Perry and Potter Foundations of Nursing Urinary Elimination JCC – Flashcards
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kidneys receive ___ of cardiac output
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20%
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location of kidneys
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each side of spinal column R is lower
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Kidney fcn
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maintain body fluid volume and composition filter blood and remove waste products regulate acid base balance
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4 organs in urinary system
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kidney ureter bladder urethra
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other kidney functions
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produce erythropoietin produce renin produce prostaglandin E2 and prostacyclin
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erythropoietin
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RBC production
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renin
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controls BP (Angiotensin I and II)
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prostaglandin E2 and prostacyclin
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vasodilation renal blood flow maintenence
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3 steps of kidney filtration
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1) glomerulus filtration *aff. art. --> glom* *elect and water go into bowmans capsule* 2) PCT tubular filtrate *water and el -->bloodstream* 3) tubular secretion *maintains pH balance*
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ureters
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tube stuctures enter bladder through posterior wall - prevents reflux of urine peristaltic waves
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peristaltic waves
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urine enters bladder in spurts
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renal colic (pain)
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ureteral obstructions cause strong peristaltic waves in attempt to clear obstructions
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bladder
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hollow, distensible muscle *stores and secretes urine* trigone external sphincter
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urethra
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carries urine from bladder to outside body through urethral meaatus
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turbulent flow
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washes free of bacteria strong enough
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length of urethra in women
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1.5 - 2.5 in (4-6 cm)
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length of uretha in men
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4-6 in (8cm)
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bladder holds about ___ ml of urine
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600
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desire to void when have approx ____-____ mL of urine in bladder
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150-200
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strong sensation to urinate ___-____ mL
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400-600
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voluntary control
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stretch receptors send signal to brain cause bladder to react a bit
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BUN
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blood urine nitrogen levels creatinine dehydration, kidney impairment
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proteinurea
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protein and blood too big to filter through walls
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nephron
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function of units
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factors influencing urination
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medication age surgery diseases / path input/output env soc/cult physch diagnostic exams
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sociocultural factors influencing urination
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work schedule age
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psychological factors influencing urination
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anxiety and emotional stress urgency frequency increase in urge to urinate incomplete bladder emptying privacy and adequate time
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fluid balance
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decreases urine production night time caffenated beverages alcoholic beverages febrile conditions
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caffeinated beverages
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diarrhetic bladder irritant
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alcoholic beverages
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inhibits release of ADH get rid of more water
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febrile conditions
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increase urine/water loss to cool down body
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hydrnephrosis
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renal damage urine retention uti
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uti
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the longer urine sites the more alkaline it gets which encourages microorganism growth
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surgical procedures
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anasthetic and narcotic analgesia a) slow glomerular filtration rates b) impair sensory and motor impulses surgical procedures a) impair urination d/t local tissue trauma
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medications diuretics (lasix/furosemide)
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prevent H2) and electrolyte reabsorption --> increase urine output
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medications anticholiinergics and antihistamines
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cause urinary retention
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misc medications
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phenazopyridine amitriptyline levadopa chemo drugs
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phenazopyridine
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orange to rust
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amitriptyline
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green / blue
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levadopa
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brown/black
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chemo drugs
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discolor urine
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diagnostic exams
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IVP : decreased urine d/t fluid limitation pre-exam exams using direct visualization of structures : edema
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alterations in urinary elimination
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urinary retention uti urinary incontinence urinary diversions
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urinary retention cause
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med anasthesia trauma obstruction *unable to respond*
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urinary retention symptoms
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pressure discomfort restlessness tenderness on symphysis pubis
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urinary retention with overflow
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urine in bladder build up pressure urinate a little pressure relieved
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urinary retention signs
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void small amounts no relief fro discomfort not urinating at all
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urinary tract infection usual causative organism
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E. coli
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UTI risk factors
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women urinary retention (alkaline) poor hygiene catheter
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cystitis
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freq urgency blood suprapubic pain dysria hematuria fever confusion
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pyelorephritis
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flant pain dysuria (painful urea) pain at costovertebral same S and S as cystitis
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DX
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dipstickfor leukocyte and nitrates risk in older adults
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TX
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antimicrobials increase fluid intake precaution
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nursing goals
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symptomatic relief teaching and prevent showers>baths perireneal cleansing front to back voiding after intercourse antimicrobial therapy no scented toilet paper no perfumes to perineal area empty bladder regularly
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urinary inconinence
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cant hold urine involuntary leakage
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urinary incontinence types
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transient functiona retention/overfow stress urge multifactorial
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transient
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med conditions short lived ( urinary incontinence )
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functional
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unable to get to bathroom in time for whatever reason ( urinary incontinence )
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retention/overflow
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cough/sneeze weakened pelvic muscle for pregnant women ( urinary incontinence )
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stress
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women before tests (urinary incontinence )
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urge
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destressor muscle contracts not enough (urinary incontinence )
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multifactorial
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combo several factors ( urinary incontinence )
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risks associated with urinary incontinence
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skin breakdown social isolation impaired body image loss of independence falls and fractures
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urinary diversions
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flow of urine directed from kidneys to abdominal surface
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ileal conduit
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connected to ureters (bladder trauma/cancer)
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continent pouch
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sphincter self catheterized (doesn't have to wear appliance)
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nephrostomy
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tube temporary in nature
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nephrostomy what does it do
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urine drainage directly from kidneys (bag always below to prevent back flow)
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if ureters are blocked in a nephrostomy
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tumor calculi perforated ureter
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nursing assessment 1) nursing history
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pattern of elimination symptoms of urinary alterations factors affecting urination
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pattern of elimination
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how often how much color time of day
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symptoms of urinary alterations
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incontinence increased frequency pain-disurea hematuria
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factors affecting urination
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what makes it better/worse age medication surgeries/procedures
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nursing assessment 2) physical assessment
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skin and mucous membranes kidneys bladder urethral meatus (red, drainage, lesions)
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nursing assessment 3) assessment of urine
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intake and output characteristics testing
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nursing assessment 4) characteristics of urine
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color clarity odor oliguria (no urine)
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urinalysis
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physical, chemical and microscopic analysis
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when is a urinalysis used
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useful for diagnosing renal disease UTI metabolic diseases not r/t kidneys
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alterations in urinary elimination
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urinary retention UTIs urinary incontinence urinary diversions
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urinary retention
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accumulation of urine in bladder -unable to empty properly
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urinary retention cause
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medication anesthesia trauma obstruction
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urinary retention symptoms
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pressure discomfort restless tender pubic symphysis
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urinary retention with overflow
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urine in bladder build up of pressure urinate a little and pressure is relieved
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urinary retention signs
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void small amounts with no relief from discomfort not urinating at all
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UTI fun facts/background info
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8.1 million HC provider visits annualy 93,300 acquired in hospital each year 75% of hospitals are from using catheters
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UTI causative organism
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E. coli
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UTI risk factors
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women urinary retention (becomes alkaline) poor hygiene catheter
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urine culture
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done to isolate microorganisms that cause clinical infections clean catch v catheter specimen
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urine culture factors affecting results
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contamination antibiotics and sulfonamides stool in w/ urine specimen
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urine culture special considerations
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sterile collection container hold antibiotics until specimen collected transport to lab asap
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nursing diagnosis
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urinary incontinence (fcn, stress, urge) impaired urinary elimination toileting, self care deficit urinary retention risk for infection risk for impaired skin integrity toileting self care deficit
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promoting healthy urinary function
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client education maintain routine maintain adequate fluid intake (30 mL/kg or .5 oz/day) promote complete bladder emptying prevent infection
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bladder training
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reduce voiding frequency and decrease urgency assess current voiding pattern suppress urination for each void by 15 min each week
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goal mL for each void
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240-500 mL of urine / 3-4 hours
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acute care setting
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maintain elimination habits medication catheterization
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overhydrated
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lower specific gravity
