Adult Health Urinary part 1
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Questions and Answers

Which urine characteristic indicates a healthy individual?

  • Cloudy with visible particles, pH of 9
  • Reddish tint, strong ammonia smell
  • Transparent yellow, odorless (correct)
  • Malodorous appearance, dark amber

    • A patient's urinalysis reveals the presence of glucose. This finding is most suggestive of:

  • Dehydration
  • Kidney stones
  • Poorly controlled diabetes (correct)
  • Urinary tract infection

    • What range defines normal urine specific gravity?

  • 1.050-1.070
  • 1.035-1.045
  • 0.990-1.000
  • 1.003-1.030 (correct)

    • A patient presents with elevated BUN and normal creatinine levels. What is the most likely cause?

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

    An order for a 24-hour urine collection has been received. Which instruction is MOST crucial to relay to the patient?

    <p>Discard the first urine sample of the day, collect all subsequent urine (A)</p> Signup and view all the answers

    A patient scheduled for an intravenous pyelogram (IVP) should be assessed for allergy to:

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

    What does an elevated Prostate Specific Antigen (PSA) level potentially indicate?

    <p>Prostate cancer (B)</p> Signup and view all the answers

    A renal angiography is performed using the right femoral artery. Post procedure, a primary nursing intervention will include which of the following?

    <p>Monitoring circulatory status and the puncture site for bleeding (C)</p> Signup and view all the answers

    Which type of catheter is specifically used to ease past an enlarged prostate?

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

    Which of these post-cystoscopy parameters are of most concern to the nurse?

    <p>Bright red urinary output with clots (D)</p> Signup and view all the answers

    What is a primary consideration when caring for a patient undergoing a renal scan?

    <p>Ensure pregnant nurses do not provide direct care (A)</p> Signup and view all the answers

    Prior to a transrectal ultrasound, nurses should ensure this is completed:

    <p>That the patient has an empty bladder (C)</p> Signup and view all the answers

    A patient has an order for an MRI of the abdomen. Which of the following is most important to assess prior to the test?

    <p>Presence of metal objects or implants (D)</p> Signup and view all the answers

    Which statement best describes a urodynamic study?

    <p>It evaluates how well the bladder stores and releases urine. (D)</p> Signup and view all the answers

    Following percutaneous renal biopsy, what instructions should be given to the patient?

    <p>Maintain bedrest with bathroom privileges for 24 hours (B)</p> Signup and view all the answers

    A patient's urine output has consistently been 500 mL per day with a documented fluid intake of 2 liters. Which of the following factors is LEAST likely to cause this discrepancy?

    <p>A diet high in fluid-retaining foods during admission (B)</p> Signup and view all the answers

    A patient's urinalysis reveals the presence of erythrocytes, but the patient denies any urinary complaints. Which of the following conditions is LEAST likely to be the cause?

    <p>Elevated serum creatinine levels with reduced kidney function (A)</p> Signup and view all the answers

    A 75-year-old female patient has been experiencing stress incontinence. Which physiological change associated with aging is MOST likely contributing to this condition?

    <p>A decrease in the elasticity of perineal muscles causing bladder control issues (B)</p> Signup and view all the answers

    A patient's specific gravity reading is 1.035. Which of the following is MOST important for the nurse to assess?

    <p>Current hydration status and fluid intake, and presence of other symptoms (C)</p> Signup and view all the answers

    A patient’s BUN is 40 mg/dL and creatinine is 1.5 mg/dL. The nurse recognizes this as MOST indicative of:

    <p>Acute renal dysfunction likely due to active kidney damage (A)</p> Signup and view all the answers

    A patient undergoing a 24-hour urine collection accidentally voids the first sample into the toilet. What is the MOST appropriate nursing action?

    <p>Document the error, discard the test and resume only after 24 hours (C)</p> Signup and view all the answers

    A patient is scheduled for a renal scan. Which of the following statements best describes how the imaging works?

    <p>A radio nucleotide tracer is injected, taken up by the kidney cells, and a specialized camera generates images (D)</p> Signup and view all the answers

    A patient requires a catheter insertion due to urethral trauma. Which type of catheter is MOST appropriate considering the circumstances?

    <p>Suprapubic Catheter (C)</p> Signup and view all the answers

    During a retrograde urethrography, the nurse would expect the radiopaque dye to be injected into which location?

    <p>Urethra using a syringe (A)</p> Signup and view all the answers

    A patient is undergoing a renal angiography. Following the procedure, the nurse notes that the patient's pedal pulses are diminished in the affected limb. Which statement is the best approach from the nurse?

    <p>Reassess the patient's circulatory status, document findings, and notify the physician immediately (C)</p> Signup and view all the answers

    Flashcards

    Normal urine output

    The normal volume of urine excreted by a healthy adult in a day.

    Urine Formation

    The process of removing waste products from the blood and forming urine.

    Water in urine

    The primary component of urine, accounting for 95% of its volume.

    Hematuria

    The presence of blood in urine, which may indicate various conditions.

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    Glucose in urine

    The presence of sugar in urine, often associated with high blood glucose levels, such as in diabetes.

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    Leukocytes in urine

    The presence of white blood cells in urine, commonly indicating a urinary tract infection (UTI).

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    Decreased kidney filtration with age

    A decrease in the efficiency of kidney filtration with age, leading to a decline in the ability to filter waste from the blood.

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    Stress incontinence

    A condition where the bladder loses tone and the muscles supporting it weaken, leading to involuntary leakage of urine, especially during coughing, sneezing, or laughing.

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    Catheterization

    A medical procedure involving the insertion of a thin, flexible tube into the bladder to collect a urine sample.

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    Urinalysis (UA)

    A laboratory test used to analyze the physical and chemical properties of urine, helping to identify any abnormalities.

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    Specific gravity

    A test used to measure the kidneys' ability to concentrate urine, providing insight into hydration status and kidney function.

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    Intravenous Pyelogram (IVP)

    A medical exam used to visualize the internal structures of the urinary tract, including the kidneys, ureters, and bladder, using X-rays and a contrast dye.

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    Cystoscopy

    A procedure involving the insertion of a thin scope with a light source into the urethra to visualize the bladder and surrounding structures.

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    Urodynamic study

    A medical test that evaluates the function of the bladder and its ability to store and release urine.

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    Foley catheter

    A tube inserted into the bladder through the urethra to drain urine, commonly used for urinary retention or monitoring.

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    Urine composition

    Normal urine is 95% water and 5% waste products.

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    Urine pH range

    Normal urine pH ranges from 4.6 to 8.

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    Urinary bladder capacity

    Normal capacity of the bladder is 750-1000 mL.

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    Hematuria causes

    Blood in urine; may indicate infection, tumors, or kidney disease.

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    Kidney function with age

    Kidney filtering efficiency can decline by 50% by age 70.

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    Prostate-specific antigen (PSA)

    Normal PSA level is less than 4 ng/mL; elevated levels suggest issues.

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    BUN and creatinine relationship

    High BUN with normal creatinine suggests dehydration; high for both suggests kidney disease.

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    Osmolality test

    Measure kidney's ability to concentrate urine.

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    Urodynamic study purpose

    Evaluates bladder function, capacity, and pressure.

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    Study Notes

    Urinary System Basics

    • Normal urine output: 1-2 liters per day
    • Factors influencing urine output: fluid intake, physical activity, blood pressure, meal intake, sweating
    • Composition: 95% water, 5% waste products (nitrogenous waste and salts)
    • Appearance: transparent yellow, lighter color with increased fluid intake, odorless but not malodorous
    • pH: 4.6 - 8
    • Urinary bladder capacity: 750-1000 mL, urge to urinate starts around 2-4 liters
    • Sterility: Healthy urine is sterile

    Urine Abnormalities

    • Hematuria: Blood in urine, can indicate infection, tumors, kidney disease or kidney stones
    • Glucose: Sugar in urine, indicates high blood glucose levels, often seen in diabetes
    • Erythrocytes: Red blood cells in urine, can indicate infection, tumors, kidney disease, or kidney stones
    • Ketone bodies: Excessive quantities of fatty acids broken down for fuel, not normal, typically seen in diabetic ketoacidosis (DKA), starvation, or other metabolic conditions
    • Leukocytes: White blood cells in urine, indicates urinary tract infection

    Aging and the Urinary System

    • Decreased filtering efficiency by age 70: ~50% of efficiency compared to age 40
    • Reasons for decreased efficiency: decreased blood supply, loss of nephrons
    • Female bladder: Loss of tone, perineal muscles may relax leading to stress incontinence
    • Males: Enlarged prostate gland can obstruct urethra, leading to restricted urine flow

    Lab and Diagnostic Exams

    • Urinalysis (UA): Voided or catheterized sample
    • Culture and Sensitivity (C&S): Performed if UA is positive, identifies organism and appropriate treatment medications
    • Specific gravity: Measures hydration status and kidney's ability to concentrate urine, normal range: 1.003-1.030
    • 24-hour Urine Collection: First urine sample is discarded, all subsequent urine is collected, kept on ice, sent to lab
    • Blood Urea Nitrogen (BUN): Elevated with dehydration, usually tested with creatinine
    • BUN Elevated, Creatinine Normal: Suggests dehydration
    • BUN Elevated, Creatinine Elevated: Suggests kidney disease
    • Normal BUN: 10-20 mg/dL
    • Serum Creatinine: Measures impaired renal function, usually tested with BUN
    • Normal Serum Creatinine: 0.5-1.2 mg/dL
    • Elevated Serum Creatinine: Suggests overload, nephritis, pyelonephritis, acute tubular necrosis, urinary obstruction
    • Lower serum creatinine: Suggests myasthenia gravis or late-stage muscular dystrophy
    • Creatinine Clearance: Measures GFR (glomerular filtration rate) over 24 hours
    • Increased Serum Creatinine, Decreased Urine Creatinine: Indicates kidney disease
    • Normal Serum Creatinine: 0.5-1.2 mg/dL
    • Normal Urine Creatinine: 107-139 mL/min (males), 87-107 mL/min (females)
    • Prostate Specific Antigen (PSA): Blood sample taken before prostate exam
    • Normal PSA: Less than 4 ng/mL
    • Elevated PSA: Can indicate prostate cancer, benign prostatic hyperplasia (BPH), or other issues
    • Osmolality: Measures kidney's ability to concentrate urine
    • Kidney, Ureter, Bladder Radiography (KUB): Assesses general abdominal status and evaluates urinary tract structures, no pre-procedure prep required
    • Intravenous Pyelogram (IVP): Evaluates urinary tract structures, filling of renal pelvis with urine, and transport of urine via ureters to bladder
    • IVP Preparation: Light supper, non-gas forming laxative, NPO for 8 hours
    • IVP Considerations: Assess allergies to iodine or iodine-containing foods
    • Retrograde Urography: Radiopaque dye injected into ureters to visualize upper urinary tract
    • Retrograde Cystogram: Dye injected into bladder
    • Retrograde Urethrography: Dye injected into urethra
    • Voiding Cystourethrogram: Detects abnormalities of bladder or urethra, catheter inserted into bladder, dye injected, x-rays taken
    • Cystoscopy: Scope with lighting source inserted into urethra to visualize bladder and surrounding structures
    • Cystoscopy Post-Procedure: Assess for hematuria
    • Renal Angiography: Radiopaque catheter inserted into artery (femoral artery) to evaluate blood supply to kidneys, assess for masses, detect complications after kidney transplant
    • Renal Angiography Preparation: NPO past midnight
    • Renal Angiography Post-Procedure: Assess puncture site for bleeding, keep patient flat with pressure dressing intact, monitor circulatory status
    • Renal Venogram: Uses femoral vein to evaluate kidneys' venous drainage, monitor puncture site, vital signs, and pulses
    • Computed Tomography (CT) Scan: With or without contrast, assesses size, masses, cysts
    • Magnetic Resonance Imaging (MRI): Provides greater detail than CT, remove metal objects, patients with metal implants cannot have MRI
    • Renal Scan: Radio nucleotide tracer injected, taken up by renal tubular cells, excreted by glomerular filtrate, computer images assess blood flow and GFR
    • Renal Scan Considerations: Pregnant nurses cannot care for patients due to radiation exposure
    • Ultrasound: Assesses size of kidney, ureters, bladder, masses, cysts
    • Transrectal Ultrasound: Provides image of prostate tumors, guides biopsies
    • Renal Biopsy: Open or needle (percutaneous) biopsy
    • Open Biopsy: Surgical incision
    • Needle Biopsy: Needle insertion
    • Renal Biopsy Post-Procedure: Bedrest with bathroom privileges for 24 hours, gradually resume activities after 48-72 hours
    • Urodynamic Study: Evaluates detrusor reflex, catheter inserted into bladder, measures bladder capacity and pressure
    • Urodynamic Study Procedure: Patient reports sensations of heat, cold, and urge to void, positions may be changed, medications may be administered
    • Foley Catheter: Balloon near tip inflates to hold catheter in urinary bladder
    • Coude Catheter: Tapered tip, less flexible, eases past enlarged prostate
    • Malecot (Mushroom) Catheter: Drains urine from kidney's renal pelvis, inserted by doctor
    • Robinson Catheter: Multiple openings in tip for intermittent drainage
    • Ureteral Catheter: Long and slender, goes past bladder into ureters
    • Whistle-Tip Catheter: Slanted, larger orifice, used if blood is present
    • Suprapubic Catheter: Inserted through abdominal wall above symphysis pubis, diverts urine flow from urethra, often used for injury, bony pelvis issues, tumor obstructions, etc.
    • Condom Catheter: Non-invasive, external, provides drainage
    • Self Catheterization: Clean technique, used for spinal cord injury or neurological disorders, patient must be instructed on signs and symptoms of infection
    • Bladder Training: Develops perineal muscle control to improve voiding
    • Clamp Unclamp Routine: Helps improve bladder tone
    • Stress Incontinence: Exercises perineal muscles to stop urine flow (Kegel exercises)
    • Habit Training: Monitors voiding patterns and schedules toileting to prevent incontinence
    • Habit Training Considerations: Fluid intake and medications impacting output must be considered

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    Description

    This quiz covers the fundamental aspects of the urinary system, including normal urine characteristics and factors influencing urine output. Additionally, it discusses various urine abnormalities and their potential health implications. Perfect for students and health enthusiasts looking to enhance their knowledge of urinary health.

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