front to the back. Use a second wipe to clean (urethra) Keeping your labia spread open, urinate a small amount into the toilet bowl, then stop the flow of urine. Hold the urine cup a few inches from the urethra and urinate until the cup is about half full. You may finish urinating into the toilet bowl. BOYS AND MEN Clean the head of the penis with a sterile wipe. If you are not circumcised, you will need to pull back (retract) the foreskin first. Urinate a small amount into the toilet bowl, and then stop the flow of urine. Then collect a sample of urine into the clean or sterile cup, until it is half full. You may finish urinating into the toilet bowl.

Regent strips are dip-sticks used to detect what in urine?

Glucose Protein Ketones pH Occult blood

What two medications medications change the color of urine. (Craven 1021)

Henazopyridine Amitriptyline

A patient admitted to the hospital for severe fluid loss due to vomiting and diarrhea has for 2 consecutive hours had less than 30ml of urine output per hour as well as low arterial blood pressure. What could the nurse diagnose as one possible issue? Decreased Muscle Tone Urinary Tract Infection (UTI) Obstruction of Urine flow Hypotension

Hypotension

Reflex Urinary Incontinence treatments (Craven 1022)

In and out catheterization; alpha-adrenergic drugs to relax internal sphincter, baclofen to relax external sphincter

Bladder

Storage compartment for urine. It is a hollow, smooth muscle that lies behind the symphysis pubis when empty. In women, the bladder is located in front of the uterus and vagina. In men, the bladder is located in front of the rectum and above the prostate gland. (Craven 1015)

intermittent catheritization

In-and-out catheterization on a routine, scheduled basis for a particular client

Functional Urinary Incontinence (NANDA)

Inability of a normally continent person to reach the BR in time to avoid unintentional loss of urine

Cytoscopy

Insertion of a tube into the bladder for the purpose of direct visualization. A cystoscope is a flexible tube that can be inserted into the urethra and guided into the bladder. A light at the end of the cystoscope allows the physician to look for abnormalities such as tumors, stones, or structural problems (Craven 1030)

enuresis

Involuntary voiding with no underlying pathophysiologic origin after the age that bladder control is usually achieved nocternal version is called "bedwetting" (Craven 1013)

Stress Incontinence (Craven 1022

Kegel exercises, weight loss if obese, vaginal pessary, estrogen vaginal creams, male external catheters, surgery

Treatment for urinary retention

Keigle muscle Schedule every 2 hours Fluid intake

Pros of external catheter device

Lower risk of UTI

Diuretic

Medication that are administered to increase urine output

A 55 year old female is being assessed with complaints of oliguria. Which influences would affect her urinary elimination? Medications Decrease in perineal muscles Fluid intake Diaphoresis

Medications Fluid intake Diaphoresis

Catheterized Patient urine output

Minimum of 30 mL per hour

Ureters

Narrow (1.25 cm), smooth muscle tubes that serve as passageways for urine to flow from the kidneys to the bladder. Peristaltic movement in the ureters propels urine toward the bladder. (Craven 1015)

ULTRASONOGRAPHY -

Noninvasive scan used to estimate kidney size and position. It is not as useful in detecting masses or tumors of the kidney.

Urine pH range is

Normal: 6 Range: 4.6-8 (Craven 1029)

5 types of incontinence

Stress Urge Reflex Functional Total

Urinary diversion

Surgical procedure in which the normal pathway of urine elimination is altered (Craven 1024)

Cystectomy

Surgical removal of all or part of the urinary bladder

Which of the following usually presents itself first in a patient with increased production of ADH (antidiuretic hormone)? Dysuria Polyuria Oliguria Enuresis

Oliguria

Dysuria

Painful voiding

polyuria

formation and excretion of large amounts of urine in the absence of a concurrent increase in fluid intake

Measures to promote voiding:

Privacy Increase fluids Time & timing Cues Relaxation Environment Medication Positioning

MAGNETIC RESONANCE IMAGING (MRI)

Provides three-dimensional images. Patients who are allergic to contrast dye or who need a more detailed image of the kidneys and blood vessels would benefit from this scan. (Craven 1030)

Specific gravity (Craven 1029)

Range: 1.015-1.025 <1.015: ↑ Fluid intake; diuretic therapy, diabetes insipidus, renal diseases >1.025: ↓ Fluid intake, ↑ fluid loss (vomiting, diarrhea, fever), ADH secretion (trauma, stress)

Abnormal findings on perineum inspection

Reddened, inflamed skin surrounding the urinary meatus and purulent discharge. (Craven 1027)

oliguria

formation and secretion of less than 500 mL of urine in 24 hours

Palpation of the bladder

Should start at the level of the umbilicus and move in a downward direction toward the symphysis pubis to detect bladder distention. Use the fingertips of both hands to palpate in an attempt to feel the top edge of the bladder. (Craven 1027)

Detrusor Muscle

Smooth Muscle of Urinary bladder

overactive bladder

frequency and urgency to urinate occurring together

Urethra

The exit passageway for urine from the bladder. In women, the urethra is short, about 3 to 5 cm (1 to 2 inches), a factor that increases the opportunity for bacteria to enter the urinary system. In men, the urethra is longer, about 20 cm (8 inches), and serves to transport both semen and urine. (Craven 1015)

Recommendations for prevention of CAUTI

The longer an indwelling catheter remains in the bladder, the greater the chance of nosocomial infection. The CDC recommends removal of indwelling catheters within 24 hours postoperatively whenever possible (Craven 1020)

Urine odor

The odor of freshly voided urine is typically described as aromatic. Collected urine that has been sitting unemptied for a long period may have a strong ammonia scent. Medications and certain foods can alter urine's odor. A strong, offensive odor is not normally present in urine that is free from infection. (Craven 1016)

Typical OUTCOME IDENTIFICATION AND PLANNING for urinary dysfunction: (Craven 1032)

The patient will: - reestablish control over voiding. - completely empty bladder with each void. - strengthen or maintain adequate perineal muscle control. - verbalize understanding of procedures necessary to promote optimal urinary function.

Cystocele

The protrusion or herniation of the bladder into the vaginal canal; produces symptoms of stress incontinence, frequency, dribbling, and inability to empty the bladder completely. (Craven 1020)

A 71 year old male presents to the emergency department with acute sudden confusion. Vitals signs are blood pressure 153/97, pulse 88, respiration 22, temperature 98.7, height 70 inches and weight 141 lbs. What test can the nurse first anticipate preparing or collecting to identify any urine abnormalities? Urine culture and sensitivity Reagent strip (dipstick) testing Computed tomography Cystoscopy

Urine culture and sensitivity

urgency

The subjective feeling of being unable to delay voiding voluntarily. Urgency implies a strong micturition reflex caused by inflammation or infection of the urethra or bladder, incompetent urethral sphincter, weak perineal muscle control, or psychological stress. (Craven 1022)

Reabsorption

The tubule actively and passively reabsorbs substances that the body wants to retain. These substances include varying amounts of water and electrolytes (Na+, K+, Cl−, and HCO3−) as well as all glucose and amino acids. Reabsorption occurs mostly in the proximal convoluted tubule but also in the distal and collecting tubules. The tubules reabsorb almost 99% of the glomerular filtrate. The 1% that remains unabsorbed forms urine. (Craven 1015)

Kidneys

The two kidneys are located on the posterior abdominal wall, in front of and on either side of the vertebral column between the 12th thoracic and 3rd lumbar vertebrae. Each kidney is enclosed by a fibrous capsule and supported by a mass of adipose tissue (Craven 1015)

Urge Urinary Incontinence treatments (Craven 1022)

Timed voiding schedule, anticholinergic drugs

Total Urinary Incontinence treatments: (Craven 1022)

Toileting routine verbal reminders, external catheters for men, absorbent products, excellent skin care and hygiene

Functional Urinary Incontinence treatments: (Craven 1022)

Toileting routine, verbal cuing reminders with assistance to bathroom, alteration of environment for easy access to bathroom, clothing that is easy to remove

Examples of anticholinergic drugs are:

Tricyclic antidepressants Antihistamines

Secretion

Tubules secrete some substances to rid them from the body. They secrete varying amounts of H+ and K+ ions as well as ammonia, creatinine, uric acid, and other metabolites. (Craven 1015)

Urine Clarity

Urine is normally transparent. May contain mucus. If it sits it may get cloudy.

How are Urolithiasis and nephrolithiasis detected:

Urogrpahy Retrograde pyelography Xray

Clinical manifestations of UTI

Voiding is painful and more frequent. Urine becomes abnormal, containing pus (pyuria) and blood (hematuria). Ultimately, if the infection ascends to the kidney, renal damage can occur. (Craven 1019)

Causes of urinary retention

Weak detrusor muscles Inhibition of reflex arc Blockage Strong Sphincter

When assessing a patient at risk for stress incontinence. What are the factors that lead to this condition? Weakness in pelvic muscle Lumbar spinal cord injury Urinary obstruction Urinary tract infection

Weakness in pelvic muscle

Catheter-associated urinary tract infection (CAUTI)

When a patient develops a UTI while an indwelling urinary catheter is in place or within 7 days of catheter removal Caused by a biofilm that develops on the catheter surface that reduces effectiveness of antibiotics (Craven 1019-1020)

Why is a woman at a higher risk for urinary incontinence over a man?

Women are twice the risk of men - which is related to decreased estrogen levels and weakened perineal muscles (Craven 1017)

Why does a woman have a greater chance of developing a UTI over a man?

Women have a shorter urethra than men do, which cuts down on the distance that bacteria must travel to reach a woman's bladder.

Collection of urine from a catheter - Sterile or not?

Yes Asepsis should be used to prevent microorganisms from entering bladder

When performing continuous bladder irrigation,________________ catheter must be in place. (Craven 1041)

a triple-lumen indwelling urethral

Urodynamic studies are used to detect ____________ or voiding. (Craven 1030)

abnormalities in bladder function

urinary retention is increased with medications having (Craven 1021)

anticholinergic effects

If the reflex arc is injured, the bladder may fill without the bladder stretch contraction mechanism working, resulting in urinary retention. This condition is called _____ _______ _________. (Craven 1020)

autonomous neurogenic bladder

Mrs. Smith is 80 years old. She's goes to the clinic complaining of back pain and frequent painful urination. Her temperature is 100.2F. What question would you ask to assess FIRST? a) Does your pain radiate? b) What symptoms seem to cause it or make it worse? c) How much pain are you feeling now? d) On what date did the symptoms first occur?

b) What symptoms seem to cause it or make it worse?

Henazopyridine (Pyridium) causes urine to turn ___________.

bright orange

A 78 year old male presents to the ER with pain while urinating, difficulty urinating, and shortness of breath. Based on the data collected, what is the nurse's initial response for this patient? Data collected: BP: 139/59, HR: 101, Respirations: 28, SpO2: 83% Pain 8/10: while urinating, Urine pH: 8.2, Specific Gravity: 1.028 a) Retake the Blood Pressure and call the Physician if it is still elevated? b) Evaluate the Patient for fluid loss (vomiting, diarrhea), due to the increased specific gravity level? c) Place the Patient on Oxygen, evaluate for possible code. d) Call the physician with the concerns of a possible UTI or metabolic alkalosis due to the increased pH level.

c) Place the Patient on Oxygen, evaluate for possible code.

A 75 year old female is presenting with dehydration and acute delirium. A urinalysis is done and the results are as follows, pH: 8.7 turbidity: cloudy RBC: Based on these findings, what recommendation would the nurse make? a) These findings are normal, patient should drink plenty of water and rest b) These findings are abnormal, patient should be given IV fluids for dehydration and an antibiotic for a urinary tract infection c) The pH is normal and turbidity isn't too bad but the RBC count is high. Further tests should be done d) These findings are inconclusive, a neurological exam should br done to rule out a CVA or TIA

c) The pH is normal and turbidity isn't too bad but the RBC count is high. Further tests should be done

Never ________ a nephrostomy tube; doing so would cause ________ that could result in renal damage. (Craven 1042) Craven, Ruth F. Fundamentals of Nursing: Human Health and Function, 7th Edition. Wolters Kluwer Health, 02/2012. VitalBook file.

clamp, backup of urine

Removal of the indwelling urethral catheter is a simple procedure performed with ________ technique (Craven 1041)

clean

Urinalysis is the most common urine screening to provide data about:

color, turbidity, pH, and specific gravity protein, glucose, ketones, red blood cells, white blood cells, bacteria, casts. (Craven 1029)