Urinary Elimination Concept Elimination Definition The term elimination

Urinary Elimination

Concept: Elimination • Definition: The term elimination is defined as the excretion of waste products. • Bowel Elimination Bowel elimination is defined as the passage of stool through the intestinal tract and dispelling the stool by means of intestinal smooth muscle contraction. • Urinary Elimination Urinary elimination is defined as the passage of urine through the urinary tract by means of the urinary sphincter and urethra. 2

Risk Factors for Problems of Elimination • Conditions that result in – Neurologic impairment (Neurogenic bladder) • Trauma to the brain or spinal cord • CVA • Diabetic neuropathy (R/T metabolic derangements) – Altered mobility • Severe arthritis – Cognitive impairment • dementia – Immunologic impairment or infection • AIDS 3

Scientific Knowledge Base: Organs of Urinary Elimination Kidneys Ureters Remove waste from the blood to form urine Transport urine from the kidneys to the bladder Bladder Urethra Reservoir for urine until the urge to urinate develops Urine travels from the bladder and exits through the urethral meatus.

Urinary System Organs Renal Nephron

Additional Kidney Functions • Production of erythropoietin is essential to maintaining a normal red blood cell (RBC) volume. – Erythropoietin stimulates bone marrow to produce RBCs and prolongs the life of mature RBCs. • Production of renin. – Renin starts a chain of events that cause water retention, thereby increasing blood volume. • Kidneys affect calcium and phosphate regulation

Renin-Angiotensin Mechanism

Kidneys affect calcium and phosphate regulation Vitamin D The Kidneys produces a substance that converts vitamin D into its active form. Intestines absorb more Ca from foods.

Factors Influencing Urination • Disease conditions • Socioeconomic factors (need for privacy) • Psychological factors (anxiety, stress, privacy) • Fluid balance – Nocturia, polyuria, oliguria, anuria – Diuresis – Fever • Medications and medical procedures

Disease Conditions Affecting Urination • Prerenal, postrenal classification • Conditions of the lower urinary tract • Diabetes mellitus and neuromuscular diseases such as multiple sclerosis • Benign prostatic hyperplasia • Cognitive impairments (e. g. , Alzheimer’s) • Diseases that slow or hinder physical activity • Conditions that make it difficult to reach and use toilet facilities • End-stage renal disease, uremic syndrome

Pre-renal, post-renal classification Decrease blood flow Condition of renal tissue Obstruction in the UT that prevents flow from kidneys

Conditions of the Lower Urinary Tract

Diabetes Mellitus and Neuromuscular Diseases

Benign Prostatic Hyperplasia (BPH)

Conditions Affecting Urination Conditions that make it difficult to reach and use toilet facilities Cognitive impairments Diseases that slow or hinder physical activity

End Stage Renal Disease (ESRD) (CKD)

Dialysis • Renal Replacement • Two methods – Peritoneal – Hemodialysis 17

Indications for Dialysis Renal failure that can no longer be controlled by conservative management (Conservative management would include dietary modifications and the administration of medications to correct electrolyte abnormalities. ) Worsening of uremic syndrome associated with ESRD, which would include nausea, vomiting, neurological changes, and pericarditis) Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures (These abnormalities would include hyperkalemia and pulmonary edema. ) by simpler measures

Factors Influencing Urination • Disease conditions • Socioeconomic factors – Need for privacy – Cultural differences • Psychological factors – Anxiety – Emotional Stress – Privacy

Factors Influencing Urination • Fluid balance – Nocturia, polyuria, oliguria, anuria – Diuresis – Fever – Foods • Medications and medical procedures

Fluid Balance • Symptoms common to urinary disturbances include – frequency – urgency – dysuria – polyuria – oliguria – incontinence – difficulty in starting the urinary stream.

Medications and Medical Procedures • Surgery (stress)

Alterations in Urinary Elimination Urinary retention Urinary tract infection An accumulation of urine due to the inability of the bladder to empty Results from catheterization or procedure Urinary incontinence Urinary diversion Involuntary leakage of urine Diversion of urine to external source

Urinary Retention An accumulation of urine due to the inability of the bladder to empty • Signs and Symptoms – Bladder distention – No UO in several hours – May void small amounts of urine 2 -3 times an hour • Treatment – Residual urine – Bladder scan – I & O catheter

Urinary Tract Infection Results from catheterization or procedure CAUTIs (Catheter-associated UTIs) • Increased hospitalization • Increased morbidity and mortality • Longer hospital stay • Increased hospital cost

Urinary Tract Infection • 7 reasons for insertion of a Foley Catheter – Urinary retention – To relieve urinary obstruction – Accurate I&O in critical patients – Bladder decompression for surgery – Urinary incontinence with stage 3 – 4 pressure ulcers – Comfort for terminal patient – Urological procedurss 26

Urinary Tract Infection • Signs and symptoms – Pain or burning during urination (dysuria) – Fever, chills, nausea, vomiting, and malaise – Frequent and urgent sensation of need to void – Blood-tinged urine (hematuria) • Treatment – Medication 27

Urinary incontinence CVA, Heat injury, spinal cord injury, diabetic neuropathy, irritating factors

Nursing Diagnoses – Impaired Social Interaction r/t Loss of independence: clothing becomes wet with urine and odor. – Impaired body image r/t incontinent of urine. – Risk for impaired skin integrity. 29

Nursing Knowledge Base & Assessment Infection control and hygiene Growth and development Muscle tone Psychosocial considerations Cultural considerations

Physical Assessment • Gather nursing history for the patient’s urination pattern and symptoms, and factors affecting urination. • Conduct physical assessment of the patient’s body systems potentially affected by urinary change. • Assess characteristics of urine. • Assess the patient’s perception of urinary problems as it affects self-concept and sexuality. • Gather relevant laboratory and diagnostic test data.

Physical Assessment Skin and mucosal membranes Kidneys Assess hydration. Flank pain may occur with infection or inflammation. Bladder Urethral meatus Distended bladder rises above symphysis pubis. Observe for discharge, inflammation, and lesions.

Assessment of Urine • Intake and output (I&O) • Characteristics of urine – Color • Pale-straw to amber color – Clarity • Transparent unless pathology is present – Odor • Ammonia in nature • Urine testing • Specimen collection

Urine Tests and Diagnostic Examinations Urinalysis Specific gravity Culture Noninvasive procedures Invasive procedures

Catheterization Catheter insertion Closed drainage systems Catheter care Perineal hygiene Fluid intake Catheter irrigations and instillations Removal of indwelling catheter Alternative to urethral catheterization

Types of Urinary Catheters

Urinary Drainage System and Infectious Organisms

Applying a Condom Catheter

Applying a Condom Catheter (cont’d)

External Urinary Device

Restorative Care • • • Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort