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CHAPTER 48- REVIEW

1. Urinary Elimination- kidneys


a. Depends on function of upper and lower urinary tract
i. Upper urinary tract: kidneys and ureters
ii. Lower urinary tract: urinary bladder, urethra, and pelvic floor
b. Nephrons filter blood and remove metabolic wastes

2. Urination- (normal urine consists of 96% water and 4% solutes)


a. Micturition, voiding, and urination all refer to the process of emptying
the bladder
b. Urine collects in the bladder until pressure stimulates special sensory
nerve endings in the bladder wall called stretch receptors
c. When the bladder contains 250 to 450 mL of urine
3. Fluid and Food intake- balanced fluid ingested= fluid eliminated
a. When fluid increases the output normally increases
b. Alcohol increases fluid output by inhibiting production of antidiuretic
hormone
c. Caffeine also increase urine production
d. High sodium foods and fluids cause fluid retention to maintain normal
electrolyte concentrations
e. Some foods and fluids can change the color of urine

4. Terminology and definitions:


a. Polyuria (or diuresis): production of abnormally large amounts of urine
by the kidneys (several liters more)- can lead to fluid loss
b. Polydipsia: excessive fluid intake (associated with diabetes)
c. Oliguria : decreased urinary output (less than 500mL/day)- report
immediately
d. Anuria: lack of production of urine
e. Dialysis: a technique by which fluids and molecules pass through a
semipermeable membrane according to the rules of osmosis
f. Urinary frequency: voiding at frequent intervals more than 4 to 6 times a
day
g. Nocturia: voiding more than 2 times per night
h. Urgency: sudden strong desire to void
i. Dysuria: voiding that is either painful or difficult
j. Urinary hesitancy: a delay and difficulty in initiating voiding
k. Enuresis: involuntary urination (nocturnal- night/ diurnal-daytime

5. Incontinence: involuntary urination is a symptom not a disease. Two forms:


a. Acute: reversible incontinence
b. Chronic: irreversible incontinence but manageable by nurses for clients
6. Renal test: levels of substances urea and creatinine used evaluate renal
function
a. Blood urea nitrogen (BUN): Urea the end product of metabolism tested
b. Creatinine clearance: creatinine is produced by muscles
i. Uses 24 hours urine and serum creatinine levels to determine
glomerular filtration rate, a sensitive indicator of renal function
7. Maintaining urinary elimination:
a. Promoting fluid intake: increasing fluid intake increases urine
production
b. Maintaining normal voiding habits: helps to adhere to normal voiding
habits
c. Assisting with toileting: those weakened by a disease process or
physically impaired may require assistance with toileting, assist to prevent
further injury
8. Foley Bag Placement:
a. Hang Foley bag below the level of the bladder

9. Suprapubic Catheter:
a. Surgically inserted abdominal wall catheter
b. Attached to closed drainage system
c. Regular assessment of clients urine, fluid, and comfort
d. No baths to prevent bacteria accumulations
e. The most common urinary diversion is the ileal conduit

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