Fundamentals - Urinary Elimination

Medications Affecting Color of Urine Teach patient what is expected

- Anticoagulants: pink or red urine-report to HCP - Diuretics: pale yellow urine - Phenazopyridine (Pyridium): orange to orange-red urine - amitriptyline (Elavil): green or blue-green urine - Levodopa: brown or black urine

Urinary Tracts

- Maintain composition and volume of body fluids - Filter and excrete blood constituents not needed; retain those that are needed - Excrete waste product (urine) - Nephrons remove the end products of metabolism and regulate fluid balance. - Urine from the nephrons empties into the kidneys. Bladder - Smooth muscle sac innervated by ANS - Serves as a reservoir for urine - Composed of three layers of muscle tissue called detrusor muscle - Sphincter guards opening between urinary bladder and urethra - Urethra conveys urine from bladder to exterior of body

Planned Patient Goals

- Produce sufficient quantity of urine to maintain fluid, electrolyte, and acid-base balance. - Empty bladder completely at regular intervals without discomfort. - Provide care for urinary diversion and know when to notify physician. - Develop plan to modify factors contributing to current or future urinary problems. - Correct unhealthy urinary habits.

Types of urinary incontinence

- Transient: appears suddenly and lasts 6 months or less - Mixed: urine loss with features of two or more types of incontinence - Overflow: over-distention and overflow of bladder - Functional: caused by factors outside the urinary tract - Stress urinary incontinence: caused by increased abdominal pressure, e.g., sneezing or coughing - Reflex: emptying of the bladder without sensation of need to void - Total: continuous, unpredictable loss of urine

kidney stones

- calyeal stone - renal pelvic stone - upper ureter stone

what puts you at risk for UTI

- people of any age can get UTIs - more women get UTIs than men - need a tube to drain their bladder (catheter) - diabetes or problems with the body's natural defense system - urinary tract abnormalities that block the flow of urine - spinal cord injuries or other nerve damage

The nurse is preparing to assess a client's postvoid residual using a bladder scanner. Arrange the following steps in the correct order. - verify that screen corssbars fall within bladder image. - observe and record the volume measurement on the screen. - position scanner head with directional arrow pointing to the head - Press scanner head onto the skin 1 to 1.5 inches above the symphysis pubis - Aim scanner head toward coccyx and activate scan

- position scanner head with directional arrow pointing to the head - Press scanner head onto the skin 1 to 1.5 inches above the symphysis pubis - Aim scanner head toward coccyx and activate scan - verify that screen corssbars fall within bladder image. - observe and record the volume measurement on the screen. Follow these steps when preparing to asses a client's postvoid residual using a bladder scanner. Pressing the gender button after turning on the machine is critical as a first step.

Patients at Risk for UTIs

- pregnancy - menopause - chronic health conditions - birth control - menopause - sexual activity - personal hygiene

2 kinds of bed pans

- regular bedpan - fracture pan

Measuring Urine Output

-Ask patient to void into bedpan, urinal, or specimen container in bed or bathroom. -Pour urine into appropriate measuring device. -Place calibrated container on flat surface and read at eye level. -Note amount of urine voided and record on appropriate form. -Discard urine in toilet unless specimen is needed.

using the nursing process

-Assessing data about voiding patterns, habits, past history of problems (duration and severity of factors, patient's perception, adequacy of self-care) -Physical examination of urinary system, skin hydration, urine -Correlation of these findings with results of procedures and diagnostic tests

urine specimens

-Routine urinalysis -Clean-catch or midstream specimens -Sterile specimens from indwelling catheter -24-hour urine specimen -Specimens from infants and children

A nurse is planning on obtaining a urinary specimen from a patient's closed urinary system. Identify the sequence of steps the nurse should take. Arrange the following steps in the proper order. - Insert a 10 mL syringe & needle into the port - Transfer the urine to a sterile specimen container - Withdraw 5 mL of urine - Wipe the port w/ an alcohol swab - Transport the specimen to the lab

1. Wipe the port w/ an alcohol swab 2. Insert a 10 mL syringe & needle into the port 3. Withdraw 5 mL of urine 4. Transfer the urine to a sterile specimen container 5. Transport the specimen to the lab

A nurse is instructing the patient regarding collection of stool specimens for fecal occult blood testing. Which of the following should the nurse instruct the patient to avoid a few days before and during the testing period to reduce the risk of false-positive results? A) Poultry B) Vitamin E supplements C) Yogurt D) Calcium supplements

A) Poultry. Red meat, poultry, seafood, and some raw vegetables can cause false positive fecal occult blood testing results.

A nurse is caring for a patient who has a suspected UTI. Which of the following results should indicate to the nurse the presence of a UTI? A) WBC count of 8,000/mm3 B) trace amount of protein C) specific gravity of 1.010 D) pH of 6.0

A) WBC count of 8,000/mm3. A WBC count about the expected reference range of 0-4,000/mm3 indicates UTI.

A nurse is teaching a patient about home collection of a stool specimen for fecal occult blood testing. Which of the following instructions should the nurse provide? A) obtain specimens from 3 different stools B) eat a diet low in fiber and residue C) avoid foods that are high in fat D) refrigerate the specimen card after obtaining the first sample

A) obtain specimens from 3 different stools. The three specimens must be taken from three separate, consecutive bowel movements.

Tell whether the following statement is true or false. Diuretics cause increased urine production, resulting in the need for increased urination and possibly urge incontinence. A. True B. False

A. True Diuretics cause increased urine production, resulting in the need for increased urination and possibly urge incontinence.

A nurse who is preparing to insert a straight urinary catheter for a male should -Grasp the penis at its base -Apply light traction to the penis -Hold the penis parallel to the patient's body -Lift the penis to a 45 degree angle to the patient's body

Apply light traction to the penis

A nurse caring for a group of patients in an ambulatory care clinic is collecting urine for several prescribed diagnostic tests. For which of the following tests is a random sample voided into a clean cup appropriate? A) urine culture and sensitivity B) routine urinalysis C) urine creatinine clearance D) urine pregnancy

B) routine urinalysis. Routine urinalysis can be done on a random clean voided specimen collected during normal voiding into a clean urine cup.

A nurse is collecting a blood specimen for culture from a patient hospitalized for pneumonia. During this procedure, the nurse should A) keep the tourniquet in place from selection of the vein to completion of the collection B) rub the pt's arm at the selected site prior to venipuncture C) elevate the pt's arm above heart level for venipuncture D) puncture the selected vein while the antiseptic solution is still visible on the skin

B) rub the pt's arm at the selected site prior to venipuncture. Stroking the arm from the distal area to the proximal area below the proposed site can help dilate the vein, but vigorous rubbing should be avoided due to the potential for injury.

Tell whether the following statement is true or false. There are no interventions effective for preventing urinary incontinence. A. True B. False

B. False Rationale: There are appropriate interventions effective for preventing urinary incontinence.

Tell whether the following statement is true or false. A urine specimen from a patient with an indwelling catheter should be obtained from the collection receptacle. A. True B. False

B. False A urine specimen from a patient with an indwelling catheter should be obtained from the catheter itself.

Is the following statement true or false? An intermittent urethral catheter, or straight catheter is used when a catheter is to remain in place for continuous drainage. A. True B. False

B. False Intermittent urethral catheters or straight catheters, are used to drain the bladder for short periods (5 to 10 minutes). If a catheter is to remain in place for continuous drainage, an indwelling urethral catheter is used.

Tell whether the following statement is true or false. Normal fresh urine has an ammonia odor. A. True B. False

B. False Normal fresh urine has an aromatic odor. As urine stands, it often develops an ammonia odor because of bacterial action.

A nurse is preparing to insert an indwelling urinary catheter for a female patient. When beginning the insertion procedure, the nurse should instruct the patient to -Bear down -Take deep breaths -Sip water -Hold her breath

Bear down

A nurse caring for a patient who has diabetes mellitus is having difficulty obtaining a capillary fingerstick blood sample for point-of-care blood glucose testing. To help increase blood flow to the finger, the nurse should A) elevate the hand on a pillow B) pierce the skin in the middle of the finger pad C) Wrap the finger in a warm cloth D) firmly milk the puncture site

C) Wrap the finger in a warm cloth. Heat helps increase blood flow to the area to be punctured.

A nurse is caring for a female patient who needs to collect a midstream urine specimen. Which of the following actions should the nurse take? A) give the pt a clean urine cup from the lab B) instruct the pt to cleanse the perineeal area from back to front C) have the pt urinate a small amount of urine before starting the collectiion D) tell the pt to collect about 10mL of urine

C) have the pt urinate a small amount of urine before starting the collection. Urinating a small amount before the collection helps clean the urethral meatus of any bacteria that may be present.

A nurse is caring for a patient who has a stage III pressure ulcer in the sacral area. Which of the following actions should the nurse take when obtaining a wound culture specimen from the pressure ulcer? A) Irrigate the wound with an antiseptic solution before collecting the specimen B) wipe the crusty area around the outside of the wound with a sterile wash C) rotate a sterile swab in the area of drainage D) collect drainage from the wound dressing

C) rotate a sterile swab in the area of drainage. Rotating a swab in the center of the wound base to collect drainage is the appropriate technique for collecting a specimen for wound culture. It is important to avoid the wound's edges when collecting the specimen.

A nurse is assessing a patient's indwelling urinary catheter drainage at the end of the shift & notes the output is considerably less than the fluid intake. Which of the following actions should the nurse take first? -Irrigate the catheter -Assess for peripheral edema -Palpate for bladder distention -Check the catheter for kinks

Check the catheter for kinks

Reasons for Catheterization

◦Relieving urinary retention ◦Obtaining a sterile urine specimen ◦Obtaining a urine specimen when usual methods can't be used ◦Emptying bladder before, during, or after surgery ◦Monitoring critically ill patients ◦Increasing comfort for terminally ill patients

At 0700, a nurse obtains a capillary blood glucose result of 180 mg/dL from a patient who has diabetes mellitus. Which of the following is a correct action for the nurse to take? A) encourage the pt to get up and walk B) repeat the test using a different machine C) give the pt a glass of oj D) Administer insulin according to the pt's sliding scale orders.

D) Administer insulin according to the pt's sliding scale orders. A reading above the expected range warrants following the provider's orders for sliding scale insulin based of the specific result.

An assistive personnel (AP) is collecting a 24-hour urine specimen from a patient. Which of the following statements by the AP indicates that the specimen collection will have to be restarted? A) I sued a container from the lab that has a preservative in it B) The patient just voided into the toilet, so the next void can be collected C) I have the container in a plastic bucket filled with ice D) The patient just told me that he forgot to put the urine in the container.

D) The patient just told me that he forgot to put the urine in the container. If the patient urinates and discards the urine, the timing of the specimen must begin again with the next urination.

Which term describes a condition in which 24-hour urine output is less than 50 mL? A. Dysuria B. Glycosuria C. Pyuria D. Anuria

D. Anuria - Anuria is synonymous with kidney shutdown or renal failure. Dysuria is painful or difficult urination. Glycosuria is the presence of sugar in the urine. Pyuria is pus in the urine.

Which of the following actions should a nurse take when removing a patient's indwelling urinary catheter? -Pull the catheter out as quickly as possible -Deflate the balloon completely -Make sure the patient has voided within 12 hr post removal -Tell the patient to expect to feel a tugging sensation on removal

Deflate the balloon completely

A nurse is likely to receive an order for urinary catheterization of a newly admitted patient who -Has persistent urinary tract infection -Has urge incontinence -Is in the ICU for gastrointestinal bleed -Is incontinent due to cognitive decline

Is in the ICU for gastrointestinal bleed

A nurse is applying a condom catheter for an older adult patient who is uncircumcised. Which of the following is an appropriate step in the procedure? -Stretching the catheter along the length of the penis -Securing the catheter w/ adhesive tape -Leaving a space between the penis & catheter's tip -Repositioning the foreskin after Application

Leaving a space between the penis & catheter's tip

Act of urination (micturition, voiding)

Process of emptying the bladder - Detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra - Muscles of perineum and external sphincter relax - Muscle of abdominal wall contracts slightly - Diaphragm lowers, micturition occurs

When providing perineal care for a female patient who has an indwelling urinary catheter, which of the following areas should the nurse cleanse last? -The urethral meatus -The labia Minorca -The perineum -The anus

The anus

female and male urinary tracts

Urinary systems- filtration, reabsorption, and excretion, fluid and electrolyte balance - kidneys and ureters (filter and excrete waste and regulate fluid balance) - bladder (reservoir for urine and sphincters control flow) - Urethra (conveys urine from bladder to exterior and male urethra functions in reproduction)

The nurse is caring for a client who has a prescription for a 24 hour urine collection. Which of the following actions should the nurse take? a) Discard the first voiding b) Keep the urine in a single container at room temperature c) Dispose of the last voiding d) Ask the client to urinate into the toilet, stop midstream, and finish urinating into the specimen container

a) Discard the first voiding discard the first voiding of the 24 hour urine specimen, and not the time b- this is wrong because it needs to be kept in a refrigerated container c- instruct the client to completely empty the bladder, and save the last voiding at the end of the collection period d- for a culture specimen, ask the client to urinate first into the toilet, then stop midstream, and finish urinating in the specimen container

A client with frequent urinary tract infections (UTIs) has returned to the ambulatory clinic with symptoms of another UTI. The nurse reviews measures to follow to promote health and decrease the risk of contracting a UTI. Which measure is appropriate for the client to follow? a) Drink two glasses of water before and after sexual intercourse. b) Wear satin or silk underwear that hugs the skin tightly. c) Wipe the perineal area from the rectal area to the urethra. d) Take baths instead of showers.

a) Drink two glasses of water before and after sexual intercourse. Measures to decrease the risk for a UTI include drinking ten 8-oz glasses of water daily; observing for signs and symptoms of a UTI; drying the perineal from the urethra toward the rectum; drinking 2 glasses of water before and after sexual intercourse; showering rather than bathing; wearing cotton underwear; avoiding tight, constricting clothing; and drinking cranberry or blueberry juice daily. Drinking two glasses of water encourages urination before and after sexual intercourse which can cleanse the urethra of any bacteria caused by the intercourse.

The nursing student who is learning skills during campus lab identifies which of the following statements about bedpans to be true? a) The rounded shelf of a regular bedpan should be placed under the client's buttocks b) a fracture bedpan should be used only for clients who have fractures of the femur or lower spine c) A fracture pan is preferred for urination and a regular bedpan is preferred for defecation d) a regular bedpan is generally more comfortable for clients than a fracture bedpan

a) The rounded shelf of a regular bedpan should be placed under the client's buttocks A is the only true statement. Very thin and older adult clients may prefer the fracture bedpan. Both types of bedpans can be used for either urination or defecation. A fracture bedpan can be used for any client.

The nurse is caring for a client who reports having cloudy, foul-smelling urine. Which other symptoms does the nurse anticipate that the client has? a) burning and frequency b) episodes of clear urine mixed with episodes of cloudy urine c) difficulty starting the stream of urine d) constipation and fluid overload

a) burning and frequency The nurse anticipates that the client has a UTI, which is characterized by cloudy, foul-smelling urine, burning, and frequency. Difficulty starting a urine stream is associated with benign prostatic hypertrophy; UTIs are not characterized by intermittent clear urine, nor by constipation and fluid overload. Dehydration is more likely.

A client who has an indwelling catheter reports a need to urinate. Which of the following actions should the nurse take? a) check to see whether the catheter is patent b) reassure the client that is is not possible for them to urinate c) re catheterize the bladder with a larger-gauge catheter d) collect a urine specimen for analysis

a) check to see whether the catheter is patent A clogged or kinked catheter causes the bladder to fill and stimulates the need to urinate. b- this is a nontherapeutic response because it dismisses the client's concern c- there are less invasive approaches the nurse can try before replacing the catheter d- although it might become necessary to collect a urine specimen, there is a simpler approach to take to assess and possibly resolve the client's problem.

A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client? a) loss of urine without any identifiable pattern or warning b) loss of small amount of urine when intra-abdominal pressure rises c) need to void is perceived frequently, with short-lived ability to sustain control of flow d) loss of urine control because a toilet is not accessible

a) loss of urine without any identifiable pattern or warning The nurse could describe the client's condition as the loss of urine without any identifiable pattern or warning. Stress incontinence can be described as the need to void being perceived frequently with a short-lived ability to sustain control of flow. Functional urinary incontinence can be described as the loss of control over urination because a toilet is not accessible.

A nurse is collecting a routine urinalysis on a client presenting to the emergency room with abdominal pain. What nursing action is important in the collection of this specimen? a) obtain a nonsterile specimen and send it to the lab b) obtain a sterile specimen and send it to the lab c) obatin a nonserile specimen, allow it to settle at room temperature for two hours, and then send it to the lab d) obtain a sterile specimen and allow it to settle at room temperature for two hours

a) obtain a nonsterile specimen and send it to the lab. A sterile urine specimen is not required for a routine urinalysis. Obtain and label specimen and sent it to the laboratory for examination. Do not leave the urine standing at room temperature for a long period of time before sending it to the lab, because this may alter both the appearance and chemistry of the urine.

Which type of incontinence is caused by pelvic floor muscle weakness? a) stress b) urge c) overflow d) functional

a) stress Stress incontinence is casued by pelvic floor muscle weakness. Urge incontinence is the inability to suppress urination after sensing the need to do so; many physical and psychological issues can be related to this problem. Overflow incontinence is related to overdistention, or overflow, of the bladder. Causes of functional incontinence include environmental barriers, physical limitations, memory loss, and disorientation.

A female client is diagnosed with a urinary tract infection (UTI) and states this is her second one in the last six months. In teaching the client about health promotion, the nurse would include which statement? a) try to urinate immediately after sexual intercourse. b) routine tub baths are fine as long as you are bathing appropriately c) Fluid intake is not a factor with UTIs d) clean the perineal area from back to front when using the bathroom.

a) try to urinate immediately after sexual intercourse. The female client who has repeated UTIs needs health promotion teaching to avoid re-occurrence of these. Urinating immediately after sexual intercourse and drinking an adequate amount of water (8 -10 oz glasses per day) are important in prevention of UTIs. Showers, rather than tub baths, and cleaning the perineal area from front to back are also measures to help prevent UTIs

A nurse is reviewing factors that increase the risk of urinary tract infections (UTIs) with a client who has recurrent UTIs. Which of the following factors shoudl the nurse include? (select all that apply) a) frequent sexal intercourse b) lowering of testosterone levels c) wiping from front to back to clean the perineum d) location of the urethra closer to the anus e) frequent catheterization

a- having frequent sexual intercourse increases the risk of UTIs in all clients d- the close proximity of the urethra to the anus is a factor that increases the risk of UTIs e- frequent catheterization and the use of indwelling catheters are risk factors for UTIs b- is no because the decrease in estrogen levels during menopause increases a client's susceptibility c- front to back decreases the risk, back to front is what increases the risk

A nurse is caring for a client with an external condom catheter. What is a guideline for applying and caring for this type of catheter? a) keep the tip of the tubing 2-3 inches beyond the tip of the penis b) Fasten the condom securely enough to prevent leakage without constricting the blood vessels c) remove the catheter every 8 hours, or more often in humid weather d) wash the penis with antimicrobial soap and dry thoroughly

b) Fasten the condom securely enough to prevent leakage without constricting the blood vessels Nursing care of a client with an external conom catheter includes vigilant skin care to prevent excoriation. This includes removing the condom catheter daily, washing the penis with soap and water and drying carefully, and inspecting the skin for irritation. In hot and humid weather, more frequent changing may be required. In all cases, care must be taken to fasten the condom securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in the area. In addition, the tip of the tubing should be kept 1-2 inches beyond the tip of the penis to prevent irritation to the sensitive glans area.

A woman informs the nurse that when she is experiencing stress it is difficult to void, and wonders why this happens. What is the nurse's best explanation? a) What medications are you taking? b) Stress causes the muscles to become tense. c) You require greater privacy to void. d) You might have a neurologic condition.

b) Stress causes the muscles to become tense. A person'd muscles may become so tense that relaxation of the perineal muscles does not occur, and voiding is inhibited.

During his stay in the hospital, a male client has established a pattern of maintaining urinary continence during the day, but he is experiencing incontinence at night. What intervention should the nurse implement in this client's care? a) toileting the client every 2 hours b) condom catheter c) intermittent catheterization at bedtime d) indwelling catheter

b) condom catheter A condom catheter may be used in the care of male clients who lack voluntary control of urination. This is preferable to invasive catheterization (which presents an infection risk). Frequent toileting may prevent episodes of incontinence but would significantly disrupt the client's sleep quality.

A client has been NPO (nothing by mouth) after midnight for surgery. It is 11 a.m. and the nurse has asked her to void before being transferred to the surgical suite. The nurse should expect her urine to be what color? a) pale yellow b) dark amber c) colorless d) tea colored

b) dark amber Urine may be dark amber or orange-brown if it is very concentrated secondary to a decreased fluid intake. Urine is lighter than normal if it is diluted. Foods or drugs can also alter the color of urine. Tea-colored or very dark urine is a sign of dehydration.

A nurse is teaching a client who reports stress urinary incontinence. Which of the following instructions should the nurse include? (Select all that apply) a) limit total daily fluid intake b) decrease or avoid caffeine c) take calcium supplements d) Avoid drinking alcohol e) use the Cred. maneuver.

b) decrease or avoid caffeine (Caffeine is a bladder irritant and can worsen stress incontinence) d) Avoid drinking alcohol (Alcohol is a bladder irritant and can worsen stress incontinence) a- because this comes from weak pelvic muscles and other structures, limiting fluids will not resolve the problem. c - calcium has no effect on stress incontinence e) the Crede maneuver helps manage reflex incontinence, not stress incontinence.

A client at a health care facility has been diagnosed with polyuria. How would the nurse describe the client's condition in the medical record? a) difficult or uncomfortable voiding b) greater than normal urinary volume c) absence of urine d) inadequate elimination of urine

b) greater than normal urinary volume Polyuria means greater than normal urinary elimination. It may accompany minor dietary variations. For example, consuming higher than normal amounts of fluids, especially those with mild diuretic effects (e.g. - coffee, tea), or taking certain medications actually can increase urination. Oliguria is inadequate elimination of urine. Anuria means the absence of urine. Dysuria is difficult or uncomfortable voiding.

A nurse is performing an intermittent closed catheter irrigation on a client and realizes that the tubing was not clamped before introducing the irrigation solution. What would be the nurse's response to this situation? a) notify the primary care provider b) repeat the irrigation c) wait 3 hours and repeat irrigation d) prepare to change the catheter

b) repeat the irrigation If the tubing was not clamped before introducing the irrigation solution, the nurse should repeat the irrigation. If the tubing is not clamped, the irrigation solution will drain into the urinary drainage bag and not enter the catheter.

The nurse is caring for a client with a prescription for a midstream urine specimen. The nurse would provide which information to the client? a) you will have a catheter put in to collect the urine b) void a small amount, stop, and discard it c) void into the specimen hat in the toilet bowl d) save all the urine for the next 24 hours

b) void a small amount, stop, and discard it When collecting a midstream urine specimen, the client voids a small amount, stops, and discards it; the first small amount helps to flush away organisms near the urinary meatus. The midstream urine specimen is a sterile specimen so it is not collected in the hat in the toilet bowl. The client will not need to be catheterized. It is a one-time specimen, so urine will not be collected for 24 hours.

A nurse is preparing to initiate a bladder-retraining program for a client who has incontinence. Which of the following actions should the nurse take? (select all that apply) a) restrict the client's intake of fluids during the daytime b) have the client record urination times c) gradually increase the urination intervals d) remind the client to hold urine until the next scheduled urination time e) provide a sterile container for urine

b- ask the client to keep track of urination times as a record of progress toward the goal of 4 hour intervals between urination c- gradually increasing the urination intervals helps the client progress toward the goal of 4 hour intervals between urination d- remind the client to hold urine until next scheduled urination time as part of progressing toward the goal of 4 hour intervals between urination a- wrong because we need to encourage the client's fluid intake during the daytime to promote urine production and establish bladder retaining e- is wrong because a bladder-retaining program does not involve collecting sterile urine specimens

A nurse is caring for a group of clients of the acute care unit. Which clients does the nurse identify that would benefit from urinary catheteriation? Select all that apply. a) A client that is unable to mobilize to the bathroom following abdominal surgery b) A client that developed a urinary tract infection c) A confused client that requires a sterile urine specimen to be obtained. d) A client with an enlarged prostate that is unable to void. e) A client is in septic shock that is unresponsive.

c) A confused client that requires a sterile urine specimen to be obtained. d) A client with an enlarged prostate that is unable to void. e) A client is in septic shock that is unresponsive. Reasons for urinary catheterization include monitoring acutely ill clients, obtaining sterile urine specimens from clients who cannot otherwise provide them, and relieving urinary retention. The presence of a urinary tract infection does not necessarily indicate a need for catheterization. A client who is immobile should be introduced to the use of a bedpan or commode.

A nurse is caring for a hospitalized 3 year old child. The mother expresses concern stating, "My child was toilet-trained for 3 months. Since being here, she is no longer toilet-trained. I cannot understand this." What appropriate response would the nurse provide to the mother? a) Since she is wetting her underwear, she probably was not fully toilet-trained yet. b) Since she is so young, you can re-train her again when she gets home. c) It is not unusual for children to regress when hospitalized; it should be short-lived. d) It is unusual for a child this age to be toilet trained.

c) It is not unusual for children to regress when hospitalized; it should be short-lived. The nurse need to reassure the parent that regression of toilet skills that occurs during a hospitalization is to be expected and is usually short-lived. Voluntary sphincter control can occur as early as 18 months, if teh child can hold urine for 2 hours, recognizes the feeling of bladder fullness, and communicate the need to void, the child can be toilet-trained. Telling the parent the child can be re-trained does not address her concerns.

Which statement should be included in the nurse's education plan for older adults regarding urinary elimination? a) Kidney function progressively increases as the body ages. b) Most older adults experience an increased blood flow to the kidneys c) Nocturia and urinary retention are more common in older adults d) The kidneys become more effective in filtration with age.

c) Nocturia (excessive urination at night) and urinary retention (condition where the bladder doesn't empty completely even if it is full) are more common in older adults. These are common in older adults.

A client states that urinary incontinence has become a problem and asks the nurse how to help control or alleviate this problem. Which statement by the nurse would be accurate? a) You need to decrease your daily fluid intake to help with this. b) Coffee and diet sodas are not factors with being incontinent of urine. c) Performing Kegel exercises can help with muscle strengthening. d) It is best to have a Foley catheter inserted to prevent incontinence.

c) Performing Kegal exercises can help with muscle strengthening. The client with urinary incontinence may benifit from performing Kegel exercises several times daily to help tone pelvic floor muscles. The client would want to avoid caffeine, alcohol, and artificial sweeteners, as these increase risk of incontinence. The daily recommended fluid intake would be 1500-2000 mL, to prevent dehydration; fluid intake may be limited at night to decrease nocturia. A Foley catheter would not be routinely placed for this, but would instead be a last resort for incontinence.

A nurse drains the bladder of a client inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? a) Foley catheter b) retention catheter c) intermittent urethral catheter d) indwelling urethral catheter

c) intermittent urethral catheter An intermittent urethral catheter (straight catheter) is a catheter inserted through the urethra into teh bladder to drain urine for a short period of time (5 to 10 minutes). With an indwelling urethra catheter (retention or Foley catheters), a catheter (tube) is inserted through the urethra into the bladder fro continuous drainage of urine; a balloon is then inflated to ensure that the catheter remains in the bladder once it is inserted.

The nurse is reviewing the urinalysis of a client suspected of having a urinary tract infection. The potential diagnosis will be supported by the presence of: a) calculi b) protein c) pus d) casts

c) pus Pyuria is the presence of pus in the urine. Pyuria occurs in the presence of any UTI

A sterile urine specimen for culture and sensitivity has been ordered for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen? a) empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. b) Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic c) withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle. d) discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen.

c) withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle. When it is necessary to collect a urine specimen from a client with an indwelling catheter itself the special port for specimens. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis. A client's catheter would not be removed for the sole purpose of obtaining a urine specimen.

The health care provider has ordered a Foley catheter for a 48 year old male client who is in traction with leg fractures. The client refuses, stating "I don't want something placed internally into me." What is the appropriate nursing response? a) This is the only option for catheterization. b) You will have to ambulate to the bathroom to urinate. c) Foley catheters do not hurt, and I will be careful placing it. d) Let me talk to your health care provider about a condom catheter.

d) Let me talk to your health care provider about a condom catheter. The nurse will support the client's autonomy by investigating other options like a condom catheter. It is nontherapeutic to discount the client's concern, or to tell the client that this is the only catheterization option. The client clearly cannot ambulate with leg fractures.

A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing? a) Functional incontinence b) Urge incontinence c) Reflex incontinence d) Stress incontinence

d) Stress incontinence The nurse should document the client's condition as stress incontinence following weakening of perineal and sphincter muscle tone secondary to giving birth. Reflex incontinence is caused by damage to motor and sensory tracts in the lower spinal cord secondary to trauma. Urge incontinence is caused by bladder irritation secondary to infection. Functional incontinence is caused by impaired mobility, impaired cognition, or an inability to communicate.

The nurse is assessing a female client who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse's best reply? a) You are experiencing total incontinence. have you had any surgeries or trauma that may be causing this? b) You are experiencing reflex incontinence. Have you had a spinal cord injury in the past? c) You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately? d) You are experiencing stress incontinence. Do you know how to do Kegel exercises?

d) You are experiencing stress incontinence. Do you know how to do Kegel exercises? Stress incontinence occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. This commonly occurs during coughing, sneezing, laughing, or other physical activities. Childbirth, menopause, obesity, or straining from chronic constipation can also result in urine loss. Pelvic floor muscle training (PFMT) can improve voluntary control of urination and significantly reduce or eliminate problems with stress incontience by strengthening perineal and abdominal muscle tone. PFMT, more commonly called Kegel exercises, targets the inner muscles that lie under and support the bladder. These muscles can be toned, strengthened, and actually made larger by a regular routine of tightening and relaxing. Transient incontinence appears suddenly and lasts for 6 months or less. It is usually caused by treatable factors, such as a result of medical treatment (use of diuretics, IV fluid administration). Total incontinence is a continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation. Urination cannot be controlled due to an anatomic abnormality.

A nurse collects a clean-catch specimen from a client at a health care facility. Which statement describes a clean-catch urine sample? a) a sample of urine collected over a period of 24 hours b) a sample of fresh urine collected in a clean container c) a sample of urine collected in a sterile environment d) a sample of urine that is considered sterile

d) a sample of urine that is considered sterile A clean-catch specimen is a sample of urine that is considered sterile. A clean-catch specimen is preferred to a randomly voided specimen. This method of collection is preferred when a urine specimen is needed during a client's menstrual cycle. A void specimen is a sample of fresh urine collected in a clean container. A catheter specimen is a sample of urine collected in a sterile environment using a catheter. A 24 hour specimen is a sample of urine collected over a 24 hour period.

The nurse collects a urine sample from a client for urinalysis. What would the nurse document as a normal characteristic? a) presence of mucus shreds b) ammonia odor c) cloudy appearance d) light yellow color

d) light yellow color Normal urine is light yellow in color. A cloudy appearance, the presence of mucus shreds, and an ammonia odor indicate abnormality in urine. The color of urine ranges from a light yellow, to a darker yellow, to a dark yellow brown called amber. Urine appears cloudy due to separation or settling of urinary constituents. Mucus shreds may be present in urinary samples taken from a catheter. The odor of freshly voided urine that has been sitting unemptied for a long period may have a strong ammonia scent.

The nurse should instruct the female client who has experienced two urinary tract infections within the past year to: a) use shower gels and bubble bath b) apply powder to the perineum c) avoid drinking cranberry juice. d) void following sexual intercourse.

d) void following sexual intercourse. Factors that increase the incidence of urinary tract infections include incorrect wiping of the anal area after bowel movements; sexual intercourse, which can bring perineal microorganisms into closer contact with the urethral meatus; and any procedure that places an object in the urethra or bladder for diagnostic procedures or therapeutic reasons.

developmental considerations - pregnancy

•Bladder pressure •UTI •Constipation

developmental considerations - aging

•Loss of muscle tone of the bladder •Inefficient emptying of the bladder ◦Diminished ability to concentrate ◦Voluntary control affected by physical (neuromuscular, thought process) problems Fewer nephrons Loss of muscle tone of the bladder àreduce the capacity of the bladder to hold urine àIncreased frequency Inefficient emptying of the bladder àUrine retention and stasis, increasing risk for UTIs Diminished ability to concentrate urine àIncrease in nocturia Voluntary control affected by physical (neuromuscular, thought process) problems

Expected outcomes when removing an indwelling catheter

◦Catheter will be removed without difficulty and with minimal patient discomfort. ◦Patient voids without discomfort post catheter removal. ◦Patient voids a minimum of 250 mL of urine within 6 to 8 hours of catheter removal. ◦Patients skin remains clean, dry, and intact, without evidence of irritation or breakdown. ◦Patient verbalizes an understanding of the need to maintain adequate fluid intake.

Diseases associated with renal problems

◦Congenital urinary tract abnormalities ◦Polycystic kidney disease-inherited disorder ◦UTI, hypertension, hematuria ◦Urinary tract infection ◦Urinary calculi ◦Hypertension ◦Diabetes mellitus ◦Gout ◦Connective tissue disorders

factors affecting urinary elimination

◦Developmental considerations ◦Food and fluid intake ◦Psychological variables ◦Activity and muscle tone ◦Pathologic conditions (enlarged prostate) ◦Medications

effects of medications on urine production and elimination

◦Diuretics: prevent reabsorption of water and certain electrolytes in tubules (urine is pale) ◦Cholinergic medications: stimulate contraction of detrusor muscle, producing urination ◦Analgesics and tranquilizers: suppress CNS, diminish effectiveness of neural reflex Color Changes ◦Anti-coagulants: report red or pink urine ◦amitriptyline (Elavil): green or blue-green urine ◦Phenazopyridine (Pyridium): orange to orange-red urine ◦Levodopa: brown or black urine

Urinary Diversion: Ileal Conduit

◦Explain reason for diversion and rationale for treatment-relieve anxiety ◦Demonstrate effective self-care behaviors ◦Describe follow-up care and support resources ◦Report where supplies may be obtained in the community ◦Verbalize related fears and concerns ◦Demonstrate a positive body image

Considerations with use of absorbent products

◦Functional disability of the patient ◦Type and severity of incontinence ◦Gender ◦Availability of caregivers ◦Failure with previous treatment programs ◦Patient preference ◦Risk (skin break down and UTI) versus benefit

Sample Nursing Diagnoses - Related to Urinary Functioning

◦Impaired Urinary Elimination ◦Urinary Retention - (E.g., ct with enlarged prostate-feel not completely empty bladder) ◦Risk for Infection ◦Risk for Impaired Skin Integrity ◦Risk for Injury

Types and Uses of Urethral Catheter

◦Intermittent urethral catheters (straight catheters) - Used to drain the bladder for short periods (5 to 10 minutes) ◦Indwelling urethral catheter (retention or Foley catheters) - Used when a catheter is to remain in place for continuous drainage - Designed using an inflated balloon so that it does not slip out of the bladder

physical assessment of urinary functioning

◦Kidneys: Palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment. ◦Urinary bladder: Palpate and percuss the bladder or use a bedside scanner. ◦Urethral orifice: Inspect for signs of infection, discharge, or odor. ◦Skin: Assess for color, texture, turgor, and excretion of wastes. ◦Urine: Assess for color, odor, clarity, and sediment.

Promoting Normal urination and voiding habits

◦Maintaining normal voiding habits ◦Promoting fluid intake ◦Strengthening muscle tone ◦Privacy, position, and assisting with toileting ◦Schedule ◦Urge to void ◦Hygiene (Cleanse female clients from front to back and Cleanse beneath the foreskin in males)

urinary elimination terms

◦Micturition - the action of urinating ◦Voiding/Continence - emptying bladder ◦Enuresis - involuntary urination ◦Dysuria - painful or difficult urination ◦Glycosuria - a condition characterized by an excess of sugar in the urine, typically associated with diabetes or kidney disease ◦Polyuria - production of abnormally large volumes of dilute urine ◦Anuria - failure of the kidneys to produce urine

Expected outcomes using urinal and bedside commode

◦Patient demonstrates how to use the urinal. ◦Patient voids using the urinal with assistance. (May assist him to a standing position) ◦Patient maintains continence. ◦Patient maintains skin integrity. ◦After to safely stand and transfer to commode

developmental considerations - children

◦Toilet training 2 to 3 years old, Effects of aging ◦Fewer nephrons •Toilet training 2 to 3 years old, enuresis-recognizing bladder fullness & communicate the need to void •Enuresis (involuntary urination, especially by children at night) and Ecopresis (involuntary defecation, especially associated with emotional disturbance or psychiatric disorder)

Indications for use of an ultrasound bladder scanner

◦Urinary frequency ◦Absent or decreased urine output ◦Bladder distention ◦Inability to void ◦Establishing intermittent catheterization schedules

Nursing care of a patient with an external condom catheter

◦Vigilant skin care to prevent excoriation - Removing the condom catheter daily - Washing the penis with soap and water and drying carefully - Inspecting the skin for irritation