1
Q
What are the factors that promote urination
A
Relaxation Contraction Gravity
2
Q
What factors influence urination
A
Age Children Geriatric Pregnancy Diet Activity: Immobility or Exercise/Strenuous activity Psychosocial factors Privacy
3
Q
What does urine output depend on
A
Depends on age
4
Q
How do you calculate urine output
A
Calculation is 0.5 mL/kg/ hr
5
Q
What is the weight conversion for urine calculation
A
1kg = 2.2 lb
6
Q
How do you convert pounds to kilograms for urine output
A
Weight divide by 2.2 = kg
7
Q
How do you calculate mL per hour
A
Multiply ml by kg/ hr = ml/ hr
8
Q
What is a urinary tract infection (UTI)
A
UTI
9
Q
What bacteria primarily causes UTIs
A
Primary bacteria that causes an UTI is Escherichia coli (E.coli)
10
Q
What is an upper UTI
A
Upper UTI - kidney (pyelonephritis) ureters (ureteritis)
11
Q
What is a lower UTI
A
Lower UTI - bladder (cystitis) urethra (urethritis)
12
Q
What defense systems help prevent UTIs
A
Ureterovesical Valves Urine Prostate Gland Normal flora of the vagina
13
Q
Define bacteriuria
A
Bacteriuria
14
Q
Define bacteremia
A
Bacteremia
15
Q
Define urosepsis
A
Urosepsis
16
Q
What are the risk factors for UTI
A
H - Hormone changes A - Antibiotics R - Renal stenosis D - Diabetes T - Toiletries O - Obstructive Prostetic Hypertension (BPH) V - Vesicoureteral reflux (VUR) O - Over-extended bladder I - Indwelling catheters
17
Q
What are the signs and symptoms of a UTI
A
Dysuria and Burning Frequency & Urgency Cloudy and Foul Odor Fever
18
Q
What are lower UTI symptoms
A
Dysuria and Burning Frequency & Urgency Cloudy and Foul Odor
19
Q
What are upper UTI symptoms
A
Fever
20
Q
How is a UTI diagnosed
A
Urinalysis Voiding vs. Foley sample Urine Culture
21
Q
What is important to remember before giving antibiotics
A
Never give antibiotics before collecting culture
22
Q
What type of urine sample is needed
A
Clean catch
23
Q
What is found in urine during UTI
A
WBC’s and bacteria
24
Q
How are UTIs treated
A
Antibiotics Sulfonamides: Bactrim Nitrofuran: Macrobid or Macrodantin Pain control Pyridium - ORANGE color urine Analgesics Heat
25
How can UTIs be prevented
Void every 2-3 hours After intercourse Avoid caffeine and alcohol Encourage fluids
26
What is urinary incontinence
Involuntary loss of urine
27
When does urinary incontinence occur
Occurs when pressure in bladder exceeds urethral closure pressure
28
Is urinary incontinence a normal part of aging
Not a sign of “old age”
29
What does urinary incontinence indicate in men
In men it’s a sign of BPH and/or prostate cancer
30
Why is urinary incontinence more common in women
More common in women - Why
31
What is stress incontinence
Sudden increase in pressure that causes involuntary passage of urine
32
Characteristics of stress incontinence
More common in women Activity that puts “stress” in the pelvis Leak small amounts
33
What is urge incontinence
Caused by uncontrolled contraction or overactive detrusor muscle Inflammation Obstruction Overactive Occurs randomly urgency then involuntary urination Leakage is frequent and large amounts
34
What is reflex incontinence
Result of nerve damage Involuntary loss of moderate amounts of urine without warning
35
What causes reflex incontinence
Spinal cord dysfunctions Typically impaired CNS Stroke MS Spinal cord lesions
36
What is a risk associated with reflex incontinence
Autonomic Dysreflexia
37
What is functional incontinence
Loss of urine due to factors that interfere with responding to need to urinate Cognitive mobility environment
38
What is transient incontinence
Reversible incontinence Inflammation temporary cognitive impairment medications
39
What is overflow incontinence
Incomplete bladder emptying that results in the bladder overfilling when full leading to urine leakage Urinate small amounts but LARGE Post-Void Residuals
40
What measures manage urinary incontinence
Absorbent products or collection devices Treatment of underlying cause Bladder Training Scheduled voiding Pelvic Floor Muscle Exercises
41
What additional measures manage incontinence
Foley is NOT indicated Restrict caffeine and alcohol Medications Some to manage Adverse effects of others
42
What is urinary retention
The inability to partially or completely empty the bladder
43
What causes urinary retention
Blockages weak muscles nerve injury neurological disorders medications
44
What is the most common cause of urinary retention in males
Usually due to enlarged prostate (BPH)
45
Why must urinary retention be treated
Will develop UTI bladder & kidney damage and or urinary incontinence
46
How is urinary retention managed
Measurement of Post-Void Residual Intermittent catheterization Sterile vs clean at home Frequent voiding Due to void every 3-4 hours In clients with documented retention we prefer them to void every 2 hrs
47
What additional measures promote urination
Adequate hydration Psychosocial factors Sitting standing
48
What are urinary diversions
Urinary Diversions
49
What is a continent urinary diversion
Continent Urinary Diversion
50
What are the two types of continent urinary diversion
Neobladder & continent cutaneous reservoir
51
What is a continent urinary diversion reservoir
Intra-abdominal urinary reservoir Control over voiding Self-catheterization
52
What is an orthotopic bladder neobladder
Construction of a new bladder in the normal anatomic position
53
What structures must be present for a neobladder
Must have bladder neck urethra
54
How does a patient urinate with a neobladder
Urinate through the urethra
55
What maneuver may be required to void with a neobladder
May need to use Valsalva maneuver to void
56
What happens if the neobladder does not empty
If unable to empty bladder will need to self cath
57
What is a continent cutaneous reservoir
Created from distal part of ileum & proximal part of colon
58
Where are ureters placed in a continent cutaneous reservoir
Ureters are placed in pouch
59
Where is a continent cutaneous reservoir located
Located in abdomen
60
What type of stoma is used in continent cutaneous reservoir
Stoma one way valve
61
How does the patient empty a continent cutaneous reservoir
Self cath
62
What are the two incontinent urinary diversions
Nephrostomy Urostomy
63
What are characteristics of incontinent urinary diversions
Continual flow of urine requiring a bag No voluntary control Risk of skin breakdown Need lifelong care permanent
64
What is a urostomy
Takes both ureters and brings them together to the abdominal wall to create a stoma
65
What is an ileal conduit
Use part of small intestine to connect to ureters and then create a stoma
66
What is common to urostomy and ileal conduit
Continual drainage Require an ostomy bag
67
What is a nephrostomy
Temporary preserve kidney function with ureter obstruction
68
What incision is used for nephrostomy
Flank incision with closed drainage system
69
What are risks of nephrostomy
Infection and damage to kidney
70
What is assessed in the nursing process for elimination
Voiding pattern Ability to void Urine Amount Color Clarity Odor Labs
71
What labs are associated with elimination assessment
Urinalysis urine culture 24 hour urine Protein glucose WBC’s
72
What nursing interventions support urinary elimination
Start a bladder retraining program Scheduled intervals with 4 hour goal Keep a log Perform intermittent catheterization Monitor for skin breakdown Provide incontinence care Monitor for social isolation
73
What are bladder training instructions
Empty bladder as soon as you get up Go to bathroom at specific times usually every 3-4 hrs Wait until next scheduled time before urinating
74
What should the patient do if urge occurs early
Use urge suppression techniques deep breathing pelvic exercises Sit down until sensation passes
75
How is bladder training progressed
Gradually increase time between voiding by 15 minute intervals
76
How long does bladder training take
Between six to twelve weeks
77
What additional bladder training tips include
Deep breathing count to 10 contract pelvic floor Hold pressure on perineal area Stop activities involving water
78
What positive self talk is encouraged
I can wait
79
What should patients avoid during bladder training
Refrain from holding breath or squeezing legs
80
When should patient attempt to urinate after urge suppression
Once the 30 minute time frame is completed
81
How should bladder training time increase
Increase period for 15 to 30 minutes each week
82
What medication is used for urinary incontinence
Nortriptyline
83
What class is nortriptyline
Tricyclic antidepressants
84
What effect does nortriptyline have
Anticholinergic effects that help relieve urinary incontinence
85
What nursing considerations are required for nortriptyline
Monitor dizziness orthostatic blood pressure Teach patient to change position slowly
86
What medications are oxybutynin and dicyclomine
Anticholinergic agents
87
What do oxybutynin and dicyclomine do
Decrease urgency and help alleviate pain from neurogenic or overactive bladder
88
What are side effects of oxybutynin and dicyclomine
Monitor dizziness tachycardia urinary retention
89
What patient history is important with oxybutynin and dicyclomine
Ask about history of glaucoma
90
What is a common side effect of oxybutynin and dicyclomine
Dry mouth
91
What patient education should be provided
Drink 2-3L of fluids a day Maintain bladder retraining Strengthen pelvic floor muscles Perform intermittent catheterization Express feelings about incontinence
92
What outcomes are evaluated
Absence of bladder distention Able to hold urine for 4 hours Free of CAUTI Able to straight cath on own Free of skin breakdown Maintain social life Therapeutic effect of medications
93
What concept map is included
Concept Map UTI
94
What questions are included in the concept map
What’s happening in the body What will I see in my assessment What labs or tests will be ordered What trends and findings are expected What medications will be ordered What nursing interventions will you do What signs show improvement What are risk factors What are long term complications List patient teaching
Nursing 2050
flashcards
Decks in class (8)
# Cards
