Term
| What are the kidneys fxn? |
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Definition
| Remove waste from the blood to form urine |
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Term
| What are the ureters fxn? |
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Definition
| Transport urine from the kidneys to the bladder |
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Term
| What is the bladders function? |
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Definition
| Reservoir for urine until the urge to urinate develops |
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Term
| What is the urethra's fxn? |
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Definition
| Urine travels from the bladder and exits through the urethral meatus. |
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Term
|
Definition
| Kidneys filter waste products of metabolism that collect in the blood. The blood reaches each kidney by a renal (kidney) artery that branches from the abdominal aorta. The nephron, the functional unit of the kidney (on the right), forms the urine. It is composed of the glomerulus, Bowman’s capsule, proximal convoluted tubule, loop of Henle, distal tubule, and collecting duct. |
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Term
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Definition
| Ureters are tubular structures that enter the urinary bladder. Urine draining from the ureters to the bladder is usually sterile. The ureters enter obliquely through the posterior bladder wall. This arrangement prevents the reflux of urine from the bladder into the ureters during the act of micturition by compression of the ureter at the ureterovesical junction (the juncture of the ureters with the bladder). An obstruction within a ureter such as a kidney stone (renal calculus) results in strong peristaltic waves that attempt to move the obstruction into the bladder. These waves result in pain, often referred to as renal colic. |
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Term
| What is the urinary bladder? |
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Definition
| The urinary bladder is a hollow, distensible, muscular organ (detrusor muscle) that stores and excretes urine. When empty, the bladder lies in the pelvic cavity behind the symphysis pubis. In men, the bladder lies against the anterior wall of the rectum, and in women, it rests against the anterior walls of the uterus and vagina. |
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Term
| How does urine leave the body? |
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Definition
| Urine exits the bladder through the urethra and passes out of the body through the urethral meatus. Normally, the turbulent flow of urine through the urethra washes it free of bacteria. Mucous membrane lines the urethra, and urethral glands secrete mucus into the urethral canal. Thick layers of smooth muscle surround the urethra. In addition, it descends through a layer of skeletal muscles called the pelvic floor muscles. When these muscles are contracted, it is possible to prevent urine flow through the urethra. |
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Term
| Where is the urethra in women? |
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Definition
| the urethra is approximately 4 to 6.5 cm (1 1/2 to 2 1/2 inches) long. The short length of the urethra predisposes women and girls to infection. It is easy for bacteria to enter the urethra from the perineal area. |
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Term
| Where is the urethra in men? |
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Definition
| which is both a urinary canal and a passageway for cells and secretions from reproductive organs, is about 20 cm (8 inches) long. The male urethra has three sections: prostatic, membranous, and penile. |
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Term
| A patient with a long-standing history of diabetes mellitus is voicing concerns about kidney disease. The patient asks the nurse where urine is formed in the kidney. The nurse’s response is the |
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Definition
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Term
|
Definition
erythropoietin is essential to maintaining a normal red blood cell (RBC) volume.
Erythropoietin stimulates bone marrow to produce RBCs and prolongs the life of mature RBCs. |
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Term
|
Definition
renin, prostaglandin E2, and prostacyclin affects blood pressure.
Renin starts a chain of events that cause water retention, thereby increasing blood volume. |
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Term
| What is prostaglandin e2? |
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Definition
| Prostaglandin E2 and prostacyclin aid vasodilation. |
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Term
| How do the kidney's effect calcium/phosphate regulation? |
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Definition
| The kidneys affect calcium and phosphate regulation by producing a substance that converts vitamin D into its active form. Patients with chronic alterations in kidney function do not make sufficient amounts of the active vitamin D. They are prone to develop renal bone disease resulting from the demineralization of bone caused by impaired calcium absorption. |
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Term
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Definition
| convert angiotensinogen (a substance synthesized by the liver) into angiotensin I. Angiotensin I is converted to angiotensin II in the lungs. |
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Term
| What does angiotensin 2 do? |
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Definition
| Angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex. Aldosterone causes retention of water, which increases blood volume. |
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Term
| What does aldosterone do? |
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Definition
| Causes the retention of water |
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Term
| What does prostaglandin E2 do? |
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Definition
| help maintain renal blood flow through vasodilation. |
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Term
| What is involved in voiding? |
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Definition
| Bladder contraction + Urethral sphincter and pelvic floor muscle relaxation |
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Term
| What causes the need to urinate? |
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Definition
| Stretching of bladder wall signals the micturition center in the sacral spinal cord. |
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Term
|
Definition
| the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract, and the bladder empties. |
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Term
| What brain structures control micturation? |
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Definition
| Brain structures that influence bladder function (cerebral cortex, thalamus, hypothalamus, and brain stem) inhibit the urge to void or allow voiding. |
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Term
| What causes reflex incontinence? |
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Definition
Damage to the spinal cord above the sacral region causes reflex incontinence
This condition causes loss of voluntary control of urination, but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void |
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Term
| What is overflow incontinence? |
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Definition
| Overflow incontinence occurs when the bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedative-hypnotics, tricyclics, and analgesia. |
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Term
|
Definition
| a life-threatening problem that affects heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage. |
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Term
| What are the factors influencing urination? |
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Definition
Disease conditions
Medications and medical procedures
Socioeconomic factors (need for privacy)
Psychological factors (anxiety, stress, privacy)
Fluid balance |
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Term
|
Definition
| awakening to void one or more times at night. |
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Term
|
Definition
| excessive output of urine. |
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Term
|
Definition
| decreased urinary output in spite of adequate fluid intake. |
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Term
|
Definition
| when the kidneys produce no urine. |
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Term
|
Definition
| increased urine formation |
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Term
| How does fever effect urination? |
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Definition
| Fever causes an increase in body metabolism and accumulation of body wastes. Although urine volume is reduced, it is highly concentrated. |
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Term
| What is pre renal disorders? |
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Definition
| Decreased blood flow to and through the kidney |
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Term
| What is disease conditions of the renal tissue? |
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Definition
| disease conditions of renal tissue |
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Term
|
Definition
| obstruction in the lower urinary tract that prevents urine flow from the kidneys |
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Term
| What are the conditions of the lower urinary tract that effect uinration? |
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Definition
| narrowing of the urethra, altered innervation of the bladder, or weakened pelvic and/or perineal muscles, affect urinary elimination. |
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Term
| How do DM and multiple sclerosis cause urination problems? |
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Definition
| cause changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions. |
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Term
| How does BPH effect urination? |
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Definition
| makes them prone to urinary retention and incontinence. |
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Term
| How do cognitive impairments effect urination? |
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Definition
| impairments, such as Alzheimer’s disease, lose the ability to sense a full bladder or are unable to recall the procedure for voiding. |
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Term
| How does parkinson's disease effect voiding? |
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Definition
| make it difficult to reach and use toilet facilities. |
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Term
| What is end-stage renal disease? |
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Definition
| the patient has symptoms resulting from uremic syndrome. An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. |
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Term
| What are the two forms of dialysis? |
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Definition
| Dialysis takes one of two forms—peritoneal dialysis or hemodialysis. Patients can use both dialysis modalities for a short or long term, but these treatments require specialized equipment and nurses with specialized education. |
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Term
| What is peritoneal dialysis? |
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Definition
| an indirect method of cleaning the blood of waste products using osmosis and diffusion, with the peritoneum functioning as a semi-permeable membrane. This method removes excess fluid and waste products from the bloodstream when a sterile electrolyte solution (dialysate) is instilled into the peritoneal cavity by gravity via a surgically placed catheter. The dialysate remains in the cavity for a prescribed time interval and then is drained out by gravity, taking accumulated wastes and excess fluid and electrolytes with it. |
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Term
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Definition
| requires a machine equipped with a semi-permeable filtering membrane (artificial kidney) that removes accumulated waste products and excess fluids from the blood. In the dialysis machine, dialysate fluid is pumped through one side of the filter membrane (artificial kidney), while the patient’s blood passes through the other side. The processes of diffusion, osmosis, and ultrafiltration clean the patient’s blood. Then the blood returns through a specially placed vascular access device (Gore-Tex graft, arteriovenous fistula, or hemodialysis catheter). Organ transplantation is the replacement of a patient’s diseased kidney with a healthy one from a living or cadaver donor of compatible blood and tissue type. The new organ is surgically implanted into the abdomen. Special medications (immunosuppressives) are administered, often for life, to prevent the body from rejecting the transplanted organ. Unlike other treatments, successful organ transplantation offers patients the potential for restoration of normal kidney function. |
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Term
| When do you know when dialysis is needed? |
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Definition
Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures
Worsening of uremic syndrome associated with end-stage renal disease (ESRD)
Renal failure that can no longer be controlled by conservative management |
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Term
| What surgical procedures effect urination? |
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Definition
Restriction of fluid intake lowers urine output.
Stress causes fluid retention. |
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Term
| What medications effect urination? |
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Definition
| Antipsychotics, antidepressants, alpha-adrenergic agonists, and calcium channel blockers can cause urinary retention and overflow incontinence. Alpha-antagonists, diuretics, sedative-hypnotics, opioid analgesics, angiotensin-converting enzyme (ACE) inhibitors, and antihistamines can cause urinary incontinence. Antiparkinson medications may cause urinary urgency and subsequent incontinence. Always consider these medications as the cause of new-onset urinary incontinence, especially in older adults. |
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Term
| What diagnostic examinations effect urination? |
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Definition
Restriction of fluid intake lowers urine output.
Direct visualization causes localized trauma and edema; patients may have difficulty voiding. |
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Term
| What is urinary retention? |
|
Definition
| An accumulation of urine due to the inability of the bladder to empty |
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Term
|
Definition
Urinary tract infection
Results from catheterization or procedure |
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Term
| What is urinary incontinence? |
|
Definition
| Involuntary leakage of urine |
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Term
| What is urinary diversion? |
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Definition
| Diversion of urine to external source |
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Term
| How should you deal with urinary problems in an aging adult? |
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Definition
Provide frequent opportunities to void. Older adults have a smaller bladder capacity than younger adults.
Encourage older adults to empty the bladder completely before and after meals and at bedtime.
Encourage patients to increase fluid intake to at least six to eight glasses a day unless medically contraindicated.
Make fluids such as cranberry juice available as part of the patient’s fluid intake. Cranberry juice and vitamin C help acidify the urine to decrease
bacterial infections of the bladder. |
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Term
| Does restricting fluid help ever? |
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Definition
| Restricting fluid intake does not decrease urinary incontinence severity or frequency. |
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Term
| Why should you take out a catheter ASAP? |
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Definition
void routine use of indwelling catheters. If one is necessary, use it no longer than necessary. The risk of infection increases dramatically for
catheterized patients. |
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Term
| A health care provider may suspect that a patient is experiencing urinary retention when the patient has |
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Definition
| Small amounts of urine voided 2 to 3 times per hour. |
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Term
| What is a continent urinary diversion? |
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Definition
| created from a distal portion of the ileum and a proximal portion of the colon. The ureters are embedded in the reservoir. This reservoir is situated under the abdominal wall and has a narrow ileal segment brought out through the abdominal wall to form a small stoma. The ileocecal valve creates a one-way valve in the pouch, through which a catheter is inserted to empty the urine from the pouch. Patients must be willing and able to catheterize the pouch 4 to 6 times a day for the rest of their lives. |
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Term
| What is a orthotopic neobladder? |
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Definition
| also uses an ileal pouch to replace the bladder. Anatomically, the pouch is in the same position in which the bladder was before removal, allowing patients to void normally. Incontinent urinary diversions are less commonly performed. Surgery involves connecting the ureters to a section of the intestinal ileum with formation of a stoma on the abdominal wall. Urine drains continuously because the patient has no sensation or control over urinary output, requiring the application of a collection pouch at all times. Some patients need urinary drainage directly from one or both kidneys. In this case, a tube is placed directly into the renal pelvis. This procedure is called a nephrostomy. Any urinary diversion poses threats to a patient’s body image. The patient must learn how to manage the diversion, and those who do not have a continent urinary diversion must wear an artificial device at all times. However, most patients are able to wear normal clothing, engage in physical activity, travel, and have sexual relations. Care must be taken not to pull on tubing, especially with a nephrostomy, because it can be pulled out, causing tissue and organ damage and infection. Most nephrostomies are sutured into the kidney. |
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Term
| Why is infection control and hygiene important with urinarion? |
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Definition
| The urinary tract is sterile. The use of infection control principles will help to prevent the spread of UTI. |
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Term
| Why is increased fluid intake important? |
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Definition
| Increased fluid intake results in increased diluted urine formation, which reduces the risk of urinary tract infection. |
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Term
| What do growth and development factors determine? |
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Definition
| the patient’s ability to control the act of urination across the life span. Infants, children, and the elderly experience problems with urination. The young need to learn to recognize the need to urinate. The elderly need to deal with decreased functioning that accompanies aging. |
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Term
| What do weak abdominal muscles do? |
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Definition
| impair the ability of the urinary sphincter to maintain tone. Immobility, muscle damage during vaginal delivery, and muscle atrophy or trauma contribute to problems with urination. |
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Term
| What psychosocial issues are r/t urination? |
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Definition
| body image, self-esteem, roles, and identity may influence urination. Gender differences also occur: Males stand and females sit. |
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Term
| What is the nursing knowledge base for urination? |
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Definition
Infection control and hygiene
Growth and development
Muscle tone
Psychosocial considerations
Cultural considerations |
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Term
| What is important to note in history? |
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Definition
Patterns of urination
Symptoms of urinary alterations
Factors affecting urination |
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Term
| A young girl is having problems urinating postoperatively. You remember that children may have trouble voiding |
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Definition
| In the presence of a person other than their parents. |
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Term
| What is involved in the physical assessment portion of an elimination assessment? |
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Definition
Conduct physical assessment of the patient’s body systems potentially affected by urinary change.
Assess characteristics of urine.
Assess the patient’s perception of urinary problems as it affects self-concept and sexuality.
Gather relevant laboratory and diagnostic test data. |
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Term
| What are you looking for when inspection the skin and mucus membranes? |
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Definition
| Assess hydration by looking at turgor and texture |
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Term
| What are you looking for in the kidneys? |
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Definition
| Flank pain may occur with infection or inflammation. |
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Term
| What are you looking for in the bladder? |
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Definition
| Gentle palpation on a distended bladder causes the patient to feel tenderness, pain, or the urge to urinate. Percussion produces a dull tone. |
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Term
| What are you looking for in urethral meatus? |
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Definition
in females: retract the labia to observe the urethral meatus. Look for drainage or lesions and ask the patient if this is uncomfortable. Drainage indicates infection.
in males:small opening at the tip of the penis. Inspect the meatus for discharge lesions and inflammation. For the uncircumcised patient, you will need to retract the foreskin. |
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Term
| How do you inspect urine? |
|
Definition
Intake and output
Characteristics of urine
Color
Pale-straw to amber color
Clarity
Transparent unless pathology is present
Odor
Ammonia in nature
Urine testing
Specimen collection |
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Term
| What is a low output rate? |
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Definition
| hourly output of less than 30 mL for longer than 2 hours is cause for concern and further assessment |
|
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Term
| What are the tests/diagnostic examinations involved with urine? |
|
Definition
-Urinalysis
-Specific gravity
-Culture
-Noninvasive
-Invasive |
|
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Term
| What is specific gravity? |
|
Definition
| the weight or degree of concentration of a substance compared with an equal volume of water. |
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Term
|
Definition
| requires a sterile or clean-voided urine sample. It will take 24 to 48 hours to reveal the findings of bacterial growth. The test for sensitivity will determine which antibiotic will be most effective. |
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Term
| What are the noninvasive procedures? |
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Definition
| KUB (abdominal roentgenogram [plain film; kidney, ureter, bladder, or flat plate]), CT (computed axial tomography scan), and IVP (intravenous pyelogram) or urodynamic testing (uroflowmetry). |
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Term
| What are the invasive procedures? |
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Definition
| cystoscopy and arteriography. |
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Term
| How do measure urine from a bag? |
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Definition
, a separate plastic graduated measuring receptacle is used to obtain more precise measurement of urine output.
Each patient needs to have a graduated receptacle for his or her exclusive use to prevent potential cross-contamination. Label each container with patient name.
The container needs to be rinsed after emptying, and the tubing that drains the bag securely clamped and cleaned with alcohol before it is put back in the holder.
Report any extreme increase or decrease in urine volume. An individual’s daily output generally ranges from 1200 to 1500 mL of urine. Hourly output of less than 30 mL for longer than 2 consecutive hours is cause for concern. Similarly, you need to report consistently high volumes of urine (polyuria) (i.e., over 2000 to 2500 mL daily). |
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Term
| What are the nursing diagnosis r/t urinary problems? |
|
Definition
- Pain
- Risk for infection
- Imparied skin integrity
-Constipated
-Social Isolation
-Disturbed body image
-Urinary incontinence
-Toileting self care deficit
-Impaired urinary elimination
-Urinary retention |
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Term
| How do you implement planning for urianry problems? |
|
Definition
-Health promotion
Patient education
Promoting normal micturition
-Stimulating micturition reflex
Maintaining elimination habits
Maintaining adequate fluid intake
Promoting complete bladder emptying
Preventing infection |
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|
Term
| What methods promote micturation? |
|
Definition
| help patients sense the urge to urinate and control urethral sphincter relaxation. |
|
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Term
| What does the patient's ability to void depend on? |
|
Definition
| feeling the urge to urinate, being able to control the urethral sphincter, and being able to relax during voiding. Help patients learn to relax, and stimulate the reflex to void by helping them assume the normal position for voiding. |
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|
Term
| What helps women to void? |
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Definition
| squatting or sitting position. If the patient is unable to use toilet facilities, position him or her in a squatting position on a bedpan or bedside commode. |
|
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Term
| What helps promote relaxation? |
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Definition
| The sound of running water helps many patients void through the power of suggestion. Stroking the inner aspect of the thigh stimulates sensory nerves and promotes the micturition reflex. You can also pour warm water over the patient’s perineum and create the sensation to urinate. If you need to measure urine output, first measure the volume of water that you pour over the perineal area. |
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|
Term
| What is the simplest method of promoting micturition? |
|
Definition
| is maintaining optimal fluid intake. |
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Term
| How do you implement in the acute care setting? |
|
Definition
Maintaining elimination habits
Allow time and provide privacy.
Medications
Parasympathetic stimulation of the detrusor muscle aids emptying.
Cholinergic drugs increase bladder contraction and improve emptying.
Catheterization |
|
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Term
| What are the steps of cathetirization that ensure decreased spread of infection? |
|
Definition
Catheter insertion
Closed drainage system
Catheter care
Perineal hygiene
Fluid intake
Catheter irrigations and instillations
Removal of indwelling catheter
Alternative to urethral cathetirization |
|
|
Term
| What prevents the spread of infection w/ catheters? |
|
Definition
Follow good hand hygiene techniques.
Do not allow the spigot on the drainage system to touch a contaminated surface.
Only use sterile technique to collect specimens from a closed drainage system.
If the drainage tube becomes disconnected, do not touch the ends of the catheter or tubing. Wipe the end of the tubing and catheter with an antimicrobial solution before reconnecting.
Ensure that each patient has a separate receptacle for measuring urine to prevent cross-contamination.
Prevent pooling of urine in the tubing and reflux of urine into the bladder.
Avoid raising the drainage bag above the level of the bladder.
If it becomes necessary to raise the bag during transfer of the patient to a bed or stretcher, clamp the tubing or empty its contents into the drainage bag first.
Provide for drainage of urine from the tubing to the bag by positioning the tubing.
Before exercise or ambulation, drain all urine from the tubing into the drainage bag.
Avoid prolonged kinking or clamping of the tubing.
Empty the drainage bag at least every 8 hours. If you note large outputs, empty more frequently.
Encourage fluid intake (if not contraindicated).
Remove the catheter as soon as clinically necessary.
Tape or secure the catheter appropriately for the patient.
Perform routine perineal hygiene per agency policy and after defecation or bowel incontinence. |
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|
Term
| How do you put on a condom catheter? |
|
Definition
Leave 1-2 inches off the end
Be sure that the skin of the penile shaft is intact and free from swelling, redness, or open lesions before applying the condom catheter. |
|
|
Term
| How do you secure a condom catheter? |
|
Definition
. The first method uses a strip of elastic tape or rubber that encircles the top of the condom to secure it in place.
2. Another type uses a self-adhesive condom sheath.
3. The third method uses an inflatable ring within the condom to secure placement. |
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|
Term
| Where is the drainage bag w/ a condom catheter? |
|
Definition
| The end of the condom is attached to plastic drainage tubing and a bag that you attach to the side of the bed or strap to the patient’s leg. |
|
|
Term
| How often should you change a condom catheter? |
|
Definition
|
|
Term
| What is the advantage of a condom catheter? |
|
Definition
| The condom catheter itself poses little risk of UTI. Infection usually results from buildup of secretions around the urethra, trauma to the urethral meatus, or buildup of pressure in the outflow tubing. |
|
|
Term
| When is an external urinary device used? |
|
Definition
| For a man with a retracted penis, maintaining a conventional condom catheter often proves difficult. Special devices are available to help alleviate this problem |
|
|
Term
| What is important to note when using diapers and pads? |
|
Definition
| To maintain dignity, do not refer to pads and protective clothing as adult diapers, and change them frequently to control odor. Use these products only temporarily to minimize or prevent episodes of incontinence while treatment is ongoing. |
|
|
Term
| What is the restorative care involved with urinary problems? |
|
Definition
Strengthening pelvic floor muscles
Bladder retraining
Habit training
Self-catheterization
Maintenance of skin integrity
Promotion of comfort |
|
|
Term
| How do you evaluate the effectiveness of urinary implementations? |
|
Definition
Evaluate whether the patient has met outcomes and goals.
Check how the patient reports progress made.
Help the patient redefine goals if necessary.
Revise nursing interventions as indicated.
Tell me, How frequently are you voiding now?”
“Do you continue to have the feeling of urgency every time you void?”
“Have the symptoms of urgency decreased since you changed your caffeine intake?”
“Do you still have burning when you pass urine?”
“Do you still feel uncomfortable over your lower abdomen?” |
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