Urinary Elimination and Nursing Care

Flashcards covering kidney and bladder function, urinary characteristics, types of incontinence, catheter care, bedpan procedures, continence training, and cystitis management based on the lecture notes.

What are the primary functions of the kidneys and their daily urine production volume?

The kidneys remove metabolic waste and excess $H_2O$, regulate electrolytes such as sodium and potassium, and produce $1\text{--}1.5\,\text{liters}$ of urine per day.

What volume of urine in the bladder triggers signal transmission to the spinal cord, and what is the bladder's maximum capacity?

The bladder sends signals to the spinal cord when full at $250\text{--}400\,\text{mL}$ of urine, and it can hold a maximum of $1000\text{--}1800\,\text{mL}$.

How do the internal and external urinary sphincters differ in function and control?

The internal urinary sphincter relaxes automatically during the urination reflex (micturition). The external urinary sphincter is under voluntary control, relaxing to start urination and contracting to stop it.

What age-related changes occur in kidney and bladder function?

Minor illnesses or stress can decrease kidney function, bladder muscle tone weakens leading to nocturia, incomplete bladder emptying leads to residual stagnant urine that increases infection risk, and a weaker external sphincter increases incontinence risk (incontinence is NOT a normal part of aging).

What effect does decreased estrogen have on the female urinary tract?

Decreased estrogen in women leads to tissue atrophy in the urethra, bladder, and vagina, as well as an increased risk of infection and incontinence.

What are the normal characteristics, pH, and specific gravity of urine?

Normal urine is yellow, straw-colored, or amber; transparent to slightly cloudy; has a slight ammonia odor; a specific gravity of $1.010\text{--}1.030$; a pH of $5.5\text{--}7$; and a normal output of at least $30\,\text{mL/hr}$ ($1000\text{--}1500\,\text{mL/day}$).

How are anuria, oliguria, and polyuria defined?

Anuria is urine output of less than $100\,\text{mL}/24\,\text{hr}$ (caused by kidney suppression or retention). Oliguria is less than $400\,\text{mL}/24\,\text{hr}$ (may signal kidney failure, blockage, or retention). Polyuria is more than $1500\,\text{mL}/24\,\text{hr}$ (often due to diabetes).

What are the six types of urinary incontinence described in the notes?

1. Urge: sudden/strong urge to void. 2. Stress: leak during sneeze, laugh, or exertion. 3. Mixed: combination of urge and stress. 4. Overflow: bladder cannot empty due to obstruction or weak muscle. 5. Functional: cannot reach toilet due to cognitive or physical limits. 6. Nocturnal: incontinence at night.

What nursing measures can promote natural urination before resorting to catheterization?

Run water nearby, encourage deep breathing/relaxation, offer warm caffeinated tea or coffee, allow male patients to stand by the bed (with order), have female patients blow bubbles in water while on the toilet, pour warm water over the perineum, perform the Crede maneuver (with order), or offer a sitz bath.

What is the Crede maneuver?

A technique performed with a physician's order that involves massaging the bladder downward to promote urine elimination.

What step should be taken if natural voiding fails after 8 or more hours?

Use a bladder scanner to check for retained urine, which may lead to a physician's order for catheterization.

What maintenance procedures are required for a patient with an indwelling catheter?

Provide perineal care daily or more, clean $7\text{--}10\,\text{in}$ down the catheter, maintain a closed drainage system at all times, keep the bag below bladder level, clamp tubing if raising or repositioning the bag, ensure tubing is not kinked or under pressure, use clean technique to empty the bag, expect output of at least $30\,\text{mL/hr}$, and encourage fluid intake.

How do regular and fracture bedpans differ in use and placement?

Regular bedpans are used for urine and bowel (males for bowel only). Fracture bedpans are smaller and flatter, used when a patient cannot sit up; they are inserted by separating the legs and sliding under the buttocks with the deeper front edge preventing spills.

What protocol is followed for continence training?

Track voiding for $2$ days, schedule voiding every $2$ hours, provide $2000\text{--}3000\,\text{mL}$ of fluids before $6\,\text{pm}$, and have the patient toilet before bed.

What causes cystitis and what are its main symptoms?

Cystitis is bladder inflammation caused by increased concentrated urine, E. coli bacteria, catheter care breaks in aseptic technique, or chemical/injury irritation. Symptoms include frequency, urgency, dysuria, burning, suprapubic pain/tenderness, foul-smelling urine, slight temperature elevation, and confusion in older adults.

What preventative measures reduce the risk of cystitis?

Increase fluid intake to $2500\text{--}3000\,\text{mL/day}$, avoid citrus, wipe front to back, wear cotton underwear, empty the bladder and drink $2$ glasses of water after intercourse, bathe or shower daily, and consume cranberry products.

Function of the bladder

The bladder stores urine until it is ready to be expelled from the body.

Function of the urethra

The urethra is the tube that carries urine from the bladder to the outside of the body.

Function of the ureters

The ureters transport urine from the kidneys to the bladder.

Function of the meatus

The meatus is the external opening of the urethra, through which urine exits the body.

How is urine collected for analysis?

Urine can be collected via midstream clean catch, catheterization, or by using a sterile container to avoid contamination.