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Skills: ATI: Urinary Elimination Questions with Answers
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Skills: ATI: Urinary Elimination Questionswith Answers
Urinary Elimination - -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 - -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: - -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 - -surgery, immobility, medications,
and therapeutic diets.
-Urinary diversions - -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 - -Continent urinary reservoir and
Orthotopic Neobladder
-Continent Urinary Reservoir - -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 - -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 - -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 - -One or both ureters to the abdominal surface
-What are the roles of a nurse when caring for a client with urinary
diversions? - -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 - --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 - --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 - --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 - --increase in sodium leads to decreased urination
-caffeine and alcohol intake lead to increased urination
-Factors affecting normal Urinary Elimination: - -Poor abdominal and pelvic
muscle tone.
Acute and chronic disorders.
Spinal chord injury.
-Factors affecting normal Urinary Elimination:
Immobility - -Incontinence is not associate with aging. It is a result of
neurological or mobility impairments.
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