Ch. 48 urinary

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Ch. 48 urinary
2012-12-03 13:00:43
my notes 38 48

urinary kozier
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  1. clean voided urine specimens
    • - for routine urinanalysis
    • - usually done one first void in the morning
    • - at least 10 mL of urine needed
    • - may be assigned to UPA
  2. clean-catch or midstream urine specimens
    • -  for urine culture to ID microorganisms causing UTI
    • - collected in sterile container
  3. urine testing
    • - specific gravity
    • - urinary pH
    • - glucose
    • - ketones
    • - proteins
    • - occult blood
    • - osmolality
  4. upper urinary tract
    • kidneys
    • ureters
  5. kidneys
    • primary regulators of fluid and acid base balance in body
    • this is where urine is formed
  6. nephrons
    • functional unit of kidneys
    • filters blood and removes metabolic waste
  7. ureters
    carry urine from kidneys into bladder
  8. lower urinary tract
    • urinary bladder
    • urethra
    • pelvic floor
  9. bladder
    • reservior for urine
    • organ of excretion
    • can carry 300-600 mL of urine
  10. urethra
    • serves only as a passageway for urine elimination
    • in men it also serves as passageway for semen
  11. pelvic floor
    contains vagina, urethra, and rectum
  12. factors affecting voiding
    • developmental factors
    • psychosocial factors
    • fluid and food intake
    • meds (diuretics increase urine formation)
    • muslce tone (catheters decrease muscle tone)
    • pathologic conditions
    • surgical/diagnostic procedures
  13. meds cause urinary retention
    • anticholinergic
    • antidepressants
    • antipsychotic
    • antihistamine
    • antihypertensives
    • antiparkinsonism
    • beta-adrenergic blockers
    • opioids
  14. ployuria or diuresis
    • abnormally large amounts of urine produced by kidneys
    • ASSOCIATED FACTORS: ingestion of caffine/alcohol, prescibed diuretics, presence of thirst, dehydration and weight loss, diabetes mellitus, diabetes insipidus, chronic nephritis.
  15. oliguria
    • decrease urine output, less than 500mL/day or 30mL/hr for adult
    • ASSOCIATED FACTORS: decrease fluid intake, signs of dehydration, presence of hypotension, shock or heartfailure, Hx of kidney disease, signs of RF
  16. urinary frequency
    • voiding at frequent intervals more than 4-6/day
    • caused by UTI, pregnancy, stress, increase fluid intake
  17. nocturia
    • voiding 2 or more times at night
    • caused by increase fluid intake, UTI, pregnancy
  18. urgency
    • sudden, strong desire to void
    • caused by psychological stress, UTI
  19. dysuria
    • painful/difficult voiding
    • caused by UTI (inflammation, infection, or injury)
  20. urinary incontinence
    • involuntary leakage of urine or loss of bladder function
    • caused by bladder inflammation (CVA), cognitive impairment, leakage when coughing, laughing, sneezing
    • can be acute (Transient) or chronic (Established)
  21. Transient (acute UI)
    • arrives suddently, last 6 months or less
    • has reversible causes
    • ASSOCIATED FACTORS: polyuria, infection, exposure to irritants, urinary retention, stool impact/constipation
  22. T.O.I.L.E.T.E.DT=
    • used to ID possible factors contributing to transient UI
    • T= thin/dry vaginal and urethral epithelium
    • O= obstruction (bowl patterns)
    • I= infection (UTI)
    • L= limited mobility
    • E= emotional/psychological factors
    • T= therapeutic meds (tranquilizers, diuretics, narcotics, antibiotics)
    • E= endocrine disorder (diabetus)
    • D= delirium
  23. Established (chronic UI)
    • have 5 different etiologies
    •   functional UI
    •   overflow UI
    •   reflex UI
    •   stresss UI
    •   urge UI
  24. Enuresis
    • involuntary urination in children
    • ASSOCIATED FACTORS: family Hx, difficult access to toilet facilities, home stresses
  25. Retention
    • emptying of bladder is impaired urine accumulates and the bladder becomes overdistended
    • caused by recent anesthesia, recent perineal surgery, meds
  26. Neurogenic bladder
    • impaired neurological function interferes with normal mechanisms of urine elimination
    • patient doesn't perceive bladder is full, unable to control urinary sphincter
  27. BUN
    • measures urea (end product of protein metabolism)
    • 8-25 mg/100mL
  28. Creatinine clearance
    • determines the glomerular filtration rate
    • 0.6-1.5 mg/100mL
  29. NANDA for urinary elimination
    • impaired urinary elimination
    • readiness for enhanced urinary elimination
    • functional UI
    • stress UI
    • overflow UI
    • reflex UI
    • urge UI
    • urinary retention 
  30. NANDA Functional UI
    inability of usually continent person to reach toliet in time to avoid unintentional loss of urine
  31. NANDA Overflow UI
    involuntary loss of urine associated with overdistention of the bladder
  32. NANDA Reflex UI
    involunatry loss of urine at somewhat predictable intervals when a specific bladder volume is reached
  33. NANDA Stress UI
    sudden leakage of urine with activities that increase intra-abdominal pressure
  34. NANDA Urge UI
    involuntary passage of urine occuring soon after a strong sense of urgency to void
  35. NANDA Risk for urge UI
    at risk for involuntary loss of urine associated with a sudden, strong sensation of urinary urgency
  36. UTI prevention
    • drink 8 (8oz) of water/day
    • practice frequent voiding (every 2-4hrs)
    • avoid use of harsh soaps, powders, bubble baths, sprays
    • avoid tight fitting pants
    • wear cotton underclothes
    • wipe front to back
    • take showers rather than baths