Urinary System Ch 43

Vocabulary Micturation Sphincter Detrusor muscle Nephron Enuresis Nocturia

Overview: Urinary System Kidneys Ureters Bladder Urethra

Kidneys Maintain composition and volume of body fluids Filter blood constituents Eliminate what is not needed, retain those that are needed Excrete waste product (urine)

Nephrons Tiny, complex structures within the kidney Remove the end products of metabolism Regulate fluid balance Urine from the nephrons empties into the kidney pelvis

Ureters Drainage ‘tubes’ from kidneys to bladder

Bladder Smooth muscle sac Collection place for urine Composed of three layers of muscle tissue called detrusor muscle Sphincter guards opening between urinary bladder and urethra Urethra conveys urine from bladder to exterior of body

Urethra Conveys urine from the bladder to the exterior Male urethra functions excretory reproductive Female urethra is completely inside the body

Act of Micturation Process of emptying the bladder Detrusor muscle contracts, internal sphincter relaxes, urine enter posterior urethra Muscles of perineum and external sphincter relax Muscle of abdominal wall contracts slightly Diaphragm lowers, micturation occurs

Factors Affecting Micturation Developmental considerations Food and fluid intake Psychological variables Activity and muscle tone Pathologic conditions Medication

Developmental Considerations Children Toilet training 18 to 24 months, enuresis Effects of aging Nocturia, increased frequency Urine retention and stasis Voluntary control affected by physical problems

Diseases Associated With Renal Problems Congenital urinary tract abnormalities Polycystic kidney disease Urinary tract infection Urinary calculi Hypertension Diabetes mellitus Gout Connective tissue disorders

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

Medications Affecting Color of Urine Anticoagulants — red color Diuretics — lighten urine to pale yellow Pyridium — orange to orange-red urine  Hint: these are significant to remember  Elavil — green or blue-green Levodopa — brown or black

Using the Nursing Process Assess Voiding patterns Habits Past history of problems Physical examination Urinary system Skin hydration Urine Compare to results of procedures and diagnostic tests

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

Measuring Urine Output Ask patient 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.

Urine Specimens Routine urinalysis Specimens from infants and children Clean-catch or midstream specimens Sterile specimens from indwelling catheter 24-hour urine specimen

Nursing Diagnoses Urinary functioning as the problem Incontinence Pattern alteration Urinary retention Urinary functioning as the etiology Anxiety Caregiver role strain Risk for infection

Planned Patient Goals Urine output about equal to fluid intake Maintain fluid and electrolyte balance Empty bladder completely at regular intervals Report ease of voiding Maintain skin integrity

Promoting Normal Urination Maintaining normal voiding habits Promoting fluid intake Strengthening muscle tone Stimulating urination and resolving urinary retention

Maintaining Normal Voiding Habits Schedule Privacy Position Hygiene

Patients at Risk for UTIs Sexually active women Postmenopausal women Individuals with indwelling urinary catheter Individual with diabetes mellitus Elderly people

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

Factors to Consider With Use of Absorbent Products Functional disability of the patient Type and severity of incontinence Gender Availability of caregivers Failure with previous treatment programs Patient preference

Reasons for Catheterization Relieving urinary retention Obtaining a sterile urine specimen Measuring amount of PVR (post-void retained) urine in bladder (understand this) Obtaining a urine specimen (sterile) Emptying bladder before during or after surgery Monitoring of critically ill patients

Catheterization THE most common cause of nosocomial infection Maintain strict sterile technique when inserting a catheter

Patient 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

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