Which condition in older men can result in impaired flow of urine from the bladder into the urethra quizlet?
Terms in this set (181)What do the kidneys do? -Filter metabolic wastes, toxins, excess ions and water & excrete these as urine What is a Nephron? -Basic
structural and functional unit of the kidney How is Urine formed? -filtration, reabsorption and secretion Glomerular Filtration process of urine formation First step= filtration, occurs in the glomeruli. Blood pressure forces plasma, disolved substances, and small proteins out of the porous glomeruli into Bowman's Capsule to form a liquid caleld filtrate. Normally small particles filtered from blood. If damage/inflammation, large molecules (blood cells, proteins) can pass. Affects ability to dilute and concentrate urine. Glomerular Filtration Rate (GFR) the amount of filtrate formed by the kidneys per minute. How much urine is formed per hour? 50-60ml per hour How much urine can your bladder hold? 1000-2000ml a day (LOOK UP IN NOTES JUST TO DOUBLE CHECK) How long is the men's urethra versus the women's urethra? men:
20cm What muscle expels the urine out of the bladder? the detrusor muscle and the internal urethral sphincter relaxes = conscious urge to void How much can a normal bladder store? 500ml, but it may distend when needed to a capacity twice that amount Voiding can be voluntary due to what sphincter the external urethral sphincter How often do most people void? 5-6 times a day What can increase urinations indicate? -increased intake, diabetes mellitus, or a UTI To void normally you need: -normal functioning of the bladder and urethra As the concentration of urine solutes increases... specific gravity increases What is the specific gravity of distilled water? 1.00 because there are no dissolved solutes Normal specific gravity for urine is 1.010-1.025 What can a low specific gravity mean? A low specific gravity (ex. 1.001) can mean the kidney is ineffective in concentrating the urine What can a high specific gravity mean? The patient is dehydrated, ex. 1.029, or anything greater than 1.025 If a person is consuming lots of water and the SG becomes a 1.000 the color of urine will become diluted and lighter in color to almost clear If a person has diarrhea or vomitting, the urine will darken as specific gravity rises How much does a newborn void a day? -15-60ml per kg of body weight of urine per day What is the specific gravity of a newborn's urine? 1.008 How many times may a newborn void during the first 24 hours? 25 times Infants: -may wet 8-10 diapers per day Toddlers: -toilet training beginning around 18-36 months Nocturnal enuresis nighttime bed
wetting Older Adults: -size and function of kidneys begin to decrease around age 50 More problems with older adults -bladder's elasticity declines Why do people putt off voiding? personal, sociocultural and environmental factors Personal, Sociocultural and environmental factors -anxiety: anxious or tense and cannot relax the abdominal
muscle What substances increase urine production? caffeine, coffee, tea, cola and chocolate (act like a diuretic) How does alcohol increase urine production? impairs the release of ADH resulting in increased production What substances decrease urine production? -salts, heavy exercise, or when fluid intake is inadequate ( these hold in/conserve water & fluids) What medications help patients void? or make them want to void? Diuretics: treat hypertension, edema and fluid retention by increasing the elimination of urine What are the nephrotoxic drugs? -Antibiotics: Gentamycin, amphotercin B Drugs used to treat bladder conditions: -anticholinergics what disorders can affect urinary elimination? -infection or inflammation of the bladder, kidneys, or ureters (KUB) What disorders INDIRECTLY affect the urinary system? -Cardiovascular and metabolic disorders: decreases blood flow through the glomeruli and this impair filtration and urine production Urinary Tract Infections (UTIs) Normally urine is free of bacteria, viruses, and fungi. A UTI occurs when microorganisms, usually E.Coli that live harmlessly in the colon, enter the urethra and begin to multiply
overwhelming the normal flora. Urethritis an infection limited to the urethra Cystitis infection that occurs when bacteria travels up the urethra and into the bladder pyelonephritis infection (UTI) that has spread/progressed upward to the ureters or kidneys Risk Factors for UTI -sexually active women Signs and Symptoms of UTI's -back pain What are the classic signs of UTI's -WBC,s pyuria, dysuria, urgency and frequency What to educate your patient on about the UTI? -drink at
least 8-10 glasses of water daily Etiologies of urinary elimination -obstruction What medications can cause temporary problems with urinary elimination? -anesthesia, antihistamine, anticholinergics, tricyclic antidepressants What is urinary incontinence? lack of voluntary control over urination What is incontinence associated with? -skin impairment Risk factor for incontinence -older age What are the two major types of incontinence? -transient Transient: acute or reversible, UTI's, stress and medications Established urinary incontinence: chronic or persistant Types of urinary incontinence 1. urge Urge incontinence the involuntary loss of large amounts of urine accompanied by a strong urge to void. often referred to as overactive bladder Stress -Involuntary loss of small amounts of urine with activities that increase intraabdominal pressure such as sneezing, laughing, coughing and exercise. -Causes might be pregnancy, childbirth, obesity, chronic constipation, and straining of stool mixed combination of urge and stress incontinence Overflow loss of urine in combination with a distended bladder Causes include fecal impaction, neurological disorders, and an enlarge prostate Functional Untimely loss of urine when no urinary, or neurological cause is involved; no fix to it Usually caused by physical disability, immobility, pain, external obstacles, or problems in thinking or communicating that prevent a person from reaching the toilet. Reflex Loss of urine when the person does not realize the bladder is full and has no urge to void Commonly caused by CNS disorders and multisystem problems
Assessing the Urine measuring urine output and conducting variety of bedside tests What to do when measuring intake and output? know what container to use and how much it will hold Whats considered an intake fluid? oral fluids, semi-liquid foods, ice chips, IV fluids, tube feedings, and irrigations Whats considered a fluid output? urine output, GI fluid loss such as emesis, liquid feces, drainage from suction devices or wounds How to measure liquid feces? in a hat What other factors contribute to urinary output? ability of heart to circulate blood, adequate kidney functioning and the ability of the patient to void Freshly voided specimen pour the urine into a specimen container labeled with the patient's name, the date and the time of collection Clean-Catch Specimen -wipe appropriately, front to back, catch urine mid-stream because initial flow of urine may contain microorganisms from the urethral meatus Sterile specimen -Aids in determining the presence of a urinary tract infection 24-hour urine collection -may be prescribed to evaluate some
renal disorders by showing kidney function at different times of the day and night Routine Urinalysis -most commonly prescribed laboratory Acute renal failure (ARF): an acute rise in the serum creatinine level of 25% or more Anuria absence of urine dysuria painful or difficult urination end stage renal disease (ESRD) chronic rise in serum creatinine levels associated with loss of kidney function that must be treated w/ dialysis or transplantation. AKA Chronic Renal Failure (CRF) Enuresis involuntary loss of urine frequency the need to urinate at short intervals hematuria blood in the urine micturition to start the stream of urine nephropathy broad term meaning disease of the kidney nephrotoxic substance that damages kidney tissue Some antibiotics (gentamicin, tobramycin, and amikacin) and NSAIDs, lead, and contrast media have the potential to be toxic to kidneys nocturnal enuresis involuntary loss of urine while asleep oliguria urine output of less than 400ml in 24 hours pessary incontinence device that is inserted into the vagina to reduce organ prolapse or pressure on the bladder polyuria excessive urination. May be caused by excessive hydration, DM, DI, or kidney disease. proteinuria -presence of protein in the urine pyuria Pus in the urine. urgency sudden almost uncontrollable need to urinate Dipstick Testing -determine pH and specific gravity and the presence of protein, glucose, ketones and occult blood in the urine What should you always do when handling urine? wear gloves Blood Studies BUN and creatinine levels are commonly measured to assess renal function and hydration Assessment of the urinary system -voiding patterns, habits, past history of urinary problems primary goal of urinary system Patient will comfortably void approximately 1500 ml of light yellow urine in 24 hours Promoting normal urination -providing privacy, positioning, scheduling elimination, providing and monitoring fluid and nutrition and assisting with hygiene Managing Urinary Retention salt intake, medications, environment they feel comfortable going in Urinary functioning as the problem: -incontinence Urinary functioning as the etiology: anxiety, caregiver role strain, risk for infection Reasons to Catheter 1. obtain sterile specimen What should you ask patients before inserting a catheter? making sure they're not allergic to latex or iodine What medications turn your urine a deep/orange/red? Phenazopyridine hydrochloride (Pyridium) Straight Catheter single lumen tube that is inserted for immediate drainage of the bladder Indwelling Catheter aka foley or retention catheter Men usually need a.... larger lumen than women Suprapubic catheter -continous urine drainage, when the urethra must be bypassed Caring for patient with indwelling catheter: -prevention of UTI: keep bag below patient What are the two types of bladder irrigation? 1. Intermittent: medication instillation what is the main reason for bladder irrigation? Maintaining patency of the urinary catheter A client that requires continuous irrigation requires what type of catheter triple lumen Removing the Catheter: 1. must clean around meatus and perineum Behavioral Interventions for Urinary incontinence -lifestyle modification: limiting certain foods, if obese, losing weight Pessary: removable device inserted into the vagina, to relieve pressure of the pelvic organs on the urethra and is an effective treatment for stress incontinence external occlusive device removed before voiding Internal utrethral meatus plug disposable single-used plug, activities for stress incontinence, Valved catheter allows urine to be drained on schedule
bed alarm wake the patient if incontinence occurs external collection device condom caths Which catheter is the last resort? The indwelling catheter Cutaneous Uretostomy rerouting of the ureters to the surface of the abdomen Illeal Conduit/Ureal stomy removal of portion of ileum taken to abdominal wall with stoma Continent Urinary Reservior surgical pouch is created Neobladder mimics function of the urinary bladder, portion of intestines is made into reservoir connected to urethra Urinary elimination AKA: voiding, micturition. - Occurs when contraction of the detrusor muscle pushes stored urine through the relaxed internal urethral sphincter into the urethra. This triggers the conscious urge to void. - voiding may be voluntarily delayed by inhibiting the release of a second external urethral sphincter. When the person is ready to urinate, the brain signals the external sphincter to relax and urine flows through the urethra. - further contraction of the detrusor muscle normally forces out any urine remaining in the bladder. After the detrusor muscle relaxes, the bladder begins to fill with urine again. Urinary elimination continued Process: 15 to 60 mL per kg infants Older adults Decline in GFR is the most important
functional deficit caused by aging. Anxiety, lack of time, lack of privacy, and loss of dignity can affect the ability to urinate. Personal Factors Affecting Urinary Elimination toileting assistance to be provided by a person of the same gender, or they will wait until a visit from a family member before acknowledging their need for help with voiding. Sociocultural Factors Affecting Urinary Elimination which substances act as diuretics and increase urine production? that contain caffeine, such as coffee, tea, cola, and chocolate Consuming large amounts of alcohol impairs the release of antidiuretic hormone (ADH), resulting in increased production of urine. which substance causes water retention and decreases urine production. salt
high doses or long-term use of aspirin and ibuprofen can be nephrotoxic (damaging to the kidneys). renal calculi kidney stones in older men, what could cause impair urinary elimination hypertrophy of the prostate gland GFR Glomerular filtration rate: Normal urination patterns Kidneys produce urine at a rate of about 50 to 60 mL per hour or 1500 mL per day. Pyriduim Turns urine bright orange Anticholinergics prevent bladder spasms, increasing its capacity, and delaying the urge to avoid for people with urge incontinence. Specific gravity
Measure of dissolved solutes in a solution. Antidepressants Can reduce stress incontinence by causing bladder muscles to relax. Some drugs work by stimulating the nerves controlling the urethral sphincter. Antispasmodics Relax the bladder and prevent urge incontinence. Overactive bladder. Muscarinic receptor antagonists Block nerve receptors in the smooth muscle of the bladder. Estrogen for postmenopausal women when incontinence is secondary to atrophic vaginitis. Botulinum toxin Injections to control spasms of overactive bladder by relaxing the muscles. Approval for use an overactive bladder related to nerve damage such as with spinal cord injury or MS. Pathological conditions: Disorders of the urinary system that affect urinary elimination include: Pathological conditions: cardiovascular and metabolic disorders Decrease blood flow to the glomeruli and thus decreases filtration and urine production. Nervous system Affect control of urinary system organs impairing urinary elimination. Immobility and impaired communication Interferes with the ability to get to the bathroom in time or to communicate need for assistance. Cognitive changes Alter the perception of the urge to void or severe psychiatric conditions involving altered perception or ability to manage activities of daily living may lead to incontinence. UTI (UTIs) occur when microorganisms, usually Escherichia coli (E. coli), which normally lives harmlessly in the colon infection limited to the urethra is called urethritis. when bacteria travel up the urethra into the bladder causing a bladder infection cystitis Pyelonephritis inflammation of the kidney and renal pelvis Urinary retention Inability to empty the bladder completely caused by: medications associated with urinary
retention: Urinary incontinence Lack of voluntary control over urination. Types of incontinence: Transient Acute or reversible and characterized by sudden onset usually reversible signs and symptoms such as UTIs and medications, especially diuretics. Types of incontinence: Urge Involuntary loss of larger amounts of urine accompanied by a strong urge to void. Types of incontinence: stress Involuntary loss of small amounts of urine with activities increasing abdominal pressure. Types of incontinence: mixed Combination of of urge and stress incontinence Types of incontinence: overflow Loss of urine in combination with a distended bladder. Types of incontinence: functional Lots of urine when no urinary or neurological cause is involved. Types of incontinence: reflex Loss of urine when the person does not realize the bladder is full and has no urge to void. Nursing assessment: measuring I&O Kidneys produce 50-60 mL/hour or 1500 mL/day. Promoting normal urination 1. Provide for privacy. 3. Facilitate toileting routines. Nursing diagnoses Functional urinary incontinence As etiology Anxiety related to urinary urgency and a recent episode of incontinence. Urinary catheterization: straight catheter Single lumen tube inserted for immediate drainage of the bladder. Urinary catheterization: indwelling catheter: Foley Continuous bladder drainage. Urinary catheterization: suprapubic catheter Used for continuous urine drainage when the urethra must be bypassed. Nursing care (for urinary catheter) Prevent urinary
tract infection Managing urinary incontinence: pharmacological interventions Estrogen may be prescribed for postmenopausal women when incontinence is secondary to atrophic vaginitis. Managing urinary incontinence: surgical interventions When incontinence is caused by cystocele, rectocele, or enlarged prostate, surgical techniques may be appropriate fluid restriction is recommended for managing urinary incontinence if daily fluid intake is greater than 300 ml per day Freshly voided specimen To collect a freshly voided sample, collect the urine in the same manner as when you are measuring intake and output. Pour the urine into a specimen container labeled with the patient's name, the date, and the time of collection. Many facilities require packaging the container in a moisture-proof specimen-handling bag. Follow agency policy on additional packaging. Transport the specimen to the lab as soon as possible (according to agency policies). If there is a delay in getting the specimen to the lab, most agencies recommend refrigeration. Clean catch The client must cleanse the genitalia before voiding and collect the sample in midstream because the initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum. A midstream sample is free of these contaminants. Sterile specimen You can obtain a sterile urine specimen by inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter. Do not take the specimen from the collection bag because that urine may be several hours old. 24-hr urine You must use a large container and preserve all urine voided in the 24-hr time period. Occasionally you will be asked to store each voiding in a separate container. To begin collecting, have the patient void and record the time. Discard this first voiding, but save all urine for the next 24 hr. Be sure to inform the patient and all staff about the collection. Post signs in prominent locations, such as the client's bathroom or entry door, to remind staff of the ongoing test and alert them to not discard urine. Urinalysis Urinalysis techniques include "dipstick" testing and/or microscopic analysis refractometer Instrument used to measure the specific gravity of urine CDC (2009) Criteria for Indwelling Urinary Catheter (IUC) Insertion: - Acute urinary retention (sudden and painful inability to urinate (SUNA, 2008)) or
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How is the urinary system affected by aging quizlet?How is the urinary system affected by aging? the kidneys shrink. A decrease in blood flow to the kidneys diminishes its ability to cleanse the blood stream of waste. People may experience a loss of muscle control in the bladder and sphincters, which leads to incontinence and nocturia.
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What are the millions of functional units of the kidney called?Each of your kidneys is made up of about a million filtering units called nephrons. Each nephron includes a filter, called the glomerulus, and a tubule.
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