Ch 46 Urinary Elimination and Nursing Process

To assess SIGNS and SYMPTOMS, the nurse may ask

whether the patient dribbles urine before voiding, after voiding, or at other times.

A nurse is assessing the SEVERITY of a patient's urinary elimination problem. Which question is most appropriate?

"How often are you awakened with the urge to void while you are sleeping?"

What instructions regarding bladder training should be included in the teaching plan for the family of a patient who is incontinent because of a stroke?

"Offer the patient the commode or urinal every 2 hours."

A registered nurse is educating nursing students about the factors that influence urination. Which of a student nurse's statements indicates a need for further education?

"Patients with pathologic conditions such as arthritis and dementia may experience either bladder over activity or deficient bladder emptying."

To determine any PREDISPOSING FACTORS, the nurse may ask

whether the patient recently has been hospitalized or received a diagnosis of a new medical problem.

To assess the EFFECTS of the patient's urinary elimination problem, the nurse may ask

whether the urinary problem interferes with the patient's usual activities.

Catheters with diameters of 12 Fr are used for

young girls.

The patient's urine specific gravity is 1.05. The urine tests positive for ketone bodies. Which could be possible causes? Select all that apply.

Starvation Dehydration Diabetes mellitus

The nurse is reviewing laboratory results for a patient and notices the urine tested positive for ketones. Which underlying factors may lead to the presence of urinary ketone bodies?

Starvation Dehydration Uncontrolled diabetes mellitus

A 55-year-old man is admitted to the hospital with urinary retention. which size catheter

14 Fr

Which patient is most likely to exhibit symptoms such as dysuria, urgency, frequency, and nocturia?

A patient with a urinary tract infection

A nurse is caring for an elderly patient who has recently started taking an antimuscarinic medication to treat urinary continence. Which nursing intervention is most important in this situation?

Assessing the patient for mental status changes

The nurse is caring for a patient with urinary incontinence. Which actions should the nurse perform to promote comfort for the patient? Select all that apply.

Change dressings and linens when wet. Use absorbent pads. Catheterize the patient with orders from the health care provider.

The nurse notes that the patient's indwelling catheter bag has been empty for 4 hours. What is the priority action?

Check for kinks in the tubing.

Which nursing interventions are helpful to prevent a urinary tract infection in the patient?

Emphasize wearing cotton underwear. Promote complete emptying of bladder by double voiding. Emphasize the importance of perineal hygiene.

Which intervention is most appropriate for a patient with functional urinary incontinence?

Provide normal fluid intake and establish a toilet schedule.

A nurse is caring for a patient who is receiving treatment for a urinary elimination problem. After a few days of taking the prescribed medications, the patient reports a dry mouth, constipation, and blurred vision. Which medication is the most likely cause of the patient's symptoms?

Fesoterodine

A patient who has undergone urological surgery is prescribed urinary catheterization. Which diameter of catheter does the nurse anticipate will be used for this patient?

Greater than 16 Fr

What should the nurse include in the plan of care for a patient with urge urinary continence?

Helping the patient strengthen the pelvic floor muscles and learn fluid and food modifications

The nurse receives a prescription to obtain a post-void residual for a patient via catheterization. What is the best way to obtain this measurement?

Intermittent catheterization

A nurse is caring for an elderly patient who is receiving treatment for urinary incontinence. After reviewing the patient's prescription, the nurse knows to observe the patient for cognitive impairment. Which medication is the patient most likely taking?

Oxybutynin Antimuscarinic agents such as oxybutynin are used to treat different types of urinary incontinence. These drugs may cause cognitive impairment in older adults

A nurse is caring for a patient with an indwelling catheter. Which nursing action may increase the risk for a catheter-associated urinary tract infection?

Keeping the drainage bag above the level of the bladder

should be used in patients who have undergone urological surgery

Large catheters with diameters greater than 16 Fr

A patient is being assessed for a possible urinary tract infection (UTI). Before sending a urinalysis specimen to the laboratory, the nurse collects a small amount of urine to perform a dipstick test. If the patient has a UTI, which component should be detected in the urine?

Leukocytes

Which of a student nurse's statements regarding urinary incontinence requires correction?

Mixed incontinence is a combination of stress and functional incontinence." b/c Mixed incontinence is a combination of stress and urge, not functional, incontinence.

A nurse is caring for a patient with a spinal cord injury who reports an absence of awareness of bladder filling and the urge to void. A family member adds that the patient also sometimes has leakage of urine without awareness. Which nursing intervention is most important for the patient?

Monitoring for autonomic dysreflexia

A nurse instructs an elderly patient to restrict fluid intake 2 hours before bedtime. Which complication is the nurse trying to reduce?

Nocturia

may exhibit polyuria.

Patients receiving diuretic therapy and those with uncontrolled diabetes mellitus

A patient reports having the urge to void, but urine starts leaking before the patient reaches the bathroom. Which treatment strategies would be helpful for this patient? Select all that apply.

Scheduled toileting Absorbent products Clothing modification

While caring for a female patient with altered urinary elimination, the nurse instructs the patient to assume a squatting position when voiding. What is the reason behind this recommendation?

To promote complete bladder emptying

The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. What should the nurse teach the patient to do?

Use the Credé method.

Ketones are produced as

a by-product when the body uses fat for energy production. When a patient is not taking in adequate amounts of carbohydrate, such as in starvation, the body uses other sources for energy. Dehydration can also lead to ketonuria. A patient with uncontrolled diabetes mellitus breaks down fatty acids for energy

. A toileting schedule based on the patient's elimination patterns can help reduce episodes of incontinence. Catheters are used as

a last choice, because of the potential for infection and body self-image issues.

Cotton underwear

absorbs moisture and helps to keep the skin on the perineal area dry.

Patients with painful urination associated with urinary tract infections may be prescribed

urinary analgesics such as phenazopyridine, which will turn the urine orange.

Antimuscarinic medications may

cause cognitive impairment in older adults; therefore, the nurse should assess the patient carefully for mental status changes.

Catheters with diameters of 8 to 10 Fr are used for

children

Antimuscarinic agents, such as fesoterodine, are used to treat

different types of urinary incontinence. These medications may cause dry mouth, constipation, and blurred vision.

Intermittent catheterization is used when

evaluating the residual urine following urination. The investigation requires measurement of urine remaining in the bladder after voiding. Intermittent catheterization prevents the risk of infection.

While caring for a patient with urge urinary continence, the nurse should

help the patient strengthen the pelvic floor muscles, learn techniques to inhibit the urinary urge, and learn fluid and food modifications

Long-term catheterization is done

in patients with urinary retention. It may also be done for patients with recurrent episodes of urinary infections, skin breakdown, and terminal illness.

Diuretics

increase urinary output by preventing the resorption of water and certain electrolytes.

Catheters with diameters of 5 to 6 Fr are used for

infants

Anticholinergics, such as atropine

inhibit bladder contractility and thereby increase the risk for urinary retention.

Anticholinergics, such as atropine,

inhibit bladder contractility, thereby increasing the risk for urinary retention

Patients with reflex urinary incontinence have an increased risk of AUTONOMIC DYSREFLEXIA, which is

life-threatening condition. This is a medical emergency that requires immediate intervention, so the nurse's most important intervention is to monitor the patient for autonomic dysreflexia and notify the health care provider immediately.

Local trauma during lower abdominal surgery may

obstruct urine flow; therefore, patients who undergo lower abdominal surgery may require the temporary use of an indwelling urinary catheter.

Short-term catheterization is required for

obstructive conditions, surgical repair of bladder and urethra, prevention of urethral obstruction, and bladder irrigation.

To begin a bladder-training program, the nurse should teach the family to

offer the patient the commode, bedpan, or urinal every 2 hours. Making this offer frequently enough prevents accidents and establishes a routine

A patient with kidney failure may experience

oliguria

A patient with kidney failure may experience

oliguria.

patients who take drugs with phenazopyridine will void

orange urine.

Reflex urinary incontinence occurs in

patients who have spinal cord injuries and, it is characterized by diminished or absent awareness of bladder filling and the urge to void. patient may also have leakage of urine without awareness. Patients with reflex urinary incontinence have an increased risk of autonomic dysreflexia, which is a life-threatening condition.

Patients receiving diuretic therapy and those with uncontrolled diabetes mellitus may exhibit

polyuria.

With the Credé method

pressure is put on the suprapubic area with each attempted void. The maneuver promotes bladder emptying by relaxing the urethral sphincter.

rink adequate amounts of fluid. To help relieve stress urinary incontinence, the nurse may

provide pelvic muscle training.

to help the patient learn efficient and safe toilet transfers.

responsibility of an occupational therapist

should help the patient obtain assistive devices for the home that are covered by insurance.

social worker

Electrical stimulation is helpful for patients with

stress incontinence

Anticholinergics,

such as atropine, inhibit bladder contractility and thereby increase the risk of urinary retention.

Functional incontinence is characterized by

the inability to reach the bathroom in time. Scheduled toileting involves teaching the patient to void at specified times so that there is no urgency. Use of absorbent products helps prevent soiling of clothes. Clothing can be modified to make it easier to remove when there is an urgency to void.

To manage stress urinary incontinence,

the nurse should teach the patient pelvic muscle exercises.

Specific gravity would be increased if

the patient were dehydrated.

Antimuscarinic agents are helpful for patients with

urge incontinence.

Phenazopyridine is a

urinary analgesic that may be prescribed to patients with painful urination associated with urinary tract infections;