2 The healthy adult produces 1500 mL of urine per day Urination & micturition & voiding…all mean to empty urine from the bladder.Some substances increase urine production like coffee, tea, caffeine, alcohol and some medicationsA diet high in salt causes the body to retain water
3 Urinary System2 Kidneys ureter’s bladder urethra meatusMeatus: opening to outside of the bodyKidneys: made up of million tiny nephron’s. Nephron’s are the working unit of the kidney. Blood passes through the kidney’s and the nephron’s then urine is formed.Kidneys remove waste from the blood and maintain the body’s water balance2 uteter’s:Bladder:Urethra: from the bladder to the meatus (opening to outside of bodyFUNCTION: of the URINARY SYSTEM is to maintain fluid balance and maintain electrolyte balance.
4 1. Normal characteristics of urine: Output 1500 mL urine dailyNormal color of urine is: amberClear with no particlesHas a faint odorUrination, micturition, voiding: all mean emptying the bladderChanges with aging:Kidney function decreasesBladder weakens and decreases with sizeIncontinenceRisk for UTI
5 2. Observe urine for: Color Clarity Odor Amount Particles Report changes to the nurse:Urgency & frequencyFoul odorIncontinencePain (dysuria) or burning on urinationDecrease or No urine output
7 4. Abnormal Urinary Problems: Table 22-1 pg 335 Anuria: no urine (kidney failure)Polyuria: 3000 mL per dayDysuria: difficulty or painful urinatingHematuria: blood in the urineNocturia: Urinating during the nightUrinary Incontinence: Not being able to control bladder function
8 5. Urination devices or equipment You store urination devices in the bottom of the bed stand or bottom drawer:Bedpans: Fracture pan and regular bedpan PageBedpan: Bedpan is used when a person cannot get out of bed. Person will use bedpans for bowel movementsFracture pan: Thinner rim and only ½ inch deep. Smaller end is placed under the buttock. Used for persons with casts, traction, fragile bones from osteoporosis, arthritis, hip replacement. The fracture pan is more comfortable for older people and women.b. Urinal: men can sit or stand. Hook the urinal to bedrail so he can reach it.- remind men to hang urinals on bedrails and to signal when he is done.c. Commodes: For people who cannot walk to the bathroomd. Urine Hat: Placed in the toilet for measuring urinee. Documenting output – Graphic Sheet formTypes of Measuring containers:Down drain catheterUrinalCommodeSpecimen pan/hatEstimating when incontinentg. Clean EQUIPMENT: wash out and clean – swish and dump into the toilet – then use disinfectant
9 6. Elimination Considerations: A. INCONTINENCE: is the involuntary loss of urine from the bladder. Can be temporary or permanent. It is common in older people.REMEMBER, Incontinence is beyond the person’s controlUrge Incontinence: Urine is lost in response to a sudden, urgent need to void.Stress Incontinence: Urine leaks during exercise, sneezing, laughing, coughing and liftingUsually their self esteem is affected. Garments get wet and odor develops. Skin irritation, infections, and pressure sores can develop if not taken care of immediately.
10 Prevention of Incontinence: Box 22-2 Nursing measures or persons with urinary incontinenceKaegal exercises (10rep X 10) each dayBowel and bladder training program (goal: to get voluntary control of urination) For the person to use the toilet at certain times of the dayForce fluidsCall light within reachBe patientUse incontinent pads and briefsNeeds good skin care (peri-care)B. Urinary Tract Infection: An infection in the bladder caused by the invasion of disease causing micro-organisms (pathogens)Prevent a UTI box 22-2 pg 343Promote fluid intakeHave person wear cotton underwearKeep perineal area clean and dry
11 7. CATHETERS: a tube used to drain urine from the bladder * Catheter’s NEVER TREAT incontinence* Increases risks of infection in the urineA. Types of catheters:Straight Catheter: drains the bladder and is removeda. used for: sterile specimens, residual urine, pre-op and post-op, Spina bifida and paraplegicsFoley Catheter: (indwelling catheter) is left in the bladdera. used for: post-op, acute illnessCondom (external) catheter: males only, applied daily, use elastic tape because it expands when the penis changes size. *NEVER USE ADHESIVE TAPE.a. used for prostate issues, quadraplgicsSuprapubic catheter: inserted into the bladder through a cut in the stomach. Maybe chosen because more comfortable and causes less infection.a. Used for chronic conditions, paraplegics
12 B. Care of Catheters Box 22-3 pg 345 1. Catheters must be below the bladder at all times and tubing over the leg2. Catheter bag is hung on the bed frame never to the side rail or on the floor3. Change down drain bag to leg bag when ambulating or going outside4. Urine catheter bags are emptied1. end of shift 2. changing from leg bag to drainage bag 3. when full5. Catheter care is done: BID and PRN, clean from the meatus to 4-6 inches down the tube.6. No tension on meatus7. No Kinks in tubing
13 C. Emptying catheter bag 1. Collect equipment and gloves2. Clean tip with alcohol pad3. Tube should not touch side of graduate4. Clean tip with alcohol pad5. Re-clamp and reinsert into storage sheathD. Measuring Output1. Place on flat surface to measure at flat surface2. Dispose of properly in toilet, rinse and dry container
14 8. Chapter 33 pg 503-510 A. COLLECT SPECIMEN Wear gloves Use a clean container – do not touch the inside of the container or lidLabel it: with –Pt Name –DOB –Date –Time –Type of specimen. Label goes on the container not on the lid.Place specimen in to transport bag, wash hands and take to designated locationThe specimen must not contain feces or toilet paper
15 B. TYPES OF SPECIMENS:Random: collected at anytime. No special measures are takenClean catch (midstream):A. perineal care is done before collecting specimenB. Have person start to void in toiletC. Stop voidingD. Finish voiding in the container24 hour urine specimen: all urine voided during a 24 hour period is collected.A. Initial voiding is discarded and the clock is startedB. Collect all urine for the next 24 hoursC. Store urine collection per laboratory instructionsD. Document every void**Always report to nurse abnormalities or urine like: color, odor, clarity, amount & particles**
16 C. Kidney Stones: Calculi, they develop in the kidney, C. Kidney Stones: Calculi, they develop in the kidney, ureter’s or bladder. They vary in size. All urine is strained. Any stones are sent to the lab.S/S: hematuria, acute pain, very painful in the back area and when urinating.Tx: Force fluids and may need surgery.Causes: genetic or too much calcium or magnesiumRisk factors: male yrs old, CaucasianD. Terms:- Cystitis: inflammation of the bladder, called bladder infectionDialysis: procedure that is done to remove waste products from the body when the kidneys fail. This is done with a dialysis machine.Kidney Failure: loss of the kidney’s ability to excrete wastes, concentrate urine, and conserve electrolytes