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Urinary/Lower UTI Chapter 46
Terms in this set (157)
Urinary system is?
Kidneys remove wastes from the blood to form urine.
What does low cardiac output=?
Lower perfusion to kidneys
What percentage of CO circulates /minute through kidneys?
Where do ureters transfer urine from?
Kidneys to the bladder
Bladder holds urine until?
The urge to urinate develops (signal from brain)
Where does urine leave through?
How many inches is the urethra in females?
How many inches is the urethra in males?
What is Nephron?
-functional unit of the kidney
-removes wastes and forms urine
What is the Adult normal urine output?
What does output of <30 mL/HR indicate?
Possible circulatory, blood volume or renal alterations
How do kidneys function during regulation?
•Body fluid volume and osmolality
What do the kidneys excrete?
-Metabolic waste products
What hormones do kidneys secrete?
Erythropoietin, renin prostaglandins
Blood in urine
small amount of urine
absence of urine formation
burning or pain with urination
awakening from sleep due to urge to void
abnormal secretion of large amounts of urine
protein in the urine
bacteria in the urine (UTI)
Have to pee a lot
immediate and strong desire to void that is not easily deferred
urine dribbles (usually w/catheter)
inability to control urination
difficulty starting urination(feel like you have to pee but can't)(usually in enlarged prostate)
factors influencing urination
•Medications and medical procedures
•Symptoms of fluid balance
Symptoms of fluid balance
•Nocturia, polyuria, oliguria, anuria, diuresis
What decreases in effects of aging on the urinary system?
•Decrease in kidney size, weight and glomerular function
•Decreased renal blood flow (GFR)
What things effect the urinary system because of aging?
•Altered hormonal levels
•Loss of elasticity and muscle support
What medications can increase urine output?
•Diuretics (Lasix, Hydrochlorothiazide)
What medications decrease Urine Output?
•NSAIDs, anticholinergics, antihistamines
What medications change Urine appearance?
•Phenazopyridine/pyridium (AZO), amitriptyline
What medications can cause renal toxicity?
•Gentamicin, vancomycin, NSAIDs, chemotherapy
•Be careful with "mycins" can à kidney damage
During assessment, the history & interview should include?
•Patterns of urination
•Symptoms of urinary alterations
•Factors affecting urination
During assessment, what should be taken during the physical assessment?
•Urine output (I&O)
•Lower abdominal or flank pain
During assessment, laboratory & diagnostic tests should include?
What do you assess with skin and mucosal membranes?
Assess hydration or
signs of skin impairment
What does the skin show?
If patient is dehydrated or fluid overload
What test is done for dehydration status?
Pinching the skin
(if skin is tense then pt is dehydrated)
Flank pain in kidneys may occur with?
infection or inflammation
Where does distended bladder rise?
Above symphysis pubis
What do you asses with the urethral meatus?
Observe for discharge, inflammation, and lesions.
Yellow-Amber urine color
•Pale straw (less concentrated)
•Amber (more concentrated)
Clarity(Transparent) Urine color
•Cloudy (presence bacteria and WBCs)
Odor(Aromatic) with urine
•Ammonia in nature
•Stronger (more concentrated)
•Sweet or fruity(uncontrolled diabetes patients usually) (acetone/acetoacetic acid)
What are tests and diagnostic examinations done?
What are the urine specimen collection?
•Random Urinalysis (UA)
•Urine Culture (Midstream, Clean Catch)
•Timed Specimen (24 hour specimen)
What are the blood tests for renal function?
•Blood Urea Nitrogen (BUN)
•Electrolytes (Na, K, Ca, P, HCO3)
Radiologic & diagnostics tests
•Kidneys, Ureters, Bladder (KUB)
•Computed tomography Scan (CT)
•Intravenous Pyelogram (IVP)
•Renal Bladder Ultrasounds (Bladder Scan)
In acute care, how do you maintain elimination habits?
Allow time and provide privacy
In acute care, what can you give?
Catheter size in infants
Catheter size in pediatrics
Catheter size in most adults
What happens if leakage occurs with catheter?
Change the lumen size
Material for catheterization
•Plastic or Red Rubber (intermittent)
•Latex (up to 3 weeks)
•Pure silicone or Teflon (up to 2-3 months)
Balloon size for indwelling catheter
•Sterile water (in kit)
•Pediatric: 3 mL
•Adults: 5 and 30 mL
Build up of secretion or encrustations can lead to?
Perform every shift and prn after every?
How do you care for the catheter?
•Cleanse with soap and warm water around the catheter and down the entire length
What do you need to be careful with the catheter?
Careful to not advance further into bladder
When do you remove catheter?
•Remove as soon as it is no longer needed!
When removing catheter what do you want to prevent?
Trauma to urethra
When do you deflate balloon?
Deflate balloon prior to removal
What may be experienced after catheter removal?
Dribbling and Dysuria
How do you assess patient's urinary function after catheter removal?
By noting first void
What do you do if there is NO urine output in 4 hours(unrelated to discomfort)
What technique can be used to prevent CAUTI?
Insertion using aseptic technique and sterile equipment
Why do you secure to prevent CAUTI?
To prevent movement and pulling
How does the urinary drainage system need to be maintained to prevent CAUTI?
Maintain a closed urinary system drainage system: Do not break
Where does the bag need to be kept to prevent CAUTI?
Drains by gravity: Keep bag below the level of the bladder
What kind of flow needs to be maintained to prevent CAUTI?
The drainage system can't touch what to prevent CAUTI?
Do not allow drainage system to touch the floor
When emptying, to prevent CAUTI what is not allowed to touch any surfaces?
To prevent CAUTI when do you empty drainage bag prn?
•when ½ full (~1000 mL) and every 8 hours
•Before starting activities
What needs to be performed to prevent CAUTI?
Routine perineal care and after each BM
To prevent CAUTI, if the drainage tube becomes disconnected what can't be touched?
-Ends of the catheter or tubing
-Wipe ends with antimicrobial solution before reconnecting
To prevent CAUTI, what needs to be avoided with tubing?
Avoid prolonged kinking or clamping of tubing
To prevent CAUTI where do you want to avoid positioning the patient?
On the drainage tube
When do you want to change the catheter?
-If it is obstructed with sediment
-DO NOT IRRIGATE OR FLUSH
What are alternatives to catheterizations?
•Incontinent or comatose men
•Soft, pliable rubber sheath that slips over the penis
•Surgical placement of a catheter through the abdominal wall above the symphysis pubis and into the urinary bladder
An accumulation of urine due to the inability of the bladder to empty properly
Results from catheterization or procedure
involuntary leakage of urine
Diversion of urine to external source
What are symptoms of urinary retention?
•Pubic pressure & discomfort:
•Tenderness on palpation
•No relief post void
•Leakage: 25-60 ml
Acute urinary retention can be caused by?
Chronic urinary retention can be caused by?
Post Void Residual (PVR) conditions?
•spastic bladders, spinal cord injuries
When is the bladder scanner used?
10-15 minutes after voiding to determine residuals
With urinary retention what do you want to encourage?
-Bladder complete bladder emptying
For urinary retention pt needs to void?
Q 2-3 hours while awake
What needs to be recorded with urinary retention?
-Record all voids
-Amount and time
How can a warm bath help with urinary retention?
What method can be used for urinary retention to attempt void?
Crede's method (push dow on bladder to try to push our urine)
What can Valsalva Maneuver help with?
What is the most health care acquired infections?
What percentage of UTI's are from indwelling catheters?
-5% increase in bacteria in urine/day
What is the most common microorganism found in UTI?
What other organisms are found in UTI?
Where are these microorganisms mostly coming from?
Patient's normal flora
Sexually transmitted illnesses can cause?
What can UTI lead to?
Bacteremia or urosepsis
Who is more susceptible to UTI's?
•Women > Men
•Older > Younger
Multiple sexual partners
•Nausea and vomiting
What is the best indicator for older patients with UTI?
•Change in Level of consciousness (LOC)
•Afebrile (without a fever)
•Urinary tract infection of the LOWER portion - bladder
Symptoms of UTI (cystitis)
•Urinary tract infection - UPPER tract to the kidneys
What can UTI Pyelonephritis lead to?
Symptoms of UTI: Pyelonephritis
•Flank pain (+ CVA tenderness on exam)
What treatments can be done for UTI Pyelonephritis?
IV abx and fluids
What can you teach patients about treatment?
When teaching women about proper hygiene, how does a women wipe?
Wiping from front to back
When teaching patient about proper hygiene, how does a male clean?
Cleans beneath foreskin in males
How do you teach patient on how to care for catheter?
Catheter care at least 3 times/day and after BM
What do you need to teach patient to avoid to prevent UTI?
•Avoid harsh soaps, scented feminine hygiene products
Teach patient to void every
Teach patient to stay?
•Incontinence is the involuntary leakage of urine that is sufficient to be a problem.
How long can Urinary incontinence last?
•Can be temporary, permanent, or continuous or intermittent
What can cause urinary incontinence?
Physical mobility or environmental barriers
What are the types of urinary incontinence?
•Mixed (urge and stress)
How can females be at risk for urinary incontinence
Multiple pregnancies and vaginal births
What is not a normal part of aging?
What conditions are risk factors for urinary incontinence?
•Neurological disorder: CVA, Parkinson's, spinal cord disorders
•Cognitive changes: confusion, dementia, depression
•Physical limitations: immobility, fractures
What medications can be risk factors for urinary incontinence?
Obesity is a risk factor for?
Functional urinary incontinence
•Loss of urine caused by factors outside the urinary tract
What are relevant factors to functional urinary incontinence?
•Environmental barriers(wheelchair can't fit in RR)
What interventions can be done for functional urinary retention?
Stress urinary incontinence
•Involuntary leakage of urine during increased abdominal pressure in the absence of bladder muscle contraction
Relevant factors to stress urinary incontinence
•Lifting with full bladder
Treatments & Interventions with Stress Urinary Incontinence
Urge Urinary Incontinence
•Involuntary passage of urine after a strong sense of urgency to void
What can Urge Urinary Incontinence have?
Relevant factors to Urge Urinary Incontinece?
What interventions can be done for Urge Urinary Incontinence?
• Kegel exercises
• Lifestyle modifications (weight loss, fluid modifications)
How is treatment with Mixed(urge and stressed)?
Based on symptoms that are most bothersome
•Lack of urge to void, unawareness of bladder filling, reflex emptying when certain volume reached
Relevant factors of Overflow
Spinal cord dysfunction
Treatment for overflow
Hyperactive/Overactive Urinary Incontinence
Urinary urgency is associated with urinary frequency and nocturia
Treatment for Hyperactive/Overactive Urinary Incontinence
•Intake of 1.5-2 L of fluid a day
•Limited carbonated and caffeinated drinks
What is urinary diversions?
Reroute urine flow from it's normal pathway
Types of Urinary Diversions
•Continent urinary reservoir
•Urostomy or Ileal Conduit
•Strengthening pelvic floor muscles
• Kegel exercises
•(usually with CNS problems)
•Maintenance of skin integrity
Promotion of comfort
How can an older adult have more frequent opportunities to void?
Bladder emptying before, after meals and bedtime
What do you want to encourage older adults?
DO NOT restrict fluids
What needs to be avoided with older adults?
Diuretics such as coffee, tea, and alcohol
What catheters do older adults need to avoid?
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