Chapter 44 Urinary Elimination Mosby items and derived
Chapter 44 Urinary Elimination Mosby items and derived items © 2005 by Mosby, Inc.
Urinary System • • • Kidneys Ureters Bladder Urethra Act of urination Mosby items and derived items © 2005 by Mosby, Inc.
Factors Influencing Urination • • Disease conditions Sociocultural factors Psychological factors Muscle tone Mosby items and derived items © 2005 by Mosby, Inc.
Factors Influencing Urination (cont'd) • • Fluid balance Surgical procedures Medications Diagnostic examinations Mosby items and derived items © 2005 by Mosby, Inc.
Alterations • • Urinary retention Urinary tract infections Urinary incontinence Urinary diversions Mosby items and derived items © 2005 by Mosby, Inc.
Urinary Incontinence • • • Functional Overflow Reflex Stress Urge Mosby items and derived items © 2005 by Mosby, Inc.
Infection Control and Hygiene • Asepsis • Client education • Catheterization and other procedures Mosby items and derived items © 2005 by Mosby, Inc.
Growth and Development • • Infants Toddlers and young children Adults Older adults Mosby items and derived items © 2005 by Mosby, Inc.
Psychosocial Considerations • Self-concept • Culture • Gender Mosby items and derived items © 2005 by Mosby, Inc.
Assessment of Urinary Elimination • Nursing history – Pattern of urination – Symptoms of alterations – Factors affecting urination Mosby items and derived items © 2005 by Mosby, Inc.
Assessment of Urinary Elimination (cont'd) • Physical assessment – Skin and mucous membranes – Kidneys – Bladder – Urethral meatus Mosby items and derived items © 2005 by Mosby, Inc.
Assessment of Urinary Elimination (cont'd) • Assessment of urine – Intake and output – Characteristics: color, clarity, odor – Urine testing: specimen collection Mosby items and derived items © 2005 by Mosby, Inc.
Assessment of Urinary Elimination (cont'd) • Common urine tests – Urinalysis – Specific gravity – Culture • Diagnostic examinations – Consents – Allergies – Pre- and postprocedure interventions Mosby items and derived items © 2005 by Mosby, Inc.
Nursing Diagnoses • • • Incontinence Risk for infection Toileting self-care deficit Impaired urinary elimination Urinary retention Mosby items and derived items © 2005 by Mosby, Inc.
Planning • 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 Mosby items and derived items © 2005 by Mosby, Inc.
Implementation: Health Promotion • Client education • Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake • Promoting complete bladder emptying • Preventing infection: hygiene and acidifying urine Mosby items and derived items © 2005 by Mosby, Inc.
Implementation: Acute Care • • Maintaining elimination habits Medications Urethral catheterization Alternatives to urethral catheterization: suprapubic catheters, condom catheters Mosby items and derived items © 2005 by Mosby, Inc.
Urethral Catheterization • • Types Insertion Drainage systems Routine care: hygiene, fluids Prevention of infection Irrigations and instillations Removal Mosby items and derived items © 2005 by Mosby, Inc.
Implementation: Restorative Care • • • Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort Mosby items and derived items © 2005 by Mosby, Inc.
Evaluation • Client care • Client expectations Mosby items and derived items © 2005 by Mosby, Inc.
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