Kozier Ch 48 Urinary Elimination

Card Set Information

Author:
cswett
ID:
114763
Filename:
Kozier Ch 48 Urinary Elimination
Updated:
2011-11-13 21:47:50
Tags:
Kozier 48 Urinary Elimination
Folders:

Description:
Kozier Ch 48 Urinary Elimination
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user cswett on FreezingBlue Flashcards. What would you like to do?


  1. Functions of the Kidney
    • •Regulation of Fluid and Electrolytes
    • •Regulation of Acid-Base
    • •Hormones
    • –Erythropoietin- stimulates RBC production
    • –Renin
    • •Substance that converts Vit D to
    • active form for Calcium absorption
  2. •Anatomy & Physiology & Structures of urination
    • –Kidneys
    • •nephron

    • –Ureters
    • –Bladder
    • –Urethra
    • –Pelvic floor
    • –Urination
  3. Functions of the Kidney
    • •Regulation of Fluid and Electrolytes
    • •Regulation of Acid-Base
    • •Hormones
    • –Erythropoietin- stimulates RBC production
    • –Renin
    • •Substance that converts Vit D to active form for Calcium absorption
  4. Kidneys
    • •Nephrons-
    • –Filter blood & remove metabolic wastes
    • –Plasma proteins & blood cells too large to cross
    • membrane
    • •Na & water excretion/retention regulated by ADH & aldosterone
    • •Normal Urine Output 1500-1600/day & 30 ml /hour
  5. Urinary System
    • •Ureters
    • –Connects kidneys to bladder (10-12 in long, small (0.5 in) diameter
    • –Flap prevents reflux

    • •Bladder- reservoir
    • –Muscles allow for wall of bladder to expand & fill
    • & release urine
    • –Bladder can hold 300-600 ml of urine

    • •Urethra
    • –From bladder to urinary meatus
    • –Shorter in women (1.5 in) than men (8 in)

    • •Pelvic floor
    • –Muscles in abdomen provide a sling like structure holding bladder in place
    • –Sphincters allow urine to be held or passed
  6. Urination
    • •Urination (micturation, voiding)
    • –Process of emptying the bladder
    • –Awareness of urine in bladder is when 250-450 ml urine stimulates sensory nerves
    • –Awareness to void based on:
    • •Intact nervous system
    • •Ability to sense a full bladder

    • •Normal urinary output
    • –average 1500 mL/24 hr (60 mL/hr )
    • –should be no less than 30mL/hr
    • –Most people void 5-6 times/day
  7. Micturition/Voiding/Urination
    • •Normal process
    • What is involved
    • –Bladder fills & stretches
    • (unfolds upward)
    • –Impulses sent to spinal cord
    • –Inner sphincter opens
    • –Sensation of “Need to void”
    • –Voluntary urination
  8. Factors Affecting Voiding
    Developmental Factors
    • •Ability to micturate (control urination)
    • –18 – 24 months old

    • •Aging impairs micturition
    • –Disease processes
    • •Reaching toilet
    • •Balance
    • •Unable to get up from toilet
  9. Factors affecting voiding
    Older Adults
    • Older Adults: Lifespan considerations P. 1289
    • –Kidney function decreases
    • –Urgency and frequency common
    • •Men- enlarged prostate
    • •Women- weakened muscles supporting bladder & weakness of sphincter
    • –Capacity of bladder less:
    • •Incomplete emptying
    • •Nocturia - getting up to void more than twice a night
  10. Factors affecting voiding
    Psychosocial
    Fluid & Food
    • •Psychosocial- factors that cause an inability to relax
    • –Privacy, normal position, not enough time

    • •Fluid & food-
    • –Intake of fluids
    • –Caffeine-increased diuresis
    • –Alcohol-inhibits release of ADH
    • –Urine color- beets turn urine red
  11. Factors affecting voiding
    Medications
    Surgical Procedures
    • •Medications- list on 1290
    • –Diuretics increase urine output
    • –Anticholinergics- inhibit free flow of urine
    • –Nephrotoxic (damage to the kidney)
    • –Meds turn urine color- pyridium (used for bladder spasms from UTI) turns urine orange


    • •Surgical procedures:
    • – of reproductive & urinary tract can affect ability to pass urine
    • –Stress triggers release of ADH & increase in aldosterone
    • –Anesthetics:
    • •decrease BP & glomerular filtration decrease awareness to void
  12. Factors affecting voiding
    • Pathological Conditions:
    • •Renal failure
    • •Bladder/kidney infections
    • •Kidney stones
    • •Hypertrophy of the prostate
    • •Decreased blood flow through glomeruli
    • –Heart failure
    • •Altered cognition
    • •Mobility problems
    • •Neurological conditions- MS, diabetes
    • •Communication problems
  13. Nursing Process: Assessment
    History
    • •Nursing History
    • –Elimination patterns
    • •Daily voiding patterns
    • •Frequency and times
    • •Volume and appearance
    • •Nighttime voiding

    • •History:
    • Ask about Factors associated with Altered Urinary Elimination - such as:
    • •Polyuria - excessive amount of urine (diabeties insipidus)
    • •Oliguria - not voiding enough
    • anuria - not voiding at all
    • •Frequency - more than 4 - 6 times a day
    • •Nocturia - two or more times a night
    • •Urgency - sudden strong desire to void
    • •Dysuria - painful urination
    • •Incontinence - cant hold it
    • •Hesitancy - going & stopping - cant empty bladder
    • •Retention - not totally emptying bladder

    • •History: ask about-
    • •Fluid intake
    • •Prior history of renal stones
    • •History of urinary track infections (UTIs)
    • •Bladder/kidney surgery
    • •Medication use
    • •Other diseases/conditions affecting urination
  14. Nursing Pricess: Assessment
    Physical Assessment
    • •Physical Assessment:
    • –Percussion of kidneys
    • –Palpation & percussion of bladder
    • –Inspect urinary meatus
    • –Look & smell for urine
    • –Check skin- general color & texture, local irritation
    • –Check for edema
  15. Nursing Process: Assessment
    Assessment of Urine
    • •Assessment of Urine
    • –Measure fluid intake and output (I/O)
    • –Observe universal precautions
    • –Residual urine (less than 100 mL after voiding)

    • Characteristics of urine
    • –Color (pale, straw, amber) & clarity
    • –Odor, more concentrated, stronger odor
    • –Sterile - urine normally sterile
    • –pH- usually acidic 4.5 - 8
    • Specific gravity- 1.010-1.025
    • –No presence of glucose, ketones, or blood
  16. Assessment
    • Urine Collection
    • •Voided urine – ambulatory patients who go to bathroom put specimen “hat” over toilet & instruct pt.
    • •Midstream clean catch – cleanses perineal area with towelette front to back, starts urinating then goes into specimen cup
    • *less than 10,000 organisms & multiple orgainsms = contamination from skin - not treated
    • •Sterile – catheterize or remove sample from indwelling catheter by accessing port on indwelling
    • catheter
    • •24 hour urine- to begin have pt void and record the
    • time. Collect all urine from this time

    • •Diagnostic Tests:
    • –Urinalysis–“dipstick”, measures pH, specific gravity, protein glucose
    • –Urinalysis- sent to lab to assess characteristics of urine (Sp.Gr.)
    • –Urine Culture (sterile specimen)
    • –Blood tests- assesses renal function
    • •BUN (8-20 mg/dl)
    • •Creatinine (0.5-1.1mg/dl)
    • *if creatinine is normal but BUN is up - dehydrated - need to be better hydrated)
  17. Nursing Diagnosis
    • Main one:
    • •Impaired urinary elimination

    • •Many types of Urinary Incontinence
    • –Functional - cant get to bathroom (broken leg)
    • –Reflex - when specific volume is in the bladder
    • –Stress - sudden abd pressure -sneeze or cough
    • –Urge - sudden strong urge to void
    • –Total (continuous & unpredictable passage of urine)

    • •Urinary retention
    • •Risk for infection
    • •Low self-esteem
    • •Risk for impaired skin integrity
    • •Body image disturbance
    • •Self-care deficit, toileting
    • •FVD or FVE
    • •Lack of knowledge
    • •Risk for social isolation
  18. Planning
    • •Goals and expected outcomes. Client will:
    • –Maintain or restore a normal voiding pattern
    • –Remain dry throughout night
    • –Will have intact skin
    • –Will not develop an infection
  19. Maintaining Normal Urinary Elimination
    • •Promote fluid intake
    • –1500 ml/day, more if UTI or fluid loss
    • •Maintain normal voiding habits (Guidelines p. 1299)
    • –Positioning: normal position, commodes
    • –Relaxation: privacy, allow time, run water
    • –Timing: avoid delays, establish pattern
    • –Confined to bed: warm bedpan, high-fowlers
    • •Assist with toileting
  20. Lower Urinary Tract Infections
    • RISKS
    • •Women > men
    • •E.Coli
    • •Indwelling catheters
    • •Wiping back to front
    • •Holding urine too long
    • •Synthetic undies & hose
    • •Tight clothing
    • •People with diabetes
    • •Intercourse
    • •Baths & soaps

    • •S & S - signs & symptoms
    • •Frequency
    • •Urgency
    • •Burning, pain (dysuria)
    • ** elderly may not experience dysuria - if they experience shaky chills with no other symptoms - probably
    • •Cloudy urine (WBCs)
    • •Blood in urine (hematuria)
  21. Uninary Incontinence
    • •½ of 1.5 million Americans who live in nursing homes are incontinent
    • •Incontinence is not a normal change with aging
    • •Risk factors:
    • –Men (BPH - benign prostetic hypertrophy - enlarged prostrate), Women (childbirth)
    • –Obesity, diabetes
  22. Urinary Incontinence: Types
    • •Types
    • •Functional – usually continent person can’t reach toilet on time
    • **Confusion, dementia, depression
    • **Impaired mobility
    • **Sedation or diuretic therapy

    • •Reflex- when specific bladder fullness is reached
    • **Enlarged prostate
    • **Spinal cord injury

    • •Stress- due to increased intra-abdominal pressure
    • **Laughing, coughing
    • **Weak perineal muscles (pregnancies)

    • •Urge- soon after strong urge to void
    • **CVA, Parkinson’s, perineal weakness
  23. Managing Urinary Incontinence
    Continence (Bladder) training

    • Bladder Training: goal is for pt. to hold greater volumes of urine & increase interval between voidings. Initially void every 2 hours then increase to every 4-6 hrs.
    • Teach distraction & relaxation strategies


    –Habit training or scheduled voiding: involves timed voiding. To keep dry, have ct. void at regular intervals


    • Strengthening Pelvic Floor Muscles
    • •Kegel exercise

    •Maintain Skin Integrity: keep dry, barrier creams

    •Anti-incontinence devices: pessary or intravaginal support device, condom catheters (men), indwelling catheter (used as last resort)

    •Medications: Estrogen, anticholinergics (oxybutynin ER [Ditropan XL])- decreases urgency & frequency by blocking receptors in detrusor muscle of bladder thereby decreases contracts of urine & increases urine storage.

    •Surgical: bladder suspension, prostate resection
  24. Urinary Retention
    • •Causes:
    • –Obstruction – stones, fecal impaction, scar tissue
    • –Inflammation & swelling from infection or surgery
    • –Lack of innervation to bladder
    • –Medications, anesthesia

    • –Confirmed by:
    • –Bladder scan, straight cath (post void residual >100 ml)

    • •Management:
    • –Assess for risk factors such as prostatic hypertrophy, medications with anticholinergic effects (valium, benadryl)
    • –I & O
    • –Assess for small amounts of urine voided 2-3 times/hour
    • –Palpate bladder for distention
    • –Place in normal voiding position, run water, Crede’s manuever (if ordered)
  25. Catheterization
    • •Insertion of a tube into the bladder to remove urine.
    • •Only do when necessary
    • •Danger is infection

    • •Straight catheterization
    • •Clean intermittent Self Cath (CISC)
    • •Condom catheters- external
    • •Indwelling catheter
    • –Urethral
    • –Suprapublic

    • •Bladder irrigations- picture
    • p. 1312
    • •Urinary Diversions- surgical opening for elimination of urine . Healthy stoma is pink to brick red.
  26. Care of clients with a catheter
    • •Insert with aseptic technique
    • •Prevent UTI by keeping drainage tube and collection bag a closed system
    • •Empty bag every 8 hours & before transport
    • •Maintain free flow of urine
    • •Provide catheter care by cleaning catheter with washcloth using soap water in downward motion
    • •Provide perineal hygiene and secure tubing to the leg
    • •Increase fluids to 3000 ml/day
    • •Diet- acidify urine to decrease chance of UTI (eggs, cheese, meat, poultry, whole grains, cranberries,
    • plums, prunes

    • •Indwelling catheter removal
    • –Deflate balloon!
    • –May leak until gains control
    • –1st void may be difficult. Assess in few hours
    • –If have not voided may need a bladder scan
  27. Evaluation
    • •Did the client:
    • –maintain or restore a normal voiding pattern
    • –remain dry throughout night
    • –have intact skin
    • –develop an infection
    • •Were the interventions appropriate? Are scheduled toileting times appropriate? Is access to toilet a problem? Are mobility aids needed:
    • BSC, walker, elevated toilet seat, grab bars.
    • Taking a diuretic, should continence aids like condom catheter, or absorbant pads be considered or used?
  28. Ongoing Assessment of Clients with Indwelling Catheters
    • 1. Ensure that there are no obstrucitons in the drainage
    • 2. Check for tension on the tubing and if secured to thigh and fastened to clothes
    • 3. Ensure that gravity drainage is maintained
    • 4. Ensure that the drainage system is well sealed or closed
    • 5. Observe flow of urine q 2-3 hrs & note color, odor, and abnormal constituents

What would you like to do?

Home > Flashcards > Print Preview