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Urinary Elimination

Urinary Elimination. Teresa V. Hurley, MSN, RN. 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

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Urinary Elimination

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  1. Urinary Elimination Teresa V. Hurley, MSN, RN

  2. 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: detrusor muscle contracts and urine is pushed through internal urethral sphincter into urethra

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

  4. Urinalysis • Abnormal • Protein: renal disease, 2nd to exercise and stress • Glucose: elevated BS; diabetes • Ketones: CHO metabolism • Diabetes, fever, fasting, starvation, high protein intake, vomiting, post-op • Hemoglobin: UTI, nephritis, trauma, lithiasis, hemolytic rx • Bilirubin: liver disease • Urobilinogem: cirrhosis, heart failure, pernicious anemia, mono • Nitrates: bacteria • Leukocyte esterase: bacteria, fungal, parasitic, tumor, nephritis

  5. Hematological 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, TPN • Decreased: liver disease, decrease protein intake

  6. Factors Affecting Micturition • Developmental considerations • Food and fluid intake • Psychological variables • Activity and muscle tone • Pathologic conditions • Medication

  7. 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

  8. 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 Effects of Medications on Urine Production and Elimination

  9. Medications Affecting Color of Urine • Anticoagulants — red color • Diuretics — lighten urine to pale yellow • Pyridium — orange to orange-red urine • Elavil — green or blue-green • Levodopa — brown or black

  10. Using the Nursing Process • 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

  11. Assessing a Problem With Voiding • Explore its duration, severity, and precipitating factors. • Note client’s perception of the problem. • Check adequacy of client’s self-care behaviors.

  12. 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 Physical Assessment of Urinary Functioning

  13. 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. Measuring Urine Output

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

  15. Promoting Urination • Maintaining voiding habits • Promoting fluid intake • Strengthening muscle tone • Kegel Exercises (PFME) to Tx stress, urge mixed • Imagine voiding, stop flow, tighten rectal muscles • Hold 5-10sec and rest 5-10sec • Daily 40-60 PFME doing 2-4 sets of 15 each time

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

  17. 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

  18. Client 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

  19. 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

  20. UTI. Sepsis. Trauma- specially in men. DO NOT USE FORCE! USE STERILE ASEPTIC TECHNIQUE! Research clean technique can be used for self catheterization at home. Hazards of Catheterization

  21. Reasons for Catheterization • Relieving urinary retention. • Obtaining a sterile urine specimen.. • Emptying the bladder • before, • during, • after surgery or diagnostic procedures. • Monitoring of critically ill patients.

  22. Indwelling catheter remains in place for continuous drainage. Intermittent catheter used to drain bladder for short periods of time. Suprapubic catheter inserted surgically above the pubic bone for continuous drainage. Types of Catheters

  23. Urinary Diversions • Ureterostomy • Bladder is removed • One or both ureters redirected from kidney through the abdominal wall

  24. Ileal Conduit • Bladder removed and small intestine (ileum) used as conduit between ureters and skin surface. Urine collects continuously

  25. Client Care Goals:Interventions Indwelling Catheter • Prevent UTI (meatus burning, cloudy, foul, chills, fever) • Maintain closed system • Cleanse catheter soap/H2O; pat dry • Alcohol swab for contamination • Empty bag q 8 h or more • Bag below bladder level • Maintain urine acidity: cranberry juice, prunes, plums, tomatoes, eggs,meat, cheese, citrus fruits • Change only sediment collects, sandy particles, trouble draining • Maintain Urine Flow ( prevent urinary stasis and backflow) • Gravity drainage • Check for kinks, coils, lying on tube • Clamp if higher than bladder • Do not allow on floor

  26. Client Goals • Prevent Infection Transmission • Wash hands before and after • Wear gloves • Promote Urine Production (pathogen flushing; tube irrigation; prevents stasis) • Oral intake 8-10 glasses (3000 mL/day) unless contra-indicated • Parenteral or Enteral feedings • Monitor I & O q 8 h • Check for blood, sediments, color, odor

  27. Client Goals • Maintain Skin and Mucosal Integrity • Prevent fecal and encrustation to catheter and perineal area • Cleasnse: soap/H2O • Sandy particle encrustation at the meatus (catheter change)

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