Urinary Elimination
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Urinary Elimination






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Urinary Elimination Urinary Elimination Presentation Transcript

    • Ma. Tosca Cybil A. Torres, RN, MAN
  • Pretest:
    • The urinary system consists of organs that produce and excrete urine from the body.
    • Urine contains waste: mostly excess water, salts and nitrogen compounds.
    • Primary organs are the kidneys
    • Normal adult bladder can store up to .5 liters.
    • Also responsible for regulating blood volume and blood pressure.
    • Regulates electrolytes.
  • Organs of the Urinary System
    • The components of the urinary system include :
    • the kidneys
    • the ureters
    • the urinary bladder
    • the urethra.
  • Kidneys
    • The kidneys are bean-shaped organs located at the back of the abdominal cavity.
    • They lie on either side of the spinal column.
    • This area is known as the flank area and is against the muscles of the back.
    • The external kidney has a notch at the concave border known as the hilum.
    • The hilum is the entrance for renal artery, veins, nerves and lymphatic vessels.
  • Internal Structure of the Kidney
    • The cortex is the outer layer; arteries, veins, convoluted tubes and glomerular capsules
    • The medulla is the inner layer; renal pyramids
  • Nephrons
    • 1 million nephrons
    • The functional unit of the kidney
    • Remove waste products of metabolism from the blood plasma.
    • Waste products are urea, uric acid, creatinine, sodium, potassium chloride and ketone bodies.
  • Urine formation:
  • Ureters, bladder and urethra
    • Ureters -tubes that carry newly formed urine from the bladder to the kidneys.
    • Bladder -muscular sac that serves as a reservoir for urine; bladder stretches to accommodate urine.
    • Urethra - tube extends from the bladder to the external opening of the urinary system, the urinary meatus
  • Urine
    • The formation of urine has 3 processes, filtration, reabsorption and tubular secretion.
    • Urine consists of 95% water and 5% solid substances.
    • The need to urinate is usually felt at 300-350ml of urine in the bladder.
    • Typically 1000-1500 mL is voided daily.
  • Physical Characteristics of Urine
    • Odor
      • Fresh urine is slightly aromatic
      • Standing urine develops an ammonia odor
      • Some drugs and vegetables (asparagus) alter the usual odor
  • Physical Characteristics of Urine
    • pH
      • Slightly acidic (pH 6) with a range of 4.5 to 8.0
      • Diet can alter pH
    • Specific gravity
      • Ranges from 1.010 to 1.025
      • Dependent on solute concentration
  • Chemical Characteristics of Urine
    • Urine is 95% water and 5% solutes
    • Nitrogenous wastes (organic solutes) include urea, ammonia, uric acid, and creatinine
    • Other normal solutes include:
      • Sodium, potassium, phosphate, and sulfate ions
      • Calcium, magnesium, and bicarbonate ions
    • NaCl is the most abundant inorganic salt in the urine.
    • Urea is the chief organic solute.
    • Abnormally high concentrations of any urinary constituents may indicate pathology
    • Disease states alter urine composition dramatically
  • Lifespan considerations
    • Child
    • At 10 weeks gestation the kidney begin to form
    • Newborns kidneys are not able to concentrate urine
    • Kidneys are more susceptible to trauma
    • Diapers- more susceptible to UTI
    • Older Adult
    • Kidney lose mass and the blood vessels degenerate
    • Kidneys lose their ability to filter
    • Dehydration can happen more quickly
    • Electrolyte balance happens more quickly
    • Loss of muscles tome in urinary structures
    • Decreased bladder capacity
  • Urination
    • Micturation, voiding, and urination all refer to the process of emptying the urinary bladder
    • Stretch receptors- special sensory nerve endings in the bladder wall that is stimulated when pressure is felt from the collection of urine
      • Adult: 250-450mL of urine
      • Children: 50-200mL of urine
  • Factors affecting voiding
    • Growth and development
    • Psychosocial factors
    • Fluid and food intake
    • Medications
    • Muscle tone and activity
    • Pathologic conditions
    • Surgical and diagnostic procedures
  • Altered Urine Production
    • Polyuria- a.k.a. diuresis
      • production of abnormally large amounts of urine by the kidneys
      • 2500mL/day for adults
      • Causes:
        • Excessive fluid intake
        • Intake of alcohol and caffeine
        • Diabetes mellitus
        • Hormone imbalances
        • CKD
      • Other signs associated with diuresis: polydipsia, dehydration and weight loss
  • Oliguria
    • Voiding scant amounts of urine
    • Less than 500mL/day
    • Anuria
    • Voiding less than 100mL/day
    • May result from low fluid intake, kidney disease, severe heart failure, burns and shock
    • Usually accompanied by fever and heavy respiration
  • Altered urinary Elimination
    • Frequency - voiding at frequent intervals that is more often than usual.
    • Total amount of urine voided may be normal but amount of each voiding are small---50-100mL
    • May result from increased fluid intake, cystitis, stress, or pressure on the bladder
    • Nocturia or nycturia- increased frequency at night that is not a result of an increased fluid intake
    • Expressed in terms number of times the person gets out of bed to void
  • Altered urinary Elimination
    • Urgency- feeling that the person must void.
    • Usually accompanies psychologic stress, and irritation of the urethra
    • Common in young children who have poor external sphincter control
    • Dysuria- voiding that is either painful or difficult
    • May result from stricture of the urethra, urinary infections, injury to the bladder and/ or the urethra.
    • Described as a burning sensation during voiding
    • Burning during micturation if often due to an irritated urethra. Burning following urination may be a result of bladder infection
    • Often associated with urinary hesitancy (delay and difficulty in initiating voiding)
  • Altered urinary Elimination
    • Enuresis - repeated involuntary urination in children beyond the age when voluntary bladder control in normally acquired (4-5yrs)
    • Urinary incontinence- is considered a symptom, not a disease.
    • Types:
    • Functional incontinence- involuntary unpredictable passage of urine
    • Reflex incontinence- involuntary loss of urine occurring at somewhat predictable intervals when a specific bladder volume is reached.
    • Stress incontinence- loss of urine of less than 50cc occurring with increased intra-abdominal pressure
    • Total incontinence- continuous and unpredictable loss of urine.
    • Urge incontinence- involuntary passage of urine occuring soon after a strong sense of urgency to void.
    • * urinary retention with overflow- dribbling incontinence that results when the bladder is greatly distended with urine because of an obstruction
    • Neurogenic bladder- describes any voiding problem related to neurologic impairment or dysfunction.
    Altered urinary Elimination
  • Altered urinary Elimination
    • Urinary retention- accumulation of urine in the bladder (as much as 3L) with associated inability of the bladder to empty itself.
    • Adult- can hold 250-450ml of urine in the bladder before micturation reflex in triggered.
    • Prolonged retention leads to stasis (slowing of the flow of urine) and stagnation of urine which increases the possibility of UTI.
    • Retention if distinguished from oliguria or anuria by the distention of the bladder.
    • Characterized by small, frequent voiding or absence of urine output
  • Assessment
    • Nursing history
    • Data about voiding patterns and habits, any problems voiding, and past or present problems involving the urinary system
    • Data about any problems that may affect urination
  • Collecting urine specimens
    • Clean catch or midstream specimens must be free as possible from external contamination by MO near the urethral opening.
    • About 120ml of urine is generally required for examination.
    • General guidelines:
    • The specimen must be free of fecal contamination
    • Female clients should discard toilet tissue in the toilet or trash bins rather than in the bedpan
    • Put lid tightly on the container to prevent spillage of the urine and contamination of other objects
    • If the outside of the container has been contaminated, clean it with a disinfectant.
  • Collecting a Timed Urine Specimen
    • May short periods (1-2hrs) or long periods (12-24hrs)
    • Steps:
    • Place alert signs about the specimen collection at the client’s bedside or bathroom
    • Label specimen containers to include date and time of each voiding as well as the usual client ID data. Containers may be numbered sequentially
    • Explain to the client the purpose of the test, when it begins, or what to do with it.
  • Measuring Residual Urine
    • residual urine- urine remaining in the bladder following the voiding
    • Purposes of measuring residual urine:
    • To determine the degree to which the bladder is emptying
    • Assess the need to establish therapy that will empty the bladder.
    • * To measure the residual urine, the nurse asks the client to void then immediately catheterizes the client.
  • Diagnostic tests
    • Urinalysis
    • Blood tests: (BUN and Creatinine clearance)
    • Cystoscopy
    • Intravenous pyelogram (IVP)/ excretory pyelogram
    • Retrograde pyelogram
    • CAT scan
    • UTZ
  • Diagnosing:
    • Possible nursing diagnoses:
    • Incontinence
      • Functional incontinence
      • Reflex incontinence
      • Stress incontinence
      • Total incontinence
      • Urge incontinence
    • Altered urinary elimination
    • Urinary retention
    • High risk for infection
    • Self-esteem disturbance
    • High risk for impaired skin integrity
    • Social isolation
    • Self care deficit: toileting
  • Implementing
    • Maintaining Normal Urinary Elimination
    • Promoting normal fluid intake
    • Maintaining normal voiding habits
      • Relaxation
        • Provide privacy
        • Allow client sufficient time to void
        • Suggest the client to read or listen to music
        • Provide sensory stimuli
        • Pour warm water over perineum or have the client sit in a warm bath to promote muscle relaxation
        • Apply hot-water bottle to the lower abdomen
        • Turn on running water within hearing distance
        • Relieve physical or emotional discomfort
      • Timing
        • Assist clients to have the urge to void immediately
        • Offer toileting assistance at usual times of voiding
      • Positioning
        • Assist client in a normal position for voiding
        • Use bedside commodes as necessary for females and urinals for males standing at bedside
        • Encourage client to push over the pubic area with hands or to lean forward
  • Managing Urinary Incontinence (UI)
    • Continence (bladder) training
    • Bladder training- requires that the client postpone voiding, resist or inhibit the sensation urgency, and void according to a timetable rather than according to the urge to void. The goal is to lengthen the intervals between urination to correct the client’s habit of frequent urination
    • Habit training- also referred to as timed voiding or scheduled toileting. There is no attempt to motivate the client to delay voiding is the urge occurs.
    • Prompt voiding- supplements the habit training by encouraging the client to use the toilet and reminding the client when to void
  • Pelvic Muscle Exercises (PME)
    • Referred to as perineal muscle tightening or Kegel’s exercises
    • Streghthen pubococcygeal muscles and can increase the incontinent female’s ability to start and stop the stream of urine
    Managing Urinary Incontinence (UI)
  • Managing Urinary Incontinence (UI)
    • Positive reinforcements
    • Maintaining skin integrity
    • Applying external urinary devices
  • Managing Urinary Retention
    • Urinary catheterization