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Normal intake-output (intake=2500ml.day
           output=1500ml.day)  discuss the normal amount of fluid per day – stress the need to remain hydrated especially in Florida, that older people do not drink therefore – assess, and encourage!  Discuss the type of fluids: not coffee of tea but fruit juices etc.  That the intake and output should be similar – or there is something wrong!
Urinary retention – terms?  causes? Bladder distention – how assessed?, mention that nurses hold urine and cause a possible infection with retention, it can be caused by obstructions, surgical trauma, medications, etc. bladder holds 2000cc of urine but urge to void is after 150cc or so.  If urine is retained – it can cause: urosepsis, UTIs 
Urinary incontinence – types?  Examples? Functional: involuntary-sensory deficits; Overflow: dribbling/leaking-diabetes, meds, enlarged prostate, spinal injury, uterine prolapse; Reflex: involuntary- spinal injury with spasm or unawareness; Stress: small amounts- coughing or sneezing with urgency or frequency; Urge- involuntary large amt lost – after drinking, infection or decreased bladder capacity.
Factors related to age, social, emotions, muscle,surgery, medications,disease – kids= excrete large amounts of urine but can’t control micturation, older adults=have nocturia, urinary frequency, residual urine and more infections but don’t use diapers or catheters unless a last resort!,  Social culture influences the privacy and method one may toilet.  Emotions- stress and anxiety increases frequency.  Weak muscle tone may indicate need for Kagel exercises and catheters require bladder training.  Surgery- anesthetics and narcotics affect urination (decrease it) and they may be unable to void after surgery esp. spinals! Urinary diversions result in stomas.  Meds- diuretics increase urine output – be sure they work! Pyridium=orange urine, amitriptyline=green urine, levodopa= brown urine, chemo= may change urine color too.
 
Normal intake-output (intake=2500ml.day
           output=1500ml.day)  discuss the normal amount of fluid per day – stress the need to remain hydrated especially in Florida, that older people do not drink therefore – assess, and encourage!  Discuss the type of fluids: not coffee of tea but fruit juices etc.  That the intake and output should be similar – or there is something wrong!
Urinary retention – terms?  causes? Bladder distention – how assessed?, mention that nurses hold urine and cause a possible infection with retention, it can be caused by obstructions, surgical trauma, medications, etc. bladder holds 2000cc of urine but urge to void is after 150cc or so.  If urine is retained – it can cause: urosepsis, UTIs 
Urinary incontinence – types?  Examples? Functional: involuntary-sensory deficits; Overflow: dribbling/leaking-diabetes, meds, enlarged prostate, spinal injury, uterine prolapse; Reflex: involuntary- spinal injury with spasm or unawareness; Stress: small amounts- coughing or sneezing with urgency or frequency; Urge- involuntary large amt lost – after drinking, infection or decreased bladder capacity.
Factors related to age, social, emotions, muscle,surgery, medications,disease – kids= excrete large amounts of urine but can’t control micturation, older adults=have nocturia, urinary frequency, residual urine and more infections but don’t use diapers or catheters unless a last resort!,  Social culture influences the privacy and method one may toilet.  Emotions- stress and anxiety increases frequency.  Weak muscle tone may indicate need for Kagel exercises and catheters require bladder training.  Surgery- anesthetics and narcotics affect urination (decrease it) and they may be unable to void after surgery esp. spinals! Urinary diversions result in stomas.  Meds- diuretics increase urine output – be sure they work! Pyridium=orange urine, amitriptyline=green urine, levodopa= brown urine, chemo= may change urine color too.
 
Normal intake-output (intake=2500ml.day
           output=1500ml.day)  discuss the normal amount of fluid per day – stress the need to remain hydrated especially in Florida, that older people do not drink therefore – assess, and encourage!  Discuss the type of fluids: not coffee of tea but fruit juices etc.  That the intake and output should be similar – or there is something wrong!
Urinary retention – terms?  causes? Bladder distention – how assessed?, mention that nurses hold urine and cause a possible infection with retention, it can be caused by obstructions, surgical trauma, medications, etc. bladder holds 2000cc of urine but urge to void is after 150cc or so.  If urine is retained – it can cause: urosepsis, UTIs 
Urinary incontinence – types?  Examples? Functional: involuntary-sensory deficits; Overflow: dribbling/leaking-diabetes, meds, enlarged prostate, spinal injury, uterine prolapse; Reflex: involuntary- spinal injury with spasm or unawareness; Stress: small amounts- coughing or sneezing with urgency or frequency; Urge- involuntary large amt lost – after drinking, infection or decreased bladder capacity.
Factors related to age, social, emotions, muscle,surgery, medications,disease – kids= excrete large amounts of urine but can’t control micturation, older adults=have nocturia, urinary frequency, residual urine and more infections but don’t use diapers or catheters unless a last resort!,  Social culture influences the privacy and method one may toilet.  Emotions- stress and anxiety increases frequency.  Weak muscle tone may indicate need for Kagel exercises and catheters require bladder training.  Surgery- anesthetics and narcotics affect urination (decrease it) and they may be unable to void after surgery esp. spinals! Urinary diversions result in stomas.  Meds- diuretics increase urine output – be sure they work! Pyridium=orange urine, amitriptyline=green urine, levodopa= brown urine, chemo= may change urine color too.
 
Normal intake-output (intake=2500ml.day
           output=1500ml.day)  discuss the normal amount of fluid per day – stress the need to remain hydrated especially in Florida, that older people do not drink therefore – assess, and encourage!  Discuss the type of fluids: not coffee of tea but fruit juices etc.  That the intake and output should be similar – or there is something wrong!
Urinary retention – terms?  causes? Bladder distention – how assessed?, mention that nurses hold urine and cause a possible infection with retention, it can be caused by obstructions, surgical trauma, medications, etc. bladder holds 2000cc of urine but urge to void is after 150cc or so.  If urine is retained – it can cause: urosepsis, UTIs 
Urinary incontinence – types?  Examples? Functional: involuntary-sensory deficits; Overflow: dribbling/leaking-diabetes, meds, enlarged prostate, spinal injury, uterine prolapse; Reflex: involuntary- spinal injury with spasm or unawareness; Stress: small amounts- coughing or sneezing with urgency or frequency; Urge- involuntary large amt lost – after drinking, infection or decreased bladder capacity.
Factors related to age, social, emotions, muscle,surgery, medications,disease – kids= excrete large amounts of urine but can’t control micturation, older adults=have nocturia, urinary frequency, residual urine and more infections but don’t use diapers or catheters unless a last resort!,  Social culture influences the privacy and method one may toilet.  Emotions- stress and anxiety increases frequency.  Weak muscle tone may indicate need for Kagel exercises and catheters require bladder training.  Surgery- anesthetics and narcotics affect urination (decrease it) and they may be unable to void after surgery esp. spinals! Urinary diversions result in stomas.  Meds- diuretics increase urine output – be sure they work! Pyridium=orange urine, amitriptyline=green urine, levodopa= brown urine, chemo= may change urine color too.
 
Terms used: oliguria= diminished urinary output, anuria=inability to produce urine  in ( ESRD) end-stage renal disease= no urine is produced which may result in uremic shock=increase in nitrogen wastes fluid and electrolyte imbalance and nausea, vomiting, headaches, coma and convulsions. (refer the student to page 1388 and information of dialysis – will learn about this in upper level courses)
Assess the patient – check urine output, do skin turgor tests, see med the patient is on, assess the bladder for distension, note color of urine=dark amber?, odor? Clear?, specific gravity = hi is concentrated, lo is dilute; PH = 4.6-8 is norm;
Caused by infections (bladder, kidney), calculus, tumor, not enough fluid intake, irritation to system=blood, constipation problems, pregnancy, sensory or environmental issues,chronic diseases=MS, UTI, etc. (information on urinary diversions is found on p.1392,more at upper levels)
Interventions: force fluids, warm water – perineum or hand in water, go to the bathroom when necessary, keep clean- wipe to back, give meds, avoid catheters if possible! Check prostate for problems.
Random specimen – not sterile but into a clean cup
Clean voided- used for culture and sensitivity, midstream collection after washing well
Sterile specimen- use sterile container and uses a catheter or takes from a catheter with a 3cc syringe and 25 gauge needle into the port. Need to clamp catheter first for 15 minutes to collect urine (3-5 ml of urine)
Timed specimen – 24 hr urine, discard first voided specimen and then start the collection into a container ( usually in ice bath). If one voiding is missed – start over!  Void before defecation.
Children’s – offer fluids before, use potty chair with hat, or collection device with plastic bag attached
Normal intake-output (intake=2500ml.day
           output=1500ml.day)  discuss the normal amount of fluid per day – stress the need to remain hydrated especially in Florida, that older people do not drink therefore – assess, and encourage!  Discuss the type of fluids: not coffee of tea but fruit juices etc.  That the intake and output should be similar – or there is something wrong!
Urinary retention – terms?  causes? Bladder distention – how assessed?, mention that nurses hold urine and cause a possible infection with retention, it can be caused by obstructions, surgical trauma, medications, etc. bladder holds 2000cc of urine but urge to void is after 150cc or so.  If urine is retained – it can cause: urosepsis, UTIs 
Urinary incontinence – types?  Examples? Functional: involuntary-sensory deficits; Overflow: dribbling/leaking-diabetes, meds, enlarged prostate, spinal injury, uterine prolapse; Reflex: involuntary- spinal injury with spasm or unawareness; Stress: small amounts- coughing or sneezing with urgency or frequency; Urge- involuntary large amt lost – after drinking, infection or decreased bladder capacity.
Factors related to age, social, emotions, muscle,surgery, medications,disease – kids= excrete large amounts of urine but can’t control micturation, older adults=have nocturia, urinary frequency, residual urine and more infections but don’t use diapers or catheters unless a last resort!,  Social culture influences the privacy and method one may toilet.  Emotions- stress and anxiety increases frequency.  Weak muscle tone may indicate need for Kagel exercises and catheters require bladder training.  Surgery- anesthetics and narcotics affect urination (decrease it) and they may be unable to void after surgery esp. spinals! Urinary diversions result in stomas.  Meds- diuretics increase urine output – be sure they work! Pyridium=orange urine, amitriptyline=green urine, levodopa= brown urine, chemo= may change urine color too.
 
Normal intake-output (intake=2500ml.day
           output=1500ml.day)  discuss the normal amount of fluid per day – stress the need to remain hydrated especially in Florida, that older people do not drink therefore – assess, and encourage!  Discuss the type of fluids: not coffee of tea but fruit juices etc.  That the intake and output should be similar – or there is something wrong!
Urinary retention – terms?  causes? Bladder distention – how assessed?, mention that nurses hold urine and cause a possible infection with retention, it can be caused by obstructions, surgical trauma, medications, etc. bladder holds 2000cc of urine but urge to void is after 150cc or so.  If urine is retained – it can cause: urosepsis, UTIs 
Urinary incontinence – types?  Examples? Functional: involuntary-sensory deficits; Overflow: dribbling/leaking-diabetes, meds, enlarged prostate, spinal injury, uterine prolapse; Reflex: involuntary- spinal injury with spasm or unawareness; Stress: small amounts- coughing or sneezing with urgency or frequency; Urge- involuntary large amt lost – after drinking, infection or decreased bladder capacity.
Factors related to age, social, emotions, muscle,surgery, medications,disease – kids= excrete large amounts of urine but can’t control micturation, older adults=have nocturia, urinary frequency, residual urine and more infections but don’t use diapers or catheters unless a last resort!,  Social culture influences the privacy and method one may toilet.  Emotions- stress and anxiety increases frequency.  Weak muscle tone may indicate need for Kagel exercises and catheters require bladder training.  Surgery- anesthetics and narcotics affect urination (decrease it) and they may be unable to void after surgery esp. spinals! Urinary diversions result in stomas.  Meds- diuretics increase urine output – be sure they work! Pyridium=orange urine, amitriptyline=green urine, levodopa= brown urine, chemo= may change urine color too.