23 hours ago 1. You receive a report from the NAP that a patient with no history of urinary elimination problems has had 150 mL of oral liquids in 6 hours and has voided 100 mL of clear, dark amber urine. His vital signs at the start of the shift were as follows: blood pressure, 108/76 mm Hg; pulse, 72 beats/min; respirations, 18 breaths/min; temperature, 98.6 F. >> Go To The Portal
The NAP reports to the nurse that a patient's catheter drainage bag has been empty for 4 hours. What is a priority nursing intervention? - Assess the catheter and drainage tubing for obvious occlusion.
It is important to know the reasons for urinary elimination problems, find acceptable solutions, and provide understanding and sensitivity to all patients’ needs. Urinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove wastes from the blood to form urine.
• Identify factors that commonly influence urinary elimination. • Compare and contrast common alterations in urinary elimination. • Obtain a nursing history for a patient with urinary elimination problems. • Identify nursing diagnoses appropriate for patients with alterations in urinary elimination. • Obtain urine specimens correctly.
Factors in a patient’s history that normally affect urination are age, environmental factors, medication history, psychological factors, muscle tone, fluid balance, current surgical or diagnostic procedures, and presence of disease conditions.
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Anxiety can impact bladder emptying due to inadequate relaxation of the pelvic floor muscles and urinary sphincter. The nurse should give the patient privacy and adequate time if appropriate. No evidence suggests that an underlying physiological (does not recognize signals or not drinking enough fluids) or psychological (lonely) condition exists.
Placing the drainage bag on the side rail of the bed could allow the bag to be raised above the level of the bladder and urine to flow back into the bladder. The urine in the drainage bag is a medium for bacteria; allowing it to reenter the bladder can cause infection. A key intervention to prevent catheter-associated urinary tract infections is ...
An output of 30 mL/hr or less for 2 or more hours would be cause for concern; 80 mL/hr is normal. The normal pH of urine is between 4.6 and 8.0.
Dehydration, reduced renal blood flow, and increase in antidiuretic hormone secretion elevate specific gravity. Normal specific gravity is 1.0053 to 1.030. An output of 30 mL/hr or less for 2 or more hours would be cause for concern; 80 mL/hr is normal. The normal pH of urine is between 4.6 and 8.0. Protein up to 8 mg/100 mL is acceptable; however, values in excess of this could indicate renal disease.
The flow of urine follows these structures: kidney, ureters, bladder, and urethra.
To prevent nocturia, suggest that the patient avoid drinking fluids 2 hours before bedtime. Clearing a path to the bathroom, illuminating the path, or shortening the distance to the bathroom may reduce falls but will not correct the urination problem. Kegel exercises are useful if a patient is experiencing stress incontinence.
The first nursing intervention for any patient with incontinence who is able to toilet is to provide the patient with toilet access. This patient is not cognitively intact; thus a bladder retraining program is not appropriate for her.
The most characteristic symptom of overflow incontinence is to dribble urine. The other options point to stress incontinence, functional incontinence, or a urinary tract infection.
Measurement of postvoid residual (PVR) requires the measurement of urine volume left in the bladder within 10 minutes of voiding. You need to first implement measures to stimulate voiding and help the patient to void before measuring the bladder volume so as to obtain as accurate value as possible.
Keeping the bowels regular, wearing cotton underwear, and cleaning the perineum from front to back are interventions that lead to healthy bladder habits. Making sure that a patient has adequate hydration ensures that the bladder is flushed regularly and helps prevent a urinary tract infection.
The most appropriate initial action would be to ensure that the catheter is not occluded. Do not encourage fluids if the catheter is blocked.
Rolling the patient is the safest, most comfortable way for one person to help an immobilized patient to use a bedpan.
Rationale: Nursing assistive personnel (NAP) are responsible for maintaining the privacy of the patient. The NAP also provide perineal care before and after the procedure, and are responsible for assisting the nurse in positioning the patient for catheterization. Inserting the catheter into the urethral meatus and inflating the balloon of the catheter are skilled activities that should be performed by the nurse.
Rationale: If a patient is diagnosed with stress urinary incontinence related to a weakened pelvic musculature, the nurse is least likely to reinforce teaching related to type 2 diabetes. This type of teaching is needed in cases where there is risk of infection due to diabetes. A patient who has stress urinary incontinence related to a weakened pelvic musculature should be encouraged to lose weight and maintain adequate hydration. The nurse should also instruct the patient to avoid caffeine and other bladder irritants.
Rationale: To examine a female patient, the nurse should place the patient in dorsal recumbent position to allow for full exposure of the genitalia. Bladder fullness can be assessed via gentle palpation of the lower abdomen. A full bladder feels like a smooth and rounded mass.
Rationale: The normal pH of the urine ranges from 4.6 to 8.
Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.
B. The scan measurement should be performed within 20 minutes of voiding.
Rationale: The nurse should not allow the drainage bag to get full before emptying. An overfull drainage bag creates tension and undue pressure on the catheter, which may induce trauma to the urethra or urinary meatus. The nurse should maintain a closed urinary drainage system that does not permit any channels for entry of pathogens. The nurse should make sure that there is no urine backflow from the tubing and bag into the bladder. The nurse should perform perineal hygiene after each bowel movement.
life-threatening problem such as shock or dehydration. Normal urine output is 1000 to 2000 mL/day; an output of 30 mL/hr or less
Age-related changes such as loss of pelvic muscle tone can cause involuntary loss of urine known as Urinary incontinence. Urinary
The drainage bag should be emptied and output recorded every 8 hours or when needed. Urine specimens are obtained by.
Intravenous pyelography is performed by administering iodine-based dye to view functionality of the urinary system. Many. individuals are allergic to shellfish; therefore, the first nursing priority is to assess the patient for an allergic reaction that could be. life threatening.
Attempting to void in the presence of another can cause anxiety and tension in the muscles that make voiding difficult . The nurse
into the bladder. The kidney, bladder, and urethra do not produce peristaltic waves. Obstruction of both bladder and urethra
Administering an antihistamine medication to the patient. ANS: D. Before the procedure is begun, the nurse should assess the patient for food and other allergies and should administer an. antihistamine, because a contrast iodine-based dye is used for the procedure.
Bladder capacity varies with the individual but generally ranges from 600 to 1000 mL of urine ( Lewis et al., 2011 ), and an adult normally voids every 2 to 4 hours. However, individuals are able to sense the desire to urinate when the bladder contains a smaller amount of urine (150 to 200 mL in an adult and 50 to 100 mL in a child). It is important to teach parents that children do not have enough neurological development to be toilet trained until after 24 months and some are not developed enough until 36 months. As the volume increases, the bladder walls stretch, sending sensory impulses to the micturition center in the sacral spinal cord. Impulses from the micturition center respond to or ignore this urge, thus making urination under voluntary control. If the person chooses not to void, the external urinary sphincter remains contracted, inhibiting the micturition reflex. However, when a person is ready to void, the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract, and efficient emptying of the bladder occurs. It is vital that nurses understand this process to be able to assess and determine which form of incontinence or bladder problem may be occurring.
In severe urinary retention the bladder holds as much as 2000 to 3000 mL of urine. Retention occurs as a result of urethral obstruction, surgical or childbirth trauma, and alterations in motor and sensory innervation of the bladder such as occurs with neuropathy secondary to diabetes. It may occur after removal of an indwelling catheter. Medication side effects or anxiety may also result in urinary retention. If a patient cannot void or completely empty the bladder, he or she must be catheterized because a UTI, kidney stones, and hyperreflexia can occur.
Damage to the spinal cord above the sacral region causes reflex incontinence. This condition causes loss of voluntary control of urination; but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void. If a chronic obstruction caused by neurological damage such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing bladder overactivity and possibly causing the bladder to not empty completely. Overflow incontinence occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia ( Lewis et al., 2011 ). Hyperreflexia, a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage.
As retention progresses, retention with overflow develops. Pressure in the bladder builds to a point at which the external urethral sphincter is unable to hold back urine. The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape. As urine exits, the bladder pressure falls enough to allow the sphincter to regain control and close. With retention a patient may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. Be aware of the volume and frequency of voiding to assess for urinary retention. Assess the abdomen for evidence of bladder distention and tenderness.
If the person chooses not to void, the external urinary sphincter remains contracted, inhibiting the micturition reflex. However, when a person is ready to void, the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract, and efficient emptying of the bladder occurs.
The ureters are tubular structures that enter the urinary bladder. Urine draining from the ureters to the bladder is usually sterile.
Urinary elimination depends on the function of the kidneys, ureters, bladder , and urethra . Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes. Intact efferent and afferent nerves from the bladder to the spinal cord and brain must be present ( Fig. 45-1 ).