Podcast
Questions and Answers
An elderly patient reports frequent nocturia. Which physiological change is least likely contributing to this condition?
An elderly patient reports frequent nocturia. Which physiological change is least likely contributing to this condition?
- Hormonal changes affecting the sleep cycle and bladder control.
- Decreased kidney function, leading to reduced urine concentration.
- Loss of bladder muscle tone, leading to incomplete emptying.
- Increased bladder elasticity, resulting in a larger functional bladder capacity. (correct)
A patient reports involuntary urine loss when laughing or coughing. Which type of urinary incontinence is most likely causing this?
A patient reports involuntary urine loss when laughing or coughing. Which type of urinary incontinence is most likely causing this?
- Urge incontinence due to bladder spasms.
- Overflow incontinence due to urinary retention.
- Functional incontinence due to cognitive impairment.
- Stress incontinence due to weakened pelvic floor muscles. (correct)
When teaching a patient about ways to minimize the risk of UTIs, what should the nurse emphasize?
When teaching a patient about ways to minimize the risk of UTIs, what should the nurse emphasize?
- Using douches regularly to maintain vaginal hygiene.
- Limiting fluid intake to reduce the frequency of urination.
- Postponing urination until the bladder is completely full.
- Consuming cranberry juice to acidify the urine. (correct)
A patient with end-stage renal disease is experiencing uremic syndrome. What assessment finding is the least likely manifestation of this condition?
A patient with end-stage renal disease is experiencing uremic syndrome. What assessment finding is the least likely manifestation of this condition?
Which intervention is most crucial when performing urinary catheterization to minimize the risk of infection?
Which intervention is most crucial when performing urinary catheterization to minimize the risk of infection?
A patient with Alzheimer's disease is experiencing urinary incontinence. What type of incontinence is most likely contributing to this?
A patient with Alzheimer's disease is experiencing urinary incontinence. What type of incontinence is most likely contributing to this?
A patient who underwent surgery is experiencing urinary retention. What factor is the least likely cause of urinary retention?
A patient who underwent surgery is experiencing urinary retention. What factor is the least likely cause of urinary retention?
A nurse is preparing to collect a sterile urine specimen from an indwelling urinary catheter. What is the most appropriate method for obtaining the urine sample?
A nurse is preparing to collect a sterile urine specimen from an indwelling urinary catheter. What is the most appropriate method for obtaining the urine sample?
A patient has been diagnosed with urge incontinence. Which lifestyle modification is least likely to be recommended to help manage this condition?
A patient has been diagnosed with urge incontinence. Which lifestyle modification is least likely to be recommended to help manage this condition?
A nurse is caring for a patient with a suprapubic catheter. What intervention is most important to prevent skin breakdown around the insertion site?
A nurse is caring for a patient with a suprapubic catheter. What intervention is most important to prevent skin breakdown around the insertion site?
What is the primary reason a new nurse should seek assistance with urinary catheterization?
What is the primary reason a new nurse should seek assistance with urinary catheterization?
A patient is scheduled for a urinary diversion due to bladder cancer. What is the primary teaching point the nurse should emphasize?
A patient is scheduled for a urinary diversion due to bladder cancer. What is the primary teaching point the nurse should emphasize?
A patient is prescribed an intermittent catheterization. In teaching the procedure, what is most important for the nurse to emphasize?
A patient is prescribed an intermittent catheterization. In teaching the procedure, what is most important for the nurse to emphasize?
The nurse assesses a post-operative patient who has not voided in 8 hours. What signs and symptoms may indicate urinary retention versus normal post-operative symptoms?
The nurse assesses a post-operative patient who has not voided in 8 hours. What signs and symptoms may indicate urinary retention versus normal post-operative symptoms?
A nursing home resident has recurrent UTIs. The care plan includes increased fluid intake. How can the nurse best evaluate the effectiveness of this intervention?
A nursing home resident has recurrent UTIs. The care plan includes increased fluid intake. How can the nurse best evaluate the effectiveness of this intervention?
What is the most crucial consideration when selecting the correct size of an indwelling catheter for a patient?
What is the most crucial consideration when selecting the correct size of an indwelling catheter for a patient?
When caring for a patient with a nephrostomy tube, what are the primary interventions to prevent complications related to infection and tube function?
When caring for a patient with a nephrostomy tube, what are the primary interventions to prevent complications related to infection and tube function?
The nurse receives an order to insert a urinary catheter into a male patient. Which action is most important?
The nurse receives an order to insert a urinary catheter into a male patient. Which action is most important?
What is the primary goal of bladder training?
What is the primary goal of bladder training?
A patient has an external condom catheter. How should the nurse handle application?
A patient has an external condom catheter. How should the nurse handle application?
A patient with diabetes mellitus is experiencing changes in urinary elimination. Which underlying physiological mechanism is most likely contributing to these changes?
A patient with diabetes mellitus is experiencing changes in urinary elimination. Which underlying physiological mechanism is most likely contributing to these changes?
What is the key difference between stress incontinence and urge incontinence?
What is the key difference between stress incontinence and urge incontinence?
A patient has overflow incontinence. What is the greatest risk for this patient?
A patient has overflow incontinence. What is the greatest risk for this patient?
When a patient reports urinary frequency, what information do you gather?
When a patient reports urinary frequency, what information do you gather?
A patient is experiencing a functional urinary problem. What action would you take?
A patient is experiencing a functional urinary problem. What action would you take?
A nurse is obtaining a sterile urine sample from a catheter. They should clamp the catheter for how long before obtaining?
A nurse is obtaining a sterile urine sample from a catheter. They should clamp the catheter for how long before obtaining?
After inserting a catheter, what is the most important check to do?
After inserting a catheter, what is the most important check to do?
For a patient with Urinary Tract Problems related to Stress and Urge, what intervention can you complete?
For a patient with Urinary Tract Problems related to Stress and Urge, what intervention can you complete?
If you have a patient who has not voided for 8 hours after surgery, what would you do?
If you have a patient who has not voided for 8 hours after surgery, what would you do?
What symptoms may indicate urinary retention?
What symptoms may indicate urinary retention?
What are the purposes of Urinary Catheterization?
What are the purposes of Urinary Catheterization?
Which is not a key piece to catheter insertion male and female?
Which is not a key piece to catheter insertion male and female?
Alterations in urinary elimination could be caused by?
Alterations in urinary elimination could be caused by?
Select the correct description that can cause urinary elimination issues?
Select the correct description that can cause urinary elimination issues?
Risk factors for urinary tract infections do not include?
Risk factors for urinary tract infections do not include?
For the urinary system, the nurses' role is?
For the urinary system, the nurses' role is?
What is the normal urine amount that an adult holds?
What is the normal urine amount that an adult holds?
Which option is most crucial when managing risks of infection?
Which option is most crucial when managing risks of infection?
A patient with a long-term indwelling urinary catheter develops a UTI. Which mechanism most likely contributed to this infection?
A patient with a long-term indwelling urinary catheter develops a UTI. Which mechanism most likely contributed to this infection?
A patient is scheduled for a urinary diversion with the creation of an ileal conduit. What long-term complication should the nurse specifically monitor for?
A patient is scheduled for a urinary diversion with the creation of an ileal conduit. What long-term complication should the nurse specifically monitor for?
A patient with end-stage renal disease (ESRD) is awaiting dialysis. What dietary instruction is most important regarding urinary elimination?
A patient with end-stage renal disease (ESRD) is awaiting dialysis. What dietary instruction is most important regarding urinary elimination?
Following a transurethral resection of the prostate (TURP), a patient has continuous bladder irrigation. What finding warrants immediate intervention?
Following a transurethral resection of the prostate (TURP), a patient has continuous bladder irrigation. What finding warrants immediate intervention?
A patient is started on a new medication and develops acute urinary retention. Which drug class is least likely to contribute to this?
A patient is started on a new medication and develops acute urinary retention. Which drug class is least likely to contribute to this?
An older adult patient reports occasional stress incontinence. What exercise would be most appropriate for the nurse to recommend?
An older adult patient reports occasional stress incontinence. What exercise would be most appropriate for the nurse to recommend?
A nurse is teaching a patient with urge incontinence about bladder training. Which statement indicates a need for further teaching?
A nurse is teaching a patient with urge incontinence about bladder training. Which statement indicates a need for further teaching?
What is the most significant risk associated with long-term use of indwelling urinary catheters in older adults?
What is the most significant risk associated with long-term use of indwelling urinary catheters in older adults?
Which of the following assessment findings is most indicative of urinary retention?
Which of the following assessment findings is most indicative of urinary retention?
A patient with a nephrostomy tube reports flank pain and decreased urine output. What is the priority nursing intervention?
A patient with a nephrostomy tube reports flank pain and decreased urine output. What is the priority nursing intervention?
A patient is prescribed an anticholinergic medication for urge incontinence. What pre-existing condition would be a contraindication for this medication?
A patient is prescribed an anticholinergic medication for urge incontinence. What pre-existing condition would be a contraindication for this medication?
A patient is being discharged with intermittent self-catheterization. Which statement indicates effective teaching regarding infection control?
A patient is being discharged with intermittent self-catheterization. Which statement indicates effective teaching regarding infection control?
A patient is experiencing significant post-operative pain that is impacting their ability to void. How would you describe this type of urinary retention?
A patient is experiencing significant post-operative pain that is impacting their ability to void. How would you describe this type of urinary retention?
What is the most important consideration when caring for a patient with a recently created ileal conduit?
What is the most important consideration when caring for a patient with a recently created ileal conduit?
Which symptom is of utmost concern to a patient with a urinary diversion?
Which symptom is of utmost concern to a patient with a urinary diversion?
A nurse observes what problem with elimination is most important for nurses to monitor?
A nurse observes what problem with elimination is most important for nurses to monitor?
Which action puts the patient at most risk for a HAI during catheter insertion?
Which action puts the patient at most risk for a HAI during catheter insertion?
Which patient is most at risk for alterations in urinary elimination?
Which patient is most at risk for alterations in urinary elimination?
Which description best describes overflow incontinence?
Which description best describes overflow incontinence?
What can cause urinary retention?
What can cause urinary retention?
What is an important step if the nurse is obtaining a sterile sample from an existing catheter?
What is an important step if the nurse is obtaining a sterile sample from an existing catheter?
What teaching items are important if a patient is being discharged with self-catheterization?
What teaching items are important if a patient is being discharged with self-catheterization?
Which catheter is used to drain the bladder for short periods of time?
Which catheter is used to drain the bladder for short periods of time?
If a patient c/o flank pain and decreased urine output, what is the priority action?
If a patient c/o flank pain and decreased urine output, what is the priority action?
The nurse assesses a geriatric patient with a new urinary issue and remembers that older adults have?
The nurse assesses a geriatric patient with a new urinary issue and remembers that older adults have?
What are possible causes of alterations in elimination.
What are possible causes of alterations in elimination.
What is an issue to consider with anti cholinergic medications?
What is an issue to consider with anti cholinergic medications?
With long-term use of indwelling catheters, what is the most significant risk?
With long-term use of indwelling catheters, what is the most significant risk?
To promote urinary function, how much urine normally stimulates the need to void in an adult?
To promote urinary function, how much urine normally stimulates the need to void in an adult?
Flashcards
Urinary Elimination
Urinary Elimination
A basic human function that can be compromised by illness and conditions.
Nurse's role in urinary elimination
Nurse's role in urinary elimination
To evaluate urinary tract function & help with bladder emptying.
Alterations in urinary elimination
Alterations in urinary elimination
Urinary tract infections, urinary retention and urinary incontinence.
Urinary Tract Infections (UTIs)
Urinary Tract Infections (UTIs)
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UTIs in women
UTIs in women
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Physical assessment
Physical assessment
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Condom Catheters
Condom Catheters
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Urinary Diversion
Urinary Diversion
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Causes of urinary diversion
Causes of urinary diversion
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Nephrostomy Tube
Nephrostomy Tube
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Urinary Retention
Urinary Retention
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Urinary Incontinence
Urinary Incontinence
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Stress Incontinence
Stress Incontinence
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Urge Incontinence
Urge Incontinence
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Overflow Incontinence
Overflow Incontinence
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Functional Incontinence
Functional Incontinence
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Study Notes
Introduction to Urinary Elimination
- Urinary elimination serves as a basic human function influenced by illness and other conditions.
- Assessing urinary tract functions and providing support for bladder emptying are key nursing roles.
- Other aspects of urinary elimination include catheterization, managing indwelling catheters and reducing infection risk.
Factors Influencing Urination
- Multiple factors affect urination
- Regarding the amount of urine in the bladder:
- The average adult bladder can hold up to 600 mL of urine.
- The average child’s bladder can hold 150 to 200ml of urine.
- When urine volume increases, the micturition center in the spinal cord is stimulated.
- Urination is normally a voluntary process.
Life Span Considerations
- Kidney function declines with age.
- Older adults commonly experience urinary urgency and frequency.
- A loss of bladder elasticity and muscle tone can lead to nocturia and incomplete emptying in older adults.
Diseases and Conditions Affecting Urination
- Nerve and perfusion changes associated with diabetes influence urination.
- Changes to the nerve are related to multiple sclerosis.
- Prostatic hyperplasia in men results in urinary retention.
- Cognitive function can be influenced by Alzheimer’s, and may affect sensation of when to void.
- Build up of waste from end-stage renal disease can cause fluid and electrolyte imbalances. -Dialysis and kidney transplants may be necessary.
Common Urinary Elimination Problems
- Urinary retention involves urine accumulation as a result of the bladder's inability to empty.
- Possible causes for urinary retention include:
- Urethral obstruction
- Surgical trauma
- Childbirth
- Alterations in sensory innervation
- Anxiety
- Side effects of medications
Urinary Tract Infections (UTIs)
- UTIs are the most common healthcare-associated infection.
- Catheterization and surgical manipulation increase risk of UTIs.
- Escherichia coli (E. coli) is responsible for 75-95% of UTIs.
Alterations in Urinary Elimination
- UTIs are caused by bacteria entering the urinary tract.
- UTIs are more common in women since they have shorter urethra's.
- An untreated UTI, such as pyelonephritis, can result in kidney infection.
- Risk factors for UTIs includes:
- Sexual activity
- Menopause
- Urinary retention
- Urinary obstruction
- Frequent urinary catheter use
- Diabetes
- Urinary tract abnormalities.
- Symptoms include painful urination and frequent need to urinate
Causes of Urinary Tract Infections
- Any condition resulting in urinary retention will encourage infections since urine stagnates.
- Having an indwelling catheter can cause infection.
Urinary Incontinence
- Incontinence involves involuntary leakage of urine.
- This is often caused by aging.
- More than 50% of long-term care residents have incontinence.
- Common complications include skin breakdown.
Types of Urinary Incontinence
- Stress incontinence occurs with coughing, sneezing, laughing, or physical activity.
- Urge incontinence is characterized by a strong and sudden need to urinate.
- Reflex incontinence is urinary leakage caused by nerve damage.
- Overflow incontinence results from incomplete bladder emptying leading to overfilling.
- Functional incontinence involves a physical inability to reach the toilet in time.
- Mixed incontinence is when a patient experiences more than one type of incontinence simultaneously.
Nursing Process: Assessment
- The RN assessment includes physical assessment of the kidneys, bladder, external genitalia, urethral matter, and perineal skin.
- Assessment of urine itself is important:
- Monitor intake and output.
Describe the urine's:
- Color
- Clarity
- Odor
- Monitor intake and output.
Describe the urine's:
Nursing Diagnoses of Urinary Elimination Problems
- Common nursing diagnoses related to urinary elimination issues:
- Functional, overflow, reflex, stress or urge urinary incontinence
- Infection
- Impaired self-toileting
- Impaired skin integrity
- Urinary retention
Nursing Implementation for Urinary Issues
- Health promotion:
- Includes patient education and promoting normal micturition.
- This involves adequate fluid intake and maintaining elimination habits.
- Promote complete bladder emptying.
- Prevent infection.
Common Urine Studies
- Freshly voided specimen
- Clean catch
- Sterile specimen
- 24-hour urine
Catheter Insertion Guidelines (Male and Female)
- Requires a provider's order.
- Explain procedure to patient in detail
- It may be needed to assist the patient into the correct position for sanitation - Lithotomy.
- Insertion is a sterile procedure:
Foley Catheter Insertion (Male v Female)
- Female: Ask the patient to bear down as if voiding to expose urethral meatus.. - Advance catheter 2-3 inches until urine appears, then advance an additional 5 cm.
- Males: Hold penis perpendicular to the body and pull up slightly on the shaft. - Ask patient to bear down and insert catheter slowly through meatus. - Advance catheter between 7-9 inches, until urine appears.
Obtaining Sterile Urine Specimens with a Catheter: Nursing Implications
- Clean catch: Equipment is assembled and the patient is instructed on technique.
- Straight cath: Assembled equipment is used, the procedure explained, and the catheter inserted with sterile technique.
- Sterile specimens need to be sent to the lab in a sterile 5-10 ml container.
Obtaining a Sterile Specimen From an Existing Catheter
- Clamp the catheter for 30 minutes before aspiration to get fresh urine.
- Disinfect the access port.
- Use a 10-15ml syringe and a large bore needle to collect 5-10 ml of urine. -Label, double bad and send to the lab. -Newer catheters use a Luerlock for needleless access.
- If necessary, change the Foley to ensure a true sample is retrieved.
Infection Control and Hygiene
- The urinary tract is considered a sterile environment.
- Apply all knowledge of surgical asepsis during care.
- Perineal care and catheter care are performed using clean procedure
Alterations in Urinary Elimination: Urinary Diversion
- Urinary diversion occurs when ureters are diverted to an abdominal stoma.
- Causes of urinary diversion: include
-Cancer of the bladder
- Trauma
- Radiation
- Chronic cystitis
- An alternative is nephrostomy.
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