Urinary System & Disorders

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Questions and Answers

What is the most important risk factor for the development of a catheter-associated UTI (CAUTI)?

Frequency of catheter changes

Type of catheter used

Duration of catheterization (correct)

Type of medication administered

Which of the following is NOT a commonly accepted indication for the insertion of a urinary catheter?

Postoperative acute urinary retention

Prolonged immobilization

Bladder outlet obstruction

Obtaining urine for routine tests in a patient who can void (correct)

What should be prioritized to reduce the risk of catheter-associated UTIs?

Inserting catheters for nursing convenience

Timely removal of unnecessary catheters (correct)

Using catheters as a standard practice

Increased frequency of catheterization

Which of the following scenarios would be a valid indication for catheterization?

Required accurate input and output measurements Signup and view all the answers

Which condition is a contraindication for urinary catheter use?

Prolonged use after surgery without proper indications Signup and view all the answers

What happens when urinary retention progresses?

Bladder distension can lead to overflow incontinence. Signup and view all the answers

Which of the following can cause acute urinary retention?

Postpartum complications and certain medications. Signup and view all the answers

What key sign indicates acute urinary retention?

Absence of urine output over several hours. Signup and view all the answers

What is a potential complication of bladder distension in individuals with spinal cord injury above T6?

Autonomic dysreflexia. Signup and view all the answers

Which condition is likely to lead to chronic urinary retention in individuals with male genitalia?

Prostate enlargement. Signup and view all the answers

What is an effect of general and regional anesthetics on the urinary system?

They suppress micturition control. Signup and view all the answers

Which procedure may be necessary for a patient experiencing overflow incontinence due to urinary retention?

Intermittent catheterization. Signup and view all the answers

Which symptom would most likely be experienced by an alert patient with severe bladder distension?

Severe pain. Signup and view all the answers

What is micturition?

The neural response allowing urine to leave the body Signup and view all the answers

At what point does the urge to void typically begin for adults?

When the bladder is half full Signup and view all the answers

Which of the following alterations in urinary elimination causes involuntary leakage of urine?

Urinary incontinence Signup and view all the answers

What condition is characterized by an accumulation of urine due to the inability of the bladder to empty?

Urinary retention Signup and view all the answers

Why are patients with female genitalia more susceptible to urinary tract infections?

They have a shorter urethra compared to males Signup and view all the answers

Which of the following can be a cause of urinary tract infections?

Abnormal anatomy of the urinary tract Signup and view all the answers

What is nocturia?

Waking in the night to urinate Signup and view all the answers

Which alteration in urinary elimination results from catheterization and may cause urinary tract infections?

Urinary retention Signup and view all the answers

What is a primary reason for creating a urinary diversion?

Divert urine flow due to conditions like bladder cancer Signup and view all the answers

Which statement describes the ileal conduit accurately?

The ureters are implanted into an isolated segment of the ileum. Signup and view all the answers

What is a characteristic of an incontinent urinary diversion?

Requires continuous use of an ostomy appliance. Signup and view all the answers

What is the primary function of the Indiana pouch?

To serve as a continent internal pouch requiring intermittent catheterization. Signup and view all the answers

Which statement about the orthotopic neobladder is true?

It is created using the ileum and reconnects to the urethra. Signup and view all the answers

What is an ideal characteristic of a urinary stoma?

It should have a healthy red mucosa. Signup and view all the answers

What complication can occur if urine consistently contacts the skin in incontinent urinary diversions?

Development of skin irritation and breakdown Signup and view all the answers

What differentiates a continent urinary diversion from an incontinent one?

Continent diversions need intermittent catheterization. Signup and view all the answers

What is the typical odour of concentrated urine?

Stronger than normal Signup and view all the answers

What does a sweet or fruity odour of urine indicate?

Uncontrolled diabetes or starvation Signup and view all the answers

Which urine collection method involves discarding the first morning urine?

24-Hour urine collection Signup and view all the answers

What abnormal finding in urinalysis may indicate a urinary tract infection?

Leukocyte esterase and nitrites Signup and view all the answers

What is the normal pH range for urine?

4.5 to 8.0 Signup and view all the answers

What does the presence of ketones in urine suggest?

Uncontrolled diabetes or starvation Signup and view all the answers

What is a potential cause of hematuria in urine analysis?

Kidney stones or trauma Signup and view all the answers

What does the presence of bilirubin in urine indicate?

Liver or gallbladder disease Signup and view all the answers

What is a common responsibility before a diagnostic examination?

Administering bowel preparation medications Signup and view all the answers

Which of the following is NOT a responsibility after a diagnostic procedure?

Discharge the patient immediately Signup and view all the answers

What is an important consideration when promoting normal micturition?

Ensuring adequate fluid intake Signup and view all the answers

What does chronic kidney disease (CKD) involve?

Progressive, irreversible loss of kidney function Signup and view all the answers

What is a key marker of kidney damage in chronic renal failure?

Glomerular filtration rate (GFR) Signup and view all the answers

Which action is NOT appropriate for preventing urinary tract infections?

Using a urinary catheter without a prescriber’s order Signup and view all the answers

What is an effective method to promote complete bladder emptying?

Double voiding Signup and view all the answers

Which condition is characterized by pathological abnormalities in the kidneys?

Chronic renal failure Signup and view all the answers

Study Notes

Micturition

Complex neural response allowing the bladder to contract, the urethral sphincter to relax, and urine to leave the body.

Voiding Reflex

Voluntary control over bladder emptying develops as a child matures.
Adults typically feel the first urge to void when the bladder is half full.

Common Alterations in Urinary Elimination

Urinary tract infections (UTIs): Involuntary leakage of urine.
Urinary incontinence: An accumulation of urine due to the bladder's inability to empty.
Nocturia: Waking in the night to urinate.
Urinary retention: Commonly result from catheterization (CAUTI), may also be caused by hygiene.
Urinary diversions: Diversion of urine to an external source.

Common Symptoms of Urinary Alterations

Incontinence: Involuntary loss of urine
Urgency: Sudden, compelling desire to urinate difficult to defer.
Dysuria: Pain, burning, or discomfort during urination.
Frequency: Voiding more than eight times in 24 hours.
Hesitancy: Delay in initiating urination
Polyuria: Notably larger urine excretion volume.
Oliguria: Diminished urinary output relative to intake.
Nocturia: Number of times urine is passed during the main sleep period.
Dribbling: Leakage of urine despite voluntary control.
Hematuria: Passage of visible blood mixed with urine
Elevated postvoid residual urine: Volume of urine in bladder after emptying.

Urinary Tract Infections (UTIs)

UTI involves the lower urinary tract causing cystitis, urethritis, and prostatitis in male patients.
Patients with female genitalia are more susceptible to infection due to the short urethra
Causes: obstruction of the urinary tract (e.g., benign prostatic hyperplasia, pelvic organ prolapse), incomplete bladder emptying, and abnormal anatomy.
Risk factors: older adults, antibiotic use, progressive underlying disease, and decreased immunity.
UTI can spread to the upper tract, causing kidney infection (pyelonephritis) and potentially long-term kidney damage.
Bacteria can spread to the bloodstream (bacteremia) resulting in urosepsis
Symptoms of lower UTIs: pain/burning sensation during urination (dysuria), fever, chills, nausea, vomiting, and malaise.
Symptoms of upper UTIs: inflammation of the bladder causing a frequent/urgent need to void, incontinence, and confusion

Clinical Manifestations of UTIs

Irritation to the bladder and urethral mucosa resulting in blood-tinged urine (hematuria).
Cloudy, foul-smelling urine or a change in urine colour, in the absence of other symptoms, does not indicate infection.
If the infection spreads to the upper urinary tract (i.e., the kidneys), rapid onset of flank or lower back pain, tenderness, fever, and chills can occur.
Catheter-associated UTIs (CAUTIs): results in increased length of hospital stay, morbidity, and mortality for patients.
Reduce unnecessary use of in-dwelling catheters and remove them as soon as clinically indicated; good perineal care is recommended.

Indications for Urinary Catheterization

Post-operative or acute urinary retention
Bladder outlet obstruction (e.g., gross hematuria, BPH, pelvic organ prolapse, urethral strictures)
Need for accurate measurements of I&O
Prolonged immobilization
Continuous bladder irrigation (CBI)
Administration of medications into the bladder (cancer)
Improving comfort at the end of life
Perioperative in selected surgical procedures.

Contraindications for Urinary Catheterization

Perceived comfort in patients with urinary or fecal incontinence.
Using a catheter to obtain urine for tests when patients can void voluntarily.
Prolonged postoperative use without appropriate indications.

Urinary Incontinence

Defined as a complaint of involuntary loss of urine.
Often occurs with other lower urinary tract symptoms. (e.g., daytime frequency, nocturia, urgency, intermittent or slow stream, hesitancy, postmicturition symptoms)
Psychosocial impact ranges from lifestyle changes to stigma, embarrassment, and self-imposed social isolation.
Types include transient, urgency, stress, mixed, UI associated with chronic retention, functional, neurogenic

Nocturia

Bothersome symptom defined as the need to get up at night on a regular basis to urinate.
Prevalence increases with age.
Possible causes: overactive bladder, prostate enlargement (men), excess urine production at night (nocturnal polyuria), heart failure, obstructive sleep apnea, loss of vasopressin.
Associated with metabolic imbalances (hyperglycemia, hypercalcemia).

Urinary Retention

Accumulation of urine in the bladder due to the bladder's inability to empty.
Micturition reflex is impaired
The build-up of urine causes pressure, discomfort, tenderness, restlessness, and diaphoresis.
Possible causes: Post-partum, urogenital surgery, medication adverse effects (anticholinergic), fecal impaction, Post-operative urinary retention (POUR), Chronic urinary retention.

Safety Alert: Autonomic Dysreflexia

Bladder distention can trigger autonomic dysreflexia in individuals with spinal cord injury above the T6 level.
Dysregulation of the autonomic nervous system leads to uncoordinated autonomic response (potentially life-threatening hypertension).
Immediate recognition and correction (e.g. irrigating or changing the Foley catheter) is critical.

Urinary Diversion

A urinary stoma to divert urine flow from the kidneys to the abdominal surface.
Reasons for diversion include: bladder cancer, trauma, radiation injuries, fistulas, and chronic cystitis.
Temporary or permanent.
Patients require an ostomy appliance.
Local irritation and skin breakdown are possible due to urine contact with skin.

GU Fistula

Abnormal connection between the urinary and genital tracts.

Urinary Diversion Methods

Ileal Conduit: Loop of ileum separated with intact blood supply where ureters are implanted; remaining ileum reconnected
Orthotopic Neobladder: Internal pouch formed from the ileum and reconnected to the urethra
Indiana Pouch: Creates a continent internal pouch from the ileum; a portion is connected to the abdominal wall
Ideal urinary stoma are symmetrical, do not have skin breakdown and protrude about 1.5cm

Nursing Considerations: Urinary Elimination

Infection control and hygiene: sterile urinary tract
Catheter duration is most important risk factor for UTIs
Medical and surgical asepsis during catheterization
Growth and development: changes in kidney and bladder function with aging, less effective emptying, increased susceptibility to UTIs, and elevated postvoid residual volume.
Psychological considerations: urinary problems can impact sexuality and self-concept, embarrassment, and self-isolation
Cultural considerations: cultural needs around urinary function.

Assessment of Urine

Color: Pale straw to amber (depending on concentration); dark red/bright red (kidney/bladder/urethra bleed); dark amber (bilirubin)
Clarity: Transparent at voiding; cloudy if left standing/high protein/bacteria
Odor: Characteristic; stronger with concentration; ammonia with stagnant urine; sweet/fruity (diabetes, starvation)

Urine Testing Collection Techniques:

Clean-Catch Midstream: Patient cleans urethral area; begins urinating and collects midstream in sterile container.
24-hour urine collection: Urine collected over 24 hours, discarding first void, collecting remaining urine in provided container.
Catheterized sample: Collected by healthcare professional directly from catheter.

Urinalysis

Color, Clarity, Odor: Normal values. Changes in these can indicate problems
pH (Acidity): Normal range (4.5-8). High pH may suggest infection or high-protein diet; low pH indicates high-protein diet or certain medications
Protein: Normally absent or in small amounts. Proteinuria can indicate kidney disease or infection.
Glucose: Absent. Glycosuria suggests high blood sugar levels (uncontrolled diabetes)
Ketones: Absent. Ketonuria can indicate uncontrolled diabetes, starvation, or a low-carbohydrate diet.
Leukocyte Esterase & Nitrites: Indicate infection
Blood: Absent. Hematuria can indicate infection, trauma, or kidney stones
Bilirubin & Urobilinogen: Absent. Bilirubin suggests liver or gallbladder disease

Diagnostic Examinations

Noninvasive examination
Invasive examination

Common Post-Procedure Interventions

Assessing intake and output
Observing characteristics of the urine, including color, clarity, and presence of blood

Health Promotion

Promoting regular micturition: Use sensory stimuli to stimulate voiding reflex
Maintaining elimination habits, adequate fluid intake promoting complete bladder emptying: double voiding/intermittent catheterization, bladder scanning
Preventing infection: good perineal hygiene, hand washing, fluid intake, good quality perineal products.
Use of urinary catheter requires prescript
Incontinence alone is not reason to insert catheter

Class Learning Outcomes

Compare common alterations in urinary elimination.
Describe nursing implications of common diagnostic tests.
Discuss nursing measures to prevent episodes of incontinence.
Describe nursing and collaborative care for clients with chronic renal failure and chronic kidney disease.
Describe indications for peritoneal and hemodialysis.
Describe nursing care for clients undergoing peritoneal and hemodialysis.

Chronic Kidney Disease (CKD)

Progressive, irreversible loss of kidney function.
Chronic renal failure
Kidney damage: pathological abnormalities (nephron destruction), markers of damage (blood, urine, imaging tests)
Glomerular filtration rate (GFR) decline (<60 mL/minute/1.73 m²) for 3+ months.
80% GFR loss without significant body response
Compensatory mechanism: remaining nephrons increase in size (hypertrophy)
Leading causes of end-stage renal disease include diabetes mellitus, hypertension, renal vascular disease (affecting blood flow), renal artery stenosis/thrombosis, renal vein thrombosis.

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Description

Explore the complexities of micturition and urinary alterations in this quiz. Learn about the neurological responses involved in bladder control, common urinary issues like UTIs and incontinence, and their symptoms. Test your knowledge of urinary physiology and related disorders.