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111 Cards in this Set

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what are some medications that affect urination?
-diuretics
-anticholinergics
-antihistamines
-antihypertensives
What drugs may alter GFR?
-narcotics
-anesthetics
What drugs may color the urine?
- pyridium
- levodopa
- chemo drugs
what is the feeling of need to void immediately called?
urgency

- causes are full bladder, bladder irritation or inflammation from infection, incompetent urethral sphincter, or psychological stress
what is painful or difficult urination called?
dysuria

- causes are bladder inflammation, trauma, or inflammation of the urethral sphincter
what is voiding at frequent intervals (<2h) called?
frequency

- causes are increased fluid intake, bladder inflammation, increased pressure on bladder(pregnancy, psychological stress)
what is difficulty initiating urination called?
hesitancy

-causes are prostate enlargement, anxiety, urethral edema
what is voiding large amounts of urine called?
polyuria

- caused by excess fluid intake, DM, diabetes insipidus, use of diuretics, postobstructive diuresis
what is diminished urinary output relative to intake (usually 400ml/24h) called?
oliguria

-caused by dehydration, renal failure, UTI, increased ADH secretion, congestive heart failure
What is urination, particularly excessive or frequent at night called?
nocturia

-caused by excessive fluid intake before bed (especially coffee or alcohol), renal disease, aging process, prostate enlargement
What is leakage of urine despite voluntary control of urination called?
dribbling

-causes are stress incontinence, overflow from urinary retention
What is involuntary loss of urine called?
incontinence

-caused by unstable urethra, loss of pelvic muscle tone, estrogen depletion, fecal impaction, neurological impairment
What is blood in the urine called?
hematuria

-caused by neoplasms of the kidney or bladder, glomerular disease, infection of kidney or bladder, trauma to urinary structures, calculi, and bleeding disorders
What is accumulation of urine in the bladder with bladder not able to empty fully called?
retention

-caused by urethral obstruction, bladder inflammation, decreased sensory activity, neurogenic bladder, prostate enlargement, postanesthesia effects, side effects of medications (ex. anticholinergics, antidepressants)
What is teh volume remaining after voiding called (>100ml)?
residual urine

-caused by inflammation or irritation of bladder mucosa from infection, neurogenic bladder, prostate enlargement, trauma, or inflammation of urethra
what are the s/s of urinary retention?
- pressure
- discomfort
- tenderness over bladder area
- restlessness
- sweating
- bladder retention
What causes UTIs?
-poor hygiene
-sexual intercourse
-catheterization
What are the s/s of a UTI?
-dysuria
-fever
-chills
-nausea
-vomiting
-malaise
-hematuria
-frequency
-concentrated cloudy urine
-WBCs and bacteria in the urine
what is the involuntary, unpredictable passage of urine in a client with intact urinary and nervous system?
-functional incontinence
What is the cause of functional incontinence?
-change in environment: sensory, cognitive, or mobility deficits
A patient with these symptoms indicates what problem?

-urge to void that causes loss of urine before reaching appropriate receptacle
-the client with cognitive changes may have forgotten what to do
functional incontinence
A patient with these symptoms indicates what problem?

-dribbling a few drops of urine to larger amounts of urine with urgency and frequency
overflow incontinence
A patient with these symptoms indicates what problem?

-unawareness of bladder filling, lack of urge to void, uninhibited bladder spasm contraction
reflex incontinence
A patient with these symptoms indicates what problem?

-loss of urine with increased intraabdominal pressure, urinary urgency, and frequency
stress incontinence
A patient with these symptoms indicates what problem?

-urinary urgency, often with frequency (more often than every 2 hours); bladder spasm or contraction; voiding in either small amounts (<100ml) or large amounts (>500ml)
urge incontinence
What is the voluntary or involuntary loss of a small amount of urine (20-30ml) from an overdistended bladder called?
overflow incontinence
what are the causes of overflow incontinence?
-hypotonic or underactive detrusor secondary to drugs
-fecal impaction
-diabetes
-spinal cord injury
-men-prostate enlargement
-women-severe uterine prolapse
what is the involuntary loss of urine occurint at somewhat predictable intervals (large or small volume) called?
reflex incontinence
What are the causes of reflex incontinence?
-spinal cord dysfunction (either inhibition of cerebral awareness or impairment of the reflex arc)
what is the leakage of small volumes of urine caused by sudden increase in intraabdominal pressure called?
stress incontinence
what causes stress incontinence?
-lauging
-coughing
-sneezing
-lifting
-obesity
-full uterus in third trimester
-incompetent bladder outlet
-weak pelvic musculature
what is the involuntary passage of urine after a strong sense of urgency to void called?
urge incontinence
what are the causes of urge incontinence?
-decreased bladder capacity
-irritation of bladder stretch receptors
-alcohol or caffeine ingestion
-increased fluid intake
-infection
What is a urinary stoma to divert the flow of urine from the kidneys to the abdominal surface called?

Is it temporary or permanent?
-urinary diversion

-could be either!

*client would have to wear a stoma pouch, which could cause skin breakdown
Toddlers gain daytime control of micturition between ages __1__ with nightime control by age __2__
1. 2-3

2. 5
What causes incontinence in pregnancy?
-frequency and loss of muscle tone in the pelvic floor
What are factors affecting urination?
-age
-environmental factors
-fluid balance
-medications
-psychological factors
-surgical or diagnostic procedures
-presence of disease conditions
percussion of a full bladder reveals a __ sound
dull
when can random routine urinalysis be collected? where from?
-can be collected during normal voiding
-from a indwelling catheter, urinary diversion collection bag, or in a clean specimen cup
Where can a sterile specimen (culture and sensitivity) be collected from?
-can be collected from port on catheter using sterile technique
What are timed urine specimens used for?
measuring levels of:
-adrenocortical steroids/hormones
-creatinine clearance
-protein quantity tests
Timed urine specimens are collected over how long (three different tests)?
-2 hour
-12 hour
-24 hour
1. what is considered a extreme decrease in output that must be reported in I&O?
2. Extreme increase?
1. <30ml/hr for more than 2 hours
2. >2000-2500ml daily
what causes red urine?
-bleeding
-beets
-rhybarb
-blackberries
What causes orange urine?
pyridium
what causes dark amber urine?
bilirubin in liver dysfunction
what happens to the clarity of the urine in renal disease?
it becomes cloudy or foamy from high protein concentrations or thick and cloudy with bacteria
what happens to the odor of urine in incontinent clients?
it smells like ammonia
what is the normal value of urine specific gravity?
1.010-1.025
what does urine specific gravity measure?
-concentration of particles in urine.
What does high urine specific gravity mean?
-concnetrated urine

-dehydration, reduced renal blood flow, and increased ADH secretion
What does low urine specific gravity mean?
-dilute urine

-overhydration, early renal disease, and inadequate ADH secretion
What is normal pH of urine?
4.6-8.0

average is 6.0

*urine that stands for several hours becomes alkaline
What is the normal measurement of protein in the urine?
-none to 8mg/100ml

*seen in renal disease because damage to glomeruli or tubules allows protein to enter urine
What is the normal measurement of glucose in the urine?
none

-diabtes causes.
What is the normal level for ketones in the urine?
none

-occur in poorly controlled DM. also happens in dehydration, starvation, or excessive aspirin usage
What is the normal level for blood in the urine?
-up to 2 RBCs

*blood can enter urine after damage to glomeruli or tubules, or after trauma, disease, or surgery of lower urinary tract,
What is the normal level of WBCs in the urine?
0-4 per low-powered field

*greater numbers indicate UTI
Waht is the normal level for bacteria in the urine?
-none

-may indicate UTI if present
What is the normal level for casts in the urine?
-none

-are cylindrical bodies whose shapes take on likeness of objects within the renal tubules.
What lab test measures the amount of urea nitroget in the blood (urea is the waste product of protein metabolism formed by the liver and excreted by the kidney). What is an abnormal finding?
-BUN

-increased in kidney disease
What lab test measures the amount of waste product found in skeletal muscle, and what is an abnormal finding?
creatinine

increased in renal disease
What should the ratio of BUN to creatinine be?
1:10
what electrolytes will be increased with renal disease?
-potassium
-phosphorus
-magnesium

*so stay away from these in diet if you have renal disease!
What electrolytes will be decreased with renal disease?
-calcium

*so will need extra calcium in diet if have renal disease!
What is a noninvasive procedure that looks at the collecting ducts and renal pelvis and outlines the ureters, bladder and urethra using dye that excreted in urine called?
IVP- intravenous pyelogram

*special IV injection that converts to a dye in urine. Must assess for shellfish (iodine) allergy beforehand.
A client with normal renal function and no heart or kidney disease should drink how much fluid daily?
2000-2500ml
What kind of medication depresses the neurotransmitter acetylcholine, which stimulates the bladder? It reduces incontinence caused by bladder irritation.
Anticholinergics (ex. Pro-Banthine and oxbutynin chlorine/Ditropan)
wat drug increases the contraction of the bladder and improves emptying, decreasing retention and overflow incontinence?
cholinergic drugs (ex. bethanechol/Urecholine)
What drugs relacx the prostatic smooth muscle in men with dribbleing or overflow incontinence caused by prostatic enlargement?
Alpha-adrenergic blockers (ex. terazosin (Hytrin)
Coude catheter used for:
men with an enlarged prostate- it has a stiff tip for easier insertion
what are indications for intermittent catheterization?
-relief of discomfort of bladder distention, provision of decompression
-obtaining sterile urine specimen
-assessment of residual urine after urination
-long-term management of clients with spinal cord injuries, neuromuscular degeneration, or incompetent bladders
What are indications for short-term indwelling catheterization?
-obstruction to urine outflow (ex. prostate enlargement)
- surgical repair of bladder, urethra, and surrouding structures
- prevention of urethral obstruction from bloodclots
-measurement of urinary output in critically ill clients
- continuous or intermittent bladder irrigations
What are indications for long-term indwelling catheterization?
-severe urinary retention with recurrent episodes of UTI
-skin rashes, ulcers, or wounds irritated by contact with urine
-terminal illness when bed linen changes are painful for client
Children typically require what size catheter?
8-10 Fr
Unless CI, adults should drink at least ______ml of noncaffeinated fluid daily
1400-2000
Fruit juices _____ peristalsis
stimultae
Milk products may _____ peristalsis
slow

*but may speed up in some
Parylitic ileus:
when peristalsis stops, usually lasts 24-48 hours after surgery, caused by anesthesia
Narcotics ____ peristalsis
slow
Anticholinergics _____ GI mobility
depress
Antibiotics do what to GI tract?
disrupt normal flora, causing diarrhea
NSAIDS do what to GI tract?
promote GI irritation
What does aspirin do to the GI tract?
interferes with production of protective mucus
What does iron do the the GI tract and stool?
-it causes discoloration of stool (black)

-leads to constipation
Straining in constipation can cause:
-increased intraocular pressure (glaucoma)
-increased ICP
-hemorrhoids
What illnesses cause constipation?
-parkinson's disease
-MS
-rheumatoid arthritis
-chronic bowel disorders
-depression
-hypothyroidism
-hypocalcemia
-hypokalemia
Impaction
-results from unrelieved constipation

-most at risk are confused, debilitated, dehydrated, or unconscious patients
What are s/s of impaction?
-inability to pass stool for several days
-oozing of diarrhea stool
-anorexia
-nausea
-vomiting
-abd distention
-cramping
-rectal pain
What causes diarreha?
-meds
-enteral nutrition
-food allergies
-diseases
-surgeries
-diagnostic tests
-food bourne viruses
What are engorged veins either internal or external in the lining of the rectum?
hemorrhoids
what causes hemorrhoids?
-straining
-pregnancy
-heart failure
-liver disease
Artificial opening
stoma
opening in the ileum
ileostomy
opening in the colon
colostomy
What can cause a false positive in a test for occult blood in stool?
-red meat
-fish
-poultry
-vit C
-aspirin
-NSAIDS
what is a stool for occult blood test used for? How many times must it test positive to be truly positive?
-used for diagnosing colong cancer, intestinal tumors, bowel inflammation, or ulcerations
-performed over 3-5 days, must have 3 positives
white or clay stool indicates:
absence of bile
black or tarry stool indicates:
iron ingestion or upper GI bleeding
red stool indicates:
lower GI bleeding or hemorrhoids
pale stool with fat indicates:
malabsorption of fat
translucent mucus in stool indicates:
colitis
bloody mucus in stool indicates:
inflammation, infection
excessive fat in stool may indicate:
malabsorption syndrome, pancreatic disease, or inflammation
cleansing enema
complete evacuation of feces from the colon
tap water enema
used to stimulate defecation, can cause water toxicity and circulatory overload
normal saline enema
safest solution, stimulates peristalsis. Best for infants and small children
hypertonic enema
pulls fluid from interstitial spaces, distension promotes defectaion. Are low volume. Contraindicated with dehydration and young infants
Soap sud enema
create the effect of intestinal irritation and stimulate peristalsis
oil retention enema
lubricates the rectum and colon making stool softer and easier to pass
The stool discharged from an ostomy is called
effluent