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66 Cards in this Set
- Front
- Back
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Filtration
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The kidneys filter and excrete blood constituents that are not needed and retain those that are.
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Fluid and Electrolyte Balance
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The nephrons maintain and regulate fluid balance through the mechanisms of selective reabsorption and secretion of water, electrolytes, and other substances.
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Regulation of BP
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Kidneys help maintain the composition and volume of body fluids.
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Urinary incontinence
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Any involuntary loss of urine that causes such a problem
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Autonomic bladder
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People whose bladders are no longer controlled by the brain because of injury or disease void by reflex only. This also occurs during infancy
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Urinary retention
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occurs when urine is produced normally but is not excreted completely from the bladder. Fx include: meds, an enlarged prostate, or vaginal prolapse.
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Enuresis
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Continued incontinence of urine past the age of toilet training
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Nocturia
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urination during the night
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Hematuria
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Blood in the urine
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Anuria
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24 hour urine output is less than 50 mL
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Dysuria
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Painful or difficult urination
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Frequency
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increased incidence of voiding
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Glycosuria
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Presence of sugar in the urine
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Oliguria
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Scanty or greatly diminished amount of urine voided in a given time; 24-hour urine output is less than 400 mL
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Polyuria
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Excessive output of urine (diuresis)
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Proteinuria
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Protein in the urine; indication of kidney disease
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Pyuria
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Pus in the urine; urine appears cloudy
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Supression
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Stoppage of urine production; normally the adult kidneys produce urine continously at the rate of 60-120mL/hr
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Urgency
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Strong desire to void
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Changes with the Aging Process
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Decrease nephrons
Decrease muscle tone & contractility Decrease ability to reabsorb Na+, Cl- , & water Decrease bladder capacity Increase ↑size of prostate |
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Decrease muscle tone
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Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination
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Decrease in nephrons
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The diminished ability of the kidneys to concentrate urine may result in Nocturia
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Decrease Contractility
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May lead to urine retention and stasis, which increase the likelihood of urinary tract infection
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Pathologic conditions
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Neuromuscular disorders, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time.
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Factors affecting urinary elimination
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1. Nocturia
2. Enuresis 3. Alcohol 4. Caffeine 5. Fever 6. Medication |
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Caffeine
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Caffeine-containing beverages have a diuretic effect, increasing urine production
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Fever and diaphoresis (profuse perspiration)
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Results in body fluid conservation by the kidneys. Urine production is decreased, and the urine is highly concentrated.
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Assessment: Kidneys
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The kidneys are normally well protected by considerable fat and connective tissue, making palpation difficult. This requires deep palpation and should be practiced only under the supervision by an advanced practitioner.
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Assessment: Bladder
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Palpate or bedside scanner is another way to assess the bladder.
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Assessment: Urethral meatus
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Inspect the urethral orifice for any signs of inflammation, discharge, or foul odor. In females, its a slit-like opening below the clitoris and above the vaginal orifice. In males, its at the tip of the penis.
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Assessment: Skin
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Because problems with urinary functioning may result in disturbances in hydration and excretion of body wastes, assess the skin carefully for color, texture, and turgor.
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Urine Studies
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1. Blood studies
2. Urinalysis (Table 37-1) 3. Clean catch/Midstream 4. 24-hour |
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Blood studies
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a. BUN: 10-20 mg/dL (17-18 mg/dL; Taylor)
b. Creatinine: male 0.6-1.2 mg/dL; female 0.5-1.1 mg/dL (0.4-1.5 mg/dL; Taylor) |
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Urinalysis Color
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A freshly voided specimen is pale yellow, straw-colored, or amber, depending on its concentration
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Urinalysis Odor
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Normal urine smell is aromatic. As urine strands, it often develops an ammonia odor because of bacterial action
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Urinalysis Turbidity
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Fresh urine should be clear or translucent; as urine strands and cools, it becomes cloudy.
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Urinalysis PH
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The normal PH is about 6, with a range of 4.6-8
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Urinalysis Specific Gravity
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This is a measure of the concentration of dissolved solids in the urine. The normal range is 1.015 to 1.025
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Urinalysis Constituents
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Organic constituents of urine include urea, uric acid, creatinine, hippuric acid, indican, urene pigments, and undetermined nitrogen.
Inorganic constituents are ammonia, sodium, chloride, traces of iron, phosphorus, sulfur, potassium, and calcium. |
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Clean-catch or midstream specimen
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This means that the patient voids and discards a small amount of urine, continues voiding into the container, removes container and continues voiding, then discards the last amount of urine in the bladder
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24 hour
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urine collected in 24 hours
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Diagnostic Tests
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1. KUB
2. CT/IVP 3. Renal ultrasound 4. Invasive a. Cystoscopy b. Biopsy |
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Nursing Responsibilites
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Nurses are responsible for preparing the patient for the procedure and giving appropriate aftercare. Explaining the procedure helps reduce the patient's anxieties.
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Functional Urinary Incontinence
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Altered environment; Sensory, cognitive, or mobility defecits
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Urinary Retention
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High urethral pressure caused by weak detrusor; inhibition of reflex arc; strong sphincter
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Pattern alteration
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Some patients report urinating on demand in no apparent pattern. Others have inflexible patterns that have developed over the years and become anxious if these are interrupted.
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Urinary functioning as the etiology
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1. Acute pain
2. Anxiety 3. Caregiver role strain 4. Risk for infection |
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Acute Pain
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Acute pain related to bladder spasms, dysuria, urinary retention, cancer of the bladder, diagnostic procedures
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Anxiety
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Related to incontinence, diagnostic procedures
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Caregiver Role Strain
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related to incontinence of family member
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Risk for infection
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Related to indwelling urinary catheter
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Impaired Urinary Elimination Causes
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1. Causes/Predisposing factors
a. Post-surgical/Anesthesia b. Indwelling catheter c. BPH (benign prostatic hypertrophy) d. Fecal impaction/chronic constipation |
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Impaired Urinary Elimination Clinical Manifestations
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a. Bladder distention overflow
b. Frequency c. Urgency |
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UTI Causes
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a. Nosocomial
b. Inadequate perineal hygiene |
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UTI Clinical Manifestations
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a. Classic triad:
• Dysuria • Frequency • Urgency • fever, chills, n/v, malaise • hematuria • Urine: cloudy |
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Stress Incontinence
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cause by Increase in intra-abdominal pressure
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Urge Incontinence
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abrupt and strong desire to void
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Mixed Incontinence
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s/s of urge & stress
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Functional Incontinence
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Inability to get to the toilet
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Reflex Incontinence
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emptying of the bladder without sensation of need to void
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Total Incontinence
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continuous loss of urine
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VII. Promoting Health 37-1
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A. Promoting Normal Urination
B. Maintaining Normal Voiding Habits C. Care of patient with an indwelling catheter |
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A. Anticholinergic / Urinary antispasmodic
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1. Action:
a. Relax smooth muscles of the urinary tract b. overactive bladder contractions c. bladder capacity 2. Uses a. Overactive bladder b. Urge incontinence c. Frequency 3. Side Effects a. Headache b. Insomnia c. Drowsiness d. Dizziness e. Alter mental status f. Blurred vision g. Dry mouth GI distress h. Urinary retention & hesitancy 4. Medications a. oxybutynin (Ditropan, Ditropan XL) b. Tolterodine (Detrol, Detrol LA) |
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B. -Adrenergic blocker (antagonists)
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1. Action
a. Relax smooth muscle improving urine flow b. urethral sphincter resistance to urinary outflow 2. Uses: urine flow and symptoms of BPH 3. Side Effects a. Impotence, libido ~ Procar b. Dizziness c. Hypotension d. Headache e. Diarrhea and nausea 4. Medications a. Terazosin (Hytrin) b. alfuzosin (UroXatral) c. finasteride (Proscar) d. tamsulosin (Flomax) |
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C. Antibiotics
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1. Action: prevent bacteria synthesis and destroy bacterial actions
2. Uses: treat UTI 3. Side Effects a. GI distress b. Rash 4. Medications a. Nitrofurantois (Macrodantin, Macrobid) b. Ciprofloxacin hydrochloride (Cipro) c. Co-trimoxazole (Bactrim) |
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D. Urinary tract analgesic: Phenazopyridium (Pyridium)
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1. Action: local anesthetic effect
2. Use: relieve pain or irritation associated with UTI 3. Side effects a. headache b. Vertigo c. Nausea d. GI distress |
