1. Urinary Elimination

2. 1. Kidneys 2. Ureters 3. Bladder 4. Urethra

3.  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

4.  Urine: clear, yellow, aromatic, without pathogens or parasites  Specific Gravity: 1.025 (concentrate urine) ◦ Increases with dehydration ◦ Decreases with increased fluid intake

5. ◦ Protein: renal disease ◦ Glucose: elevated BS; diabetes ◦ Ketones: CHO metabolism ◦ Bilirubin: liver disease ◦ Nitrates: bacteria ◦ Leukocyte : bacteria, parasitic, nephritis

6. Hematological BUN 8-16 mg/dl (end product protein metabolism) Creatinine 0.6-1.2mg/dl (muscle metabolism of creatin)  Increased: renal failure, infection, obstruction, dehydration, increase protein intake.

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

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

9.  Diuretics — prevent reabsorption of water and certain electrolytes in tubules  Analgesics and tranquilizers — suppress CNS diminish effectiveness of neural reflex

10. 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

11.  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

12.  Nursing history ◦ Pattern of urination ◦ Symptoms of alterations ◦ Factors affecting urination

13.  Physical assessment ◦ Skin and mucous membranes ◦ Kidneys ◦ Bladder ◦ Urethral meatus

14.  Assessment of urine ◦ Intake and output ◦ Characteristics: color, clarity, odor ◦ Urine testing: specimen collection

15.  Common urine tests ◦ Urinalysis ◦ Specific gravity ◦ Culture  Diagnostic examinations ◦ Consents ◦ Allergies ◦ Pre- and post-procedure interventions

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

17.  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

18.  Client education  Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake  Promoting complete bladder emptying  Preventing infection: hygiene and acidifying urine

19.  Maintaining elimination habits  Medications  Urethral catheterization  Alternatives to urethral catheterization: suprapubic catheters, condom catheters

20.  Types  Insertion  Drainage systems  Routine care: hygiene, fluids  Prevention of infection  Irrigations and instillations  Removal

21.  Strengthening pelvic floor muscles  Bladder retraining  Habit training  Self-catheterization  Maintenance of skin integrity  Promotion of comfort

22.  Client care  Client expectations

23.  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.

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

25.  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

26.  Sexually active women  Postmenopausal women  Individuals with indwelling urinary catheter  Individual with diabetes mellitus  Elderly people

27. 1. Stress — increase in intra abdominal pressure 2. Urge — urine lost during abrupt and strong desire to void 3. Mixed — symptoms of urge and stress 4. Overflow — over distention and over flow of bladder 5. Functional — caused by factors outside the urinary tract

28.  UTI.  Sepsis.  Trauma- specially in men.  DO NOT USE FORCE!  USE STERILE ASEPTIC TECHNIQUE!

29.  Relieving urinary retention.  Obtaining a sterile urine specimen..  Emptying the bladder ◦ Before, during, after surgery or diagnostic procedures.  Monitoring of critically ill patients.

30. 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.

31. The end