URINARY
What is a common cause of urinary retention?
- BPH
What are some pathological factors that affect voiding?
- BPH -
What are conditions often present with POLYURIA?
- Diabetes - Metabolic Ketoacidosis
What is considered chronic urinary incontinence?
- Stress - Urge - Reflex - Retention with overflow (BPH) - Functional (connected to cognitive/physical impairment- Alzheimers)
Why are women more prone to urinary tract infections?
- Urethra is short - Proximity of the urinary meatus to the vagina/anus
What passes through the pelvic floor?
- Vagina - Urethra - Rectum
What are some surgical factors that affect voiding?
- abdomen surgery
What are some Fluid and food intake factors that affect voiding?
- alcohol intake - caffeine intake - Sodium intake - Diuretics - Antihistamines
What kind of psychosocial circumstances can hinder or not allow a client to stimulate the micturition reflex?
- anxiety - muscle tension - lack of privacy - abnormal position - insufficient time - perceived time pressures
Older adults who's cognition has been impaired may not:
- be aware of their need to urinate - be able to respond to the urge by seeking toilet facilities
What can weaken the pelvic floor muscles?
- childbirth - pregnancy - chronic constipation - decreased estrogen (menopause) - Obesity - aging - lack of general fitness
What are the names of some meds that affect urination?
- ex-lax - lasix - diprivan - diuretics (increased sodium execretion)
Why may cause incontinence in older adults?
- mobility problems - neurologic impairments
What are some psychosocial factors that affect voiding?
- position of pt - anxiety
What should never be found in the urine?
- proteins - keytones - blood - glucose
What causes a decrease in renal blood flow?
- reduced cardiac output - vascular changes
What are some muscle tone factors that affect voiding?
- stretch and contractility - Iatrogentically - long-term catheter use (bladder doesn't expand the way it should)
At what approximate age can a child begin to control the urge to urinate, and communicate their need to empty the bladder, and perceive bladder fullness?
2 1/2- 3 years of age
What percent of cardiac output (blood) passes thru kidneys every minute?
21%
How much of nephrons are lost by 80 years of age?
30%
What is the normal bladder capacity?
300-600mL
When do kidneys reach their maximum size?
35-45 years of age
What is considered acute urinary incontinence?
6 months of less
What prevents backflow reflux of urine up the ureters?
A flaplike fold of mucous membrane at the junction between ureter and bladder
How much do most people void a day?
About 4-6x a day
When do the kidneys begin to diminish in size and function?
After 50 years of age
Why are females more prone to UTIs?
Because our urethra is SHORTER than males and closer to the vagina
Where is the female urinary meatus located?
Between the labia minora and just below the clitoris
How are the ureters shaped?
Curved
Which muscle allows the bladder to expand as it fills with urine?
Detrusor muscle
What causes residual urine in the bladder?
Diminished bladder muscle tone/contractility
Why is voluntary urinary control absent during the infant stage?
Due to neuromuscular immaturity
When does most renal growth occur?
During the first 5 years of life
Pain or difficult urination
Dysuria
T or F UTIs are more frequently found in young infant girls
FALSE
True of False The bladder is incapable of distending because of its mucous membrane lining
FALSE
T or F Bladder contractibility increases in older adults
False
What is involuntary urination called?
INCONTINENCE
Involuntary urination is only "normal" in which population?
INFANTS
Where does the bladder lie in men?
In front of rectum and above prostate gland
Where does the bladder lie in women?
In front of the uterus and vagina
Ignoring the urge to void can result in:
Increased risk of UTI
Residual urine in the bladder after voiding can result in:
Increased risk of bacterial growth and infection
During which stage is urine minimal because of immature kidneys?
Infant stage
What is under involuntary control in the pelvic floor?
Internal Sphincter and bladder neck
From the renal pelvis where does urine move next?
Into the ureters
What happens if there is injury to any part of relating to the urinary system results in what?
Involuntary emptying of the bladder (incontinence)
Where does the urethra extend to?
It extends from the bladder to the urinary meatus
Is stress incontinence related to stress?
NO
Should blood ever be in urine?
No, NOT normal
Low amounts of urine- less than 30ccs/hr
OLIGURIA
During which stage does decreased renal blood flow occur?
Older adults stage
During which stage does the ability to concentrate urine decline?
Older adults stage
Where do the adrenal glands sit?
On top of each kidney
Large amounts of urine
POLYURIA
Which lab value represents the concentration of the urine?
SPECIFIC GRAVITY
Normal color of urine:
STRAW TO AMBER
What is the most common type of urinary incontinence?
Stress Urinary Incontinence
What is considered to be the organ of excretion?
THE BLADDER
What muscle stores and excretes urine?
THE BLADDER
Where do the lower ends of the ureters enter?
THE BLADDER (posterior or corners of bladder floor)
What are the primary regulators of fluid and acid and balance in the body?
THE KIDNEYS
Which organ is highly dependent on blood flow?
THE KIDNEYS
T or F Bladder muscle tone diminished in older adults
TRUE
True or False The bladder wall holds considerable elasticity
TRUE
True or False Both men and women's urethra have a mucous membrane lining continuous with bladder and ureters
TRUE
Where is urine formed?
The Kidneys
What consists of sheets of muscles and ligaments, providing support to the viscera of the pelvis
The Pelvic Floor
What is located at base of bladder marked by ureter openings at the posterior corners and opening of the urethra at inferior corner?
The Trigone
What serves as a reservoir for urine?
The bladder
What happens of the time and place are appropriate to urinate what happens?
The conscious portion of the brain relaxes the external urethral sphincter muscle and the person urinates
Where does most shrinkage occur in the kidney?
The cortex
Which muscle contracts to release urine to the outside of the body during voiding?
The detrusor muscle
Where is the male meatus located?
The end of the penis
What allows an individual to choose when to urinate?
The external sphincter
What is under voluntary control in the pelvic floor?
The external sphincter
What serves ONLY as passageway for urine?
The female urethra
What the primary regulators of acid base balance?
The kidneys
What serves as a passageway for semen AND urine?
The male urethra
What happens of the time and place are inappropriate to urinate what happens?
The micturition reflex usually subsides until the bladder becomes more filled and the reflex is stimulated again
What part of the kidneys filter blood and remove metabolic wastes?
The nephrons
What needs to be intact in order to facilitate the voluntary control of urination?
The nerves supplying the bladder/urethra, the neural tracts of the cord/brain, and the motor area of the cerebrum
What do the terms micturition and voiding refer to?
The process of emptying the urinary bladder
What happens after the stretch receptors are stimulated?
The stretch receptors send impulse to spinal cord, specifically the voiding reflex center an cause internal sphincter to relax stimulating urge to urinate
What is the highest that a bladder can extend to in an extreme situation?
The umbilicus
Where can an infection of the urethra extend to?
Thru the urinary tract all the way to the kidneys
What is the second most common infection in children?
UTIs
Until when does urine collect in the bladder?
Until pressure stimulates stretch receptors (special sensory nerve endings in bladder)
Strong desire to void but may not have enough urine in the bladder
Urgency
The bladder overfills and urine leaks out due to pressure on the urinary sphincter
Urinary Incontinence
What is one of the #1 sources of hospital acquired infections?
Urinary catheters
From the kidneys where does urine move to next?
Urine moves thru collecting ducts into calyces of renal pelvis
At what age does kidney efficiency GREATLY increase?
after 2 years of age
When does FULL urinary control occur?
at 4-5 years old
Where does the female urethra lie?
directly behind the symphysis pubis, anterior to vagina
What does urinary elimination depend on?
effective functioning of: -upper urinary tracts kidneys & ureters -lower urinary tracts urinary bladder, urethra, and pelvic floor
During infant stage describe urine
odorless and colorless
Nocturia is when:
person voids 2 or more times per night
When are the stretch receptors in the bladder usually stimulated?
when bladder fills with 250-450 mL of urine (adults) or 50-200mL (children)