question

Urinary retention

answer

Inability to void even with sufficient urine present in bladder

question

Urinary suppression or anuria

answer

Complete failure of kidneys to produce urine (less than 100mL / 24hours)

question

Oliguria

answer

diminished amount of urine formation (25-30 mL / hour)

question

Enuresis

answer

involuntary urination by a child past age when voluntary bladder control is expected

question

Nocturia

answer

awakening prematurely from sleep in order to empty the bladder

question

Urgency

answer

feeling of full bladder with urgent need to empty

question

Frequency

answer

need to empty bladder often, even though it may not be full

question

Nocturnal enuresis

answer

night time bedwetting

question

Hesitancy

answer

difficulty beginning urinary stream

question

Dysuria

answer

painful or burning urination; "difficulty" voiding

question

Polyuria

answer

increased urinary output (2000 mL / 24 hours) seen in diabetics

question

Diurinal enuresis

answer

daytime involuntary urination (incontinence)

question

Residual urine

answer

amount of urine left in bladder immediately after the patient has voided

question

Micturition

answer

urination, voiding

question

Characteristics of normal urine: Amount

answer

average 24 hour output = 1500-2000 average hourly output = 30-60 mL / hr panic value = 30 mL / hr x's 2 hours

question

Characteristics of normal urine: quality of stream

answer

should begin within 15 sec. of void attempt and not start/stop during voiding stream is about the diameter of a pencil

question

Characteristics of normal urine: urine lab values

answer

pH = 4.6 - 8.0 specific gravity = 1.010 - 1.025 based on hydration status

question

Characteristics of normal urine: color

answer

normal = straw colored, pale to amber, transparent

question

Abnormal urine color: red or orange

answer

may be from meds

question

Abnormal urine color: Hematuria Dark red or smoky

answer

bleeding in the upper urinary tract (kidney/ureters)

question

Abnormal urine color: Hematuria bright red with clots

answer

bleeding in the lower urinary tract (bladder, urethra)

question

Abnormal urine color: dark amber (yellow)

answer

possible presence of urobilinogen (decomposed bilirubin): liver and gallbladder disease possible dehydration

question

Abnormal urine color: pyuria

answer

pus in urine milky yellow infection

question

Abnormal urine color: cloudy/hazy

answer

due to presence of bacteria, inflammation, presence of sperm or prostatic fluid

question

Common lab studies frequently associated with urinary elimination: urinalysis

answer

general examination of urine to establish baseline information or provide data to establish a tentative diagnosis and determine whether further studies are needed

question

Common lab studies frequently associated with urinary elimination: creatinine clearance

answer

creatinine = waste product of protein breakdown clearance of creatinine by kidney approximates the GFR collect 24 hour specimen

question

Common lab studies frequently associated with urinary elimination: composite urine collection

answer

measures specific components, such as electrolytes, glucose, protein, creatinine, and minerals collected of a period ranging from 2 to 24 hours

question

Common lab studies frequently associated with urinary elimination: urine culture "clean catch" "midstream"

answer

confirms suspected urinary tract infection and identifies causative organisms

question

Common lab studies frequently associated with urinary elimination: concentration test

answer

evaluates renal concentration ability measured by specific gravity readings

question

Common lab studies frequently associated with urinary elimination: residual urine

answer

determines the amount of urine left in bladder after urinating finding may be abnormal in problems with bladder innervation, sphincter impairment, BPH, or urethral strictures

question

Common lab studies frequently associated with urinary elimination: protein determination

answer

test detects protein (primarily albumin) in the blood

question

Common lab studies frequently associated with urinary elimination: blood urea nitrogen (BUN)

answer

used to detect renal problems concentration of urea in blood is regulated by rate at which kidney excretes urea

question

Common lab studies frequently associated with urinary elimination: sodium

answer

main extracellular electrolyte determining blood volume usually values stay within normal range until late stages of renal failure 135-145 mEq/L

question

Common lab studies frequently associated with urinary elimination: potassium

answer

kidneys are responsible for excreting majority of body's potassium In kidney disease, potassium determinations are critical because potassium is one of the first electrolytes to become abnormal elevated potassium levels > 6mEq/L can lead to muscle weakness and cardiac dysrhythmias normal: 3.5-5.0 mEq/L

question

Common lab studies frequently associated with urinary elimination: calcium

answer

main mineral in bone and aids in muscle contraction, neurotransmission, and clotting in kidney disease, decreased reabsorption of calcium leads to renal osteodystrophy 8.6 - 10.2 mEq/L

question

Assessment of the urinary tract:

answer

note voiding patterns measure intake and output palpate and percuss bladder bladder scan (US)

question

Urinary incontinence

answer

inability to voluntarily control urine flow as bladder pressure exceeds urethral resistance

question

Stress incontinence

answer

involuntary loss of urine that occurs when the bladder cannot handle increased amounts of abdominal pressure, due to weakness or urethra and surrounding muscles small amounts of urine typically leak during exercise, coughing, sneezing, laughing most common type seen

question

Urge Incontinence

answer

Loss of urine with an abrupt and a strong desire to urinate commonly due to a sudden involuntary, uncontrolled contraction of the detrusor muscle a symptom of overactive bladder instead of relaxing during urination, this muscle becomes very hypertonic

question

Mixed incontinence

answer

combination of stress and urge most often seen in elderly women

question

Overflow incontinence

answer

bladder becomes overfilled because sensation to void is not felt by client detrusor muscle is weak and underactive and/or the urethra is obstructed bladder cannot be completely emptied: spills over behaviors: constant dribbling, urgency, frequent urination often due to neurological deficits, medication side effects, bladder neck obstruction from an enlarged prostate or injury, fecal impaction

question

Functional incontinence

answer

leakage of urine R/T physical, environmental, or psychologic cause client can't physically get to the bathroom R/T immobility or restraint client is depressed/ has dementia need help getting to the bathroom

question

Total incontinence

answer

result of neurologic disease with dysfunction of nerves controlling bladder may include urge or overflow

question

Reflex incontinence

answer

related to neurologic abnormalities, which cause the detrusor muscle to contract abnormally spinal injuries

question

Causes (etiology) or urinary incontinence:

answer

UI occurs when bladder pressure exceeds urethral closure pressure Bladder fails to contract at the appropriate time or contracts inappropriately (detrusor muscle instability) Urethra may open or close inappropriately (urethral sphincter weakness) Abnormalities outside the bladder and urethra Pelvic floor ligament weakness

question

DRIP:

answer

D: delirium, dehydration, depression R: restricted mobility, rectal impaction I: infection, inflammation, impaction P: polyuria, polypharmacy

question

medical and nursing interventions for the client with urinary incontinence. Can prescribe medications

answer

Stress: in incontinence, the bladder pressure is greater than urethral resistance give meds to increase resistance of urethra and increase urethral pressure: makes bladder pressure less than urethra Urge: in incontinence, the bladder contracts involuntarily Give meds to control hypertonic bladder and increase bladder capacity These meds reduce bladder contractions Reflex/overflow Give meds to enhance bladder contractions and/or decrease urethral resistance

question

medical and nursing interventions for the client with urinary incontinence. Change the patient's diet

answer

Weight reduction for obese clients to reduce abdominal pressure Avoid caffeine, alcohol, sugar substitutes These are bladder stimulants Avoid constipating foods

question

medical and nursing interventions for the client with urinary incontinence. Introduce exercise therapy

answer

These are the first line of treatment for Stress Incontinence; also used to treat urge and mixed incontinence Pelvic muscle exercises (PME) Kegel exercises Strengthen the pelvic floor

question

medical and nursing interventions for the client with urinary incontinence. Scheduled voiding regimens

answer

Timed voiding Habit retraining Prompted voiding Bladder retraining

question

medical and nursing interventions for the client with urinary incontinence. Anti-incontinent devices

answer

For women: Intra-vaginal devices (pessary, balloons) Applies pressure on the urethra For men: urethral clamps or plugs

question

medical and nursing interventions for the client with urinary incontinence. Containment devices

answer

Incontinence pads and briefs Urinary catheterization

question

medical and nursing interventions for the client with urinary incontinence. Surgical management

answer

Suggested for certain types of stress incontinence Bulking agents: collagen or silicone bead injections are inserted around the urethra Implantation of an artificial urinary sphincter Bladder neck suspension procedures These procedures will pull the neck up and/or restore normal urethro-vesico angle Stabilizes the bladder neck

question

how to protect the skin of an incontinent patient

answer

Provide hygiene immediately after incontinence Use absorptive pads (CHUX) to wick away moisture and provide a quick drying surface to the skin Use gel diapers More absorptive than disposable cellulose or cloth diapers Allow pt to lie on top of pad and let uncovered areas of skin dry Reposition pt to allow other skin surfaces to dry Check these patients regularly since they are at an increased risk for skin breakdown and pressure ulcers

question

complications of altered bladder elimination

answer

Can cause UTIs , skin breakdown, social isolation R/T embarrassment, body image disturbance

question

bladder training

answer

Bladder retraining: attempt to increase volume that the bladder can hold each time To start, encourage the pt to void every 30 minutes to 1 hour, then gradually increase bladder capacity by extra 30 min-1 hour The goal is 2-3 hours

question

pathophysiology of cystitis

answer

and inflammation of urinary bladder. It's patho-phys is on a CELLULAR level with an organism. It's a disturbance in the integrity of the urothelial cells of the bladder and/or urethra, which allows the organism to invade. These cells produce mucin which protects the bladder cells from the effects of urine sitting there all the time. The bacteria attaches to bladder cells and cells commit suicide and slough off. SOME bacteria worse and send out small projections called "TYPE 1 PILI" that are tipped with a protein that allows them to lock into receptors on bladder lining -- they borough in and stay there. This is why many think REPEATED infections.

question

pathophysiology of pyelonephritis

answer

The inflammation & bacterial infection of renal pelvis. When the bladder does not empty fully due to REFLUX of URINE and/or UNTREATED CYSTITIS, so organisms invade renal pelvis.

question

Signs and symptoms of cystitis (bladder infection) and urethritis (urethra infection)

answer

May be asymptomatic. Urgency to void * Burning with urination, dysuria * Slight to gross hematuria. Frequency= often, small amt's. * Pain (Cystitis) - tender suprapubic area or low back pain. Urethritis - reddened urethra, burning, pruritus. Bladder distention. Hazy ---> cloudy urine (maybe). Foul-smelling urine (maybe). Elderly clients with UTI are at a greater risk for UROSEPSIS, a generalized infection caused by GRAM NEGATIVE BACTEREMIA.

question

Signs and symptoms of pyelonephritis:

answer

Inflammation - Scar tissue formation with healing and decreased renal tubule reabsorption & secretion and impaired renal function Fever, chills - often spike high fever-- 102 - 103o Malaise & fatigue Nausea/vomiting, maybe Flank &/or abd. pain - assess CVA (costal-vertebral angle ) Pain on urination (dysuria); hematuria. Usually have cystitis (symptomatic or asymptomatic) May have underlying G/U obstruction.

question

Acute pyelo.

answer

----> renal impairment

question

Chronic pyelo.

answer

----> renal failure.

question

Nursing diagnoses for patients with UTI

answer

a.) Impaired urinary elimination b.) Deficient Knowledge R/T methods of prevention and treatment protocols

question

What is the purpose and function of urothelial cells?

answer

produce mucin mucin is a mucopolysaccharide which normally protects the bladder cells from the affects of urine sitting there all the time

question

Why are the elderly at higher risk for UTI?

answer

increased relaxation of pelvic structures: don't empty bladder fully decreased thirst: drink less water decreased immune system chronic diseases: stroke, diabetes

question

Interventions Medications

answer

antiseptics: bacteriostatic: raise urine acidity so bacteria can't grow antibiotics: bacteriocidal anti-infectives: may cause crystalluria and kidney stones

question

Interventions Fluids and diet

answer

increase fluids to 2-3L per day cranberry juice

question

Interventions pain relief

answer

urinary analgesics: pyridium: anesthetizes urinary mucosa antispasmodics: anticholinergics: decrease bladder spasms and promotes complete bladder emptying

question

Prostate gland

answer

a gland surrounding the neck of the bladder in males, releasing prostatic fluid

question

Seminal vesicle

answer

a pair of glands that open into the vas deferens near its junctions with the urethra and secretes many of the Components of semen

question

Erectile tissue

answer

numerous vascular spaces that may become engorged with blood

question

Epididymis

answer

a highly convulated duct behind the testis along which the sperm passes through the vas deferens

question

Testis

answer

an organ that produces spermatozoa

question

pathophysiology of BPH

answer

Prostate gland enlarges by abnormally increasing the number of cells (hyperplasia) & glandular tissue. As the gland enlarges, it presses on the urethra & bladder & obstructs the flow of urine. Can lead to urinary retention, reflux, bladder trabeculation, hypertrophy, & hyperirritability, reflux to ureter & renal pelvis, with hydronephrosis. In time, bladder wall can become non-compliant & hypotonic...---> resulting in post-residual voids & increasing chance of infection.

question

signs & symptoms indicative of BPH

answer

Urinary urgency & frequency - from hyper-irritable bladder. Nocturia Hesitancy in starting urination Decrease in size & force of urine stream Terminal dribbling Sensation of incomplete bladder emptying S/S of UTI secondary to stasis of urine.

question

pre-operative teaching related to the patient with a transurethral resection of the prostate (TURP)

answer

Urinary drainage must be restored prior to surgery → coude (curved tip) catheter may be inserted with lidocaine gel (acts as lubricant and local anesthesia); maintain sterile field Antibiotics are administered before invasive surgery Encouraging a high fluid intake (2-3L/day) helpful in managing infection Educate patient that surgery may affect sexual function → retrograde ejaculation (ejaculate goes up into bladder) which decrease orgasmic sensation but is not harmful because it is eliminated during next urination

question

post-operative teaching related to the patient with a transurethral resection of the prostate (TURP)

answer

Bladder irrigation Blood clots are expected after surgery, but if there are large amounts of bright red blood in urine, it can indicate hemorrhage which can occur from displacement of the catheter, dislodgement or a large clot or increases in abdominal pressure Bladder spasms occur as a result of irritation of the bladder mucosa from the insertion of the resectoscope, presence of a catheter, or clots leading to obstruction of the catheter Catheter removal is often 2-4 days after surgery and patient should urinate within 6 hours after removal. If he cannot, reinsert a catheter for a day or two Sphincter tone may be poor immediately after catheter removal, resulting in urinary incontinence or dribbling Strengthen via Kegel exercises 10-20 x/hour Encourage patient to practice starting and stopping the stream several times during urination If continence is not improved after 12 months, refer patient to continence clinic You can instruct patient to use penile clamp, condom catheter or incontinence pads to avoid embarrassment from dribbling Observe patient for signs of post-operative infection A diet high in fiber facilitates passage of stool (prevent patient from straining while having BM → straining increases intraabdominal pressure which can lead to bleeding at post-op site)

question

Explain the rationale for bladder irrigation following a TURP

answer

Bladder irrigation is typically done to remove clotted blood from the bladder and ensure drainage of urine

question

continuous & intermittent bladder irrigation

answer

Intermittent or continuous urinary catheter irrigations maintain catheter patency by keeping the bladder clear and free of blood clots or sediment

question

assessments & nursing interventions specific to continuous bladder irrigation (CBI)

answer

Rate of infusion is based on color of drainage Ideally should be light pink without clots Continuously monitor the inflow and outflow of irrigant If outflow is less than inflow, assess the catheter patency for kinks or clots If outflow is blocked and patency cannot be reestablished by manual irrigation, stop the CBI and notify the physician

question

To calculate proper I & O with bladder irrigation:

answer

for the output, subtract the amount of irrigant

question

Discharge instructions to provide after TURP:

answer

no lifting, driving, strenuous activities for 2-3 weeks no straining with BM encourage fluids to 12-14 glasses a day avoid bladder irritants

question

complications of TURPS:

answer

dribbling and incontinence are normal initially bleeding decreased urinary stream UTI

Altered Urinary Elimination – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards