1. Urinary System
Ch 43

2. Vocabulary Micturation Sphincter Detrusor muscle Nephron Enuresis
Nocturia

3. Overview: Urinary System
Kidneys
Ureters
Bladder
Urethra

4. 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)

5. 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

6. Ureters
Drainage ‘tubes’ from kidneys to bladder

7. 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

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

9. 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

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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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.

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

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

20. 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

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

22. Maintaining Normal Voiding Habits
Schedule
Privacy
Position
Hygiene

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

24. 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

25. 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

26. 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

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

28. 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

29. 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