TEXT STEP #1 Build a solid foundation. Urinary System Function, Data Collection, and Therapeutic Measures Urinary System Function, Data Collection, and Therapeutic Measures • When teaching females self-catheterization, have them stand with one foot on the toilet, if able, during the catheterization.
Chapter 36
693
PRACTICE ANALYSIS TIP Linking NCLEX-PN® to Practice The LPN/LVN will:
Chapter 36
679
Gerontological Issues boxes prepare you to provide quality care to older adults. Key Points • The urinary system consists of two kidneys and two ureters, the urinary bladder, and the urethra. The kidneys form urine and the rest of the system eliminates urine. Consequently, dehydration, common in older adults, and changes in renal function are a serious consideration for individuals in this age group who need medication therapy. The risk of adverse medication reactions, such as toxicity and overdose, increases. It can be important to monitor kidney function (such as serum creatinine and blood urea nitrogen [BUN] levels) in an older adult receiving medication therapy. Home Health Hints • Secure pets in another room when performing sterile procedures such as urinary catheter changes. When inserting a urinary catheter, use a flashlight as needed. Have an extra catheter kit and a sterile specimen con- tainer available. owing in part to arteriosclerosis and diminished renal blood flow. The urinary bladder decreases in size, and the tone of the detrusor muscle decreases. These changes may result in the need to urinate more often or in residual urine in the bladder after voiding. Older adults often experience more infections of the urinary tract. Gerontological Issues Age-Related Renal Changes These changes typically occur in the renal system as people age: • Decreased filtration efficiency of the kidneys affects the body’s ability to eliminate drugs • Decreased renal function slows the excretion of certain medications, so they remain in the body longer • Collect specimen for diagnostic testing (e.g., urine). • Check for urinary retention (bladder scan, ultrasound, palpation). • Insert, maintain, and remove urinary catheter. • Provide care to client with bladder management protocol. • Reinforce teaching to the patient and caregiver to keep water to drink next to the patient to maintain hydration. TV commercials can be a reminder to take sips. • Reinforce teaching for the nurse to be notified if the cath- eter becomes plugged as well as how to take the catheter out if it becomes plugged and the nurse is not readily available. Leave a syringe to deflate the balloon with instructions not to cut the balloon valve stem.
URINARY SYSTEM DATA COLLECTION • Reinforce teaching to patient or caregiver on how to switch drainage bags from a large bag to a leg bag if desired for ambulation. When unattached to the urinary drainage system, an extra drainage bag should be cleansed with a solution of 1 part white vinegar and 3 parts water (1/4 cup vinegar, 3/4 cup water) or a solu- tion of 1 part bleach to 10 parts water (1/4 cup bleach, 21/2 cups water). Be Safe! boxes help you remember concepts essential to safe care. Health History If the patient has impaired kidney function, head-to-toe data collection is needed because kidney disease can affect every system of the body. Table 36.2 describes sample questions to ask for a health history to use along with the WHAT’S UP? format (see Chapter 1) for symptoms. Physical Examination Table 36.3 lists objective data to collect on all body systems. Many disease states may precipitate kidney disease such as diabetes, gout, hypertension, and neoplasms. Other factors include excessive use of over-the-counter analgesics, infec- tions, or manipulation of the urinary tract during procedures. Key signs and symptoms include costovertebral angle pain, flank pain, dysuria , and back and leg pain. The patient may have peripheral edema and periorbital edema in the morning. The skin may be pale, itchy, and dry. Electrolyte abnormal- ities may cause arrhythmias or seizures. The patient’s level of consciousness may be altered, ranging from lethargy to coma. High-frequency deafness may occur with hereditary nephritis. Cardiovascular friction rubs may be heard in ure- mic patients. The lungs may fill with fluid and crackles heard in the lungs. BE SAFE! AVOID FAILURE TO RESCUE! After an uncircumcised male is catheterized, the foreskin must be properly repositioned over the glans penis. It cannot be left retracted, as this can cause injury. If left retracted, subsequent swelling may make it impossible to pull the foreskin over the glans penis later. This can cause ischemia of the glans penis, a medical emergency. The HCP must be notified immediately. An emergency circumcision may be needed if the foreskin cannot be properly positioned. Always ensure that the foreskin is positioned properly after catheterization or perineal care.
The Aging Renal and Urinary Systems edema, fever, chills, itchy dry skin, changes in level of consciousness, and alterations in voiding pattern. • Weight is the best indicator of fluid balance in the body. Weigh the patient at the same time each day, in the same or similar clothing, and with the same scale. Look for Pelvic floor muscles weaken Kidneys trends in weight gain or loss related to fluid balance. • Intake and output should be carefully measured. Intake includes oral, IV, irrigation, tube feeding, and other CRITICAL THINKING Mrs. Bohke is a 64-year-old female patient admitted to the hospital with a diagnosis of pneumonia. During her stay, she tells the nurse she has trouble getting to the bathroom in time and often dribbles before she can get there. Males Females 1. What type of urinary incontinence does Mrs. Bohke have? 2. When caring for a patient with incontinence, is it helpful GFR decreases • Several blood and urine tests reflect kidney function. If the kidneys are not filtering adequately, the serum test values, such as the creatinine and blood urea nitrogen, will be elevated. A renal biopsy diagnoses or provides information about kidney disease. • Contrast media used in diagnostic testing and procedures can be nephrotoxic and cause contrast-induced acute kidney injury within 48 hours. • Urinary incontinence is defined as the involuntary Nephrons decrease fluids. Output includes urine, emesis, nasogastric effluent, wound drainage if it is copious, and any other drainage. • A urinalysis is a commonly performed diagnostic test for the urinary system, kidney disease, and systemic diseases that may affect the kidneys. Decreased ability to concentrate urine to decrease fluid intake? Why or why not? Suggested answers are a the end of the chapter. Prone to bladder infections, urinary incontinence, and urethral irritation Difficulty voiding Urine retention Increased risk from Urine retention Prostate enlarges
• The purpose of urine formation is the removal of potentially toxic waste products from the blood. The kidneys regulate blood pressure, electrolyte balance, acid–base balance, formation of erythropoietin, and activation of vitamin D. Critical Thinking Exercises throughout each chapter help connect what you read to what you will see and do in the clinical setting, and include suggested answers at the end of the chapter to check your understanding.
Urinary bladder
Dysuria • With age, the number of nephrons in the kidneys decreases, often to half the original number by age 70 or 80. The glomerular filtration rate also decreases. The urinary bladder decreases in size, and the tone of the detrusor muscle decreases. This may result in the need to urinate more often or in residual urine in the bladder after voiding. Older adults are also more subject to infections of the urinary tract. • Hypertension and diabetes are the most common causes of renal problems. Urinary frequency • If the patient has impaired kidney function, head-to-toe data collection is needed because kidney disease can affect every system of the body. • Common symptoms of kidney disease include dull ache
Decreased bladder size and tone of detrusor muscle
Powered by FlippingBook