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88 Cards in this Set
- Front
- Back
Location of Kidneys
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lie on either side of vertebral column
behind the peritoneum against deep muscles of the back Left is higher than the Right b/c of liver |
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Functions of the Kidneys
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remove wastes from the blood to form urine
regulates: F/E Acid Base Balance Produces hormones (Renin, Aldosterone) |
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Functions of the Ureters
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transport urine from the kidneys to bladder
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The bladder function:
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holds urine until the urge to urinate develops
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Urine is transported by what process?
And through what structure? |
Peristaltic Waves (spurts)
urethra |
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Compare the Urethra from the male and female
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Male has 2 functions:
passageway for cells/secretions of reproductive organs & urinary elimination longer (20 cm; 8") Female 1 function: urinary elimination Shorter (4-6.5cm; 1.5-2.5") |
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Functions of the Prostrate:
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Adds seminal fluid
neutralizes PH (acid) in vagina supplies fructose to the sperm |
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What is the pressure within the bladder?
Why? |
low
protects against infection |
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Pts w/ altered kidney function can't produce what hormone and are prone to what disease?
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Erythropoietin (acts within the bone marrow to stimulate RBCs)
Anemia |
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What are the nerve centers for Micturition?
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Brain & Spinal cord (cerebral cortex, thalmus, hypothalmus & brain stem)
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the bladder holds as much as _____ ml of urine
We are able to sense the desire to urinate when the bladder has ___ to ___ ml of urine |
600
200-300 (3 cups) |
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when patients urinate frequently what can they develop?
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urinary retention
UTI |
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What are the characteristics and color of urine first thing in the morning?
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concentrated (1.025)
Amber -dark yellow |
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5 factors effecting Micturition?
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Fluid balance
Activity Age Cultural Developmental Disease surgical procedures (triggers general adaptation syndrome--3 stage process of stress-SNS (alarm reaction, resistance stage & exhaustion stage) |
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Give 3 Physiological changes in elderly:
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kidneys inability to concentrate urine
decreased (detruser muscles)capacity to hold urine leads to incontinence b/c the bladder decreases contractility leading to urinary retention Immobility (muscle hyperatrophy) Protate size increases due to Benign Prostate Hypertrophy |
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Causes of UTIs in Women:
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poor perineal hygiene
Inadequate hand washing failure to wipe front to back frequent sexual intercourse |
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What stimulates stretch receptors which trigger the response to empty the bladder?
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urine volume (200-300 ml)
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2 sphincters:
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internal (involuntary)
external (voluntary) |
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define pneumaturia:
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bubbles within the urine (air)
caused by: connections between the colon & bladder --fistulas or punctures that lets air in |
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What are the terms used for the process of emptying the bladder?
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voiding
urination micturition |
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What is the frequency of voiding?
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it is variable (every 4 hours)
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Define hesitancy?
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difficulty initiating the stream
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Define Pyuria?
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Pus in the urine
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Inability to void?
The bladder can hold up to ___ - ___ ml |
urinary retention
3000-4000 |
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After a UTI develops and the infections worsens what are the signs?
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fever, chills, nausea, vomitting & malaise
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What is an irritated bladder called?
Name symptoms? |
Cystitis
frequent and urgent sensation of the need to void |
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What is the appearance of the urine in the presense of an infection?
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concentrated
cloudy b/c of WBCs or bacteria |
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What is it called if an infection spreads to the upper urinary tracts (kidneys)?
What signs are common? |
pyelonephritis
flank pain, tenderness fever & chills |
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Name urinary diversions:
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Urinary stoma (directs urine from the kidneys directly into the abdominal surface d/t trauma, ca of the bladder, radiation, fistulas, or chronic cystitis)
Ileal loop or conduit (separates a loop of ileum w/ it's blood supply, the ureters are implanted into the segment of ileum and the remaining ileum is reconnected to the digestive tract Continent Pouch (provides urinary storage in leakproof pouch) |
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Catheterization requires what type of hygiene?
Perineal care or examination of the genitalia require? |
sterile technique (urinary tract is sterile)
Medical asepsis, including hand hygiene |
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Define Glycosuria?
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sugar in the urine
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Fever and diureses cause the kidney to?
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conserve fluid
concentrate urine |
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What medications are known to be pehrotoxic?
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ASA, NSAIDS, gentomycin, lasix (iv push), ibuprophin, chemotherapy
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Tranquilizers inhibit the ___ for ____?
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reflex for voiding
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Antihystamines cause urinary ____.
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retention
(men: prostrate enlargement) |
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Name certian foods that have a diuretic effect?
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alcohol
caffeine |
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What is the normal color and clarity of urine?
What is the clarity in urine with renal disease? |
pale, straw to amber color
transparent cloudy or foamy b/c of high protein thick & cloudy b/c of bacteria/wbc |
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bleeding from the kidneys or ureters cause the urine to become what color?
Bleeding from the bladder turns urine? Pyridium? Bilirubin |
dark red
bright red bright orange Dark amber |
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Characteristics of the odor of urine:
Stagnant: Acetone or acetoacetic acid |
ammonia
sweet or fruity (by products of fat metabolism) seen in diabetes mellitus or starvation |
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The type of test determines the method of collection--label all specimens with:
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clients name
date time of collection transport with in 30 min (or refridgerate up to 2 hours) |
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Name types of specimen collections?
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random
clean voided midstream sterile timed specimen |
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Random collection is used for what type of urine testing?
collection process: storage of urine specimen |
routine urinalysis
normal voiding indwelling catheter or urinary diversion collection bag clean specimen cup |
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Clean voided or midstream is used for what type of urine testing?
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culture (microorganism)/sensitivity(antibiotic)
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Sterile Specimen is used for what type of urine testing?
from a? collection process? |
culture/sensitivity
indwelling catheter sterile specimen by aseptic technique thru sampling port found on side of catheter Clamp tubing below the port allowing fresh uncontaminated urine to collect in tube. After wiping the port w/ alcohol swab, insert a sterile syringe hub and withdraw 3-5ml of urine |
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Timed urine specimen measures?
List times: timed period begins after the client: and ends: |
levels of adrenocortical steroids or hormones, creatine, or protein quantity tests
2-, 12-, or 24 hour urinates ends w/ final voiding at the end of time period |
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Urinalysis should be examined?
and using what kind of specimen? |
a/s/a/p, within 2 hours
first voided |
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abnormal values in urinalysis?
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protein (8-100/ml) indicates renal disease d/t damage to glomeruli or tubules which allows protein to enter urine
Glucose indicates diabetes mellitus Ketones indicates diabetes mellitus d/t breakdown of fatty acids crystals are result of food metabolism (uric acid or calcium phosphate result in renal calculi) Specific gravity (1.010-1.030) |
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List disease processes that effet Urine Elimination and why?
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Diabetes Mellitus (< bladder tone & effects nerve function)
Prostate enlargement (benign prostrate hypertrophy causing UR) Cardiac Disease (CHF leads to < UO, nocturia) Uremic Syndrome (nitrogenous waste/blood) Alzheimers (<LOC, don't process urge) End stage renal disease Fever/diaphoresis (kidneys conserve fluid &urine production < Multiple sclerosis (change in nerve function, loss of bladder control) Surgeries (pts fast prior to causing depressed CNS and UO is <) Post surgery (delayed voluntary control of voiding) |
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Name the symptoms of retention?
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difficulty urinating -initiating the flow
discomfort in pubic area output <than intake retention w/ overflow (bladder is full, but voiding in small quantities) |
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Nursing Interventions for Urinary Retention?
Assess for: Fluid intake should be: Lab work: |
Call physician (get an order for cath test)
Straight catheter (one time use to assess residual) Bladder scanner (no physican order/less invasive) characteristics urine in foley (abnormalities) odor 2000 ml BUN, creatine, hematocrit, urine specific gravity |
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Explain use for Foley Catheter:
Straight catherter: |
long term, urinary retention
short term, one time use for incontinence |
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Purposes for catheterization:
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relieve retention
obtain sterile specimen measure residual keep bladder empty bypass obstruction administer meds (not common) |
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Diagnostic Examinations:
2 approaches for visualization: direct or indirect noninvasive |
ab roentgenogram (no bowel prep)
CT scan (bowel cleansing) IVP (IV pyelogram) bowel cleansing Ultrasound Renal (no bowel prep) Bladder (just fluid prep) Urodynamic testing (uroflowmetry) |
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Diagnostic Examinations:
2 approaches for visualization: direct or indirect invasive |
Endoscopy-cystoscopy (bowel prep)
Arteriogram (angiography) fluids only |
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Nursing responsibilites for diagnostic examinations:
Nursing responsibilites following the study: |
consent
iodine allergy r/t to dye (pyelogram) diet (clear liquids) or NPO I/O characteristics of urine (color, clarity, presence of blood) encourage fluid intake |
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To minimize nocturia avoid fluids...
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2 hours before bed time
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name foods that increase urine acidity:
and decrease bacterial adherence to the bladder |
meats, eggs, whole-grain breads, cranberry juice
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Types of catheters:
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condom
intermittent (straight) indwelling (foley) |
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types of catheters:
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Triple Lumen (fill balloon 30 ml)
Double Lumen (fill balloon 5ml) Straight Catheter (no balloon---red/rubber) |
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Uses of Straight "intermittent" Catheter:
Lumen: |
relieves retention
obtain urine specimen check for residual single |
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Uses of Indwelling Foley Catheter:
Lumen type: Size of Lumen for female/male: |
Severe urinary retention w/UTI
Continuous drainage (irrigation) Double or Triple Lumen female: 14-16 Male: 18-20 |
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Explain ports for 2 or 3 Lumen
One lumen: Second lumen: Third Lumen: |
drains urine thu the catheter to collecting tube
carries sterile H2O to/from balloon for inflation or deflation used to instill fluids or meds into bladder |
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Coude Catheter:
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intermittent cath w/ a curved tip
male patients who have enlarged prostates that partly obstruct the urethra less traumatic b/c it's stiffer and easier to control than straight tip |
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What is the difference in steps for inserting an indwelling and single-use catheter?
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the difference lies in the procedure taken to inflate the indwelling cath balloon and secure the cath
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What type of drainage system should be in place after inserting an indwelling catheter and why?
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closed to minimize the risk of infection
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Hang urinary drainage bags from:
Never: |
bed frame or wheelchair without touching the floor
bed rails |
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For obtaining specimens on an indwelling cath never...
and obtain specimen from... |
open the drainage system
special port in the tubing |
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Never raise the drainage bag above...
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the level of the bladder
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Name the types of urinary incontinence:
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Functional (outside factors)
Stress (involuntary leakage) Urge (involuntary passage of urine) Mixed (combo of urge/stress) Reflex (Involuntary loss @ intervals) |
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Position of female and male for catheter insertion:
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female: dorsal recumbent or sims
male: supine |
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record I/O every ___ hours for catheterization
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8-12
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Removal of the indwelling catheter:
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physican order
empty collection bag deflate balloon (10 ml syringe) have the patient deep breath and gently pull catheter out clean the area increase fluid intake tell pt first voiding may burn I/O for 24 hours check bladder distention |
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Sites at risk for the introduction of microorgansims with a catheter:
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catheter insertion
drainage bag spigot tube injection junction of tube and bag |
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To maintain patency of indwelling catheters you should...
what can collect in the tubing.... |
irrigate or flush a catheter
blood, pus or sediment |
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Before you irrigate a urinary catheter you should...
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assess the catheter for blockage
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Suprapubic catheterization placement:
performed under: |
surgical placement through the abdominal wall above the symphysis pubis and into the urinary bladder
anchored in place by sutures local or general anesthesia |
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What is the maintenance of the tubing and drainage bad of the suprpubic catheter?
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The same as indwelling catheter
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How do you strengthen pelvic floor muscles?
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Kegal exercise
start and stop the stream of urine sit or stand w/out tensing muscle of legs, butt or ab contract/relax circumvaginal muscles/urinary/anal sphinctors for 3-4 seconds and repeat cycles for 10 times, 5 times/day w/ 30 sec rest in between maintenance: 1/2 sets a week |
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Kegals treats..
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incontinence, overactive bladder, mixed cause of urinary incontinence
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______ control from higher brain centers and _____ control from the spinal cord influence the act of micturition
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voluntary
involuntary |
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Symptoms common to urinary disturbances include:
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frequency, urgency, dysuria, polyuria, oliguria, incontinence, and difficulty in starting the urinary stream
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lubricate the length of the catheter tip for male and female
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male: 5-7", 12.5-17.5cm
female: 1-2", 2.5-5cm |
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when collecting urine specimen how much mls are required?
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20-30ml
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In general a 5ml balloon requires of many ml of fluid for inflation?
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10ml
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Where do you secure the tubing with a female patient?
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inner thigh w/ nonallergic tape and allow slack for movement
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Where do you secure the tubing with a male patient?
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thigh or lower abdomen w/ penis directed toward chest, allow slack for movement coiled on bed
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documenting insertion of catheter:
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type and size of catheter inserted
amount of fluid used to inflate balloon characteristics of urine amount of urine reasons for catheterization specimen collection if necessary patients response to tx teaching topics |
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Explain to the patient what they should feel during catheter insertion that is normal?
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burning/or pressure sensation
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