URINARY ELIMINATION

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Disease conditions of urinary elimination.: DECREASED BLOOD FLOW to kidney from intravascular fluid volume deficit results in oliguria or anuria.
OBSTRUCTION OF URINE FLOW= from stones, tumors,prostatic enlargement, kinking of urinary catheter.
ACTS OF URINATION: 150-200ml of urin causes bladder wall to stretch and initiates sacral cord reflex whereby detrusor muscle contracts and internal urethral sphincter relaxes.
Consious act of urination?: involves relaxatoin of external urethral sphincter and contracton of detrusor muscle when person is able to use the bathroom and is aware of the urge.
What causes loss of voluntary control over urinary elimination: Damage to the spinal cord above sacral region
When does the bladder empty?: when minimun volume is reached through the micturation reflex pathway?
How to manage incontinence: briefs used. promted voiding ever 2 hrs condom or texas catheters with leg bags for mobility.
how does urinary retention happen? (autonomic bladder): when reflex arc is injured, bladder fills without bladder stretch mechanism working.
how to manage autonomic bladder: intermittent catheterization or foley

alphaadrenergic blocker(prazosin) relaxes bladder sphincter.

Urinary diversion surgery
Implantable sphincter stimulator.
Neurologic conditions of urinary elimination.: Peripheral nerve damage causing loss of bladder tone, reduced sensation of bladder fullness, and difficulty controlling urination

Incontinece caused by trama, hemorrhage, or tumer in frontal lobs that control voluntary nature of voiding.
Normal urine output and color of urine.: 1500ml of amber or yellow urin daily
Why do adults normally not have to wake during the night to void?: because kidney concentrates urine and blood flow decreases.
What prevents older adults from making making it to RR on time?: Mobility problems
Older adults and bladder control.: May lose the ability to identify a full bladder.
changes in older adults (1): Benign prostatic hypertrophy in male
changes in older adults (2): bladder contractility does not empty bladder completely and residual volume remains after voiding.
changes in older adult (3): constipation causes frequency incontinent.
changes in older adult (4): glomerular filtration rate and kidney's ability to concentrate urine decreases resulting in nocturia.
changes in older adult (5): loss of bladder muscle tone and capacity to hold urine leads to urinary frequency.
3 factors the influence urination: sociocultural factors
psychological factors
decreased tone of muscles
what are sociocultural factors: men stand woman sit to urinate. some cultures use same toilet facilities.
What are psychological factors?: anxiety or emotional stress cause a sense of urgency and increased frequency or incomplete emptying of bladder.
What does decreased muscle tone of abd and pelvic muscles do: impair bladder contraction and control of external urethral sphincter.
Decreased muscle tone of urinatry muscles is from.: obesity, childbirth, menopausal atrophy, chronic constipation, continous bladder drainage.
What does cystocele-protrusion of the bladder into the vaginal canal do?: causes frequency, dribbling,and inability to empty bladder completely.
what is polyuria: excessive output of urine
what is nocturia: excessive urination at night
What is excessive output of urine a sign of: renal dysfunction,k kidneys cannot concentrate urine.
What effect does caffeine and alcohol have on urine output: Increased.
(Inhibits adh release.)
what effect does a fever have on urine volume: Reduces it making it concentrated
what risk do spinal anesthetics have on urine output?: urinary retention.
because of decreased sese of need to void and inabliityh of bladder muscles and sphincters to respond.
swelling of lower abd and pelvis related to surger may cause what?: obstruct flow of urine-routine use of catheters.
stress response to sugery and anesthetics do what?: slow glomerular filtration rate, decreaseing urine output.
what do diuretics do: increase urine output
risk of urinary retention with what meds?: anticholinergics, antihistamines, belladonna alkaloids, and phenothiazines.
what do cholinergics do and name an example of one.: bethanechol,
stimulates contraction of detrusor muscle to promete voiding and stimulates gi tract smooth muscle.

sweating, slaivation, vd, cramps decreased bp.
what does the medication pyridium do to urine: colors urine a bright orange to rust color
cholinergics, parasympathomimetics are used cautiosly with?: ulcers, gi or urinary obstruction, coronary artery bypass procedure, asthma, pregnancy.
what medications are toxic to kidneys? How to monitor them?: aminoglycoside, antiinfectives, chemotherapy.
monitor I and O, maintain hydration.
Cystoscopy can cause what? what will happen?: urtehral edema and spasm of bladder sphincter.
pt may not be able to void. urine pass may be red or pink due to blood from trama.
what test requires clear liquids the evening before thest and laxatives to clear colon?: intravenous pyelogram.
what to do following iv pyelogram test: hydrate, since dehydration with the iv dye may cause renal failure.
what causes incomplete emptying of bladder: urethral obstruction, durgical trama, alterations in motor and sensory innervation of bladder, side effects of meds or anxiety.
defining characteristics of urinary retention are?: bladder distention.
small frequent voiding of 50 to 100 mb or absence of urine output, dribbling.
urinary retention signs are.: postvoid residual over 100ml
overflow incontinence,
dysuria, restlessness, diaphorsis
measures to promote voiding are?: standing for males.
sensory stimuli
pain relief so muscles relax
sensory stimuli to promte urination are?: run water, warm bath, stroke inner thigh, musice to relax, spearmint oil, place hands in warm water, warm bedpan.
the side effects of prozasin are?: orthrostatic hypotention, angina, edema, sob, weakness, Nausua, vomiting
how to treat inhibition of reflex arc: by emtying bladder with intermittant catheterizing q4h using clean technique.
also with sugery of urinary blockage and strong urinary sphincter relaxed with alpha adrenergic agent (prozasin)or sphincter stimulator.
lower uti cystitis is caused by: improper perineal hygiene, irritation or truma to urethra or bladder, urinary retention.
defining characteristics of a lower uti: dysuria, frequency, urgency, incontinence, urine is cloudy and concentrated.
preventing UTI: wipe front to back
drink 2000-3000ml per day
void q4h
no bubble baths or tub baths
avoid nylon underware,
void after sexual intercourse.
Treatment of uti (meds): fluoroquinolones- broad spectrum bactericidal antiinfectives such as levaquin or cipro
Bacteriostatic drug developed early was: sulfa drugs
toxic effects of sulfa drugs: rash, sore throat, purpura
adverse effect of sulfa drugs: serum sickness in 7 to 10 days with joint pain, uritcaria leukopenia.
Why do you increase fluids with sulfa drugs: to avoid development of crystals in urine and to clear urinary tract of pus
with uti instruct client to: avoid sunlight, avoid coffee, tea cola chocolates, alcohol, high citric acid juices, and spices.
Urinary tract analgesic causes? how to give it?: pyridium, discolors urine reddish orange and contac lens.
observe for yellow skin and sclera as evidence of hepatic dysfuncion Give with food.
upper Uti (pyelonephritis) is caused by: bacteria traveling through the blood or by upward movement of bacteria from urethra to bladder to kidney.
symptoms of a upper uti: pain in back and flank or stomach. fever, nausua vomit, weakness, urine cloudy with puss, wbc and rbc's greater then 2per hpf, protein, crystals, esterase.
treatment of upper uti (pyelonephritis): iv for nausea, vomiting and to flush kidneys
antiinfectives
antipyretic for fever reduction
what is functional incontinence: inability or unwillingness of person with normal bladder and sphincter control and intact nervouse system to reach bathroom in time to void.
factors of functional incontinence: environmental barriers. disorientation, mobility or sensory impairment, cognitive function imparied from sedatives.
Treatment of functional incontinence: habit training, scheduled toileting, environmental alterations, catheter.
what causes loss of small amount of urine from an overdistended bladder?: overflow incontinence
overflow incontinence is caused by: weakened detrussor muscles due to drugs fecal impaction diabetes, spinal coard injuury prostate enlargement, uterine prolapse.
defining characteristics of overflow incontinence are: dribbling with urgency and frequncy
involuntary loss of urine occurring at somewhat predictalbe intervals when a specific bladder volume is reached is?: reflex incontinence.
reflex incontinence is cause by: spinal cord dysfunction above the sacral cord that impares the reflex arc or inhibition of cerebral awareness
treat reflex incontinence with: catheterization texs or condom, and schelduling toileting.
sudden, involuntary loss of small amounts of urine with increased intrabdominal pressure, urgency, frequency or urination greather the q2h.: stress incontinence
causes of stress incontinence: coughing, laughing, sneeing lifting obesity , weak pelvic musculature, incompentent bladder, full uterus in third trimester.
Treatment of stress incontinence: kegal exercises, and estrogen for menopause
bladder suspension surgery
avoid alcohol, and caffeine, nutrasweet
treat with alpha-adrenegic agonist
reduce weight if obese
involuntary loss of urine after a strong feeling of the need to urinate accompanied by frequency, bladder spasm, inability to reach toilet in time: Urge incontinence
causes of urge incontinence: decreased bladder capacity, irritation of stretch receptors, alcohol or caffeine, increased fluid intake or infeciton
treatment of urge incontinence: anticholinergics such as propantheline.
Increases bladder capacity and sphincter tone. relax smooth muscle of bladder wiht bladder irritation.

acidify urine with cranberry juice, blueberrys, eggs, meats, whole grain breade, prunes, plums.

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