Anatomy and physiology of elimination system With nursing diagnosis and assessment of the organs of urinary sydtem

1. COLLEGE OF NURSING J.P.M.C
KARACHI
Subject : ACN 1
Topic : Urinary Elimination pattern
Teacher: Zahid Ali phulpoto
Date:

2. OBJECTIVE
• At the end of this lecture student will be able to
describe
• Anatomy and physiology of Urinary system
• Terminologies related to urinary system
• Factor effecting urination
• Use nursing process to evaluate urinary problem
• Urinary incontinence, its types and its management
• Kegal excercise

4. Urinary System
• Kidneys filter nitrogen, metabolic wastes,
excess ions and water
• Urine produced at a rate of 60 mL/hour
• Bladder stores average 500 mL or more
Void: detrusor muscle contracts and urine is
pushed through internal urethral sphincter
into urethra

5. Urinalysis
• Urine: clear, yellow, aromatic, without
pathogens or parasites
• Specific Gravity: 1.025 (concentrate urine)
– Increases with dehydration
– Decreases with increased fluid intake

6. Urinalysis
• Abnormal
– Protein: renal disease, 2nd to exercise and stress
– Glucose: elevated BS; diabetes
– Ketones: CHO metabolism
• Diabetes, fever, fasting, starvation, high protein intake, vomiting, post-
op
– Hemoglobin: UTI, nephritis, trauma, lithiasis, hemolytic rx
– Bilirubin: liver disease
– Urobilinogem: cirrhosis, heart failure, pernicious anemia,
mono
– Nitrates: bacteria
– Leukocyte esterase: bacteria, fungal, parasitic, tumor,
nephritis

7. Altered urine production and elimination
• 1- Hematuria: red blood cell in the urine.
• 2- Dysuria: painful or difficult urination.
• 3- Anuria: total urine out put less than 50 ml in 24 hr.
• 4- Oliguria: total urine out put less than 500 ml in 24 hr.
• 5- Urinary frequency; is voiding at frequent intervals, that is
more than usual.
• 6- Urgency: is sudden strong desire to void.

8. Factor affecting voiding
• Developmental factor: Infant may urinate 20 times a day. The
output decreased at older people according to the decrease of
renal function.
• Fluid and food intake: the healthy body maintains a balance
between the amount of fluid ingested and the amount of fluid
eliminated. Some foods and fluid change in urine color.
• Medications: diuretics increase urine formation.
• Pathologic conditions: such as kidney or heart disorders.
• Psychosocial factors: such as not suitable time or place.

9. Effects of Medications on Urine
Production and Elimination
• Diuretics — prevent
reabsorption of water
and certain electrolytes
in tubules
• Cholingeric medications
— stimulate contraction
of detrusor muscle,
producing urination
• Analgesics and
tranquilizers —
suppress CNS diminish
effectiveness of neural
reflex

11. Assessment
A complete assessment of the patient's urinary
function include:
• Nursing history: normal voiding pattern and
frequency, appearance of urine and any recent
changes, habits of diet and fluid intake.
• Physical examination of the genitourinary system,
hydration status, and examination of the urine:

12. Physical Assessment of
Urinary Functioning
• Kidneys — check for
costovertebral
tenderness
• Urinary bladder —
palpate and percuss the
bladder or use bedside
scanner
• Urethral meatus —
inspect for signs of
infection, discharge, or
odor
• Skin — assess for color,
texture, turgor, and
excretion of wastes
• Urine — assess for
color, odor, clarity, and
sediment

13. Assessment
• Measuring urinary output normally, the kidney
produce urine at a rate of approximately 60 mL per
hr or about 1500 ml per day, urine out put below 30
ml/hr indicate kidney malfunction.

14. Measuring Urine Output
• Ask client to void into
bedpan, urinal, or
specimen container in
bed or bathroom.
• Pour urine into
appropriate measuring
device.
• Place calibrated
container on flat
surface and read at eye
level.
• Note amount of urine
voided and record on
appropriate form.
• Discard urine in toilet
unless specimen is
needed.

15. Diagnostic tests: blood urea nitrogen,
creatinine and urine analysis.
• Routine urinalysis
• Specimens from infants and children
• Clean-catch or midstream specimens
• Sterile specimens from indwelling catheter
• 24-hour urine specimen

16. Diagnosis
– Impaired urinary elimination.
– Functional urinary incontinence.
Planning:
• Maintain or restore normal voiding pattern

17. Promoting Urination
• Maintaining voiding habits
• Promoting fluid intake
• Strengthening muscle tone
– Kegel Exercises (PFME) to Tx stress, urge mixed
– Imagine voiding, stop flow, tighten rectal muscles
– Hold 5-10sec and rest 5-10sec
– Daily 40-60 PFME doing 2-4 sets of 15 each time

18. Client’s at Risk for UTIs
• Sexually active women
• Postmenopausal women
• Individuals with indwelling urinary catheter
• Individual with diabetes mellitus
• Elderly people

19. URINARY INCONTINENCE
• Urinary incontinence is the involuntary
leakage of urine; in simple terms, to wee
when you don't intend to. It is the inability to
hold urine in the bladder because voluntary
control over the urinary sphincter is either
lost or weakened. Urinary incontinence is a
much more common problem than most
people realize.Sep 9, 2015

20. Four Types of Urinary Incontinence
• Stress — increase in intraabdominal pressure
• Urge — urine lost during abrupt and strong desire
to void
• Mixed — symptoms of urge and stress
incontinence present
• Overflow — overdistention and overflow of
bladder
• Functional — caused by factors outside the
urinary tract

21. Client Education for Urinary Diversion
• Explain reason for diversion and rationale for
treatment
• Demonstrate effective self-care behaviors
• Describe follow-up care and support resources
• Report where supplies may be obtained in
community
• Verbalize related fears and concerns
• Demonstrate a positive body image

22. Evaluating Effectiveness of Plan
• Maintain fluid, electrolyte, and acid-base
balance
• Empty bladder completely at regular intervals
with no discomfort
• Provide care for urinary diversion and when to
notify physician
• Develop a plan to modify factors contributing to
problem
• Correct unhealthy urinary habits

23. Reasons for Catheterization
• Relieving urinary retention.
• Obtaining a sterile urine specimen..
• Emptying the bladder
– before,
– during,
– after surgery or diagnostic procedures.
• Monitoring of critically ill patients.

24. Urinary Diversions
• Ureterostomy
– Bladder is removed
– One or both ureters redirected from kidney
through the abdominal wall
– Ilea Conduit
– Bladder removed and small intestine (ileum) used
as conduit between ureters and skin surface.
Urine collects continuously

25. Kegal exercise
• Kegel exercises strengthen the pelvic floor
muscles, which support the uterus, bladder,
small intestine and rectum. You can do Kegel
exercises, also known as pelvic floor muscle
training, just about anytime.

26. Why Kegel exercises matter
• Many factors can weaken your pelvic floor muscles,
including pregnancy, childbirth, surgery, aging,
excessive straining from constipation or chronic
coughing, and being overweight.
• You might benefit from doing Kegel exercises if you:
• Leak a few drops of urine while sneezing, laughing
or coughing (stress incontinence)
• Have a strong, sudden urge to urinate just before
losing a large amount of urine (urinary
incontinence)

27. con
• Leak stool (fecal incontinence)
• Kegel exercises can be done during pregnancy or
after childbirth to try to prevent urinary
incontinence.
• Keep in mind that Kegel exercises are less helpful
for women who have severe urine leakage when
they sneeze, cough or laugh. Also, Kegel exercises
aren't helpful for women who unexpectedly leak
small amounts of urine due to a full bladder
(overflow incontinence).

28. Kegal exercise (muscle strenthing)
• Find the right muscles. To identify your pelvic
floor muscles, stop urination in midstream or
tighten the muscles that keep you from passing
gas. These maneuvers use your pelvic floor
muscles. Once you've identified your pelvic floor
muscles, you can do the exercises in any position,
although you might find it easiest to do them
lying down at first.
• Perfect your technique. Tighten your pelvic floor
muscles, hold the contraction for three seconds,
and then relax for three

29. con
• seconds, and then relax for three seconds. Try
it a few times in a row. When your muscles get
stronger, try doing Kegel exercises while
sitting, standing or walking.
• Maintain your focus. For best results, focus on
tightening only your pelvic floor muscles. Be
careful not to flex the muscles in your
abdomen, thighs or buttocks. Avoid holding

30. con
• Avoid holding your breath. Instead, breathe
freely during the exercises.
• Repeat 3 times a day. Aim for at least three
sets of 10 repetitions a day.
• Don't make a habit of using Kegel exercises to
start and stop your urine stream. Some
doctors think this could cause a bladder
infection

31. SUMMERY
• Urinary system is part for the removal of waist
products from body via urine Urine produced at a
rate of 60 mL/hour
• Bladder stores average 500 mL
• Age, medication ,psychology ,and fluid intake
affect the urination some medication also effect
urine Oder and color
• Urinary incontinence is problem for many people
we must manage this problem ,promte snce off
well being

32. con
• Lab test helps us to diagnose patient and treat
them accordingly
• Kegal exercises help to strengthen the pelvic
muscle and improve urination process

33. REFFERENCES
• C. Dugdale, David (16 September 2011). "Female urinary
tract". MedLine Plus Medical Encyclopedia.
• Jump up^ Maton, Anthea; Jean Hopkins; Charles William
McLaughlin; Susan Johnson; Maryanna Quon Warner;
David LaHart; Jill D. Wright (1993). Human Biology and
Health. Englewood Cliffs, New Jersey, USA: Prentice
Hall. ISBN 0-13-981176-1.
• Jump up^ Caldwell HK, Young WS III (2006). "Oxytocin
and Vasopressin: Genetics and Behavioral
Implications" (PDF). In Lajtha A, Lim R. Handbook of
Neurochemistry and Molecular Neurobiology:
Neuroactive Proteins and Peptides(3rd ed.). Berlin:
Springer. pp. 573–607. ISBN 0-387-30348-0.