ch 38 based on slides urinary system

What are the four main organs of the urinary system?

Kidneys, ureters, bladder, and urethra.
Rationale: They form a continuous pathway that filters, stores, and excretes urine.

What is the function of the kidneys?

They filter blood, remove metabolic waste, and regulate electrolytes, fluid volume, and pH.

What is the function of the ureters?

They carry urine from each kidney to the bladder through peristaltic waves.

What is the function of the bladder?

It stores urine until voluntary elimination occurs.

What is the function of the urethra?

It serves as the passageway for urine to exit the body.

What is the functional unit of the kidney?

The nephron.

What are the three main processes of the nephron?

Filtration, reabsorption, and secretion.

Why are the kidneys vital for homeostasis?

They maintain internal balance of fluids, electrolytes, and acids by forming and adjusting urine composition.

How do the ureters move urine to the bladder?

By rhythmic peristaltic contractions that propel urine forward and prevent backflow.

Where do the ureters deliver urine?

Into the bladder, at the posterior base.

. What is micturition?

The process of emptying the bladder (urination).

Which muscle contracts during micturition?

The detrusor muscle of the bladder.

What happens when the internal urethral sphincter relaxes?

Urine moves into the upper urethra under involuntary control.

Which structures provide voluntary control of urination?

The external urethral sphincter and perineal muscles.

How does the abdominal wall assist urination?

Its contraction increases intra-abdominal pressure to expel urine.

What role does the diaphragm play in voiding?

It lowers to create downward pressure that aids urine expulsion.

When does micturition occur in the reflex sequence?

After detrusor contraction, sphincter relaxation, and increased abdominal pressure combine.

What does the term micturition mean?

The process of urinating or voiding the bladder.

How can developmental stage affect micturition?

Infants lack control; children develop control during toilet training; older adults may lose control due to muscle or cognitive decline.

How can psychological factors such as stress or anxiety affect urination?

They may increase frequency or cause urinary retention due to tense sphincter muscles.

How does physical activity affect urinary elimination?

Regular activity promotes muscle tone, aiding bladder control and complete emptying.

How does poor muscle tone affect micturition?

Weak muscles can cause incomplete bladder emptying or incontinence.

How do food and fluid intake influence urination?

Increased fluids increase urine output; caffeine and alcohol act as diuretics, increasing frequency.

How do pathologic conditions affect urination?

Disorders like urinary tract infections or neurological diseases can cause urgency, retention, or incontinence.

How can medications influence urinary elimination?

Some stimulate urine production (diuretics), while others suppress it or alter urine color.

How does positioning affect urination?

Standing or sitting facilitates bladder emptying better than lying down due to gravity and muscle engagement.

At what age do most children achieve toilet training?

Between ages 2 and 3 years, when their nervous system matures enough for bladder control.

What is enuresis?

Involuntary urination, especially during sleep.

Up to what age is enuresis considered normal?

Up to around age 5.

What urinary change commonly occurs in older adults at night?

Nocturia – increased nighttime urination.

Why does nocturia occur more often in older adults?

Decreased bladder capacity and reduced concentrating ability of the kidneys.

What causes increased daytime urinary frequency in the elderly?

Reduced bladder elasticity and weaker detrusor muscles.

What does urinary retention or stasis mean?

Incomplete bladder emptying that leaves residual urine.

What risks are associated with urinary stasis?

It promotes bacterial growth and increases the risk of urinary tract infections.

How can aging affect voluntary control of urination?

Loss of muscle tone and cognitive changes reduce control over the external sphincter.

What psychosocial issues might accompany incontinence in older adults?

Embarrassment, social isolation, and anxiety, which can worsen urinary symptoms.

What is the primary effect of diuretics on urination?

They increase urine production by preventing water and electrolyte reabsorption.

What is a possible side effect of diuretics related to continence?

Urge incontinence due to increased urine volume and frequency.

What do cholinergic medications do to bladder function?

They stimulate detrusor muscle contraction and promote urination.

How do analgesics and tranquilizers influence urination?

They may suppress the central nervous system and impair the micturition reflex, leading to retention.

What medication class can produce red-colored urine?

Anticoagulants, due to blood presence in urine.

What medication causes urine to appear pale yellow?

Diuretics, because of diluted urine from increased output.

What color change is caused by phenazopyridine (Pyridium)?

Orange to orange-red urine discoloration.

Which drugs or vitamins may cause blue-green urine?

Amitriptyline and B-complex vitamins.

What color can urine turn when a patient takes levodopa?

Brown or black due to oxidation of metabolites.

What is the first step in assessing urinary function?

Obtain a nursing history to determine the patient’s normal elimination pattern and any changes.

What information should be gathered about usual urinary patterns?

Frequency, volume, and timing of urination during the day and night.

Why is it important to ask about recent changes in urination?

Sudden changes may indicate infection, retention, or other urinary disorders.

What are examples of aids to elimination a nurse should document?

Catheters, urinals, bedside commodes, or absorbent products.

What questions should you ask about voiding difficulties?

Ask about burning, urgency, hesitancy, dribbling, or incomplete emptying.

Why should urinary diversions be included in the assessment?

They alter normal elimination patterns and require specific skin and device care.

How are the kidneys assessed in nursing practice?

By advanced practitioners through palpation for tenderness at the costovertebral angle.

How is the bladder assessed for distention?

By palpation, percussion, or using a bladder scanner to estimate retained urine volume.

What should be inspected at the urethral orifice?

Look for inflammation, discharge, odor, or signs of infection.

Why should the perineal and sacral skin be examined?

To detect irritation, redness, or breakdown caused by moisture or incontinence.

What observations should be made about the urine itself?

Note color, clarity, odor, and presence of sediment.

How is urinary output measured in continent patients?

Have the patient void into a urinal or bedpan, then pour urine into a graduated container for measurement.

How is output estimated in incontinent patients?

By weighing absorbent pads or briefs before and after use.

How is urine output measured from an indwelling catheter?

Empty the calibrated drainage bag and record the measured amount.

How is a routine urinalysis specimen collected?

Have the patient void into a clean container using standard hygiene.

What technique is used for a clean-catch (midstream) urine sample?

Use sterile supplies and have the patient collect the midstream portion after cleansing.

How is a sterile specimen obtained from a catheter?

Aspirate urine from the catheter sampling port using sterile technique, not from the collection bag.

How is a urine specimen collected from a urinary diversion?

Collect from the ostomy or stoma opening using sterile technique.

What is the purpose of a 24-hour urine specimen?

To measure substances excreted over time for quantitative analysis of renal function.

What does it mean when urinary functioning is the primary problem?

The patient’s main issue is directly related to elimination, such as retention or incontinence.

What are examples of urinary diagnoses when it is the primary problem?

Impaired Urinary Elimination, Urinary Retention, and Urinary Incontinence.

When is urinary functioning considered an etiology of another diagnosis?

When it causes or contributes to a secondary problem like infection or anxiety.

Give examples of nursing diagnoses where urinary issues are the cause.

• Risk for Infection (related to urinary stasis or catheter).

• Anxiety (related to incontinence).

• Caregiver Role Strain (related to urinary care demands).

Why is establishing regular voiding habits important?

It trains the bladder, reduces urgency, and promotes complete emptying.

What is timed voiding?

Scheduling urination at set intervals to prevent accidents and retention.

Why should adequate fluid intake be encouraged?

Fluids flush bacteria, dilute urine, and maintain normal kidney filtration.

What beverages should patients limit to avoid bladder irritation?

Caffeine, alcohol, and carbonated drinks.

How do Kegel exercises help urinary control?

They strengthen pelvic-floor muscles and improve voluntary sphincter control.

Why is privacy important during toileting?

Privacy decreases anxiety and helps relax pelvic muscles for easier voiding.

How can nurses help patients with limited mobility urinate more easily?

Provide bedside commodes, ensure quick access, and offer assistance when needed.

What is the desired balance between fluid intake and urine output?

Output should approximately equal intake, showing fluid balance.

What indicates effective bladder emptying?

The bladder empties completely at regular, appropriate intervals.

What does comfort during voiding signify?

The patient reports no pain or dysuria.

What is the goal regarding skin integrity?

The perineal and perianal skin remains intact and free from irritation.

What self-care goal should patients achieve?

Demonstrate proper self-care and toileting behaviors for independent urinary management.

What is the purpose of maintaining a regular voiding schedule?

It helps the bladder empty at predictable intervals, preventing over-distention or retention.

Why should oral fluid intake be encouraged?

Adequate fluids keep urine dilute, support kidney filtration, and reduce UTI risk.

How much water should adults generally drink each day unless contraindicated?

About 2 to 2.5 liters (8–10 cups) of water daily to maintain hydration and urine production.

Which beverages should be limited because they irritate the bladder?

Caffeine, alcohol, and carbonated or highly acidic drinks.

What exercises improve pelvic-floor muscle tone?

Kegel exercises, which strengthen the muscles that support the bladder and urethra.

How are Kegel exercises performed?

By tightening the muscles used to stop urination for 3–5 seconds, then relaxing; repeated several times daily.

Why should abdominal or thigh muscles be avoided during Kegel exercises?

Using them reduces pelvic-floor isolation and limits strengthening of the correct muscles.

Why is privacy important for normal urination?

A relaxed environment decreases anxiety and promotes sphincter relaxation for easier voiding.

How does positioning affect complete bladder emptying?

Sitting or standing aligns the bladder and urethra for optimal muscle coordination and gravity assistance.

How can nurses help hospitalized patients maintain privacy?

By closing curtains, ensuring door privacy, and limiting interruptions during toileting.

Why are sexually active individuals with female anatomy at higher UTI risk?

They have a shorter urethra and the urethral opening is close to the vagina and anus, allowing bacteria to enter easily.

Why do postmenopausal women have increased UTI risk?

Decreased estrogen causes changes in vaginal flora and tissue, reducing natural protection against bacteria.

How does using a diaphragm for contraception increase UTI risk?

It exerts pressure on the urethra, impeding bladder emptying and altering normal flora.

Why do indwelling urinary catheters elevate infection risk?

They create a direct pathway for microorganisms to enter the bladder.

What age-related factors increase UTI risk in older adults?

Incomplete bladder emptying, decreased immune response, and increased incontinence.

How does urinary stasis contribute to infection?

Residual urine allows bacteria to multiply in the bladder.

What patient-teaching point helps prevent UTIs?

Encourage adequate hydration and complete bladder emptying at each void.

Why should patients wipe from front to back after toileting?

It prevents fecal bacteria from entering the urethral area.

What is transient incontinence?

Temporary, sudden loss of control lasting ≤ 6 months, often due to an acute condition (e.g., infection, medication).

What is stress incontinence?

Leakage of urine during increased abdominal pressure such as coughing, sneezing, or laughing.