Normal Urine characteristics
1. volume: 250-400 mL avg amount per void
2. Light yellow (straw) to amber color
3. clarity is clear w/o sediment
4. Odor aromantic
5. urine speicifc gravity 1.002-1.030
Alterations in voiding patterns
1. anuria - less than 100ml of urine output in a 24 hr period.
2. dysuria - painful voiding
3. oliguria - less than 500ml of urine output in a 24 hr period
4. less than 30 ml of urine output in a hour can mean lack of blood flow to the kidneys.
5. polyuria - abnormally large volumes of dilute urine.
6. pyuria - presence of pus in urine
7. nocturia - wake during night
patients should be urinating at least 30 mL/hr anything less the doctor should be notified.
Pt empties 190 mL of urine over 6 hrs = 190/6 = 31 mL. Intervention?
1. Bladder scan, first line is to stand pt up to attempt urination.
What factors affect urinary elimination?
1. BPH- benign prostatic hypertrophy: enlarge prostate gland, common condition in older men.
2. Developmental factors
3. Personal sociocultural environmental factors
4. Nutrition / hydration / activity level
5. meds
6. surgery / procedures
7. pathological conditions
Lasix considerations
1. call light in reach, beside commode/urinal at besides, fall precautions, monitor input/output, monitor blood pressure, monitor potassium
Life span considerations in elimination
1. Adults and older adults: ureters, bladder and urethra lose muscle tone with ageing; bladder able to hold less urine. Kidneys become less effective regulator of ECF.
Assessment: dysfunction
1. pain or burning with urination
2. pink or reddish colored urine
3. inability to empty bladder completely
4. incontinence upon coughing, sneezing, lifting
5. difficulty stopping or starting urinary stream
6. how identified chronic urinary problems currently are managed.
UTI Assessment Risk Factors
1. Older women; sexually active women; pregnant women; enlarged prostate (men); hx of utis; kidney stones; DM; immunocompromised
2. Presence of indwelling catheter: pathogens during catheterization, failing to maintain closed drainage system, catheter irritates urethral mucosa, the longer the catheter remains in the higher the risk, urine collection bag is closed system.
UTI symptoms
1. bladder spasms, burning, chills, dysuria, edema, fever, foul smelling urine, hematuria, confusion, agitation, ams
CAUTIs Interventions for prevention
1. Consider alternatives first
2. Asepsis during catheterization of an indwelling catheter.
3. Maintain unobstructed urinary flow
4. Do not irrigate unless obstructed
5. Leave the catheter in place only for as long as it is needed, the risk of a CAUTI increases the longer the catheter stays in.
6. meds: preventive antibiotics if indicated; however can lead to antibiotic resistance.
Urinary retention pages
1. read 1106
Types of collections
1. clean-catch: midstream
2. Sterile specimen: blue piece from cath.
3. 24-hour: check kidney function, store on ice
Promoting normal urination
1. privacy; positioning; routines; hygiene ; nutrition/hydration
Catheter risks and complications
1. cauti
2. microorganisms are stagnant and not flushed along the urethra through voiding
3. Catheters provide a connection between the external environment and normally sterile environment
4. urethral injury: if the size of the catheter is too large; forced through strictures; incorrect angle; not well lubricated.
Skin care considerations and prevention
1. barrier creams for skin protection
2. change linens
3. turn team q2
4.
Stress adapatation
1. ability to cope or adjust to a stressful situation;
2. the inability to adapt can lead to pathological manifestations.
read pg. 1352