Nursing 200 Foundations > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Components of urine list

A

96% water, Uric acid, hormones, electrolytes: Na, Cl, K, Mg, etc; urea, enzymes

Critical thinking: let’s say a pt is using daily diuretics for chronic condition, he would urinate a lot (hyperuricemia) and cause dehydration, hyperglycemia (due to induced of K depletion of non potassium diuretics that decrease insulin secretion and/or decrease in insulin sensitivity causing high blood sugar), 3 hypos = hyponatremia, hypokalemia, hypochloremia, orthostatic hypotension (dizziness, fainting and light headache)

Urinalysis = why specific gravity urine is high = dehydration (too much solutes out bc keep water retain)
= if low = maybe drink too much water or person has underlying disease and cause of extreme thirst

Urea in urine = high = just eat a lot of proteins or increase protein breakdown
= low = kidney problems, malnutrition (lack of protein in diet)

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2
Q

What ADH do?

A

ADH is being released by the posterior pituitary glands that is produced by the hypothalamus. It will be triggered to release when there is dehydration (renal tubules reabsorption of more water back inside body), and not or stop release when there is hypervolemic state.

Critical thinking:
Diabetes insipidus cause pt to urinate a lot and cause losing a lot of electrolytes due to problems with posterior pituitary glands or hypothalamus that can’t produce or not releasing enough ADH (vasopressin).

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3
Q

What is normal osmolarity serum range? What does it mean when increasing and when decreasing?

A

Normal osmolarity serum level is 275-295.
If increasing = dehydration = high sodium level
If decreasing = overhydrate = low sodium level

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4
Q

Alterations in urinary elimination may alter body image causing what to people?

A

Cause people to feel decrease in self-esteem, depression, isolation, etc

Critical thinking: pt has alterations in urinary elimination and they don’t want to change frequently bc they don’t have enough financial.
Pt might feel decrease in self-esteem bc they need to wear an ostomy bag outside after a colostomy

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5
Q

2 functions of the urinary system

A

+ filters and eliminates waste products
+ maintain fluid and Na level

Critical thinking: pt who needs dialysis due to kidney disease (eGFR < 60), kidney failure (eGFR < 15) and they need dialysis = can’t filter waste properly and is building up of solutes serum level, especially sodium and potassium. Pt can also have metabolic acidosis due to kidney not properly work to reabsorb bicarbonate and low RBCs (anemia) due to not secrete erythropoietin to stimulate more production of RBCs.

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6
Q

2 parts of upper urinary tract and their function

A

+ kidneys: remove wastes from blood to form urine
+ ureters: move urine in peristaltic wave and transport urine into the bladder

Critical thinking: if let’s just say that the bladder and ureters are not working well, they can do nephrostomy = tube collection drainage of urine from the renal pelvis
If only the bladder is not working, they can do a ureterostomy

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7
Q

3 parts of the lower urinary system

A

+ urinary bladder: stores urine (around 600 mL to 1L). When bladder has around 200 mL, they would cause the stress receptors in the trigone area to be triggered and cause the urge to urinate.
+ urethra: male = ~20 cm, female = ~4 cm = easier to get UTI. Urine travels from the bladder through the urethra and out. Try to have a turbulent flow of urine to wash out all bacteria.
+ urethral sphincter: internal and external sphincter. Should have voluntary control. When contracts = narrow or stop outflow urine.

Critical thinking: if urethra is not working, but the bladder is working, they can do vesicostomy. Rare in adult, usually in children.
If the pt lose voluntary control of urethra, can be incontinent.
If want to form new bladder, then can do continent = kock pouch and neonbladder, if incontinent = can do ileal conduit

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8
Q

How to have a voluntary control of urination? (Hint: 5 things)

A
  1. Intact spinal cord tracts to the bladder, urethra
  2. Intact central nervous system
  3. Good functioning genitourinary system. Must have perfusion of 20-25% from the CO (HR x SV) so like around 4-6L
  4. Good functioning cardiovascular system: must have enough RPP= renal perfusion pressure. To do that, must have enough of SBP of 90 or MAP of 65 mmHg = (SBP + 2 DBP)/3
  5. Intact motor area of cerebellum
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9
Q

7 factors affecting urination

A
  1. Disease conditions
  2. Fluid balance
  3. Surgical procedures
  4. Sociocultural factors
  5. Psychological factors
  6. Muscle tone
  7. Medications
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10
Q

How many percentage pre renal stage makes up renal failures?

A

30%

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11
Q

What cause pre renal failure stage? Give 3 examples

A

Decrease in the RPP (renal perfusion pressure) = either decrease in blood or pressure
+ sepsis (excessive vasodilation of BVs due to cytokines, kitins, etc called distributive shock)
+ dehydration
+ shocked (can be hypovolemic shock due extreme low BP can be due to burns, diuretics, extreme blood loss, etc; cardiogenic shock due to arrhythmias, heart attack, blood clots, etc)

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12
Q

How many percentage intra-renal stage makes up renal failures?

A

65%

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13
Q

What cause intra-renal failure stage?

A

Mainly acute tubular necrosis (ATN) due to hypertension, DM or drinking toxic meds or chemicals

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14
Q

How many percentage post renal stage makes up renal failures?

A

5%

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15
Q

What cause post renal failure stage? Give 4 examples

A

Mainly outflow obstruction
Ex: BPH (benign hypertrophy prostate- enlarged prostate), any types of masses, any types deposits or like renal calculi, neurogenic bladder (bladder can’t feel urge to void and retain urine cause easier to get UTI = decrease in urine)

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16
Q

What happened to body pre-op?

A

Generally cause GAS (General adaptation Syndrome) = increase ADH = decrease urine output.
Usually can’t drink the day or the night before some procedure

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17
Q

What happened to body post op & involve in narcotics and anesthesia?

A

Decrease in urinary output bc anesthesia has not yet all wear out so decrease eGFR (however should not be lower than 60 = kidney problems, eGFR <15 = kidney failure)

Critical thinking: check for sites if there is pain, inflammation, redness. Depending on the area of surgical procedure but mostly would cause decrease in urine output due to decrease sensation and mobility
HOWEVER, post op, promoting mobility is always a good thing!!

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18
Q

What medications cause decrease in urination?

A

Anti cholinergic, antihistamines, antidepressants, narcotics/opioids

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19
Q

What is pyridium? What color change in urination this meds cause?

A

Pyridium is analgesic meds giving for pt who needs to wear off or release symptoms that the patient has for UTI like discomfort/ painful when urinating (dysuria) before starting antibiotics.
Color change: dark orange to light red color

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20
Q

What is levodopa? What color change in urination this meds cause?

A

Levodopa is meds given for Parkinsonism. Usually given with carbidopa for synergistic effects
Color change: dark red to brownish color

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21
Q

What is amitriptyline? What color change in urination this meds cause?

A

An antidepressant meds
Color change: blue or green color

Critical thinking: if pt is taking any meds listing above, need to educate before hand bc they might freak out.

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22
Q

What is more at risk of decrease in muscle tone?

A

Muscle tone (detrusor muscle) decrease = atrophy= difficult urinating & possible incontinent = urinary retention
- Prolonged immobile pts (incontinence)
- menopause women at 50-51 age
- vaginal delivery due to damage

Critical thinking: teaching kegel exercise TID and 10 times per session

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23
Q

Who needs a Foley catheter based on CDC? (Hints: 9 situations)

A
  1. Patient has acute urinary retention or bladder outlet obstruction (Ex: BPH, any types of masses, any types of deposits, renal calculi, neurogenic bladder)
  2. Need for accurate measurements of urinary output in critically ill patients (Critical I &O)
  3. Perioperative use for selected surgical procedures: Patients undergoing urologic surgery or other surgery on contiguous structures of the genitourinary tract.
  4. Anticipated prolonged duration of surgery (catheters inserted for this reason should be removed in PACU).
  5. Patients anticipated to receive large-volume infusions or diuretics during surgery.
  6. Need for intraoperative monitoring of urinary output.
  7. To assist in healing of open sacral or perineal wounds in incontinent patients.
  8. Patient requires prolonged immobilization (e.g., potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures).
  9. To improve comfort for end of life care if needed.
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24
Q

What is 3 Ex not appropriate use of Foley catheter?

A
  • As a substitute for nursing care of the patient or resident with incontinence.
  • As a means of obtaining urine for culture or other diagnostic tests when the patient can voluntarily void.
  • For prolonged postoperative duration without appropriate indications (e.g., structural repair of urethra or contiguous structures, prolonged effect of epidural anaesthesia, etc.).
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25
What is routine hygiene?
- Wear gloves for any contact with body fluids and mucous membranes
26
How often one should have a full bed bath or and if they are able to take a shower?
Once a day and if they have any feces or urine incontinence then change right away.
27
How many hours later you should have perineal care for Foley catheter or purewick catheter?
Every 12 hours
28
T or F: Infants urinate small amounts but more frequently at an average of 10-20 times per day and it is because they have immature kidneys
True
29
T or F: Infants urine is concentrated
False. It is not that concentrated
30
At what age you should train infants to potty trained?
Age range 2-4
31
How long does it take for potty train for infants?
About 18 months
32
What age infants should be fully independence urination?
4 or 5
33
How to teach children: girls and boys to wipe?
Girls: front to back to decrease UTI (less contaminations to more contaminations) Boys: usually tell them shake
34
How pregnancy (specifically second and third trimester) cause alteration in urination?
- cause increase in frequency of urination = small leak at a time = little bit incontinence = decreased in urine emptying = urine retention increase = more likely to get UTI
35
What age is renal function starts to decrease clearly and might have nocturia?
40 year old
36
What condition male 40 year old usually get?
BPH
37
What 3 things BPH increase?
increased frequency and retention and nocturia
38
What condition menopause (50-51) women usually have and why?
UTI (bc there’s estrogen decrease and change in the urethral mucosa)
39
What to teach UTI pt?
- don’t wear nylons. Wear COTTONS instead and change daily - Void after vaginal intercourse or when urge to void is perceived - Take a shower instead of bath bc everything will go down through gravity - wipe from front to back after having BM - Perform Kegel exercise three times per day 10 times per session
40
What is polyuria?
Polyuria is more than 3L of urine output with normal fluid intake per day (24hrs)
41
3 cause of polyuria?
1. Alcohol intake 2. Diuretics 3. Diabetes poorly controlled (DM or Diabetes insipidus)
42
What is oliguria?
Less than 500 mL in 24 hrs with normal fluid intake If have Foley catheter = less than 30 mL/hr or less than 720 mL/24 hrs
43
Cause of oliguria? (hint: pre renal & post renal)
Pre-renal stage: due to decrease in RPP = dehydration, sepsis, shock Post-renal stage: outflow obstructive = BPH, any types of masses, deposits, renal calculi, neurogenic bladder
44
Anuria
No output with normal fluid intake = end stage renal disease (eGFR < 15 )
45
Best index of kidney function
eGFR= 90-120
46
Kidney disease problems eGFR?
eGFR < 60
47
How many stages of CKD?
5
48
T or F: Is eGFR divided into NAA (non-African American) or AA (African American) category
True
49
How to detect an AV graft or AV fistula?
Usually pt will tell you However, if not, an X-ray can confirm it
50
How to assess an AV fistula or an AV graft?
Can feel a thrill when palpating When auscultating, should hear swoosh sound = a bruit = a functioning sound = should be turbulent flow For normal people= blood should be laminar flow
51
What is a no done in AV graft or AV fistula?
Signs should be saying no venapuncture, no IV, no BP, no ABG, no sticks lab in the arms of AV fistula or AV graft
52
Why AV graft or AV fistula is needed?
For long term hemodialysis = to prevent CAUTI from temporarily Quinton catheter
53
What should be cautious of Quinton catheter
It is a temporary central IV line that is using for hemodialysis hopefully only taken couple of weeks. However, can taken up to 3-4 months. Be careful not to bonus your pt thousands of unit of heparin. Must use 5 mL to inject heparin until see blood on both sides first then can administer whatever meds prescribed.
54
How long does it take for AV graft or AV fistula to heal?
Usually 3-4 weeks but some say it can go up to 6 months
55
How long is hemodialysis sessions? How often?
Generally it takes 3-4 hrs and pt usually need 3 treatments per week (depending on the severity)
56
What is hemodialysis machine called?
Dialyzer
57
How does hemodialysis work?
One needle on one vein and one needle on the artery. Blood from vein will go to machines, and their high concentration of solutes will go through the selective barrier membrane to help cleaning blood. Then clean blood will be back to the body to the artery.
58
Pros and cons of peritoneal dialysis vs. hemodialysis
Pros: peritoneal dialysis: can do at home, in long time, can be comparable to hemodialysis Cons: peritoneal dialysis: can cause peritonitis (infection of the membrane around the abdomen organs, malnutrition of proteins Pros: hemodialysis: effective quick, need fewer treatments per week than peritoneal dialysis Cons: can cause infection; have to do AV graft or AV fistula for long term treatment
59
What is in dialysate bag?
Depend on what is lacking in each individual Can be Na, K, Ca Mg, Cl, HCO3-, dextrose or non electrolyte glucose
60
How procedure of peritoneal peritoneal being carried out?
Need physician to do flexible soft catheter inserting into the abdomen to the peritoneum membrane (usually takes 10-20 days for healing)
61
How long and how often is dialysate bag for peritoneal dialysis?
Depend on each pt, they might do it dwelling time (leave dialysate fluid in peritoneum) every 4-6 hrs. And that would be 3-5 times per day (CAPD)
62
How many types of peritoneal dialysis? List out
3 CAPD: continuous ambulatory peritoneal dialysis CCPD: continuous cyclic peritoneal dialysis (total 8-9 hrs, 3-5 times cleaning) per sessions IPD: intermittent peritoneal dialysis
63
What is frequency?
When person goes more than 6 times per day Usually one go about 5 times on average
64
What causes frequency?
Stress, pregnancy, UTI, (diuretics, infants, uncontrolled DM)
65
What is stress incontinence? Give ex
When putting pressure on the abdomen and causing pressure on the abdomen (no emotional relation). Ex: laughing cause a little leaking
66
What is overflow incontinence?
Blockage of the urethra causing leakage/dribbling at a steady rate
67
Ex of overflow incontinence
BPH, MS, Parkinsonism
68
What is urge incontinence due to?
Due to involuntary contraction of the bladder
69
What is urge incontinence cause of?
Mostly of overactive bladder, BPH, or due to involuntary sphincter control
70
What is mixed incontinence?
Mixed btwn urge and stress incontinence
71
What is neurogenic bladder?
A condition cause person not feel the urge to void due to nerves not intact (usually damage of S2-S4 sacral cause more likely to get neurogenic bladder)/ disturbed function of the newvois system
72
How often people do self-catheterization for neurogenic bladder?
Every 6 hours
73
What is nocturia?
Wake up at night to void more than 2 times
74
What causes nocturia?
BPH, CHF pts on diuretics, uncontrolled DM
75
What is enuresis mean?
Involuntary urination of children because they don’t have control over it yet; Can also mean stress incontinence
76
What is defined retention?
Urine output less than 500 mL in 24 hrs, or when there’s Foley catheter, that means urinary retention when there is less than 720 mL in 24 hrs or less than 30 mL/hr.
77
Urinary retention cause? (Hint: 4 causes)
1. BPH 2. Post-op first 4 hours 3. Spinal cord injury pt 4. Over-distended bladder
78
What is dysuria and means?
Painful urination. Mean possibly UTI
79
BUN (urea nitrogen) normal range
10-20 mg/dL
80
Creatinine normal range
0.5-1.5 mg/dL
81
Hgb/hct normal range
Hematocrit (hct): Male: 42-52% Female: 37-47% Hemoglobin (Hgb): Male: 14-18 g/dL Female: 12-16g/dL
82
Albumin normal range
3.4 to 5.4 g/dL Low albumin = malnutrition: liver disease, kidney disease, inflammatory disease High albumin = severe dehydration
83
K normal range
3.5-5 mEq/L
84
Na normal range
135-145 mEq/L
85
List 6 diagnostic testing for abnormal urination
1. BUN, creatinine, eGFR 2. Renal ultrasound (ex: bladder scan) 3. KUB X-ray 4. Urine culture & sensitivity and electrolytes through urinalysis or 24hr urine collection 5. MRI scan of the pelvis 6. CT scan of pelvis
86
List continent vs incontinent urinary diversions
Continent: 1. Kock pouch 2. Neobladder Incontinent: 1. Suprapubic catheter 2. Vesicostomy 3. Neophrostomy 4. Ureterostomy 5. Ileal conduit
87
What is Kock pouch?
Surgical procedure creating a new reservoir/bladder through the nipple valve in the abdomen out. Needs to do self catheterization every 4 hours or so.
88
What is neobladder?
Mostly bc of bladder cancer. Cut part of the bladder or full bladder and use part of ileum to create a new bladder. Urethra need to be INTACT
89
Problems with neobladder?
Can’t feel the urge to void bc the spinal cord to old bladder nerve is cut off since the trigone area is now gone. So need to practice to go in the toilet and try to relax, to urinate every 4 hours or so.
90
Where is catheter of the tube inserted for a suprapubic catheter?
Inserted into the bladder directly through the abdomen wall above the pubic symphysis.
91
What is suprapubic catheter?
A type of catheter besides Foley catheter to get pt urine through incision wall made at the pubic symphysis site. For short term only.
92
What is a ureterostomy?
Maybe a bladder cancer. A surgical procedure that brought the ureters to the surface of the abdomen like a type of stomach: can put appliance on one side or bilaterally.
93
What is a nephrostomy?
A surgical procedure where tube is inserted to the renal pelvis to catch urine out of a collection bag (a type of Foley catheter). Can be done one side or bilaterally.
94
What is a vesicostomy?
A surgical procedure done when the urethra is not working and still, the bladder is working. So need to bring bladder and attached to the anterior portion of the abdomen. Can be nipple valve or stoma
95
What is Ileal conduct?
Same like kock pouch, but is not a physically looking like bladder but just take part of the ileum and then sew to the abdomen wall and create a stoma which is incontinent.
96
Which urinary diversion can’t be bladder cancer?
Suprapubic catheter (Say) Nephrostomy (No) Vesicostomy (Voice)
97
What is average urine output?
1.2-1.5 L
98
What is color of the urine?
Pale straw to an amber color, some shade of yellow
99
What is clarity of urine?
Should be transparent, no sediments, no cloudy
100
What happens when urine sits longer?
The longer urine sits = the more it precipitates, the more cloudy it becomes = the more ammonia smell.
101
What is foamy urine indicating?
High protein level = body can’t conserve proteins, might be due to kidney disease
102
4 signs of UTI urine
Thick Cloudy Foul smelling urine Hematuria
103
What is fruity, sweet, acetone smell urine indicating?
Incomplete fat metabolism, DM patient
104
What are other conditions causing hematuria besides UTI? (Hint: 3 things)
Cancer of the genitourinary systems Trauma of kidney Kidney stones
105
If have to take a sample of urine, how to take?
First, wipe down the port for 15 seconds using alcohol wipes Then take sterile syringe to get sample from the port of the Foley catheter there (Never use the urine out of the Foley collection bag directly)
106
Is bladder scan a non invasive procedure?
Yes
107
What image of bladder scan is a male?
Prostate or walnut looking
108
What image of bladder scan is a child?
Small kid with leg up in the air
109
What image of bladder scan is a female?
The one with a dress
110
Is female pt who did hysterectomy will shown as male for bladder scan?
Yes
111
What position when doing bladder scan?
15 degree HOB, knee gatch down (legs flat on bed)
112
How to put ultrasound gel for bladder scan?
2 inches above the pubic symphysis
113
At what volume need to do in and out catheterization from bladder scan?
Most facility would say over than 300 mL
114
Contraindications of bladder scan
Abdomen wound, pregnancy
115
What is 8 hour rule of bladder scan?
If pt hadn’t urinate in 8 hrs. First can encourage them to go. And if they can’t go, do bladder scan. If it shows more than 300 mL, then need to do in and out catheterization. Then later 8 hours, they said they can’t urinate, then can repeat the process. However, then instead doing in and out catheterization, then can ask physician for order of Foley catheter for urinary retention.
116
Steps of inserting a Foley catheter
117
When to change a purewick catheter?
Q12H or every time it is soiled or when it is clogged with menstrual blood or stool
118
What is the correct placement of purewick catheter?
between anus & pubic bone, need to separate the labia and buttocks. Then wedge catheter in between the labia and gluteus muscles.
119
Is purewick catheter an external adult female catheter and need to turn on of 40 mmHg continuous sunction
Yes
120
What is a purewick catheter?
A catheter use for people who do not meet the criteria of a Foley catheter but they are incontinent
121
How effective is a purewick catheter?
It catches up to 95% of urine.
122
Give me 4 nursing diagnosis of alteration in urinary elimination
1. Disturbed body image 2. Impaired urinary elimination 3. Impaired skin integrity 4. Urinary retention
123
Give me 2 risks of alteration in urinary elimination
1. Risk for urinary retention 2. Risk for impaired skin integrity
124
General goal with urination
Normal voiding with complete bladder emptying
125
What are three outcome measures?
No bladder distention Void of more than 300 mL Will perform Kegel exercise TID
126
When male pt using urinal, if they can’t pee lying, what do you do?
Have them to sit or stand up peeing
127
To measure urine, what you do?
Use urinal hat pan at the bedside commode and have a look at it after pt void it, don’t let it sit for too long.
128
List 5 implementations for heath promotions
1. Client education 2. Maintain elimination habits 3. Fluid intake 4. Prevent infections 5. Acidifying urine = to inhibit microbial growth
129
What to eat to make urine more acidic?
Meat, eggs, grains and proteins
130
What juice helps to decrease bacterial adherence of bacteria?
Cranberry juice
131
What to clean pt with Foley catheter with?
CHG (chlorehexidine gluconate) wipes for external genitalia not internal genitalia. Don’t use harsh soaps
132
Is condom catheter invasive?
No. Just like purewick catheter= for pts who are not fitting the criteria of a Foley catheter
133
How to compare pts penis?
Using pattern to compare at the base/middle of the shaft of the penis
134
What is inconvenient of a condom catheter?
It does not have a stat lock so it moves around a lot unlike a Foley catheter. And try to pull the pubic hair down so it does not get stuck in the condom catheter.
135
What is coude catheter with curved tip to it for?
For male pt who has enlarged prostate glands
136
What is a three way catheter?
Has 3 ports: 1st port is used for inflate the balloon 2nd port is for collection bag inserting 3rd port is for bladder irrigation
137
So physician will document that every 24 hours, this patient will need a Foley catheter, and nurses will be the one to determine if the patient still need the Foley catheter or not and have a convo with physician. T or F
True
138
How to not have dependent loop for a Foley?
Put at foot level, don’t put at knee level so gravity helps to drain urine better. Fix kinks.
139
What is most thing not to do if having a foley?
Must not have a breach system. When collect urine into a graduated cylinder, must have tissue paper underneath and tip not touching anything.
140
One contraindication of a statlock
Do not stretch for edema pt - must use about 5-8 gauze to open the pad of statlock, if not can hurt pt with one force of removing
141
How often do you change a statlock device?
Every 5 days
142
What is pelvic floor exercise?
A kegel exercise: needs to push pressure on urinary sphincter (not abdomen, legs or buttocks) on 10 seconds, 10 times repeat, three times per day.
143
What is bladder training?
To avoid the urge to void = hopefully void less than normal increase frequency = to decrease frequency of urination & increase the time btwn the intervals of urinating.
144
What is habit training?
Helping pt to void at a regular interval by scheduling toileting and assist if needed
145
List implementation for restorative care
Pelvic floor exercise, bladder training, habit training, skin integrity, comfort
146
What is comfort process?
Clean pt as much as needed Can help pt in a site bath to soak the perineal area and rectal area to warm area (temp less than 105 degree) = increase comfort and clean area
147
Is to irrigate foley mean has to open the system and can cause risk of UTI. True or F
True
148
Don’t notify provider if there is only 1 evidence/symptom/sign. True or F
True
149
Besides caffeine, what can increase frequency?
Alcohol, citrus, artificial sweetness
150
Is collecting specimen in sterile way don’t need to don sterile gloves, however, need to use a sterile specimen container like sterile syringe. True or False
True
Nursing 200 Foundations
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