Urinary Elimination

1.Kidneys 2.Ureters 3.Bladder 4.Urethra 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: muscle contracts and urine is pushed through internal urethral sphincter into urethra Urinary system

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

– Protein: renal disease – Glucose: elevated BS; diabetes – Ketones: CHO metabolism – Bilirubin: liver disease – Nitrates: bacteria – Leukocyte : bacteria, parasitic, nephritis Abnormal Urinalysis

Hematological BUN 8-16 mg/dl (end product protein metabolism) Creatinine mg/dl (muscle metabolism of creatin) Increased: renal failure, infection, obstruction, dehydration, increase protein intake. Hematological

1.Developmental considerations 2.Food and fluid intake 3.Psychological variables 4.Activity and muscle tone 5.Pathologic conditions 6. Medication Factors Affecting Micturition

Children – Toilet training 18 to 24 months. Effects of aging – Nocturia, increased frequency, urine retention and stasis, voluntary control affected by physical problems Developmental Considerations

Diuretics — prevent reabsorption of water and certain electrolytes in tubules Analgesics and tranquilizers — suppress CNS diminish effectiveness of neural reflex Effects of Medications on Urine Production and Elimination

1.Anticoagulants: Red color 2.Diuretics : Lighten urine to pale yellow 3.Pyridium; Orange to orange-red urine 4.Elavil : Green or blue-green 5.Levodopa : Brown or black Medications Affecting Color of Urine

Assessing data about voiding patterns, habits, past history of problems Physical examination of urinary system, skin hydration, urine Correlation of these findings with results of procedures and diagnostic tests Using the Nursing Process

Nursing history – Pattern of urination – Symptoms of alterations – Factors affecting urination Assessment of Urinary Elimination

Physical assessment – Skin and mucous membranes – Kidneys – Bladder – Urethral meatus Assessment of Urinary Elimination (cont'd)

Assessment of urine – Intake and output – Characteristics: color, clarity, odor – Urine testing: specimen collection Assessment of Urinary Elimination (cont'd)

Common urine tests – Urinalysis – Specific gravity – Culture Diagnostic examinations – Consents – Allergies – Pre- and post-procedure interventions Assessment of Urinary Elimination (cont'd)

1.Incontinence 2.Risk for infection 3.Toileting self-care deficit 4.Impaired urinary elimination 5.Urinary retention Nursing Diagnoses

Goals and outcomes – Client will void within 8 hours after catheter removal – Client’s bladder is not distended on palpation Setting priorities Continuity of care Planning

Client education Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake Promoting complete bladder emptying Preventing infection: hygiene and acidifying urine Implementation: Health Promotion

Maintaining elimination habits Medications Urethral catheterization Alternatives to urethral catheterization: suprapubic catheters, condom catheters Implementation: Acute Care

Types Insertion Drainage systems Routine care: hygiene, fluids Prevention of infection Irrigations and instillations Removal Urethral Catheterization

Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort Implementation: Restorative Care

Client care Client expectations Evaluation

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.

1.Routine urinalysis 2.Specimens from infants and children 3.Clean-catch or midstream specimens 4.Sterile specimens from indwelling catheter 5.24-hour urine specimen Urine Specimens

Maintaining voiding habits Promoting fluid intake Strengthening muscle tone – Kegel Exercises. – Imagine voiding, stop flow, tighten rectal muscles.Hold 5-10sec and rest 5-10sec Promoting Urination

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

Hazards of Catheterization 1.UTI. 2.Sepsis. 3.Trauma- specially in men. 4. Do not use force! 5.Use sterile aseptic technique!

1.Relieving urinary retention. 2.Obtaining a sterile urine specimen.. 3.Emptying the bladder 1. Before, during, after surgery or diagnostic procedures. 4.Monitoring of critically ill patients. Reasons for Catheterization

1.Indwelling catheter – remains in place for continuous drainage. 2.Intermittent catheter – used to drain bladder for short periods of time. 3.Suprapubic catheter – Inserted surgically above the pubic bone for continuous drainage. Types of Catheters

The end