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Comprehensive Page-by-wk 4 information for quiz 5

Page 1

  • Source material: Wolters Kluwer, When you have to be right, Chapter 44: Urinary Elimination.

  • Focus: foundational concepts of urinary elimination, anatomy, physiology, assessment, measurement, and common pathologies and nursing considerations.

Page 2

  • Components of the Urinary System:

    • Kidneys and ureters

    • Bladder

    • Urethra

Page 3

  • Functions of the kidneys and their components:

    • Maintain the composition and volume of body fluids

    • Filter and excrete blood constituents that are not needed; retain those that are needed

    • Excrete waste products as urine

  • Nephrons’ role:

    • Regulate fluid balance via selective reabsorption and secretion of water, electrolytes, and other substances

  • Urine formation: urine from the nephron drains toward the kidneys; the nephron-produced urine is ultimately excreted via the urinary tract.

Page 4

  • Urethra: conveys urine from the bladder to the exterior.

  • Male urethra: serves both excretory and reproductive functions.

  • Female urethra: all or most of its length is internal; the external opening is external to the body but the urethra itself is largely internal.

Page 5

  • heading indicating a comparison/overview of the urinary tracts in females and males; details likely follow in graphics/text elsewhere.

Page 6

  • Anatomical layout (described in a schematic):

    • Right kidney ↔ ureter

    • Left kidney ↔ ureter

    • Bladder and urethra depicted

    • In the male, the prostate is located near the urethra; in the female, the urethral anatomy differs (no prostate).

Page 7

  • Normal Prostate vs Enlarged Prostate:

    • Normal prostate: typical size and contour

    • Enlarged prostate: increased size which can affect urinary flow and cause retention or hesitancy

Page 8

  • The Urinary Bladder anatomy and function:

    • Epithelium lining changes with bladder state (empty vs full)

    • Ureters connect to the bladder

    • Detrusor muscle: smooth muscle responsible for bladder contraction

    • Internal sphincter: involuntary control

    • External sphincter: voluntary control

Page 9

  • Act of Urination (Micturition, Voiding):

    • Stepwise process:

    • Detrusor muscle contracts

    • Internal sphincter relaxes

    • Urine enters the posterior urethra

    • Pelvic floor muscles and external sphincter relax

    • Abdominal wall contracts slightly

    • Diaphragm lowers; micturition occurs

Page 10

  • Nephron and Kidney Filtration Pathway (an overview of renal microcirculation and tubules):

    • Afferent arteriole → glomerular capillary bed

    • Glomerular capsule surrounds the glomerulus

    • Proximal convoluted tubule (PCT)

    • Loop of Henle

    • Distal convoluted tubule (DCT)

    • Collecting duct

    • Peritubular capillary network

    • Interlobular arteries/veins

  • Urine flow progression: urine formed in nephrons flows toward the renal pelvis and then to the ureter; the cortex–medulla junction is a site of functional organization.

Page 11

  • (No content provided in the transcript for this page.)

Page 12

  • Key terms to know:

    • Glycosuria: typically occurs when blood glucose exceeds the renal threshold; usually above 180\ ext{mg/dL}, the kidneys cannot reabsorb all glucose.

    • Proteinuria: indicates renal damage/disease with leakage of protein (e.g., albumin) into urine.

    • Pyuria: presence of pus in urine (white blood cells), usually due to infection or inflammation.

    • Dysuria: painful or difficult urination; signals irritation/infection of the urinary tract.

    • Gestational diabetes: diabetes developed during the 24th–28th week of pregnancy due to hormonal changes reducing insulin sensitivity.

Page 13

  • Additional terms:

    • Anuria: no urine output or very little (less than 100\ ext{mL}/24\ ext{h})

    • Oliguria: low urine output (typically <400-500\ ext{mL/day} or <30\ \text{mL/hour})

    • Nocturia: waking up multiple times during the night to urinate

  • Contributing factors to nocturia (examples given):

    • Age-related changes in bladder capacity

    • UTIs, overactive bladder (increased nocturnal contractions)

    • Heart failure with nighttime fluid shifts, diabetes, sleep apnea, medications, and urinary/prostate issues

Page 14

  • Symptoms related to urgency and frequency:

    • Frequency: urinating more than usual; defined here as more than 8\ \times/24\ \hphantom{u} \text{hour}, i.e., more than 8 times in 24 hours

    • Urgency: sudden, strong need to urinate that is hard to control; rapid onset may include fear of leakage if a bathroom isn’t reached in time

  • Distinction: Urgency focuses on the intensity of the urge, whereas frequency focuses on how often urination occurs.

Page 15

  • Types of Urinary Incontinence:

    • Transient: appears suddenly and lasts 6 months or less

    • Mixed: features of two or more types of incontinence

    • Overflow: overdistention/overflow of the bladder

    • Functional: caused by factors outside the urinary tract (e.g., cognitive or physical barriers)

    • Reflex: bladder emptying without the sensation of need to void

    • Total: continuous, unpredictable urine loss

    • Stress: urine loss related to increased intra-abdominal pressure (e.g., coughing, sneezing, lifting)

Page 16

  • Normal urine output for adults:

    • Hourly: at least 30\ ext{mL/hour}

    • Daily: 800-2000\ ext{mL/day} with normal fluid intake (~2\ ext{liters/day})

Page 17

  • (No content provided in the transcript for this page.)

Page 18

  • Developmental considerations:

    • Children: toilet training typically between ages 2–3; enuresis (bedwetting) can occur

    • Aging effects on the urinary system:

    • Nocturia

    • Increased urinary frequency

    • Urine retention and stasis

    • Changes in voluntary control due to physical problems

Page 19

  • (No content provided in the transcript for this page.)

Page 20

  • Renal calculi (kidney stones):

    • Lithotripsy: a noninvasive procedure using shock waves or ultrasonic energy to break stones large enough to block the urinary tract

    • Post-procedure care: urine must be strained to assess stone passage

Page 21

  • (No content provided in the transcript for this page.)

Page 22

  • Medications affecting urine color:

    • Anticoagulants: red urine

    • Diuretics: pale yellow urine

    • Pyridium (phenazopyridine): orange to orange-red urine

    • Amitriptyline or B-complex vitamins: green or blue-green urine

    • Levodopa: brown or black urine

Page 23

  • (No content provided in the transcript for this page.)

Page 24

  • Using the Nursing Process in urinary care:

    • Assess voiding patterns, habits, and past history of urinary problems

    • Perform physical examination of the bladder (if indicated) and urethral meatus

    • Assess skin integrity and hydration; examine urine

    • Correlate findings with results of procedures and diagnostic tests

Page 25

  • Assessing a problem with voiding:

    • Explore duration and severity

    • Identify precipitating factors

    • Note patient’s perception of the problem

    • Check adequacy of patient’s self-care behaviors

Page 26

  • Physical assessment of urinary functioning:

    • Kidneys: palpation by advanced healthcare practitioner as part of a detailed assessment

    • Bladder: palpation, percussion, or bedside bladder ultrasound

    • Urethral orifice: inspect for signs of infection, discharge, or odor

    • Skin: assess color, texture, turgor, and excretion of wastes

    • Urine: assess color, odor, clarity, and sediment

Page 27

  • BladderScan device (example shown: BVI 9400) for assessing bladder volume

  • Purpose: noninvasive measurement of residual or current bladder volume

Page 28

  • (No content provided in the transcript for this page.)

Page 29

  • Intake & Output assignment guidance:

    • Upload under Active Learning in Canvas

Page 30

  • (No content provided in the transcript for this page.)

Page 31

  • (Referenced header for measuring urine output; detailed steps provided on Page 32.)

Page 32

  • Measuring urine output: practical steps

    • Have patient void into a bedpan, urinal, or specimen container

    • Wear gloves

    • Pour urine into the appropriate measuring device

    • Place the calibrated container on a flat surface and read at eye level

    • Record the amount of urine voided on the appropriate form

    • Discard urine in the toilet unless a specimen is needed

    • If a specimen is required, transfer urine to an appropriate specimen container

Page 33

  • (No content provided in the transcript for this page.)

Page 34

  • Types of urine specimens:

    • Routine urinalysis

    • Clean-catch (midstream) specimens

    • Sterile specimens from indwelling catheter

    • Urine specimen from a urinary diversion

    • 24-hour urine specimen

    • Specimens from infants and children

    • Point-of-care urine testing

Page 35

  • Devices for collecting and measuring urine:

    • CURITY (brand)

    • PRECISION 30 (model/brand)

    • RAVRID (likely a brand/model associated with collection devices)

Page 36

  • 24-Hour Urine Specimen: procedural concept (details not provided in transcript)

Page 37

  • (No content provided in the transcript for this page.)

Page 38

  • Promoting normal urination:

    • Maintain normal voiding habits

    • Promote adequate fluid intake

    • Strengthen pelvic floor muscles (Kegel/pelvic floor exercises)

    • Assist with toileting when needed

Page 39

  • Maintaining normal voiding habits:

    • Scheduling voiding times

    • Respect patient’s urge to void

    • Ensure privacy during voiding

    • Consider patient position and hygiene

Page 40

  • Patients at risk for UTIs:

    • Sexually active women

    • Women using diaphragms for contraception

    • Postmenopausal women

    • Individuals with indwelling urinary catheter

    • Individuals with diabetes mellitus

    • Older adults

Page 41

  • Coude catheter vs standard urinary catheter (Foley):

    • Coude catheter: curved tip designed to facilitate catheterization in men with an enlarged prostate or urethral access challenges

    • Standard urinary catheter (Foley): a common indwelling catheter

Page 42

  • Quick reference visuals:

    • 1. Urinary Catheter

    • 2. Coude Catheter: used for enlarged prostate

Page 43

  • Reinforcement of catheterization options:

    • Urinary catheter (Foley)

    • Coude catheter (for enlarged prostate)

Page 44

  • Reasons for catheterization (urinary catheter or Foley catheter):

    • Relieve urinary retention

    • Prolonged immobilization

    • Obtain sterile urine specimen when patient cannot void voluntarily

    • Accurate measurement of urinary output in critically ill patients

    • Assist in healing open sacral or perineal wounds in incontinent patients

    • Empty the bladder before, during, or after certain surgical procedures and before certain diagnostic examinations

    • Improve comfort for end-of-life care

Page 45

  • (No content provided in the transcript for this page.)

Page 46

  • Patient Education for Urinary Diversion:

    • Explain the reason for diversion and treatment rationale

    • Demonstrate effective self-care behaviors

    • Describe follow-up care and support resources

    • Inform where supplies can be obtained in the community

    • Address fears and concerns openly

    • Promote a positive body image

Page 47

  • Nephrostomy: diagram shows a nephrostomy tube leading from the kidney to a drainage bag, with urine draining to the bag

  • Kidney shown as the source of the nephrostomy

Page 48

  • Kidney stoma details:

    • Cutaneous ureterostomy: a stoma from the ureter to the skin

    • Ureter depicted in relation to stoma site

Page 49

  • Ileal conduit (urostomy) after cystectomy (bladder removal):

    • Creation of a stoma on the abdominal wall connected to an ileal conduit

    • Rectum remains; bladder removed

Page 50

  • Continent Urinary Diversion (CUD):

    • Stoma on the abdomen

    • System of kidneys and ureters connected to an intestinal pouch

    • The pouch stores urine but does not drain continuously; may require intermittent catheterization

Page 51

  • Suprapubic catheter:

    • Catheter placed through the abdominal wall into the bladder

    • Descriptive image shows placement and access through abdominal wall

Page 52

  • General care guidelines for urinary stomas:

    • Stoma should protrude ½ to 1 inch (1–3 cm) above skin

    • Stoma color should be dark pink or red

    • Keep stoma moist

    • Note the size of the stoma

    • Keep surrounding skin dry and monitor for irritation

Page 53

  • (No content provided in the transcript for this page.)

Page 54

  • Dialysis overview – Hemodialysis:

    • Blood is filtered and cleaned in the dialyzer within the dialysis machine

Page 55

  • Dialysis overview – Peritoneal Dialysis:

    • Dialysate bag introduced into the peritoneal space via a catheter

    • Peritoneum serves as the semipermeable membrane

    • Dialysate containing waste products is drained from the peritoneal space into a drainage bag

Page 56

  • Dialysis comparison (Hemodialysis vs Peritoneal):

    • High-level differences, indications, and logistics (illustrated/outlined by a medical education resource)

Page 57

  • (No content provided in the transcript for this page.)

Page 58

  • Factors to consider when selecting absorbent products for incontinence:

    • Functional disability of the patient

    • Type and severity of incontinence

    • Gender

    • Availability of caregivers

    • Prior treatment failures

    • Patient preferences

  • Additional notes and cross-links:

    • The material emphasizes assessment through the nursing process, including data gathering, physical examination, and correlation with tests.

    • It integrates anatomy (kidneys, bladder, urethra, prostate in males), physiology (filtration, reabsorption, micturition), and pathology (incontinence types, UTIs, kidney stones, dialysis).

    • Practical clinical skills highlighted include measuring urine output, collecting urine specimens, performing bladder scans, and managing urinary diversions.

    • The content also ties into patient education, psychosocial aspects (body image with diversions), and quality of life considerations in urinary health.

Notes on LaTeX usage in this set: thresholds and quantitative values are presented in LaTeX when numerical. Examples include: 180\ \text{mg/dL} for glycosuria threshold, <100\ \text{mL}/24\ \text{h} for anuria, <400-500\ \text{mL/day} or <30\ \text{mL/hour} for oliguria, 30\ \text{mL/hour} minimum hourly urine output, and 800-2000\ \text{mL/day} typical daily urine output. Regular units (mL, mL/day, mL/hour) are retained for clarity where appropriate.