Fundamentals Exam 3 review
Ch 46: Urinary Elimination Learning Objectives
1. Explain the function and role of the urinary system structures in urine formation and elimination
a. Function:
i. Removal and elimination of excess water and by-products of body metabolism.
ii. Help maintain fluid and electrolyte balance.
iii. Filtration, reabsorption, removal, and excretion
b. Structure:
i. Kidney: filters waste out of the blood and turns it into urine; detoxification
1. Nephron: functional unit; main filtration system
2. Production of erythropoietin: which stimulates the bone marrow to produce RBC;
prolongs the life of mature RBCs, maintains normal RBC volume
3. Production of renin, prostaglandin E2, and prostacyclin affects blood pressure; renin
causes water retention and increases blood volume; prostaglandin and prostacyclin for
vasodilation
4. Affects calcium and phosphate regulation
ii. Ureter
iii. Bladder: acts as a reservoir; voluntary control
iv. Urethra: point of exit
2. Identify factors that commonly impact urinary elimination
a. Urinary Problems:
i. Urinary retention: an accumulation of urine due to the inability of bladder to empty
ii. UTI: results from catheterization procedure or low pH in pubic area (primarily women) to kill
bacteria
iii. Urinary incontinence: involuntary leakage of urine
iv. Urinary diversion: strays away from the typical path of urination
1. Incontinence urinary reservoir
2. Stoma: outward access to something on the inside
b. Factors:
i. Age: incontinence in older adults; little children; bladder training after catheter; fewer nephrons;
nocturia; pre-existing condition; loss of muscle tone
ii. pregnancy and childbirth can weaken the pelvic floor, and the bladder is being pressed upon;
increase in blood volume
iii. Diet and fluid intake: caffeine, alcohol, too much salt = too much water retention = less urine
iv. Immobility: functional incontinence (can’t walk to the bathroom)
v. Psychosocial factors: holding unto urine; shy bladder
vi. Pain: suppresses or inhibits urination urges; obstruction of sensation
vii. Surgical procedures: anesthesia and opioids inhibit urination urges and sensation
viii. Medications: diuretics, antidiuretics, anticholinergics, antihistamines, “chemo-”
3. Compare and contrast common alterations associated with urinary elimination
a. Urinary incontinence
b. Infection
c. Impaired self-toileting
d. Impaired skin integrity
e. Urinary retention
4. Discuss the types of urinary incontinence
a. Functional: loss of urine due to factors that interfere with responding need to urinate; mobility, cognitive;
environmental barriers. Need to go but can’t get there on time
b. Stress: increased abdominal pressure that forces urine out; absence of abdominal contraction during actions.
c. Urge: sudden urgency; bladder irritation or spasms; UTI or overactive bladder. Inability to stop urine flow
long enough to reach the bathroom due to overactive and increased bladder muscle
d. Overflow: urinary retention from bladder distention; frequent loss of small amounts of urine.
e. Reflex: involuntary loss of moderate amount of urine without warning due to hyperreflexia of bladder muscles
f. Total: unpredictable or involuntary loss of urine; can’t be fixed; permanent; suprapubic catheter or briefs.
5. Construct a plan and be able to perform a physical assessment focused on urinary elimination
a. Loss of urine when laughing, sneezing, coughing
, b. Enuresis (bed-wetting)
c. Bladder spasms
d. Urinary retention
e. Frequency, urgency, nocturia
f. Pattern of urination
g. Symptoms of urinary alterations
h. Cultural considerations
i. Self-care ability
j. Physical assessment:
i. Kidneys: inflamed and tender; presence of bruit
ii. Bladder: distended above symphysis pubis; swelling; convex curvature
iii. External genitalia and urethral meatus: redness, tenderness, rashes, lesions, evidence of scratching,
signs of irritation
iv. Perineal skin: erythema, skin erosion, burning or itching pain
6. Interpret features of normal and abnormal urine
a. Intake and output
b. Characteristics of urine:
i. Volume: normal 30mL/hour; below 30 = check for signs of blood loss or absence of
voiding/urination; above 30 = polyuria; within 2 hours
ii. Color: pale straw or yellow; depends on concentration and hydration; hematuria is bad; medication
and food can change color
iii. Clarity: transparent is normal; clear/cloudy with sediments shows the presence of bacteria and
WBCs = may or may not be normal
iv. Odor: ammonia odor; the more concentrated = the stronger the odor; foul odor = indication of UTI
7. Appraise nursing implications of common diagnostic tests of the urinary system
a. Laboratory and diagnostic testing:
i. Urine specimen must reach the lab in 2 hours
ii. Confirm name, DOB, and identity
iii. Infection control policies
iv. Urinalysis (UA): culture and sensitivity; identify UTI (presence of WBC and RBC,
microorganisms)
v. Blood creatine: renal function
b. Urinalysis:
i. Specific gravity (1.015-1.025): high reflects concentrated urine and dehydration, increased ADH,
reduced renal blood flow
ii. Ph (4.6-8.0): indicator of acid-base balance; acid protects against bacterial growth
iii. Protein (none): present in renal disease
iv. Glucose (none): present in patients with DM, high blood glucose levels
v. Ketones (none): DM; occurs with dehydration and starvation; product of fatty acid metabolism
vi. Blood (none): contamination of menstrual fluid or renal damage
vii. WBCs: presence of UTI
c. Diagnostic test:
i. Bladder scanner/bedside sonography: ultrasound = bladder abnormalities, residual urine
ii. KUB (kidney ureters bladder): x-ray
iii. IVP (intravenous pyelogram): pyelonephritis, kidney stones
iv. Renal scan: blood flow
v. Renal Ultrasound
vi. Cystoscopy: look into urethra and kidneys = detect bladder tumors and obstruction
vii. Urodynamic testing:
1. Cystourethroscopy: visualize bladder
2. Uroflowmetry: rate and degree of bladder emptying
8. Discuss nursing interventions to promote normal urinary elimination
a. Establish a toileting schedule
b. Monitor and increase fluid intake during daytime and decrease during nighttime
c. Removal or control barrier to toileting
d. Provide incontinence undergarments
e. Application of external catheters
f. Avoid the use of indwelling urinary catheters
Ch 46: Urinary Elimination Learning Objectives
1. Explain the function and role of the urinary system structures in urine formation and elimination
a. Function:
i. Removal and elimination of excess water and by-products of body metabolism.
ii. Help maintain fluid and electrolyte balance.
iii. Filtration, reabsorption, removal, and excretion
b. Structure:
i. Kidney: filters waste out of the blood and turns it into urine; detoxification
1. Nephron: functional unit; main filtration system
2. Production of erythropoietin: which stimulates the bone marrow to produce RBC;
prolongs the life of mature RBCs, maintains normal RBC volume
3. Production of renin, prostaglandin E2, and prostacyclin affects blood pressure; renin
causes water retention and increases blood volume; prostaglandin and prostacyclin for
vasodilation
4. Affects calcium and phosphate regulation
ii. Ureter
iii. Bladder: acts as a reservoir; voluntary control
iv. Urethra: point of exit
2. Identify factors that commonly impact urinary elimination
a. Urinary Problems:
i. Urinary retention: an accumulation of urine due to the inability of bladder to empty
ii. UTI: results from catheterization procedure or low pH in pubic area (primarily women) to kill
bacteria
iii. Urinary incontinence: involuntary leakage of urine
iv. Urinary diversion: strays away from the typical path of urination
1. Incontinence urinary reservoir
2. Stoma: outward access to something on the inside
b. Factors:
i. Age: incontinence in older adults; little children; bladder training after catheter; fewer nephrons;
nocturia; pre-existing condition; loss of muscle tone
ii. pregnancy and childbirth can weaken the pelvic floor, and the bladder is being pressed upon;
increase in blood volume
iii. Diet and fluid intake: caffeine, alcohol, too much salt = too much water retention = less urine
iv. Immobility: functional incontinence (can’t walk to the bathroom)
v. Psychosocial factors: holding unto urine; shy bladder
vi. Pain: suppresses or inhibits urination urges; obstruction of sensation
vii. Surgical procedures: anesthesia and opioids inhibit urination urges and sensation
viii. Medications: diuretics, antidiuretics, anticholinergics, antihistamines, “chemo-”
3. Compare and contrast common alterations associated with urinary elimination
a. Urinary incontinence
b. Infection
c. Impaired self-toileting
d. Impaired skin integrity
e. Urinary retention
4. Discuss the types of urinary incontinence
a. Functional: loss of urine due to factors that interfere with responding need to urinate; mobility, cognitive;
environmental barriers. Need to go but can’t get there on time
b. Stress: increased abdominal pressure that forces urine out; absence of abdominal contraction during actions.
c. Urge: sudden urgency; bladder irritation or spasms; UTI or overactive bladder. Inability to stop urine flow
long enough to reach the bathroom due to overactive and increased bladder muscle
d. Overflow: urinary retention from bladder distention; frequent loss of small amounts of urine.
e. Reflex: involuntary loss of moderate amount of urine without warning due to hyperreflexia of bladder muscles
f. Total: unpredictable or involuntary loss of urine; can’t be fixed; permanent; suprapubic catheter or briefs.
5. Construct a plan and be able to perform a physical assessment focused on urinary elimination
a. Loss of urine when laughing, sneezing, coughing
, b. Enuresis (bed-wetting)
c. Bladder spasms
d. Urinary retention
e. Frequency, urgency, nocturia
f. Pattern of urination
g. Symptoms of urinary alterations
h. Cultural considerations
i. Self-care ability
j. Physical assessment:
i. Kidneys: inflamed and tender; presence of bruit
ii. Bladder: distended above symphysis pubis; swelling; convex curvature
iii. External genitalia and urethral meatus: redness, tenderness, rashes, lesions, evidence of scratching,
signs of irritation
iv. Perineal skin: erythema, skin erosion, burning or itching pain
6. Interpret features of normal and abnormal urine
a. Intake and output
b. Characteristics of urine:
i. Volume: normal 30mL/hour; below 30 = check for signs of blood loss or absence of
voiding/urination; above 30 = polyuria; within 2 hours
ii. Color: pale straw or yellow; depends on concentration and hydration; hematuria is bad; medication
and food can change color
iii. Clarity: transparent is normal; clear/cloudy with sediments shows the presence of bacteria and
WBCs = may or may not be normal
iv. Odor: ammonia odor; the more concentrated = the stronger the odor; foul odor = indication of UTI
7. Appraise nursing implications of common diagnostic tests of the urinary system
a. Laboratory and diagnostic testing:
i. Urine specimen must reach the lab in 2 hours
ii. Confirm name, DOB, and identity
iii. Infection control policies
iv. Urinalysis (UA): culture and sensitivity; identify UTI (presence of WBC and RBC,
microorganisms)
v. Blood creatine: renal function
b. Urinalysis:
i. Specific gravity (1.015-1.025): high reflects concentrated urine and dehydration, increased ADH,
reduced renal blood flow
ii. Ph (4.6-8.0): indicator of acid-base balance; acid protects against bacterial growth
iii. Protein (none): present in renal disease
iv. Glucose (none): present in patients with DM, high blood glucose levels
v. Ketones (none): DM; occurs with dehydration and starvation; product of fatty acid metabolism
vi. Blood (none): contamination of menstrual fluid or renal damage
vii. WBCs: presence of UTI
c. Diagnostic test:
i. Bladder scanner/bedside sonography: ultrasound = bladder abnormalities, residual urine
ii. KUB (kidney ureters bladder): x-ray
iii. IVP (intravenous pyelogram): pyelonephritis, kidney stones
iv. Renal scan: blood flow
v. Renal Ultrasound
vi. Cystoscopy: look into urethra and kidneys = detect bladder tumors and obstruction
vii. Urodynamic testing:
1. Cystourethroscopy: visualize bladder
2. Uroflowmetry: rate and degree of bladder emptying
8. Discuss nursing interventions to promote normal urinary elimination
a. Establish a toileting schedule
b. Monitor and increase fluid intake during daytime and decrease during nighttime
c. Removal or control barrier to toileting
d. Provide incontinence undergarments
e. Application of external catheters
f. Avoid the use of indwelling urinary catheters
