Urinary Elimination: Anatomy and Factors

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Questions and Answers

What is the primary function of the glomerulus in the urinary system?

  • Secreting hormones to regulate blood pressure
  • Storing urine before elimination
  • Reabsorbing water and electrolytes
  • Filtering blood to form urine (correct)

Which part of the nephron is primarily responsible for the reabsorption of water, glucose, and amino acids back into the bloodstream?

  • Loop of Henle
  • Distal convoluted tubule
  • Collecting duct
  • Proximal convoluted tubule (correct)

Where are the kidneys located in relation to the vertebral column?

  • Between the first lumbar (L1) and fifth lumbar (L5) vertebrae.
  • Between the first cervical (C1) and fifth cervical (C5) vertebrae.
  • Between the first sacral (S1) and fifth sacral (S5) vertebrae.
  • Between the twelfth thoracic (T12) and third lumbar (L3) vertebrae. (correct)

Which process is directly facilitated by stretch receptors in the bladder?

<p>Initiation of the voiding reflex (C)</p> Signup and view all the answers

How do psychological factors primarily influence urination?

<p>By influencing the perception of the urge to void and controlling the relaxation of the urethral sphincter. (A)</p> Signup and view all the answers

How do diuretics affect the urinary system?

<p>They increase urine production by inhibiting sodium and water reabsorption. (A)</p> Signup and view all the answers

What is the primary difference between urinary urgency and frequency?

<p>Urgency is a sudden, strong desire to void, while frequency is an increased number of voids. (B)</p> Signup and view all the answers

What does the presence of glucose in the urine typically indicate?

<p>Elevated blood glucose levels (A)</p> Signup and view all the answers

During a physical assessment related to urinary elimination, which area should the nurse assess to identify bladder distention?

<p>The suprapubic region (A)</p> Signup and view all the answers

A patient reports experiencing hesitancy. What does hesitancy refer to in the context of urinary elimination?

<p>Difficulty starting the urine stream (C)</p> Signup and view all the answers

Which type of urine specimen collection is required for a urine culture to identify a urinary tract infection?

<p>Both C and D (D)</p> Signup and view all the answers

What is indicated by a urine output of less than 30 mL/hour?

<p>Decreased blood flow to the kidneys (C)</p> Signup and view all the answers

A urine specimen appears cloudy. What might this indicate?

<p>Presence of white blood cells or bacteria (A)</p> Signup and view all the answers

What is the primary reason for performing intermittent self-catheterization?

<p>To manage overflow incontinence (B)</p> Signup and view all the answers

Which intervention is most appropriate for a patient experiencing functional urinary incontinence?

<p>Providing a bedside commode and ensuring easy access to toileting facilities. (A)</p> Signup and view all the answers

What is the main action of anticholinergic medications in treating urge incontinence?

<p>To relax the detrusor muscle and increase bladder capacity (A)</p> Signup and view all the answers

What type of urinary incontinence is associated with leakage of urine due to increased abdominal pressure, such as coughing or sneezing?

<p>Stress incontinence (A)</p> Signup and view all the answers

A patient with reflex urinary incontinence is at risk for what condition?

<p>Unpredictable and involuntary loss of urine (C)</p> Signup and view all the answers

What should home care instructions for a patient with an indwelling urinary catheter include regarding fluid intake?

<p>Maintain adequate fluid intake to reduce the risk of urinary tract infections. (C)</p> Signup and view all the answers

Why is it important to maintain the urine collection bag below the level of the bladder?

<p>To promote urine flow and prevent backflow into the bladder (B)</p> Signup and view all the answers

What dietary measure is recommended to reduce the risk of urinary tract infections?

<p>Consuming foods that help acidify the urine. (B)</p> Signup and view all the answers

What is the rationale for performing bladder irrigation?

<p>To maintain patency of an indwelling catheter. (B)</p> Signup and view all the answers

Which type of catheter is designed for long-term continuous drainage of urine?

<p>Indwelling catheter (C)</p> Signup and view all the answers

What is the primary indication for a urinary ileal conduit?

<p>To divert urine after bladder removal or dysfunction. (A)</p> Signup and view all the answers

What is the primary goal of health promotion activities related to urinary elimination?

<p>To promote normal micturition and prevent urinary problems. (D)</p> Signup and view all the answers

What does the 'double voiding' technique involve?

<p>Attempting to void a second time after the initial void. (A)</p> Signup and view all the answers

Which of the following is a common nursing problem related to urinary elimination?

<p>Impaired skin integrity (D)</p> Signup and view all the answers

After catheter removal, what should the nurse instruct the patient to report?

<p>Signs and symptoms of urinary retention or infection (C)</p> Signup and view all the answers

Which diagnostic study involves the use of contrast dye to visualize the kidneys, ureters, and bladder?

<p>IVP (Intravenous Pyelogram) (C)</p> Signup and view all the answers

What is the primary purpose of a cystoscopy?

<p>To directly visualize the bladder and urethra (B)</p> Signup and view all the answers

Following a cystoscopy, a patient reports dysuria. What does ‘dysuria’ mean?

<p>Painful urination (D)</p> Signup and view all the answers

A patient is prescribed tolterodine (Detrol) for urinary incontinence. What is the mechanism of action for this medication?

<p>It blocks nerve receptors in smooth muscles of the bladder (A)</p> Signup and view all the answers

What potential finding in a urinalysis is most indicative of a urinary tract infection (UTI)?

<p>Presence of microorganisms (D)</p> Signup and view all the answers

What is the rationale for limiting bladder irritants such as caffeine?

<p>To reduce bladder spasms and frequency (B)</p> Signup and view all the answers

Following a stroke, a patient has difficulty remembering when to void and has unpredictable bladder emptying. Which intervention is most appropriate?

<p>Implement a scheduled toileting program (B)</p> Signup and view all the answers

Which nursing action is most appropriate when providing perineal care for a female patient with an indwelling catheter?

<p>Cleanse from the urethral meatus downward (A)</p> Signup and view all the answers

What is the normal pH range of urine?

<p>4.5-8 (C)</p> Signup and view all the answers

Which of the following correctly describes the Crede' maneuver?

<p>Applying firm pressure over the bladder to promote emptying (B)</p> Signup and view all the answers

Following the removal of an indwelling urinary catheter, a patient reports not having the urge to void. What is the most appropriate initial nursing intervention?

<p>Monitor the patient closely for signs of urinary retention. (A)</p> Signup and view all the answers

A patient is scheduled for an intravenous pyelogram (IVP). Which nursing intervention is most important before the procedure?

<p>Ensuring the patient has signed a consent form and assessing for allergies to contrast dye. (C)</p> Signup and view all the answers

What is a primary nursing teaching for a patient diagnosed with urge urinary incontinence?

<p>Establish a scheduled toileting regimen. (B)</p> Signup and view all the answers

A nurse is reviewing the urinalysis results for a patient. Which finding would indicate the need for further assessment related to a possible urinary tract infection (UTI)?

<p>Presence of leukocyte esterase and nitrites. (C)</p> Signup and view all the answers

A patient with a history of recurrent urinary tract infections (UTIs) asks what dietary measures may help prevent future infections. Which recommendation is most appropriate?

<p>Consume foods and fluids that promote acidic urine, such as cranberry juice. (A)</p> Signup and view all the answers

The healthcare provider orders a bladder irrigation for a patient who has undergone a transurethral resection of the prostate (TURP). What is the primary reason for performing this procedure?

<p>To prevent the formation of blood clots and maintain catheter patency. (B)</p> Signup and view all the answers

Which action is most important for the nurse to take when providing catheter care for a female patient with an indwelling urinary catheter?

<p>Use a separate, clean washcloth for each pass when cleansing the perineal area. (A)</p> Signup and view all the answers

In planning care for a patient with reflex urinary incontinence, what is a key intervention to include?

<p>Teaching the patient how to perform intermittent self-catheterization. (A)</p> Signup and view all the answers

A patient is scheduled for a cystoscopy. Following the procedure, which instruction should the nurse emphasize?

<p>Monitor for fever, chills, and abdominal pain. (A)</p> Signup and view all the answers

Which of the following is the most important instruction to give a patient who is about to begin taking tolterodine (Detrol) for an overactive bladder?

<p>Report any episodes of constipation or dry mouth. (A)</p> Signup and view all the answers

Flashcards

Urinary Elimination

Elimination of urine from the body

Kidneys

Organs that filter waste from the blood to form urine.

Ureters

Tubes that carry urine from the kidneys to the bladder.

Urinary Bladder

A hollow organ that stores urine until it is eliminated.

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Urethra

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

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Nephron

The basic structural and functional unit of the kidney.

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Glomerulus

A cluster of capillaries that filters blood in the nephron.

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Bowman's Capsule

Cup-like structure surrounding the glomerulus that collects the filtrate.

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Proximal Convoluted Tubule

Portion of the nephron tubule closest to Bowman's capsule, responsible for reabsorbing water, ions and nutrients back into the blood.

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Loop of Henle

U-shaped part of the nephron tubule that concentrates urine.

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Distal Convoluted Tubule

Portion of the nephron tubule farthest from Bowman's capsule, responsible for secreting acids, ions and other wastes.

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Renal Pelvis

Part of the kidney that collects urine from the nephrons.

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Calyces

Cup-like structures that collect urine from the renal pyramids.

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Urgency

Frequent urge to urinate.

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Frequency

Abnormally frequent urination.

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Dysuria

Painful or difficult urination.

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Nocturia

Excessive urination at night.

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Polyuria

Production of abnormally large volumes of dilute urine.

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Anuria

Absence of urine production or output.

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Oliguria

Reduced urine production or output.

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Hesitancy

Difficulty initiating urination.

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Hematuria

Presence of blood in the urine.

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Diuretics

Medications that increase urine production.

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Urinalysis

Examination of urine to diagnose and manage certain medical conditions.

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Specific Gravity

A measurement of the concentration of urine.

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Urine Culture

A test to detect and identify bacteria or yeast in the urine.

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KUB (Kidneys, Ureters, Bladder)

An imaging technique using X-rays to visualize the abdominal organs, including the kidneys, ureters and bladder.

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IVP (Intravenous Pyelogram)

An X-ray exam that uses an injection of contrast material to evaluate the kidneys, ureters and bladder.

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Cystoureterogram

An X-ray examination of the bladder and urethra using a contrast dye.

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CT Scan

A diagnostic imaging test that combines X-rays and computer technology to produce detailed images of the body.

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MRI (Magnetic Resonance Imaging)

A medical imaging technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues in the body.

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Cystoscopy

A procedure in which a scope is inserted into the urethra to visualize the bladder.

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Urinary Incontinence

Involuntary leakage of urine.

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Functional Incontinence

Incontinence due to physical or environmental limitations that prevent a person from reaching the toilet in time.

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Urge Incontinence

Incontinence due to involuntary contractions of the bladder muscles.

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Stress Incontinence

Incontinence due to increased abdominal pressure, such as coughing or sneezing.

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Overflow Incontinence

Incontinence due to a blockage or weak bladder muscles, which prevents the bladder from emptying completely.

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Indwelling Catheters

Long-term catheter inserted into the urethra or suprapubically.

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Ileal Conduit

Urine drains continuously, surgical opening in abdomen.

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Continent Surgical Diversions

Clients create new way to control urine release.

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Crede' Maneuver

Action done to help bladder walls with urine, over perineum

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Study Notes

  • Urinary elimination involves the kidneys, ureters, bladder, and urethra.

Pathophysiology of Urination

  • Stretch receptors are in the bladder
  • Voiding reflex center located in spinal cord
  • Conscious control exerted by the brain

Functions of the Urinary System

  • Kidneys are essential

  • Nephrons conduct filtration

  • Glomerulus is used for filtration

  • Bowman's Capsule collects filtrate

  • Proximal Convoluted Tubule is the site of reabsorption

  • Loop of Henle concentrates urine

  • Distal Convoluted Tubule adjusts urine composition

  • Renal Pelvis and Calyces collect urine

  • Ureters, Bladder, and Urethra transport and eliminate urine

  • Kidneys are located between the T12 and L3 vertebrae.

Factors Influencing Urination

  • Growth and development
  • Sociocultural factors
  • Psychological factors
  • Fluid intake

Additional Factors Influencing Urination

  • Pathological conditions
  • Surgical procedures
  • Medications
  • Diagnostic Examinations

Medications

  • Diuretics increase urine production.
  • Urgency: Sudden, strong desire to urinate
  • Frequency: Frequent urination
  • Dysuria: Painful urination
  • Nocturia: Urination at night
  • Polyuria: Excessive urination
  • Anuria/Oliguria: Absence or scant urine production
  • Hesitancy: Difficulty starting urination
  • Hematuria: Blood in the urine (gross or microscopic)

Nursing Assessment: Recognizing Cues

  • Nursing history is important
    • Includes patterns of urination
    • Inquires about symptoms of urinary alterations

Assessment: Recognizing Cues (Cont.)

  • Physical assessment includes examining
    • Kidneys
    • Bladder
    • External genitalia and urethral meatus
    • Perineal skin

Characteristics of Urine

  • Volume
  • Color, clarity
  • Odor
  • Sterility
  • pH
  • Specific gravity
  • Glucose
  • Ketone bodies
  • Blood

Assessment of Urine

  • Measuring urinary output is a key element
  • Measuring residual urine after voiding
  • Diagnostic Tests
    • Blood urea nitrogen (BUN) assessed
    • Creatinine and Creatinine Clearance evaluated

Specimen Collection

  • Random samples are collected without specific timing
  • Clean-void or midstream specimens are collected after cleaning the external genitalia and collecting the sample mid-urination
  • Sterile specimens are collected using sterile techniques
  • Timed collections occur over a specific period
  • Special considerations apply when collecting specimens from children

Common Urine Tests

  • Urinalysis provides general information
  • Specific Gravity measures concentration
  • Urine Culture/Sensitivity identifies bacteria and determines antibiotic effectiveness

Assessment of Urinary Elimination

  • Imaging Studies offer visualization
    • KUB (Kidneys, Ureters, Bladder) uses X-rays
    • IVP (Intravenous Pyelogram) uses contrast dye
    • Cystoureterogram examines bladder and ureters
    • CT Scan provides detailed images
    • MRI (Magnetic Resonance Imaging) shows soft tissues
  • Direct Visualization is achieved through
    • Cystoscopy (SCOPE), using a scope to view the bladder

Urinary Incontinence

  • The cause of incontinence dictates treatment
  • Acute incontinence is transient
  • Chronic incontinence is established/long term

Types of Urinary Incontinence

  • Functional: Related to cognitive or mobility deficits
  • Reflex: Occurs without warning
  • Stress: Occurs during exertion
  • Total: Continuous, unpredictable loss of urine
  • Urge: Sudden, strong urge to void
  • Overflow: Overdistention of the bladder
  • Mixed: Combination of types

Medications for Urinary Incontinence

  • Estrogen therapy addresses post-menopausal atrophic vaginitis
  • Urge incontinence
    • Anticholinergics like oxybutynin/Ditropan
    • Antimuscarinics like tolterodine/Detrol reduce contractions

Interventions for Functional Urinary Incontinence

  • Ensure an accessible toileting facility, bedside commode
  • Provide mobility assistance
  • Modify clothing for easier access
  • Establish scheduled toileting
  • Positioning

Interventions for Reflex Urinary Incontinence

  • Precipitate urination - stroke inner thigh
  • Scheduled self-catheterization for overflow incontinence
  • Use condom catheter
  • Suprapubic or indwelling catheter for severe cases
  • Bladder log/management program
  • Medications to relax detrusor muscles and increase bladder capacity

Treatments for Incontinence

  • Surgery
  • Complementary Therapy
  • Health Promotion
  • Teaching
    • Avoid bladder irritants
    • Establish scheduled toileting/habit training
    • Weigh the benefits and risks

Expected Outcomes for Urinary Incontinence

  • Maintain or restore a normal voiding pattern
  • Perform toileting activities independently with or without assistive devices
  • Contain urine with appropriate devices
  • Prevent risks of infection, skin breakdown, and lowered self-esteem

Urinary Retention

  • Accumulation of urine in the bladder due to the inability to empty.
  • Continual urine collection stretches the bladder walls, causing abdominal pressure, distention, discomfort, tenderness, restlessness, and diaphoresis.
  • Competent vesicoureteral junction prevents urine reflux during voiding.

Planning/Generating Solutions

  • Establish SMART goals and outcomes
    • Set realistic and individualized goals
    • Collaborate with the patient
  • Includes teamwork and collaboration

Desired Outcomes/Prioritize Hypotheses

  • Maintain or restore a normal voiding pattern
  • Regain normal urine output
  • Prevent associated risks
  • Perform toilet activities independently
  • Contain urine with appropriate devices
  • Report adequate fluid intake

Urinary Catheterization

  • Indicated only when absolutely necessary
  • Strict sterile technique is required
  • Trauma with urethral catheterization
  • Rubber, Latex, Silicone, sized by the diameter of the lumen (French) scale
  • Self-catheterization after instruction

Urinary Catheters

  • Retention Catheters
    • Indwelling Catheters (Short or Long term)
  • Intermittent Catheters (In and Out Cath)
  • Suprapubic Catheters (Surgically inserted)
  • Condom Catheters

Care Considerations for Indwelling Catheters/Teaching

  • Never pull on the catheter
  • Secure and ensure the catheter is not twisted
  • Always keep the drainage bag below bladder level
  • Empty the bag regularly
  • Take a shower rather than a tub bath
  • Know signs and symptoms of UTI: Abdominal Pain, Cloudy Urine, Confusion, Fever, Malaise, Hematuria
  • Ensure adequate fluid intake
  • Change equipment once a month or per facility policy

Home Care Considerations

  • Fluids: Drink adequate fluids for body size (30mL/kg)

  • Dietary Measures: acidify urine to reduce UTI and renal calculus risk Included foods: eggs, cheese, meat/poultry, whole grains, cranberries, plums, prunes, and tomatoes.

  • Perineal Care: Routine hygiene

  • Indwelling catheters must be removed when no longer needed.

Bladder Irrigation

  • Flushing/washing the bladder with specific sterile solution
  • Must have doctors orders
  • Used to maintain patency
  • Can be continuous or intermittent
  • Amount/rate must be specified if continuous
  • Performed with a 3-lumen catheter

Urinary Catheters

  • Straight catheters/Intermittent Self-catheter - single lumen
  • Retention catheters - double lumen
  • Intermittent bladder irrigation (3-way lumen)
  • Suprapubic catheter

Incontinent Surgical Diversions

  • Ureterostomy
  • Nephrostomy
  • Vesicostomy
  • Ileal Conduit: Most Common
    • Urine drains continuously

Continent Surgical Diversions

  • Allows control over urine passage
  • Internal Reservoir: Kock Pouch
  • Neobladder: Urine output is controlled

Actions/Responding: Health Promotion

  • Patient education
  • Promoting normal micturition
    • Maintaining elimination habits
    • Maintaining adequate fluid intake
  • Promoting complete bladder emptying
  • Preventing infection

Promoting Urination

  • Normal voiding positioning
  • Providing privacy
  • Double voiding
  • Running water or placing the client's hands in warm water or warm sitz bath
  • Apply Crede' Maneuver
  • Functional urinary incontinence
  • Stress urinary incontinence
  • Urge urinary incontinence
  • Risk for infection
  • Toileting self-care deficit
  • Impaired skin integrity
  • Impaired urinary elimination
  • Urinary retention

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