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How much urine can the average, normal bladder store?
When is the first urge to urinate felt?
How much urine is in the bladder when there is a feeling of discomfort?
The inability to inhibit the micturition reflex is at how many mL's?
The kidneys produce urine at a rate of about _____ mL per hour.
The kidneys produce about _____ mL of urine/day.
- 1500 mL
- Can fluctuate from 1000 mL to 2000 mL depending on various factors.
The normal specific gravity randge for urine is __________.
1.002 to 1.028
At age 80 there are only about ____ of the functioning nephrons remaining in the kidneys.
2/3 of the functioning nephrons. This results in a decline in filtration rate which affects the ability to dilute and concentrate urine but does not normally create problems unless an illness alters fluid balance such as vomiting and diarrhea-making it difficult to maintain acid-base and electrolyte balances.
____________ decreases the ability of the bladder to empty completely. Retention of urine after voiding increases the risk for bladder infections.
Loss of elasticity and muscle tone
What factors can inhibit voiding?
- Lack of time
- Lack of privacy
- Loss of dignity
- Cultural influences
What everyday substances act as diuretics and increase urine production?
- (all caffeine containing substances)
How does alcohol affect urine production?
Impairs the release of ADH resulting in increased production of urine
What are three methods for determining whether hydration is adequate and urine output is within normal limits?
Urine color, frequency, and amount
What affect does (Phenazopridine hydrochloride) Pyridium have?
Bladder analgesic that turns the urine a deep orange-red color
What affect do some antibiotics such as gentamicin (Garamycin) and amphotericin B (Amphotec, a fungicide), and high doses or long term use of aspirin and ibuprofen have on the kidneys?
Nephrotoxic (Damaging to the kidneys)
How do anesthetic agents affect urine output?
- Decrease blood pressure and glomerular filtration thus decreasing urine formation.
- Sprinal anesthesia decreases the patient's awareness to void which may lead to bladder distension.
What is a neurogenic bladder?
Occurs as a result of impaired neuro function-the person cannot perceive bladder fullness nor control the urinary sphincter.
How does a systemic infection especially associated with high fever affect kidneys?
Causes kidneys to reabsorb and retain water
What types of medications are associated with urinary retention?
T or F
Reproductive and urinary tract surgeries can affect urine solutes, normal urine characteristics, and the ability to pass urine normally.
True. Especially if there is swelling causing urinary retention.
T or F
Surgery in the pubic area, vagina, or rectum is associated with a high incidence of trauma to the urinary organs, lower abdominal swelling, loss of pelvic muscle control, and increased pressure on the kidneys, ureters, or bladder.
True. Usually will require indwelling catheter and urine may be red or pink tinged after invasive UT surgery.
How long can it take to attain urinary continence after a prostatectomy?
Within 6-12 months of surgery with active management
When will you usually measure urine output from an indwelling catheter?
At the end of each shift unless otherwise ordered.
What must be done when taking a clean-catch specimen?
- The client must cleanse the genitalia before voiding
- Must collect the sample midstream to avoid contaminants
How is a sterile urine specimen obtained?
- Inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter (Never take the specimen from the collection bag because that urine may be several hours old)
- Insert a neddle into the specimen port of the catheter and withdraw the urine
- If the urine is not flowing briskly you may need to clamp the cath for 15-30 min. to allow a fresh sample to collect.
What is important to do when obtaining a 24 hour urine collection?
Have the pt. void and record the time and then discard the first voiding but collect all urine for the next 24 hours.
What is acute renal failure?
An acute rise in the serum creatnine level of 25% or more. May be caused by inadequate blood flow to the kidney, injury, or kidney obstruction
What is anuria?
The absence of urine. Used when urine output is <100 mL in 24 hours
What is dysuria?
Painful or difficult urination. May be ass'd. with infection or patial obstruction of UT as well as meds that trigger urinary retention
What is end-stage renal disease?
- A permanent rise in serum creatnine levels ass'd with loss of kidney function-must be treated with dialysis
- Also known as chronic renal failure
What is hematuria?
Blood in the urine
What is oliguria?
Urine output of less than 400 mL in 24 hours
What is nephropathy?
Disease of kidney
What is nephrotoxic?
A substance that damages kidney tissue. Some antibiotics (gentamycin), NSAIDS, and lead
What is nocturia?
Frequent urination after going to bed. May be caused by excessive fluid intake as well as a variety of urinary problems
What is polyuria?
What is proteinuria?
Presence of protein in the urine
What is pyuria?
Pus in the urine. May be caused by lesions or UTI
What is urgency?
A sudden, almost uncontrollable need to urinate
What is dipstick testing used for?
- Testing pH and specific gravity
- Presence of protein, glucose, ketones, and occult blood in the urine
How do you measure specific gravity of urine?
- Dipstick-reagent strip
- Refractometer-most accurate
How often should you empty a collection bag for an indwelling catheter?
At least every 8 hours
In what way could you increase the pt's urine acidity to prevent bacterial growth?
Encourage foods such as cranberry juice, prunes, plums, tomatoes, meat, cheese, citrus fruits, and eggs
What are the 5 goals for caring for a pt. with an indwelling catheter?
- Prevent UTI
- Maintain free flow of urine
- Prevent transmission of infection
- Promote normal urine production
- Maintain skin and mucosal integrity
What is recommended to patients with urinary incontinence?
- Increase daily oral fluids to 3000 mL/day to encourage flushing
- Limit daily caffeine intake
- Lose weight
- Stop smoking
- Take prescribed diurectics early in the morning
- Avoid constipation
- High impact exercise is ass'd with increased stress UTI
An infection limited to the urethra is called _____?
______ occurs when bacteria travel up the urethra into the bladder causing a bladder infection.
What people are more prone to UTI's?
- Sexually active women
- Women who use spermicidal contraceptive gel
- Older women
- Men with enlarged prostate
- People with kidney stones
- Anyone with an indwelling catheter
- People with DM
- People who have a history of UTIs
What are the causes for urinary retention?
- Inflammation and swelling
- Neurological problems
What is urge incontinence?
Involuntary loss of urine ass'd with a strong urge to void (overactive bladder)
What is stress incontinence?
Involuntary loss of urine with increased intrabdominal pressure. Etiologies can include pregnancy, obesity, constipation, straining at stool. Exercise, laughing, sneezing, coughing, lifting.
What is overflow incontinence?
- Loss of urine in combination with a distended bladder.
- Causes: fecal impaction, neuro disorders, enlarged prostate
What is functional incontinence?
- Involuntary loss of urine in the absence of urinary system injuries or nervous system problems. Normally continent person not able to reach toilet in time.
- Causes: Confusion, disorientation, mobility problems
What is unconscious (reflex) incontinence?
Loss of urine when the person does not realize the bladder is full and has no urge to void.
What is enuresis?
- Involuntary urination after 5-6 years of age
- Nocturnal-night time bed-wetting
- Primary-if bladder training was never achieved
- Secondary-If control was est. then lost
_____ reroutes the ureters directly to the surface of the abdomen, forming a small stoma.
- Cutaneous urostomy.
- May be unilateral or bilateral.
- Limited use b/c it provides a pathway for pathogens on the skin to directly enter the kidney.
______ is the most common type of urinary diversion.
- Ileal conduit (Bricker's loop) a small piece of ileum is removed with blood and nerve supply intact. Results in a small pouch into which the ureters are implanted
- Prefered over the cutaneous urostomy b/c greater prevention from infection-also has stoma that is easier to fit with an appliance
What is the general goal r/t urinary elimination?
Pt will comfortably void approx. 1500 mL of light yellow urine in 24 hours
What are the ways of promoting normal urination?
- Providing privacy
- Assisting with positioning
- Facilitating toileting routines
- Promoting adequate fluids and nutrition
- Assisting with hygiene
What is the Crede's maneuver?
Applying manual pressure over the bladder to promote emptying
What is the order in managing urinary retention?
- 1.) Administer cholinergic medications
- 2.) Perform Crede's maneuver
- 3.) Perform urinary catheterization
What position should the pt. be in for catheterization?
Dorsal recumbent for both men and women
What are ways of managing urinary incontinence?
- Lifestyle modifications
- Bladder training
- Schedule voiding
- Pelvic floor muscle rehab
- Vaginal weight training
- Supportive interventions-helping pt. reach toilet and self care
_______ are excercises most commonly used for pelvic floor muscle rehabilitation.
- Kegel exercises-strengthen perineal muscles and help prevent and treat stress, urge and UI
- Must be practiced correctly and daily-a period of 6-12 mos. may be required before effective
_____medication given to treat urge incontinence.
Anticholinergics, smooth-muscle relaxants, calcium-channel blockers, and antidepressants-Relax detrusor muscle and increase bladder capacity
______ may be given to improve urethral sphincter muscle funtioning with stress incontinence
- Decreases fluid
- Take in the AM to avoid noctouria
- Take at the same time every day if not in the AM
What is Phenazopyridine Hcl (Pyridium) administered for?
- Bladder analgesic-UTI
- Discolors urine orange--->wear pad in underwear to avoid staining
- When symptoms go away--does not mean UTI is cured---the pain is gone due to the analgesic---DO NOT STOP ANTIBIOTICS
S/Sx of UTI
- Urinary frequency
- Foul smelling
T or F
Urinary incontinence is a symptom of normal aging
What is important to remember in a pt. with functional urinary incontinence?
- Make it a priority to answer call
- Use pants with elastic waist
- Avoid catheter if possible
Post voiding residual urine should be less than ______.
T or F
Residual volumes >500 mL are an emergency.
- True-potential for bladder damage
- If bladder is palpated and distended--take that to be >500 mL
How should bladder training be implemented?
- Toileting pt. on a regular schedule q2h
- If pt does well can go to q3h
- DO NOT go to q4h-Usually too long
______ and _______ are nephrotoxic drugs.
Gentamacin (Garamycin) and Amphotec (fungicide)