Sensory Perception Notes

Urinary Elimination Kidneys primary function Regulate the volume of extracellular fluid to maintain homeostasis Excrete waste products and filter the blood Filter 120–150 quarts of blood daily Convert waste products and excess fluid into urine Produce 1–2 quarts of urine per day Urine transported to bladder by ureters (one from each kidney; thin muscular tubes) Control blood pressure Produce erythropoietin (stimulates red blood cell production) Activate vitamin D Regulate acid–base balance ANEMIA EFFECTS KIDNEYS Terms to describe urinary problems Anuria – 24-hour urine output less than 50 mL Dysuria – Painful or difficult urination Frequency – Increased incidence of voiding Glycosuria – Presence of glucose in the urine Nocturia – Awakening at night to urinate Oliguria – 24-hour urine output less than 400 mL Polyuria – Excessive urine output (diuresis) Proteinuria – Protein in the urine Pyuria – Pus in the urine Urgency – Strong, sudden desire to void Urinary incontinence – Involuntary loss of urine Bladder Assessment Urine – Assess color, odor, consistency, and amount Urethra – Check for drainage, redness, and skin integrity Kidneys – Normally not palpable (unless congenital disease, cancer, or cysts present; located in the flank) Bladder – Palpate for distention How to complete a bladder assessment Bladder Scan and bladder scan Urine concentration and urine specific gravity Nurse’s role in obtaining urinary specimens ( clean catch, mid-stream and 24-hr collection) Nurse places an ultrasound device over the bladder to measure urine volume Used to determine if the bladder needs catheterization Helps avoid unnecessary catheterization if urine volume is too low Benefits: Portable, easy to use, painless, and reduces risk of catheterrelated UTIs Urine Specific Gravity o Measures the density of chemicals and particles in urine o Reflects the kidney’s ability to concentrate urine o Normal range: 1.015 – 1.025 Interpretation o High specific gravity → concentrated urine ▪ Usually indicates dehydration (if no kidney disease) o Low specific gravity → diluted urine ▪ Usually indicates overhydration (if no kidney disease) Provide sterile wipes and container Cleaning: o Females → wipe front to back (one side, then the other, then center) o Males → circular motion around urethral opening Collection: o Begin urinating into the toilet o Place sterile cup midstream (without touching perineum or inside of cup) • o Finish urinating into toilet After collection: o Secure lid tightly o Label container o Wash hands o Send specimen to lab 24-Hour Urine Collection • • • • • Provide collection container (urine tray/urinal + storage container) Instruct client to: o Date and time container when collection begins o Collect all urine for 24 hours o Keep urine refrigerated during collection period At completion → bring storage container to lab for testing Purpose: Retrains the bladder by setting a bathroom schedule and gradually increasing time between urinations Goal: Prevent accidents and teach bladder-to-brain signaling (helpful for overactive bladder) Steps: Describe Bladder training 1. Assess current pattern a. Keep an elimination journal to record bathroom times 2. Gradually increase intervals a. Start by extending time between voids by ~15 minutes b. Slowly progress to longer intervals 3. Maintain schedule a. Once an effective elimination schedule is established, stick with it consistently UTI Prevention UTI prevention and symptoms of UTI Drink 8–10 glasses (8 oz each) of water daily Monitor urine for color, amount, odor, frequency Dry perineal area front to back after urination or defecation Drink 2 glasses of water before and after sexual intercourse Void immediately after intercourse Prefer showers over baths Wear cotton-crotch underwear and avoid tight clothing UTI Symptoms Burning or painful urination Urgency to urinate (with little urine passed) Severe lower back pain Fever Nausea or vomiting Hematuria (blood in urine) Straight / Intermittent Catheters Used as needed to empty the bladder Removed immediately after bladder emptying is complete Indwelling Catheters Types of catheters (straight, intermittent, indwelling) Similar to intermittent catheters but include a small inflatable balloon at the end o Balloon holds catheter in place inside the bladder for continuous drainage Inserted into the urethra using sterile technique Connected to a urine collection system o Bag is secured to the client’s leg to prevent tension and accidental removal Collecting a Specimen from an Indwelling Catheter How to take a specimen from an indwelling catheter and how to discontinue the indwelling catheter Clean sampling port with an antiseptic wipe Use a syringe to withdraw urine from the port Transfer urine into a sterile container Label specimen and send to lab Discontinuing an Indwelling Catheter Use a syringe to deflate the balloon Gently remove the catheter Ensure proper documentation of: o Procedure performed o Client’s tolerance and response Applying a Condom Catheter How to apply the condom catheter Care of dialysis site (AV fistula) Clean the penis: o Circumcised → wash with soap and water, rinse, pat dry o Uncircumcised → gently retract foreskin, clean beneath it Position catheter: o Place rolled condom catheter at tip of penis o Leave ½ inch (1.3 cm) between catheter end and tip of penis Apply and secure: o Unroll catheter upward along the shaft past the adhesive strip o Gently press sheath against adhesive until it sticks Keep the site clean and dry Check daily for signs of infection: redness, warmth, or swelling Assess function: Feel for a thrill (vibration) Listen for a bruit (whooshing sound) Avoid on the arm with the fistula: Blood pressure measurements Venipunctures (blood draws) Tight clothing or restrictive items Stress Incontinence o Leakage occurs during coughing, sneezing, laughing, or physical activity that increases bladder pressure Urge Incontinence o Sudden, strong urge to urinate o Leakage occurs before reaching the toilet Reflex Incontinence o Leakage caused by nerve damage Overflow Incontinence o Incomplete bladder emptying o Bladder overfills, leading to urine leakage Functional Incontinence o Physical inability to reach the toilet in time o May be due to mobility issues (wheelchair bound) or fine motor impairments (arthritis) Nocturnal Enuresis (Nighttime Bedwetting) o Common in children o May occur in adults due to alcohol, caffeine, or certain medications Types of urinary incontinence How to treat urinary incontinence Lifestyle Modifications: o Improve diet and exercise to prevent constipation o Reduce caffeine and alcohol intake o Avoid medications that may cause incontinence, if possible o Quit smoking Other Interventions: o Pelvic floor exercises (Kegels) o Bladder training • o Medications o Medical devices o Surgery Skin Protection and Management: o Use pads, incontinence briefs, or waterproof undergarments to absorb urine o Apply cleansing products and barrier creams designed for urinary incontinence to protect skin