Study Exams For Ati Urinary Elimination

STUDY EXAMS FOR ATI URINARY ELIMINATION Urinary Elimination - CORRECT ANSWER-is a precise system of filtration, reabsorption, and excretion. These processes help fluid and electrolyte balance while filtering and excreting water soluble wastes. Primary organs involved in urinary elimination - CORRECT ANSWER-Kidneys; with nephrons performing most of the functions of filtration and elimination. Most adults produce between 1,500 and 2,000 mL of urine per day. Once urine is filtered it: - CORRECT ANSWER-passes through ureters into the bladder (storage reservoir for urine). Once urine collects in the bladder (150-200mL) it sends a signal to the brain to indicate the need to urinate. Person then relaxes internal and external sphincters located at bottom of the bladder and the urethra. Urine passes from the bladder through uretha where it exits the body. Factors that affect urinary elimination - CORRECT ANSWER-surgery, immobility, medications, and therapeutic diets. Urinary diversions - CORRECT ANSWER-temporary or permanent. A stoma for the drainage of urine. Created for patients who have bladder cancer, radiation injury to the bladder, or chronic urinary infections may require a diversion to drain urine from a diseased or dysfunctional bladder. Two types of urinary diversions - CORRECT ANSWER-Continent urinary reservoir and Orthotopic Neobladder Continent Urinary Reservoir - CORRECT ANSWER-It is created from a distal portion of the ileum and proximal portion of the colon. The ureters are embedded in the reservoir. The reservoir is situated under the abdominal wall and has a narrow ilieal segment brought out through the abdominal wall to form a small stoma. The ileocecal valve creates a one way valve in the pouch through which a catheter is inserted to empty the urine from the pouch. Patients must be able to catheterize the pouch 4-6x a day for the rest of their lives. Orthotopic Neobladder - CORRECT ANSWER-Uses an ileal pouch to replace the bladder. Anatomically the pouch is in the same place as the bladder was before removal. This allows patients to void normally. Nephrostomy - CORRECT ANSWER-When patients need urinary drainage directly from one or both kidneys. In this case a tube is placed directly into the renal pelvis to the abdominal surface. Ureterostomy - CORRECT ANSWER-One or both ureters to the abdominal surface What are the roles of a nurse when caring for a client with urinary diversions? - CORRECT ANSWER-Refer the client to an ostomy nurse Train the client on management of urinary diversions. Refer the client to ostomy associations for further support Refer to client to United Ostomy Associations of America. Factors affecting normal Urinary Elimination: Age - CORRECT ANSWER--full bladder control by 4-5 yrs of age -enlargement of prostate after 40 yrs of age leads to urinary frequency, hesitancy, retention, incontinence, and UTI's -childbirth and gravity weaken pelvic floor, putting patients at risk for the prolapse of bladder, leading to stress incontinence, which patients can manage with pelvic floor (kegel) exercises. Factors affecting normal Urinary Elimination: Older adult patients - CORRECT ANSWER--fewer nephrons -loss of muscle tone of bladder (frequency occurs) -inefficient emptying of the bladder (residual urine increases risk of UTI's) -increase in nocturia (waking up to pee at night) Factors affecting normal Urinary Elimination: Pregancy - CORRECT ANSWER--growing fetus compromises bladder space and compresses the bladder -there is a 30-50% increase in circulatory volume, which increases renal workload and output -hormone relaxin causes relaxation of sphincter Factors affecting normal Urinary Elimination: Diet - CORRECT ANSWER--increase in sodium leads to decreased urination -caffeine and alcohol intake lead to increased urination Factors affecting normal Urinary Elimination: - CORRECT ANSWER-Poor abdominal and pelvic muscle tone. Acute and chronic disorders. Spinal chord injury. Factors affecting normal Urinary Elimination: Immobility - CORRECT ANSWER-Incontinence is not associate with aging. It is a result of neurological or mobility impairments. Factors affecting normal Urinary Elimination: Psychosocial Factors - CORRECT ANSWER--emotional stress and anxiety -having to use public toilets, lack of privacy in a hospital. -not having enough time to urinate Factors affecting normal Urinary Elimination: Pain - CORRECT ANSWER--suppression of the urge to urinate when there is pain in the urinary tract. -obstruction in the ureter leading to renal colic -arthritis or painful joints causing immobility which leads to delayed urination Factors affecting normal Urinary Elimination: Surgical procedures - CORRECT ANSWER--alterations in glomerular filtration rate from anesthia/opioid analgesics resulting in decreased urine output -lower abdominal surgery creating obstructing edema and inflammation Factors affecting normal Urinary Elimination: Medications - CORRECT ANSWER--diuretics preventing reabsorption of water -antihistamines and anticholinergics causing urinary retention -medications changing urine color (*phenazopyridine/pyridium = orange urine. *amitriptyline = green/blue urine. *levodopa/dopar = brown/black urine.) -chemotherapy creates a toxic environment for the kidneys. Diagnostic Tests - CORRECT ANSWER-Bedside sonography/bladder scanner, Kidneys/ureters/bladder KUB, Intravenous Pyelogram, Renal Scan, Renal Ultrasound, Cytoscopy, and Urodynamic testing. Bedside sonography/bladder scanner - CORRECT ANSWER-portable ultrasound scanner noninvasively measures bladder volume to measure residual volume after voiding. Kidneys/ureters/bladder (KUB) - CORRECT ANSWER-xray to determine size, shape, and posistion of these structures Intravenous Pyelogram (IVP) - CORRECT ANSWER-injecting contrast media (iodine) allows for viewing of ducts, renal pelvis, ureters, bladder, and urethra. Determine whether pt is allergic to shellfish Renal Scan - CORRECT ANSWER-view of renal blood flow and anatomy of the kidneys (no contrast) Renal Ultrasound - CORRECT ANSWER-view of gross renal structures