funds 30 promoting urinary elimination

anuria

absence of urine output or severe reduction

• less than 100 mL over a 24-hour period

• often a sign of kidney failure / complete obstruction

ogluria

decreased urine output

• less than 400-500 mL of urine in adults over a 24-hour period

polyuria

production of abnormally large volumes of urine

• more than 2.5 to 3 liters per 24 hours

hematuria

blood in urine

nocturia

need to wake up at night to urinate

cystitis

inflammation of bladder

dysuria

difficult, painful, or burning urination

residual urine

urine that remains in the bladder immediately after the person has finished voiding

usual urine output for an adult is:

30-70 mL/hr

• if less than 30mL/hr, may have decreased tissue perfusion & decreased cardiac output

bladder empties when _ mL of urine is present (under voluntary control)

250 - 400 mL

if a pt has not voided in _ hours, it is concerning.

8

bladder can contain _ mL of urine

1000 - 1800 mL

• at least 600 mL must be excreted daily to remove waste

• average urine output is 1000 - 1500 mL daily

changes w aging

incontinence is not a normal part of aging

• decrease in functioning nephrons

• decrease in filtration rate

• decreased bladder tone - nocturia

• decreased bladder emptying increased residual

• enlargement of prostate - urethral obstruction

normal urinary elimination

characteristics of normal urine

cystitis

inflammation of the bladder

• causes: bacteria, injury, break in sterile technique

• E. Coli is most common bacteria cause

• s: frequency, urgency, dysuria, malaise, foul-smell urine, slight fever. elderly: altered mental

preventing cystitis & uti

increase fluid to 2500 - 3000 mL

avoid citrus

front to back wipe

avoid tight clothing and baths, wear cotton underwear

empty bladder after intercourse

empty bladder q2-3h

avoid sitting in wet bathing suit

urine specimens

send to lab within 5-10 min. after 15 mins, characteristic change

midstream (clean catch) specimen: to be sent for culture

• given sterile cup, wipes, be told how to hold. keep labia open after cleaning until obtained. clean right, left, middle.

strained specimen: if renal calucli

24-hour urine specimen

• specific container. all urine into container

• if void in toilet by accident, specimen is invalid

• must be refrigerated/ stored on ice

abnormalities found in urine

bladder palpation

assessing GU

• usual pattern of elimination

• incontinence / frequent urination

• burning, sense or urgency?

• time of day for elimination, nocturia?

• total daily fluid intake, is I&O normal?

types of catheters

foley: indwelling

suprapubic: directly into bladder

coude: angle of the tip. prostate issue

non-invasive ways to collect urine

condom catheter. has self adhesive. skin needs to be clean and dry, intact, & skin prep. leave 1-2 inch between tip and drain spout

pure wick:

foley catheter

• double lumen. one inflates, other is for the drainage

• come in French. smaller the number, the smaller the size

Male: 18-20 Fr

Female: 14-16 Fr

suprapubic catheter

surgically placed, directly into bladder

• if pt has long-term urinary retention

alock

triple lumen alcock with coude tip

one port for inflation, one for drainage, one for continuous bladder irrigation (CBI)

• if had had urinary/ prostate surgery. for any big clots any big clots come out. flow rate is adjusted so drainage is light pink

• volume going in has to be documented since that is not their urine output