1. King Saud University College of Nursing Fundamentals of Nursing URINARY ELIMINATION

2. Urinary Elimination  Urinary Elimination is a basic function of the kidneys, whereby the waste products are excreted (urea, ammonia, creatinine, and uric acid).  Urine consists of organic solutes such as urea, ammonia, creatinine, and uric acid  Inorganic solutes include sodium, chloride, potassium sulfate, magnesium, & phosphorus  Urination, micturation, and voiding are terms describe the process of urine elimination from the urinary bladder.

3. Urinary System  Kidneys  ureters  Bladder  Urethra

4. Kidneys and Ureters  Maintain composition and volume of body fluids  Filter and excrete blood constituents not needed, retain those that are needed  Loop of Henle –Solutes such as glucose reabsorbed here –Other substances secreted  Nephrons (functional unit of the kidney) remove the end products of metabolism and regulate fluid balance  Urine from the nephrons empties into the renal pelvis  ureters  bladder.

5. Bladder  Bladder is a hollow, muscular organ that serves as a reservoir for urine and as the organ of excretion.  Composed of three layers of muscle tissue called detrusor muscle.  Detrusor muscle allows the bladder to expand as it fills with urine, and to contract to release urine.  Sphincter guards the opening between urinary bladder and urethra.  Normal bladder capacity is between 300-600 ml of urine.

6. Urethra  The urethra extends from the bladder to the urinary meatus (opening).  Serves as a passageway of urine from the bladder to the exterior of the body.  Male urethra is about 20 cm long and serves as a passageway of semen as well as urine.  Female urethra is about 3-4 cm, that’s why women are particularly prone to urinary tract infections.

7. Process of Micturation  Process of emptying the bladder  Urine collects in the bladder until the pressure stimulates the nerve endings in the bladder wall called (strech receptors).  This occurs when the adult bladder contains about 250-450 ml of urine, while in children, this can occur at a smaller volumes (50-200) ml.  Those receptors transmit impulses to the spinal cord causing the internal sphincter of the bladder to relax and stimulate the urge to urinate.

8. Factors Affecting voiding 1.Developmental considerations 2.Food and fluid intake 3.Psychological factors 4. Muscle tone 5.Pathologic conditions 6.Medications

9. Developmental Considerations  Children –Toilet training can start at the age of 2 years. –Nocturnal enuresis or bed wetting, is the involuntary passing of urine during sleep.  Effects of aging –Nocturia, increased frequency, urine retention and stasis, voluntary control affected by physical problems. (bladder muscle tone and contractility diminish).

10. Diseases Associated With Renal Problems  Congenital urinary tract abnormalities  Polycystic kidney disease  Urinary tract infection  Urinary calculi  Hypertension  Diabetes mellitus  Prostate hypertrophy

11. Alteration of the urinary patterns  Altered urine production:  Altered urine production: Adult urine output is about 1500 ml per day a- Oliguria: low urine output (less than 30 ml/hr) a- Oliguria: low urine output (less than 30 ml/hr) b- Anuria: lack of urine production. b- Anuria: lack of urine production. c- Polyuria: large amount of urine. c- Polyuria: large amount of urine.

12. Alteration of the urinary patterns  Altered Urinary Elimination: a- Urinary Frequency: a- Urinary Frequency: - Voiding at frequent intervals that is more than usual. - Voiding at frequent intervals that is more than usual. - Caused by: Increase fluid intake, stress, UTI, pregnancy - Caused by: Increase fluid intake, stress, UTI, pregnancy b- Nocturia : Frequent voiding at night. b- Nocturia : Frequent voiding at night. c- Urinary Incontinence: inability to control urination. (involuntary urination) c- Urinary Incontinence: inability to control urination. (involuntary urination) d- Urinary Retention: impaired emptying the bladder d- Urinary Retention: impaired emptying the bladder e- Dysuria : means that voiding is either painful or difficult. e- Dysuria : means that voiding is either painful or difficult. f- Urgency : is the sudden strong desire to void e.g. with stress. f- Urgency : is the sudden strong desire to void e.g. with stress.

13. Nursing Assessment of Urinary Function  Nursing history  Physical assessment of urinary system  Hydration status  Examination of urine  Data from diagnostic tests and procedures

14. Copyright 2008 by Pearson Education, Inc. NANDA Nursing Diagnosis  Impaired Urinary Elimination  Functional Urinary Incontinence  Reflex Urinary Incontinence  Stress Urinary Incontinence  Total Urinary Incontinence  Urge Urinary Incontinence  Urinary Retention

15. Patients at Risk for UTIs  Women due to short urethra.  Postmenopausal women  Individuals with indwelling urinary catheter  Individual with diabetes mellitus  Elderly people

16. Interventions to promote Normal Urination 1.Maintaining normal voiding habits (schedule, privacy, position, hygiene). 2.Promoting fluid intake (1500 ml per day). 3.Strengthening muscle tone 4.Stimulating urination and resolving urinary retention 5.Preventing urinary tract infections 6.Managing urinary incontinence