urinary elimination
A nurse is caring for an older bedridden male client who is incontinent of urine. Which action should the nurse take first? Restrict fluid intake. Offer the urinal regularly. Apply incontinence pants. Insert an indwelling urinary catheter.
Offer the urinal regularly.
physical assessment of bladder
looking for distention -may need bladder scanner depending on size/weight of patient
nephrostomy tube
most common diversion type -directly inserted into kidney -small catheter with 2 small bags if one in each kidney (may just be in one)
care of client with urinary diversion
-inspect stoma regularly -keep skin around stoma clean and dry -measure intake and output -watch for mucous in the urine from an ileal conduit -explain each aspect of care to the client and encourage the client to participate -educate about home treatment
indwelling urethral catheter
-used when continuous draining needed -designed using an inflated balloon so that it does not slip out of the bladder -can have forever; replaced monthly -patients who have to have one all the time, if active may have bag that can be hidden
A client has been admitted with a urinary tract infection. The nurse receives a urine culture and sensitivity report that reveals the client has vancomycin-resistant enterococci (VRE). After notifying the healthcare provider, which action should the nurse take to decrease the risk of transmission to others? Insert a urinary catheter. Initiate droplet precautions. Move the client to a private room. Use a high-efficiency particulate air (HEPA) respirator during care.
Move the client to a private room.
assessment of urethral meatus
note any discharge, inflammation, and lesions
urethra
urine travels from the bladder and exits through the urethral meatus
intermittent urethral catheters
used to drain the bladder for shorter periods (5-10 mins)
removal of indwelling catheter
want to remove catheter ASAP -should not cause any pain or discomfort to remove -monitor voiding--should within first few hours of removal (dont want to recath) -increase fluid intake
An older adult male is discharged after treatment for urinary tract infection. The family members are instructed regarding age-related changes and care to be taken. In the follow-up visit, which statement made by the client's family indicates decreased risk of urinary retention in the client? <p>An older adult male is discharged after treatment for urinary tract infection. The family members are instructed regarding age-related changes and care to be taken. In the follow-up visit, which statement made by the client’s family indicates decreased risk of urinary retention in the client?</p> "I ensure he sips water just before bed." "I respond immediately when he indicates a need to void." "I provide privacy and assistance to him to void." "I encourage him to use the urinal at least every 2 hours."
"I provide privacy and assistance to him to void."
urinary tract infection
A bacterial infection of the urethra, the tube leading from the bladder to the body exterior. -can result from catheterization or procedure -one of most common health care acquired infections, commonly caused by instrumentation of urinary tract
Despite receiving 2900 mL intake for 2 days, the client's urine output has progressively diminished. The nurse identifies that the urinary output is less than 40 mL/hr over the past 3 hours. What action will the nurse take? Assess breath sounds and obtain vital signs. Decrease the intravenous flow rate and increase oral fluids. Insert an indwelling catheter to facilitate emptying of the bladder. Check for dependent edema by assessing the lower extremities.
Assess breath sounds and obtain vital signs.
A urine specimen is needed to test for the presence of ketones in a diabetic client. What should the nurse do when collecting this specimen from a urinary catheter? Disconnect the catheter, and drain the urine into a clean container. Clean the drainage valve, and remove the urine from the catheter bag. Wipe the catheter with alcohol, and drain the urine into a sterile test tube. Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine.
Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine.
A residual urine test is prescribed for a client with benign prostatic hyperplasia. What should the nurse instruct the client to do? Void after a urinary catheter is removed. Collect a specimen of urine during midstream. Attempt to void when a urinary catheter is in place. Empty the bladder before a urinary catheter is inserted.
Empty the bladder before a urinary catheter is inserted.
A client with limited mobility is being discharged. To prevent urinary stasis and formation of renal calculi, what should the nurse instruct the client to do? Increase oral fluid intake to 2 to 3 L/day. Maintain bed rest after discharge. Limit fluid intake to 1 L/day. Void at least every hour.
Increase oral fluid intake to 2 to 3 L/day.
A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the primary healthcare provider. What should the nurse do to help prevent the client from developing a urinary tract infection? Assess urine specific gravity. Collect a weekly urine specimen. Maintain the prescribed hydration. Empty the drainage bag once a day
Maintain the prescribed hydration.
The nurse is caring for a client in the postanesthesia care unit. The client had a suprapubic prostatectomy for cancer of the prostate and has a continuous bladder irrigation (CBI) in place. Which primary goal is the nurse trying to achieve with the CBI? Stimulate continuous formation of urine. Facilitate the measurement of urinary output. Prevent the development of clots in the bladder. Provide continuous pressure on the prostatic fossa.
Prevent the development of clots in the bladder.
What is the most important intervention to prevent hospital-acquired catheter-associated urinary tract infections (CAUTIs)? Removing the catheter Keeping the drainage bag off of the floor Washing hands before and after assessing the catheter Cleansing the urinary meatus with soap and water daily
Removing the catheter
The older adult client with a weakened urinary sphincter is at risk for which condition? Bladder distention Skin irritation Tendency to fall or trip over objects Urinary retention
Skin irritation
A primary healthcare provider prescribes a urinalysis for a client with an indwelling catheter. To ensure that an appropriate specimen is obtained, the nurse would obtain the specimen from which site? Tubing injection port Distal end of the tubing Urinary drainage bag Catheter insertion site
Tubing injection port
The nurse provides discharge instructions to a male client who had an ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). For which indicators of a UTI should the nurse instruct the client to be on the alert? Urgency or frequency of urination An increase of ketones in the urine The inability to maintain an erection Pain radiating to the external genitalia
Urgency or frequency of urination
The nurse is caring for an older adult client. Which genitourinary factor that contributes to urinary incontinence in older adults should the nurse consider when planning care? Sensory deprivation Urinary tract infection Frequent use of diuretics Inaccessibility of a bathroom
Urinary tract infection
urinary retention
accumulation of urine due to inability of bladder to empty -patient may feel pressure or discomfort -restlessness -diaphoresis
nursing care for patients with indwelling catheters
always hang bag below the level of the bladder on the bed frame or a chair so urine will drain down out of the bladder (prevents backflow) -bag should never touch the floor to prevent accidental contamination during emptying -keep the drainage system patent
psychological factors affecting urination
anxiety, emotional stress, and privacy issues
pre-renal
decreased blood flow to and through the kidneys
specific gravity test
dehydration or over hydration
specific diseases that affect urination
diabetes mellitus, MS, BPH, Alzheimer's disease, Parkinson's disease, degenerative joint disease
urine culture and sensitivity
diagnostic lab procedure that identifies the strand of bacterial infection and determines the best antibiotic to treat it -always start antibiotic before labs are back just in case you guess right
renal
disease condition of the renal tissue
urinary diversions
diversion of urine to external source
invasive exammination
endoscopy-cystoscopy -arteriogram (angiogram)
physical assessment of kidneys
flank pain (lower back) may occur with infection or inflammation
fever causes...
highly concentrated, but reduced urine volume
mucous in urine after first few days of diversion indicates...
infection
assessment of urine
intake and output -color: pale-straw to amer -clarity: transparent unless pathology is present ---common to have sediment/floaters with foley baths -odor: ammonia in nature (sweet or fruity indicates diabetes)
urinary incontinence
involuntary leakage of urine **not normal process of aging, but seen often in elderly
post-renal
obstruction in the lower urinary tract that prevents urine flow from the kidneys
factors affecting urination
pathological reasons can be acute (reversible) or chronic(irreversible) (pre-renal, renal, post-renal)
kidneys
remove waste from the blood to form urine
bladder
reservoir for urine until the urge to urinate develops
ureters
transport urine from the kidneys to the bladder
urinalysis
overall picture (infection, RBC, or WBC present)
indications for use of bladder scanner
urinary frequency -absent or deceased urine output -bladder distention -inability to void -establishing intermittent catheterization schedule
post void residual
use scanner, have patient void, then scan again to see how much urine left bladder (non-invasive)
specimens are collected from indwelling catheters by
using a special port in the tubing (dont open drainage system)
A registered nurse is teaching a nursing student about how to safely use a urinary catheter. Which statement made by the nursing student indicates ineffective learning? "I will avoid the pooling of urine in the tubing." "I will avoid prolonged clamping of the tubing." "I will avoid draining urine from the tubing before ambulation." "I will avoid raising the drainage tube above the level of the bladder."
"I will avoid draining urine from the tubing before ambulation."
To help prevent a cycle of recurring urinary tract infections in a female client, which instruction should the nurse share? "Urinate as soon as possible after intercourse." "Increase your daily intake of citrus juice." "Douche regularly with alkaline agents." "Take bubble baths regularly."
"Urinate as soon as possible after intercourse."
A nurse provides discharge teaching related to intermittent urinary self-catheterization to a client with a new spinal cord injury. Which instruction is most important for the nurse to include? "Wear sterile gloves when doing the procedure." "Wash your hands before performing the procedure." "Perform the self-catheterization every 12 hours." "Dispose of the catheter after you have catheterized yourself."
"Wash your hands before performing the procedure."
Which actions should the nurse perform while collecting subjective data from a client during a focused urinary assessment? Inquire about painful urination Ask the client about changes in characteristics of urination Assess the levels of blood urea nitrogen and creatinine Palpate the abdomen for bladder distention or masses Inspect the urinary meatus for inflammation or discharge
-Inquire about painful urination -Ask the client about changes in characteristics of urination
An older adult in an acute care setting is having urinary incontinence. Which interventions would help the client? Provide nutritional support Provide voiding opportunities Avoid indwelling catheterization Provide beverages and snacks frequently Promote measures to prevent skin breakdown
-Provide voiding opportunities -Avoid indwelling catheterization -Promote measures to prevent skin breakdown
noninvasive examination
-bladder scanner -abdominal xray -CT scan abdomen -IVP(intravenous pyelogram) -renal US
catheterization schedule
-every few hours -if a patient cant empty bladder normally, may straight Cath themselves (at home as well) -helps develop routine fro patient to have
Which findings in the older client are associated with a urinary tract infection (UTI)? Fever Urgency Confusion Incontinence Slight rise in temperature
Confusion Incontinence Slight rise in temperature
While reviewing the result of an intravenous pyelogram, the nurse discovers that the client has a shortened urethra. The client also complains of urinary incontinence. Which nursing intervention is beneficial for the client? Providing thorough perineal care after each voiding Encouraging the client to use the toilet or bedpan every 2 hours Responding quickly to the client's indication of the need to void Providing privacy, assistance, and voiding stimulants over the perineum
Providing thorough perineal care after each voiding
A nurse is caring for a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) in the urine. The healthcare provider orders an indwelling urinary catheter to be inserted. Which precaution should the nurse take during this procedure? Droplet precautions Reverse isolation Surgical asepsis Medical asepsis
Surgical asepsis
A nurse is providing care to a client 8 hours after the client had surgery to correct an upper urinary tract obstruction. Which assessment finding should the nurse report to the surgeon? Incisional pain Absent bowel sounds Urine output of 20 mL/hr Serosanguineous drainage on the dressing
Urine output of 20 mL/hr (should be at least 50)
hematuria
blood in the urine -may see just with eyes, or need lab to tell -just have to treat whatever is causing it
A client comes to the emergency department because of minimal urinary output despite drinking adequate fluid. The client's blood pressure is 190/94 mm Hg. For what additional clinical manifestation associated with this data should the nurse assess the client? Thirst Weight gain Urinary retention Urinary hesitancy
Weight gain
symptomatic infection of bladder can lead to
a serious upper UTI (pyelonephritis) and life-threatening bloodstream infection (bacteremia or urosepsis) --treat with antibiotics
physical assessment of skin/ mucosal membranes
assess hydration of -turgor: tented or resilient? -texture: dry and flaky? -muc. mem. in mouth should be pink and moist
if sampling from Foley catheter...
collect sample from actual port in Cath tubing, not bag
