Urinary elimination

Dr. Dergham M. Hameed

Urinary SystemUrinary System

• Kidneys and ureters

• Bladder

• Urethra

Kidneys and UretersKidneys and Ureters

• Maintain composition and volume of body fluids

• Filter and excrete blood constituents not needed, retain those that are needed

• Excrete waste product (urine)

• Nephrons remove the end products of metabolism and regulate fluid balance

• Urine from the nephrons empties into the kidneys

BladderBladder

• Smooth muscle sac

• Serves as a reservoir 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

UrethraUrethra

• Conveys urine from the bladder to the exterior

• Male urethra functions in excretory and reproductive system

• No portion of female urethra is external to the body

Act of MicturitionAct of Micturition

• 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, micturition occurs

Factors Affecting MicturitionFactors Affecting Micturition

• Developmental considerations

• Food and fluid intake

• Psychological variables

• Activity and muscle tone

• Pathologic conditions

• Medication

Developmental ConsiderationsDevelopmental 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

Diseases Associated With Renal ProblemsDiseases Associated With Renal Problems

• Congenital urinary tract abnormalities

• Polycystic kidney disease

• Urinary tract infection

• Urinary calculi

• Hypertension

• Diabetes mellitus

• Gout

• Connective tissue disorders

Effects of Medications on Urine Production and EliminationEffects 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

Medications Affecting Color of UrineMedications 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

Using the Nursing ProcessUsing 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

Assessing a Problem With VoidingAssessing a Problem With Voiding

• Explore its duration, severity, and precipitating factors.

• Note patient’s perception of the problem.

• Check adequacy of patient’s self-care behaviors.

Physical Assessment of Urinary FunctioningPhysical 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

Measuring Urine OutputMeasuring 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.

Urine SpecimensUrine Specimens

• Routine urinalysis

• Specimens from infants and children

• Clean-catch or midstream specimens

• Sterile specimens from indwelling catheter

• 24-hour urine specimen

DiagnosesDiagnoses

• Urinary functioning as the problem

– Incontinence, pattern alteration, urinary retention

• Urinary functioning as the etiology

– Anxiety, caregiver role strain, risk for infection

Planned Patient GoalsPlanned 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

Promoting Normal UrinationPromoting Normal Urination

• Maintaining normal voiding habits

• Promoting fluid intake

• Strengthening muscle tone

• Stimulating urination and resolving urinary retention

Maintaining Normal Voiding HabitsMaintaining Normal Voiding Habits

• Schedule

• Privacy

• Position

• Hygiene

Patients at Risk for UTIsPatients at Risk for UTIs

• Sexually active women

• Postmenopausal women

• Individuals with indwelling urinary catheter

• Individual with diabetes mellitus

• Elderly people

Four Types of Urinary IncontinenceFour 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

Factors to Consider With Use of Absorbent ProductsFactors 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

Reasons for CatheterizationReasons for Catheterization

• Relieving urinary retention

• Obtaining a sterile urine specimen

• Measuring amount urine in bladder

• Obtaining a urine specimen

• Emptying bladder before during or after surgery

• Monitoring of critically ill patients

Evaluating Effectiveness of PlanEvaluating 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