Urinary Elimination- Nursing Fundamental Chapter 48 Kozier – Flashcards

Depends on effective functioning of: -Upper urinary tract (kidneys, ureters) -Lower urinary tract (bladder, urethra, pelvic floor) -CV system -Nervous system

-Functional unit of the kidney -Urine is formed here

-Tuft of capillaries surrounded by Bowman's capsule -Fluids and solutes move across endothelium of the capillaries into the capsule

-Filtrate move from here into the tubule of the nephron

Most of water and electrolytes are reabsorbed

-Solutes such as glucose reabsorbed here -Other substances secreted

-Additional water and sodium reabsorbed here under control of hormones

-Calyces of the renal pelvis -Ureters -Bladder

-Urine collects in the bladder -Pressure stimulates special stretch receptors in the bladder wall -Stretch receptors transmit impulses to the spinal cord voiding reflex center -Internal sphincter relaxes stimulating the urge to void -If appropriate, the conscious portion of the brain relaxes the external urethral sphincter muscle -Urine eliminated through the urethra

-Developmental factors -Psychosocial factors -Fluid and food intake -Medications -Muscle tone -Pathologic conditions -Surgical and diagnostic procedures

-Polyuria -Oliguria, Anuria -Frequency or Nocturia -Urgency -Dysuria -Enuresis -Incontinence -Retention -Neurogenic Bladder

-Nursing history -Physical assessment of urinary system -Hydration status -Examination of urine -Data from diagnostic tests and procedures

-Normal voiding patterns -Appearance of urine -Recent changes -Past or current problems

-Percussion of kidneys and bladder to detect tenderness -Inspect urethral meatus for swelling, discharge, inflammation -Skin color, texture, turgor, signs of irritation -Edema

-Measuring urinary output -Measuring residual urine -Diagnostic Tests *Blood urea nitrogen *Creatinine

-96% water and 4% solutes -Organic solutes include urea, ammonia, creatinine, and uric acid -Inorganic solutes include sodium, chloride, potassium sulfate, magnesium, and phosphorus

-Volume -Color, clarity -Odor -Sterility -pH -Specific gravity -Glucose -Ketone bodies -Blood

-Impaired Urinary Elimination -Functional Urinary Incontinence -Reflex Urinary Incontinence -Stress Urinary Incontinence -Total Urinary Incontinence -Urge Urinary Incontinence -Urinary Retention

-Risk for Infection -Low Self-esteem -Risk for Impaired Skin Integrity -Self-care Deficit -Risk for Deficient Fluid Volume or Excess Fluid Volume -Disturbed Body Image -Deficient Knowledge -Risk for Caregiver Role Strain -Risk for Social Isolation

-Maintain or restore a normal voiding pattern -Regain normal urine output -Prevent associated risks such as infection, skin breakdown, fluid and electrolyte imbalance, and lowered self-esteem -Perform toilet activities independently with or without assistive devices -Contain urine with the appropriate device, catheter, ostomy appliance, or absorbent product

-Promoting fluid intake -Maintaining normal voiding patterns -Assisting with toileting -Preventing urinary tract infections -Managing urinary incontinence -Continence (bladder) training -Pelvic muscle exercises -Maintaining skin integrity -Applying external urinary drainage devices -Performing urinary catheterizations -Performing bladder irrigations -Providing care for clients with indwelling urinary catheters and urinary diversions

-Drink eight 8oz of water per day -Frequent voiding (every 2 to 4 hours) -Avoid use of harsh soaps, bubble bath, powder, or sprays in the perineal area -Avoid tight-fitting clothing -Wear cotton rather than nylon underwear -Always wipe the perineal area from front to back following urination or defecation (girls and women) -Take showers rather than baths if recurrent urinary infections are a problem

-Teach patient about the benefits of drinking more than eight 8oz glasses of water daily Intake of foods that create acidic urine (such as?) -Perineal care (when?) -Change catheter and drainage system only when necessary -Catheterize only when necessary -Maintain sterile closed-drainage system -Remove catheter as soon as possible -Follow good hand hygiene -Prevent fecal contamination

-Ensure tubing free of obstructions -Ensure tubing not clogged -Ensure there is no tension on catheter or tubing -Ensure no loops in tubing below entry -Keep drainage receptacle (AND TUBING) below level of client's bladder (gravity drainage maintained) -Ensure closed drainage system -Teach patient about not letting drainage bag (OR TUBING) touch the floor -Observe flow of urine every 2 to 3 hours -Note color, odor, abnormal constituents -If sediment present, check more frequently

-Assess intake and output -Note any changes in urine color, odor, or clarity (mucous shreds are commonly seen in the urine of clients with an ileal diversion) -Frequently assess the condition of the stoma and surrounding skin -Consult with the wound ostomy continence nurse (WOCN)