The ____________________ filter and excrete blood
constituents that are __________ needed and
________________ those that are.
kidneys, not, retain
_______________, the waste product excreted by the kidneys, contains organic, ____________________, and _________________ wastes.
Urine, inorganic, liquid
The __________________ is the basic structural and functional
unit of the kidneys.
Nephron
There are about __ _________________ nephrons in each kidney.
1 million
Each nephron consists of a complicated system
of __________________, _________________________, and
________________________.
arterioles, capillaries, tubules
Nephrons remove the end products of _________________________,
such as urea, creatinine, and uric acid from the
_____________ ____________________ and form _____________.
metabolism, blood plasma, urine
The nephrons maintain and regulate _____________
______________________ through the mechanisms of
selective ______________________ and secretion of
______________, electrolytes, and other substances.
fluid balance, reabsorption, water
Once formed urine form the nephrons empties into the
_____________ of each kidney.
pelvis
From each kidney, urine is transported by
___________________ ________________________ through the
ureters to the urinary ____________________.
rhythmic peristalsis, bladder
The _____________________ enter the bladder obliquely.
ureters
The urinary bladder is a smooth __________________
sac that serves as a temporary ______________________
for urine.
muscle, reservoir
The urinary bladder is composed of 3 layers
of muscle tissue: the inner _____________________________
layer, the middle ______________________ layer, and the
outer ____________________________ layer. These three
layers are called the ___________________ m
longitudinal, circular, longitudinal, detrusor
The urinary bladder muscle is _______________________ by
the autonomic nervous system.
innervated
The __________________________ nervous system carries the
_______________ impulses to the bladder and ____________
impulses to the internal sphincter. This action causes
the detrusor muscle to relax and the internal sphincter
to constrict, retaining _____
sympathetic, inhibitory, motor, urine
The parasympathetic nervous system carries motor
impulses to the ____________________ and inhibitory impulses
to the _________________ ______________________. These impulses
cause the __________________ muscle to contract and the
__________________ to rel
bladder, internal sphincter, detrusor, sphincter
The ____________________ function is to transport urine from the
bladder to the exterior of the body.
urethra's
The anatomy of the urethra differs in ______________
and ___________________.
males, females
The male urethra functions in the _____________________
system and the _______________________ system.
excretory, reproductive
No portion of the female urethra is _____________________
to the body, as in the male.
external
micturition
urination
The nerve centers for urination are situated in the
_______________ and ______________ ____________.
brain, spinal cord
Urinating is largely an ________________________reflex act.
involuntary
The _____________________ control of urination develops as
the higher nerve centers develop after _________________.
voluntary, infancy
When the act of urination is initiated, the _________________
muscle contracts, the internal sphincter ___________________,
and urine enters the posterior ____________________. The muscles
of the ____________________ and the external sphincter relax,
the
detrusor, relaxes, urethra, perineum, abdominal wall, diaphragm
_________________ _____________________ occurs when urine is
produced normally but is not excreted completely
from the bladder. Factors associated with this include
_____________________, an enlarged __________________, or
vaginal _________________.
Urinary retention, medications, prostate, prolapse
One of the more significant functions of the kidneys
is to help maintain the composition and ____________________
of _____________ ___________________.
volume, body fluids
About once every ______ minutes the body's total
_____________ __________________ passes through the kidneys
for __________________ removal.
30, blood volume, waste
Most children develop urinary control between
the ages of _____ and _____. ____________________ control
precedes __________________ control, and girls generally
develop control ________________ than boys.
2, 5, Daytime, nighttime, earlier
Voluntary control of the urethral sphincters occurs between
_____ and ______ months of age. However, many other factors
are required to achieve ________________ control of bladder
function.
18, 24, conscious
Continued incontinence of urine past the age of
toilet training is called ____________________.
enuresis
Physiologic changes that accompany normal aging may affect urination in older adults. These changes include the following:
-diminished ability of kidneys to concentrate urine
-nocturia- urination during the night
-decreased bladder muscle tone may reduce the capacity of the bladder to hold urine
-decreased bladder contractility may lead to urine retention
-neuromuscular probl
Medications prescribed for other health problems in
the older adult may interfere with ___________________ function.
For example, __________________ can cause increased urine
production, resulting in the need for increased urination
and possibly _________
bladder, diuretics, urge incontinence, sedatives, tranquilizers
When the body is functioning well, the ___________________
help the body maintain a careful balance of
_______________ intake and ___________________, which should be
about ______________.
kidneys, fluid, output, equal
Alcohol produce a __________________ effect by inhibiting
the release of _____________________ hormone, increasing
urine production.
diuretic, anti-diuretic
Foods high in ____________ may increase urine production.
water
Foods and beverages high in __________________ content
cause sodium and water reabsorption and retention,
thereby decreasing ______________ _________________________.
sodium, urine formation
Psychological variable that can affect a person's usual voiding habits include:
-person views voiding as a person and private act and is something one does not talk about
-needing assistance can be embarassing
-anxiety- especially when being assisted by the opposite biological sex
-stress- some people experience stress and may void s
During prolonged periods of ___________________________,
decreased bladder and sphincter tone can result
in poor ______________ ____________________ and urinary stasis.
immobility, urinary control
Other causes of decreased muscle tone affecting micturition:
-childbearing
-muscle atrophy due to decreased estrogen levels
-damage to muscles due to trauma
Diseases associated with Renal Problems:
-congenital urinary tract abnormalities
-polycystic kidney disease
-urinary tract infection
-urinary calculi (kidney stones)
-hypertension
-diabetes mellitus
-gout
-connective tissue disorders
___________ __________________ is a condition in which the
kidneys fail to remove _____________________ end products
from the blood and are unable to ____________________ fluid,
____________________, and pH balance.
Renal failure, metabolic, regulate, electrolyte
Acute Kidney Injury (AKI)
Also called acute renal failure, is a sudden decline in kidney function, and may be caused by conditions such as severe dehydration, anaphylactic shock, sepsis, and ureteral obstruction.
Chronic Kidney Disease (CKD)
the slow loss of kidney function over months or years as a result of irreparable damage to the kidneys. Caused by conditions such as diabetes, hypertension, and glomerulonephritis.
Medications have numerous effects on ________________
production and _______________________. Of gravest concern
are the many prescription and nonprescription
drugs known to be ____________________________ (capable of causing
kidney damage).
urine, elimination, nephrotoxic
Effects of Medications on Urine Production and Elimination
* Diuretics: prevent re-absorption of water and certain electrolytes in tubules.
* Cholinergic medication: stimulate contraction of detrusor muscle, producing urination
* Analgesics and tranquilizers: suppress CNS, diminish effectiveness of neural reflex
Certain drugs cause urine to change color, including the following:
- anticoagulants may cause hematuria (blood in the urine) leading to a pink or red color.
- diuretics can lighten the color of urine to pale yellow
_ phenazopyridine, a urinary tract analgesic, can cause orange or orange-red urine
- the antidepressant ami
The Nursing Process for Urinary Elimination:
A comprehensive nursing assessment of the functioning of a patient's urinary system includes the following:
* Collection of data about patient's voiding patterns, habits, and difficulties and a history of current or past urinary problems
* Assessment of t
Additional Terms Used to Describe Urinary Problems:
-Anuria: 24-hour urine output is less than 50mL
-Dysuria: painful or difficult urination
-Frequency: increased incidence of voiding
-Glycosuria: presence of glucose in the urine
-Nocturia: awakening at night to urinate
-Oliguria: 24-hour urine output is l
Urinary diversion
involves the surgical creation of an alternate route for excretion of urine
Assessing a Problem with Voiding:
* explore its duration, severity, and precipitating factors
* note the patient's perception of the problem
* check the adequacy of the patient's self-care
behaviors
Physical Assessment: Kidneys
Palpation of the kidneys is usually performed
by an ___________________ _________________ _____________
__________________ as part of a more detailed assessment.
advanced health care provider
Physical Assessment: Urinary bladder
Palpate and ________________ the bladder or use a
beside ___________________.
percuss, scanner
Physical Assessment: Urethral orifice
Inspect for signs of _______________________, ___________________,
or odor.
infection, discharge
Physical Assessment: Skin
Assess for color, ___________________, _________________, and
excretion of _________________.
texture, turgor, wastes
Physical Assessment: Urine
Assess for _____________, odor, _________________, and
______________________.
color, clarity, sediment
Measuring Urine Output in Patients Who Are Continent
- ask the patient to void into a bedpan, urinal, or specimen container in bed or bathroom
-pour urine into the appropriate measuring device
- place the calibrated container on a flat surface and read at eye level
-note amount of urine voided and record on
Measuring Urine Output in Patients Who Are Incontinent
It is difficult to accurately measure urinary output for incontinent patients.
- Use of scheduled toileting can assist in obtaining urine for measurement, for required lab specimens, and prevent incontinence
- Measurement of urinary output via weighing of
Measuring Urine Output in Patients With an Indwelling Catheter
- put on gloves
- place calibrated measuring device beneath urine collection bag
- place the drainage spout from the collection bag above, but not touching, the calibrated measuring device and open the clamp
- allow urine to flow form collection bag into
Collecting Urine Specimens
-routine urinalysis
-clean-catch or midstream specimens
-sterile specimens from indwelling catheter
-urine specimen form a urinary diversion
-24-our urine specimen
-specimens from infants and children
Reagents
A substance used in a chemical reaction to detect another substance. Reagents are available as tablets, fluids, impregnated paper, ad plastic strips with a special coating.
Urinary Functioning As the Problem:
Nursing diagnoses that specifically address problems
in urinary functioning include problems of
___________________________, pattern alteration, and
____________________ ____________________.
incontinence, urinary retention
Urinary Functioning as the Etiology:
Difficulty with urination or changes in normal voiding patterns may affect other areas of human functioning. The nurse's challenge is to identify human responses to alterations in urinary elimination that pose specific
- impaired skin integrity
-disturbed body image
- toileting self-care deficit
Outcome Identification and Planning:
Expected outcomes are derived from the actual or potential urinary elimination problems diagnosed. General patient outcomes include:
- produce urine output about equal to fluid intake
-maintain fluid and electrolyte balance
-empty bladder completely at regular intervals
-report ease of voiding
-maintain skin integrity
-demonstrate appropriate self-care behaviors
Nursing care to promote normal urination includes
interventions to support normal ________________ habits,
fluid ___________, strengthening of ______________ ____________,
stimulating ____________________ and resolving _______________
retention, and _____
voiding, intake, muscle tone, urination, urinary, assisting
Maintaining Normal Voiding Habits
-Schedule: nursing actions should support the patient's usual urinating pattern as much as possible
-Urge to void: Assist the patient to void when the patient first feels the urge
- Privacy: Provide privacy
- Position: help patient assume their usual void
_____________ ____________ _______________________ are the second
most common type of infection in the body and are
the leading cause of __________________ ______________________
in older adults.
Urinary tract infections, systemic infections
Patients at risk for UTI's
- sexually active women
- women who use diaphragms for contraception
- postmenopausal women
-individuals with indwelling urinary catheters
- individuals with diabetes mellitus
- older adults
_________'s are the most common type of health
care-associated infection (HAI), and up to _____ %
of these UTI's are associated with the presence
of an ___________________ ______________ ___________________ .
UTI, 75, indwelling urinary catheter
Although a break in ______________ ______________________ during
placement can lead to an infection, most ____________________
are introduced via handling of the ____________________ and
___________________ _________________ after placement.
sterile technique, pathogens, catheter, drainage device
Enlargement of the _________________ as men age can
contribute to the development of _________'s in
older men.
prostate, UTI
Transient Incontinence
Appears suddenly and lasts for 6 months or less. It is usually caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment, such as the use of diuretics or intravenous fluid administration.
Stress Incontinence
Occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. this commonly occurs during sneezing, coughing, laughing, or other physical activities.
Mixed Incontinence
Indicates that there is urine loss with features of two or more types of incontinence.
Overflow Incontinence
Chronic retention of urine, is the involuntary loss of urine associated with overdistention and overflow of the bladder.
Functional Incontinence
Urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation.
Reflex Incontinence
Patients experience emptying of the bladder without the sensation of the need to void.
Total Incontinence
A continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation.
Urinary continence is ________________________. Appropriate
interventions can significantly reduce the _________________
of urinary incontinence and even ________________ its
occurrence.
preventable, prevent
Incontinence-associated dermatitis
A form of moisture-associated skin damage due to prolonged contact of the skin with urine or feces.
Erythema
redness of the skin
Maceration
softening or dissolution of tissue after lengthy exposure to fluid
Denuding
to strip bare
Erythema, maceration, denuding, and inflammation
occur as a result of exposure to _____________ or ____________
and may effect the skin of the ___________________, perianal area,
buttocks, __________ ______________, sacrum, and ________________.
urine, stool, perineum, inner thighs, coccyx
Reasons for Catheterization
-Relieving urinary retention
-Obtaining a sterile urine specimen
-Obtaining a urine specimen when usual methods can't
be used
-Emptying bladder before, during, or after surgery
-Monitoring critically ill patients
-Increasing comfort for terminally ill pat
stoma
a surgically created opening on the body surface
An ____________ _________________ involves a surgical
resection of the small intestine, with transplantation
of the ureters to the isolated segment of small bowel.
This separated section of the small _____________________ is
then brought to the __________
ileal conduit, intestine, abdominal wall, stoma
There are two categories of dialysis:
1) hemodialysis
2) peritoneal dialysis
Patient Education for Urinary Diversion:
1) Explain __________________ for diversion and ____________________
for treatment
2) Demonstrate effective ___________-____________ behaviors
3) Describe _______________-_______ care and support
resources
4) Repor
1) reason, rationale
2) self-care
3) follow-up
4) supplies, community
5) fears, concerns
6) positive
Types of Urinary Incontinence:
1) _____________________: appears suddenly and lasts 6 months
or less
2) _________________: urine loss with features of two or more
types of incontinence
3) ____________________: overdistention and overflow of
bladder
4) ___
1) Transient
2) Mixed
3) Overflow
4) Functional
5) Reflex
6) Total
Factors to Consider With Use of Absorbent Products:
1) Functional _____________________ of the patient
2) Type and _______________________ of incontinence
3) ____________________
4) Availability of _______________________
5) Failure with previous ________
1) disability
2) severity
3) Gender
4) caregivers
5) treatment
6) patient