CHAPTER 22 Urinary Elimination

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 medications A diet high in salt causes the body to retain water

Urinary System 2 Kidneys 2 ureter’s bladder urethra meatus Meatus: opening to outside of the body Kidneys: 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 balance 2 uteter’s: Bladder: Urethra: from the bladder to the meatus (opening to outside of body FUNCTION: of the URINARY SYSTEM is to maintain fluid balance and maintain electrolyte balance.

1. Normal characteristics of urine: Output 1500 mL urine daily Normal color of urine is: amber Clear with no particles Has a faint odor Urination, micturition, voiding: all mean emptying the bladder Changes with aging: Kidney function decreases Bladder weakens and decreases with size Incontinence Risk for UTI

2. Observe urine for: Color Clarity Odor Amount Particles Report changes to the nurse: Urgency & frequency Foul odor Incontinence Pain (dysuria) or burning on urination Decrease or No urine output

3. Rules for Elimination Box 22-1 pg 334 Privacy Safety Peri-care Allow enough time Medical asepsis Follow persons habits

4. Abnormal Urinary Problems: Table 22-1 pg 335 Anuria: no urine (kidney failure) Polyuria: 3000 mL per day Dysuria: difficulty or painful urinating Hematuria: blood in the urine Nocturia: Urinating during the night Urinary Incontinence: Not being able to control bladder function

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 Page 335-337 Bedpan: Bedpan is used when a person cannot get out of bed. Person will use bedpans for bowel movements Fracture 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 bathroom d. Urine Hat: Placed in the toilet for measuring urine e. Documenting output – Graphic Sheet form Types of Measuring containers: Down drain catheter Urinal Commode Specimen pan/hat Estimating when incontinent g. Clean EQUIPMENT: wash out and clean – swish and dump into the toilet – then use disinfectant

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 control Urge Incontinence: Urine is lost in response to a sudden, urgent need to void. Stress Incontinence: Urine leaks during exercise, sneezing, laughing, coughing and lifting Usually 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.

Prevention of Incontinence: Box 22-2 Nursing measures or persons with urinary incontinence Kaegal exercises (10rep X 10) each day Bowel and bladder training program (goal: to get voluntary control of urination) For the person to use the toilet at certain times of the day Force fluids Call light within reach Be patient Use incontinent pads and briefs Needs 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 343 Promote fluid intake Have person wear cotton underwear Keep perineal area clean and dry

7. CATHETERS: a tube used to drain urine from the bladder * Catheter’s NEVER TREAT incontinence * Increases risks of infection in the urine A. Types of catheters: Straight Catheter: drains the bladder and is removed a. used for: sterile specimens, residual urine, pre-op and post-op, Spina bifida and paraplegics Foley Catheter: (indwelling catheter) is left in the bladder a. used for: post-op, acute illness Condom (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, quadraplgics Suprapubic 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

B. Care of Catheters Box 22-3 pg 345 1. Catheters must be below the bladder at all times and tubing over the leg 2. Catheter bag is hung on the bed frame never to the side rail or on the floor 3. Change down drain bag to leg bag when ambulating or going outside 4. Urine catheter bags are emptied 1. end of shift 2. changing from leg bag to drainage bag 3. when full 5. Catheter care is done: BID and PRN, clean from the meatus to 4-6 inches down the tube. 6. No tension on meatus 7. No Kinks in tubing

C. Emptying catheter bag 1. Collect equipment and gloves 2. Clean tip with alcohol pad 3. Tube should not touch side of graduate 4. Clean tip with alcohol pad 5. Re-clamp and reinsert into storage sheath D. Measuring Output 1. Place on flat surface to measure at flat surface 2. Dispose of properly in toilet, rinse and dry container

8. Chapter 33 pg 503-510 A. COLLECT SPECIMEN Wear gloves Use a clean container – do not touch the inside of the container or lid Label 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 location The specimen must not contain feces or toilet paper

B. TYPES OF SPECIMENS: Random: collected at anytime. No special measures are taken Clean catch (midstream): A. perineal care is done before collecting specimen B. Have person start to void in toilet C. Stop voiding D. Finish voiding in the container 24 hour urine specimen: all urine voided during a 24 hour period is collected. A. Initial voiding is discarded and the clock is started B. Collect all urine for the next 24 hours C. Store urine collection per laboratory instructions D. Document every void **Always report to nurse abnormalities or urine like: color, odor, clarity, amount & particles**

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 magnesium Risk factors: male 20-40 yrs old, Caucasian D. Terms: - Cystitis: inflammation of the bladder, called bladder infection Dialysis: 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