N1 - Elimination

Use of an indwelling urinary catheter leads to the loss of bladder tone.

True

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?

Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle.

specific gravity:

a characteristic of urine that can be determined with manufactured plastic strips or an instrument called a urinometer or hydrometer

cutaneous ureterostomy:

a type of incontinent cutaneous urinary diversion in which the ureters are directed through the abdominal wall and attached to an opening in the skin

A nurse caring for patients in an extended-care facility performs regular assessments of the patients' urinary functioning. Which patients would the nurse screen for urinary retention? Select all that apply. a. A 78-year-old male patient diagnosed with an enlarged prostate b. An 83-year-old female patient who is on bedrest c. A 75-year-old female patient who is diagnosed with vaginal prolapse d. An 89-year-old male patient who has dementia e. A 73-year-old female patient who is taking antihistamines to treat allergies f. A 90-year-old male patient who has difficulty walking to the bathroom

a, c, e. Urinary retention occurs when urine is produced normally but is not excreted completely from the bladder. Factors associated with urinary retention include medications such as antihistamines, an enlarged prostate, or vaginal prolapse. Being on bedrest, having dementia, and having difficulty walking to the bathroom may place patients at risk for urinary incontinence.

A nurse is caring for a patient diagnosed with bladder cancer who has a urinary diversion. Which actions would the nurse take when caring for this patient? Select all that apply. a. Measure the patient's fluid intake and output. b. Keep the skin around the stoma moist. c. Empty the appliance frequently. d. Report any mucus in the urine to the primary care provider. e. Encourage the patient to look away when changing the appliance. f. Monitor the return of intestinal function and peristalsis.

a, c, f. When caring for a patient with a urinary diversion, the nurse should measure the patient's fluid intake and output to monitor fluid balance, change the appliance frequently, monitor the return of intestinal function and peristalsis, keep the skin around the stoma dry, watch for mucus in the urine as a normal finding, and encourage the patient to participate in care and look at the stoma.

The health care provider has ordered an indwelling catheter inserted in a hospitalized male patient. What consideration would the nurse keep in mind when performing this procedure? a. The male urethra is more vulnerable to injury during insertion. b. In the hospital, a clean technique is used for catheter insertion. c. The catheter is inserted 2 to 3 in into the meatus. d. Since it uses a closed system, the risk for UTI is absent.

a. Because of its length, the male urethra is more prone to injury and requires that the catheter be inserted 6 to 8 in. This procedure requires surgical asepsis to prevent introducing bacteria into the urinary tract. The presence of an indwelling catheter places the patient at risk for a UTI.

A patient who has pneumonia has had a fever for 3 days. What characteristics would the nurse anticipate related to the patient's urine output? a. Decreased and highly concentrated b. Decreased and highly dilute c. Increased and concentrated d. Increased and dilute

a. Fever and diaphoresis cause the kidneys to conserve body fluids. Thus, the urine is concentrated and decreased in amount.

A nurse is caring for a patient who is taking phenazopyridine (a urinary tract analgesic). The patient questions the nurse: "My urine was bright orangish red today; is there something wrong with me?" What would be the nurse's best response? a. "This is a normal finding when taking phenazopyridine." b. "This may be a sign of blood in the urine." c. "This may be the result of an injury to your bladder." d. "This is a sign that you are allergic to the medication and must stop it."

a. Phenazopyridine, a urinary tract analgesic, can cause orange or orange-red urine; the patient needs to be aware of this.

reflex incontinence:

emptying of the bladder without the sensation of the need to void

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?

"Stress causes the muscles to become tense."

A client reports an episode of losing control of urination when a bathroom wasn't close by. The client states, "I'm worried this means that I'm starting to lose control of my bladder." What is the appropriate nursing response?

"Let's review your medication history and whether you consume bladder irritants."

Oliguria:

24-hour urine output is less than 400 mL

Anuria:

24-hour urine output is less than 50 mL

The health care provider has prescribed an indwelling catheter for a client. When the nurse explains the procedure, the client refuses to allow placement of the catheter. Which action should the nurse take?

Ask the client why he or she does not want a catheter.

Nocturia:

Awakening at night to urinate

Urgency:

Strong desire to void

The nurse has inserted a client's urinary catheter as ordered, but there has been no immediate flow of urine. What is the nurse's most appropriate action?

Have the client take a deep breath to relax the perineal and abdominal muscles.

Polyuria:

Excessive output of urine (diuresis)

Frequency:

Increased incidence of voiding

Urinary incontinence:

Involuntary loss of urine

What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence?

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.

A client who undergoes peritoneal dialysis is admitted to the hospital after an elective total-knee arthroplasty. Upon assessment the nurse visualizes redness, drainage, and odor to the area around the peritoneal dialysis catheter. Palpation of the abdomen causes the client pain. Which intervention is the priority?

Notifying the health care provider of the assessment findings.

The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order.

O Clean each labial fold, then the area directly over the meatus. Insert the lubricated catheter into the urethra. O Advance the catheter until there is a return of urine. Inflate the balloon with the correct amount of sterile saline.

Dysuria:

Painful or difficult urination

Effects of Aging

Physiologic changes that accompany normal aging may affect urination in older adults. The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night). • Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination. • Decreased bladder contractility may lead to urine retention and stasis, which increases the likelihood of UTI. • Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time. Medications prescribed for other health problems in the older adult may interfere with bladder function.

Glycosuria:

Presence of glucose in the urine

Proteinuria:

Protein in the urine

Pyuria:

Pus in the urine

While providing care to a client admitted to the health care facility, the client states that she has "a burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which sign/symptom would the nurse document as an abnormal finding?

Reddened perineal skin

The novice nurse is assessing the urinary bladder of a client with transient urinary incontinence. The nurse mentor would intervene if which action by the novice nurse is noted?

The novice nurse asks the client to urinate before palpating the bladder.

A nurse is caring for a male patient who had a urinary sheath applied following hip surgery. What action would be a priority when caring for this patient? a. Preventing the tubing from kinking to maintain free urinary drainage b. Not removing the sheath for any reason c. Fastening the sheath tightly to prevent the possibility of leakage d. Maintaining bedrest at all times to prevent the sheath from slipping off

a. The catheter should be allowed to drain freely through tubing that is not kinked. It also should be removed daily to prevent skin excoriation and should not be fastened too tightly or restriction of blood vessels in the area is likely. Confining a patient to bedrest increases the risk for other hazards related to immobility.

urinary incontinence:

any involuntary loss of urine

After surgery, a patient is having difficulty voiding. Which nursing action would most likely lead to an increased difficulty with voiding? a. Pouring warm water over the patient's fingers. b. Having the patient ignore the urge to void until her bladder is full. c. Using a warm bedpan when the patient feels the urge to void. d. Stroking the patient's leg or thigh.

b. Ignoring the urge to void makes urination even more difficult and should be avoided. The other activities are all recommended nursing activities to promote voiding.

10. A nurse caring for a patient's hemodialysis access documents the following: "5/10/20 0930 AV fistula patent in right upper arm. Area is warm to touch and edematous. Patient denies pain and tenderness. Positive bruit and thrill noted." Which documented finding would the nurse report to the primary care provider? a. Positive bruit noted. b. Area is warm to touch and edematous. c. Patient denies pain and tenderness. d. Positive thrill noted.

b. The nurse would report a site that is warm and edematous as this could be a sign of a site infection. The thrill and bruit are normal findings caused by arterial blood flowing into the vein. If these are not present, the access may be cutting off. No report of pain is a normal finding.

A nurse is ordered to catheterize a patient following surgery. Which nursing guideline would the nurse follow? a. The nurse would use different equipment for catheterization of male versus female patients. b. The nurse should use the smallest appropriate indwelling urinary catheter. c. The nurse should always sterilize the equipment prior to insertion. d. The nurse should choose a 12F, 5-mL or 10-mL balloon, unless ordered otherwise.

b. The smallest appropriate indwelling urinary catheter should be selected to aid in prevention of CAUTIS in the adult hospitalized patient (ANA, The equipment used for catheterization is usually prepackaged in a sterile, disposable tray and is the same for both male and female patients. Most kits already contain a standard-sized catheter. Catheters are graded on the French (F) scale according to lumen size, with 12 to 16F gauge commonly used A 14F, 5-mL or 10-mL balloon is usually appropriate, unless ordered otherwise (ANA).

The nurse is caring for a client with weakness who is ambulatory but tires easily. Which method for urinary elimination does the nurse recommend?

bedside commode

autonomic bladder:

bladder no longer controlled by the brain because of injury or disease; void by reflex only

When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine?

blood

hematuria:

blood in the urine; if present in large enough quantities, urine may be bright red or reddish brown

A nurse is preparing a brochure to teach patients how to prevent UTIS. Which teaching points would the nurse include? Select all that apply. a. Wear underwear with a synthetic crotch b. Take baths rather than showers c. Drink 8 to 10 8-oz glasses of water per day d. Drink a glass of water before and after intercourse and void afterward e. Dry the perineal area after urination or defecation from the front to the f. Observe the urine for color, amount, odor, and frequency

c, e, f. It is recommended that a healthy adult drink 8 to 10 8-0z glasses of fluid daily, dry the perineal area after urination or defecation from the front to the back, and observe the urine for color, amount, odor, and frequency. It is also recommended to wear underwear with a cotton crotch, take showers rather than baths, and drink two glasses of water before and after sexual intercourse and void immediately after intercourse.

A nurse is caring for an alert, ambulatory, older resident in a long-term care facility who voids frequently and has difficulty making it to the bathroom in time. Which nursing intervention would be most helpful for patient? a. Teach the patient that incontinence is a normal occurrence with aging. b. Ask the patient's family to purchase incontinence pads for the patient. c. Teach the patient to perform PFMT exercises at regular intervals daily. d. Insert an indwelling catheter to prevent skin breakdown.

c. Kegel exercises may help a patient regain control of the micturition process. Incontinence is not a normal consequence of aging. Using absorbent products may remove motivation from the patient and caregiver to seek evaluation and treatment of the incontinence; they should be used only after careful evaluation by a health care provider. An indwelling catheter is the last choice of treatment.

A nurse is ordered to perform continuous irrigation for a patient with a long-term urinary catheter. What rationale would the nurse expect for this order? a. Irrigation of long-term urinary catheters is a routine order. b. Irrigation is recommended to prevent the introduction of pathogens into the bladder. c. A blood clot threatens to block the catheter. d. It is preferred to irrigate the catheter rather than increase fluid intake by the patient.

c. The flushing of a tube, canal, or area with solution is called irrigation. Natural irrigation of the catheter through increased fluid intake by the patient is preferred. It is preferable to avoid catheter irrigation unless necessary to relieve or prevent obstruction However, intermittent irrigation is sometimes prescribed to restore or maintain the patency of the drainage system. Sediment or debris, as well as blood clots, might block the catheter, preventing the flow of urine out of the catheter.

A woman is reporting bladder urgency. It is most important to assess:

caffeine intake.

nephrotoxic:

capable of causing kidney damage

suprapubic catheter:

catheter inserted into the bladder through a small abdominal incision above the pubic area

indwelling urethral catheter:

catheter that remains in place for continuous urine drainage; synonym for Foley catheter

bacteriuria:

condition that occurs when bacteria enter the bladder during catheterization, or when organisms migrate up the catheter lumen or the urethra into the bladder; bacteria in the urine

total incontinence:

continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation

nocturia:

excessive urination during the night

incontinent:

experiencing involuntary or uncontrolled loss of urine or feces

A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample?

first thing in the morning

A nurse is caring for an older adult client at his home. The client has had a condom catheter applied. Which describes a condom catheter?

flexible sheath that is rolled around the penis

A nurse caring for patients in a long-term care facility is often required to collect urine specimens from patients for laboratory testing. Which techniques for urine collection are performed correctly? Select all that apply. a. The nurse catheterizes a patient to collect a sterile urine sample for routine urinalysis. b. The nurse collects a clean-catch urine specimen in the morning from a patient and stores it at room temperature until an afternoon pick-up. c. The nurse collects a sterile urine specimen from the collection receptacle of a patient's indwelling catheter. d. The nurse collects about 3 mL of urine from a patient's indwelling catheter to send for a urine culture. e. The nurse collects a urine specimen from a patient with a urinary diversion by catheterizing the stoma. f. The nurse discards the first urine of the day when performing a 24-hour urine specimen collection on a patient.

d, e, f. A urine culture requires about 3 mL of urine, whereas routine urinalysis requires at least 10 mL of urine. The preferred method of collecting a urine specimen from a urinary diversion is to catheterize the stoma. For a 24-hour urine specimen, the nurse should discard the first voiding, then collect all urine voided for the next 24 hours. A sterile urine specimen is not required for a routine urinalysis. Urine chemistry is altered after urine stands at room temperature for a long period of time. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis.

A nurse is changing the stoma appliance on a patient's ileal conduit. Which characteristic of the stoma would alert the nurse that the patient is experiencing ischemia? a. The stoma is hard and dry. b. The stoma is a pale pink color. c. The stoma is swollen. d. The stoma is a purple-blue color.

d. A purple-blue stoma may reflect compromised circulation or ischemia. A pale stoma may indicate anemia. The stoma may be swollen at first, but that condition should subside with time. A normal stoma should be moist and dark pink to red in color.

Data must be collected to evaluate the effectiveness of a plan to reduce urinary incontinence in an older adult. Which information is least important for the evaluation process? a. The incontinence pattern b. State of physical mobility c. Medications being taken d. Age of the patient

d. Incontinence is not a natural consequence of the aging process. All the other factors are necessary information for the care plan.

Psychological Variables

embarrassment and anxiety,

continent:

having self-control over urination

urinary retention:

inability to void although urine is produced by the kidneys and enters the bladder; excessive storage of urine in the bladder

overflow incontinence:

involuntary loss of urine associated with overdistention and overflow of the bladder

enuresis:

involuntary urination; most often used to refer to a child who involuntarily urinates during the night

incontinence-associated dermatitis:

moisture-associated skin breakdown caused by prolonged contact of the skin with urine or feces

A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a:

neurogenic bladder.

transient

occurrence that appears suddenly and lasts for 6 months or less and usually is caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment, such as the use of diuretics or intravenous fluid administration

voiding:

process of emptying the bladder; also called micturition or urination

urination:

process of emptying the bladder; micturition; voiding

micturition:

process of emptying the bladder; urination; voiding

urinary sheath (external condom catheter):

soft, pliable sheath made of silicone material that is applied externally to the penis and directs urine away from the body; also known as external condom catheter

functional incontinence:

state in which a person experiences an involuntary, unpredictable passage of urine

urge incontinence:

state in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void

stress incontinence:

state in which the person experiences a loss of urine of less than 50 mL that occurs with increased abdominal pressure

intermittent urethral catheter:

straight catheter used to drain the bladder for short periods (5 to 10 minutes)

continent urinary diversion (CUD):

surgical alternative that uses a section of the intestine to create an internal reservoir that holds urine, with the creation of a catheterizable stoma

urinary diversion:

surgical creation of an alternate route for excretion of urine

mixed incontinence:

symptoms of urge and stress incontinence are present, although one type may predominate

ileal conduit:

urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall

postvoid residual (PVR):

urine that remains in the bladder after the act of micturition; a synonym for residual urine

urine:

waste product excreted by the kidneys