Chapter 44: Urinary Elimination Flashcards

Flashcards covering fundamental concepts of urinary elimination, urinary diversions, lifespan considerations, diagnostic tests, catheter care, CAUTI prevention, types of incontinence, medications, and therapeutic procedures based on Chapter 44.

What is urinary elimination?

A precise system of filtration, reabsorption, and excretion that helps maintain fluid and electrolyte balance while filtering and excreting water-soluble wastes.

What are the primary organs of urinary elimination?

The kidneys.

Which structures within the kidneys perform most filtration and elimination functions?

The nephrons.

How much urine do most adults produce per day?

1,000 to 2,000 mL/day.

What is the storage reservoir for urine after it passes through the ureters?

The bladder.

How much urine collection in an adult bladder triggers stretch receptors to signal the need to urinate?

250 to 450 mL.

Through what structure does urine pass when exiting from the bladder out of the body?

The urethra.

Why are urinary diversions created by surgeons?

To reroute urine for clients who have bladder cancer or injury.

What is the difference between continent and incontinent urinary diversions?

Continent diversions have a reservoir in the abdomen that allows clients to control the elimination of urine, whereas incontinent diversions drain urine continuously without control.

What is a ureterostomy (ileal conduit)?

An incontinent urinary diversion in which the surgeon attaches one or both ureters via a stoma to the surface of the abdominal wall.

What is a nephrostomy?

An incontinent urinary diversion in which the surgeon attaches a tube from the renal pelvis via a stoma to the surface of the abdominal wall.

What is a Kock pouch (continent ileal bladder conduit)?

A continent urinary diversion in which the surgeon forms a reservoir from the ileum.

How frequently is a Kock pouch initially emptied by clean straight catheterization?

Every 2 to 3 hr initially.

How frequently is a Kock pouch emptied once the pouch expands to capacity?

Every 5 to 6 hr.

What is a neobladder?

A new bladder created by the surgeon using the ileum that attaches to the ureters and urethra, allowing the client to maintain continence.

How does a client with a neobladder learn to void?

By straining the abdominal muscles.

What specialist should be consulted to assist clients who have an incontinent diversion?

A wound ostomy continence nurse.

What nursing action is required regarding a client's stoma and peristomal skin?

Monitor stoma and peristomal skin for indications of breakdown.

At what age do children achieve full bladder control?

By 4 to 5 years of age.

What prostate change in older adult males can obstruct the bladder outlet and cause retention and urgency?

An enlarged prostate.

How do childbirth and gravity affect the pelvic floor?

They weaken the pelvic floor, putting clients at risk for prolapse of the bladder, leading to stress incontinence.

What exercises can clients perform to help manage stress incontinence due to weakened pelvic floor muscles?

Pelvic floor (Kegel) exercises.

Why do post-menopausal clients experience decreased perineal tone?

Due to reduced estrogen levels.

What manifestations can decreased estrogen levels and reduced perineal tone cause in post-menopausal clients?

Urgency, stress incontinence, and UTIs.

What change occurs in nephron count in older adult clients?

They have fewer nephrons.

What causes urinary frequency in older adult clients?

Loss of muscle tone of the bladder.

Why does inefficient emptying of the bladder in older adults increase the risk for UTIs?

It leads to residual urine.

Why do older adult clients experience an increase in nocturia?

Due to a decrease in bladder capacity.

How does a growing fetus in pregnancy affect the bladder?

It compromises bladder space and compresses the bladder.

By what percentage does circulatory volume increase during pregnancy?

30% to 50%.

What effect does the hormone relaxin have during pregnancy?

It causes relaxation of the sphincter.

How does an increase in sodium intake affect urination?

It leads to decreased urination.

How do caffeine and alcohol intake affect urination?

They lead to increased urination.

How can immobility contribute to urinary incontinence?

Incontinence can occur as a result of impaired mobility due to difficulty transferring to the bathroom.

What are three psychosocial factors that can affect urinary elimination?

Emotional stress and anxiety, having to use public toilets, and lack of privacy during hospital stays.

What effect can pain in the urinary tract have on urination?

It can cause suppression of the urge to urinate.

What condition is caused by an obstruction in the ureter leading to severe pain?

Renal colic.

How do anesthesia and opioid analgesics affect urine output during surgical procedures?

They cause alterations in glomerular filtration rate, resulting in decreased urine output.

How can lower abdominal surgery affect urinary elimination?

It creates obstructive edema and inflammation.

What mechanism of action do diuretics have on water in the kidneys?

They prevent reabsorption of water.

What urinary complication can antihistamines and anticholinergics cause?

Urinary retention.

What effect does chemotherapy have on the kidneys?

It creates a toxic environment for the kidneys.

What urine color change is caused by Phenazopyridine?

Orange, red.

What urine color change is caused by Amitriptyline?

Green-blue.

What urine color change is caused by Levodopa?

Dark.

What urine color change is caused by Riboflavin?

Bright yellow.

What is the purpose of bedside sonography with a bladder scanner?

It is a noninvasive portable ultrasound scanner for measuring bladder volume and residual volume after urination.

What does a Kidneys, ureters, bladder (KUB) X-ray determine?

Size, shape, and position of these structures.

What contrast medium is injected during an intravenous pyelogram (IVP)?

Contrast media (iodine).

What allergy contraindicates the use of contrast medium in an intravenous pyelogram?

Allergy to shellfish.

What does a renal scan evaluate without contrast?

Renal blood flow and anatomy of the kidneys.

What diagnostic procedure uses high-frequency sound waves to view gross renal structures?

Renal ultrasound.

What instrument is used during a cystoscopy to visualize the bladder and urethra?

A lighted instrument.

How is urodynamic testing performed to test bladder muscle function?

By filling the bladder with $CO_2$ or 0.9% sodium chloride and comparing pressure readings with reported sensations.

Which type of bedpan is used for clients who must remain supine or in body or leg casts?

Fracture pan.

Which type of bedpan is used for clients who can sit up?

Regular pan.

What equipment on an indwelling catheter drainage bag is used for precise I&O measurement?

A hard plastic urometer.

What hourly urine output threshold for more than 2 hr is a cause for concern?

Less than 30 mL/hr.

What basic equipment is required when starting a bladder retraining program for urge incontinence?

A clock.

What time of day should clients be educated to take diuretics?

In the morning.

What type of specimen container is required for a standard urinalysis?

Non-sterile.

What type of specimen container is required for clean-catch midstream and catheter specimens?

Sterile.

How is a clean-catch midstream urine sample obtained by the client?

After thorough cleansing of the urethral meatus, clients catch the urine sample midstream.

What technique is required to obtain a catheter urine specimen for C&S?

Surgical asepsis (sterile technique).

What is the first action taken during a timed 24-hr urine collection?

Discard the first voiding.

How should urine collected during a timed urine collection be stored before transport?

Refrigerate the specimen.

What catheter size range is recommended for children?

8 to 10 Fr.

What catheter size range is recommended for adult females?

14 to 16 Fr.

What catheter size range is recommended for adult males?

16 to 18 Fr.

What catheter material should be used for clients with latex allergies?

Silicon or Teflon products.

How often should routine catheter care be performed at the insertion site?

At least three times a day and after defecation.

What should the nurse check first if a client with an indwelling catheter reports bladder fullness?

Check for kinks in the tubing, and check for sediment in the tubing.

Where should the urine collection bag be placed relative to the bladder?

At a level below the bladder to avoid reflux.

What is a Catheter-associated urinary tract infection (CAUTI)?

An infection that occurs while an indwelling catheter is in place or up to 48 hr after discontinuing.

Name three risk factors for CAUTI related to indwelling catheter management.

Use of indwelling catheters, increased dwell time, and opening the closed urinary drainage system.

What are common manifestations of CAUTI in standard adult clients?

Urinary frequency, urgency, nocturia, flank pain, hematuria, cloudy, foul-smelling urine, and fever.

What are systemic manifestations of CAUTI specifically observed in older adults?

New onset of increased confusion, recent falls, new onset incontinence, anorexia, fever, tachycardia, hypotension.

How often should a nurse assess the ongoing need for an indwelling urinary catheter?

Daily.

What is stress urinary incontinence?

Loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting.

What is urge urinary incontinence?

Inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle with increased bladder pressure.

What is overflow urinary incontinence?

Urinary retention from bladder overdistention and frequent loss of small amounts of urine due to obstruction of the urinary outlet or an impaired detrusor muscle.

What bladder condition can result from overflow incontinence caused by neurological disorders?

A neurogenic (flaccid) bladder.

What is reflex urinary incontinence?

Involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction.

What is functional urinary incontinence?

Loss of urine due to factors that interfere with responding to the need to urinate (cognitive, mobility, and environmental barriers).

What is transient urinary incontinence?

Reversible incontinence due to inflammation or irritation (UTI), temporary cognitive impairment, disease process (hyperglycemia), medications (diuretics, anticholinergics, sedatives).

Name four medication classes that increase the risk of urinary incontinence.

Diuretics, opioids, anticholinergics, and calcium channel blockers.

What laboratory tests are performed to assess for renal dysfunction in urinary incontinence?

Blood creatinine and BUN.

What diagnostic procedure measures the rate and degree of bladder emptying?

Uroflowmetry.

What diagnostic procedure measures the strength of pelvic muscle contractions?

Electromyography.

What is the specific timing and repetition sequence for Kegel exercises?

Tighten pelvic muscles for a count of 10, relax slowly for a count of 10, and repeat in sequences of 15 in the lying-down, sitting, and standing positions.

What bladder compression techniques can be performed to help manage reflex incontinence?

Credé, Valsalva, double voiding, and splinting.

What antidepressant with anticholinergic effects helps relieve urinary incontinence?

Nortriptyline.

Why must nurses ask clients about a history of glaucoma before administering oxybutynin or dicyclomine?

These medications increase intraocular pressure.

What adverse effects should clients report when taking urinary antispasmodics or anticholinergic agents?

Report dysuria, palpitations, and constipation.

What contraindications exist for the use of Phenazopyridine?

Hepatic disorders and renal insufficiency.

What client education instruction should be provided regarding Phenazopyridine and jaundice?

Notify the provider immediately if jaundice occurs (yellowing of skin, palms and soles of feet, mucous membranes).

What target maximum output volume should guide the frequency of intermittent urinary catheterization?

Keep output at 300 mL or less.

Post-void residual volume must be less than what amount before suprapubic or urinary catheters are removed following surgical repair?

Less than 50 mL.

How much fluid should a client be instructed to drink daily to promote healthy urinary elimination?

2 to 3 L of fluid daily.

Why are clients advised to avoid caffeine and alcohol consumption to manage urinary incontinence?

Because caffeine and alcohol can irritate the bladder and increase diuresis and the urge to urinate.