Urinary Elimination Teresa V Hurley MSN RN Urinary

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Urinary Elimination Teresa V. Hurley, MSN, RN

Urinary Elimination Teresa V. Hurley, MSN, RN

Urinary System Kidneys filter nitrogen, metabolic wastes, excess ions and water n Urine produced

Urinary System Kidneys filter nitrogen, metabolic wastes, excess ions and water n Urine produced at a rate of 60 m. L/hour n Bladder stores average 500 m. L or more Void: detrusor muscle contracts and urine is pushed through internal urethral sphincter into urethra n

Urinalysis n Urine: clear, yellow, aromatic, without pathogens or parasites n Specific Gravity: 1.

Urinalysis n Urine: clear, yellow, aromatic, without pathogens or parasites n Specific Gravity: 1. 025 (concentrate urine) Increases with dehydration n Decreases with increased fluid intake n

Urinalysis n Abnormal n n n Protein: renal disease, 2 nd to exercise and

Urinalysis n Abnormal n n n Protein: renal disease, 2 nd to exercise and stress Glucose: elevated BS; diabetes Ketones: CHO metabolism n n n 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

Hematological BUN 8 -16 mg/d. L (end product protein metabolism) Creatinine 0. 6 -1.

Hematological BUN 8 -16 mg/d. L (end product protein metabolism) Creatinine 0. 6 -1. 2 mg/d. L (muscle metabolism of creatin) Increased: renal failure, infection, obstruction, dehydration, increase protein intake, TPN n Decreased: liver disease, decrease protein intake n

Factors Affecting Micturition Developmental considerations n Food and fluid intake n Psychological variables n

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

Developmental Considerations n Children n n Toilet training 18 to 24 months, enuresis Effects

Developmental Considerations n Children n n Toilet training 18 to 24 months, enuresis Effects of aging n Nocturia, increased frequency, urine retention and stasis, voluntary control affected by physical problems

Effects of Medications on Urine Production and Elimination n Diuretics — prevent reabsorption of

Effects of Medications on Urine Production and Elimination n Diuretics — prevent reabsorption of water and certain electrolytes in tubules n Cholingeric medications — stimulate contraction of detrusor muscle, producing urination n Analgesics and tranquilizers — suppress CNS diminish effectiveness of neural reflex

Medications Affecting Color of Urine Anticoagulants — red color n Diuretics — lighten urine

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

Using the Nursing Process Assessing data about voiding patterns, habits, past history of problems

Using the Nursing Process Assessing data about voiding patterns, habits, past history of problems n Physical examination of urinary system, skin hydration, urine n Correlation of these findings with results of procedures and diagnostic tests n

Assessing a Problem With Voiding Explore its duration, severity, and precipitating factors. n Note

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

Physical Assessment of Urinary Functioning n n Kidneys — check for costovertebral tenderness Urinary

Physical Assessment of Urinary Functioning n n Kidneys — check for costovertebral tenderness Urinary bladder — palpate and percuss the bladder or use bedside scanner n n n 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 Output n n Ask client to void into bedpan, urinal, or specimen

Measuring Urine Output n n Ask client to void into bedpan, urinal, or specimen container in bed or bathroom. Pour urine into appropriate measuring device. n n n 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 Specimens Routine urinalysis n Specimens from infants and children n Clean-catch or midstream

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

Promoting Urination Maintaining voiding habits n Promoting fluid intake n Strengthening muscle tone n

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

Client’s at Risk for UTIs Sexually active women n Postmenopausal women n Individuals with

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

Four Types of Urinary Incontinence Stress — increase in intraabdominal pressure n Urge —

Four Types of Urinary Incontinence Stress — increase in intraabdominal pressure n Urge — urine lost during abrupt and strong desire to void n Mixed — symptoms of urge and stress incontinence present n Overflow — overdistention and overflow of bladder n Functional — caused by factors outside the urinary tract n

Client Education for Urinary Diversion Explain reason for diversion and rationale for treatment n

Client Education for Urinary Diversion Explain reason for diversion and rationale for treatment n Demonstrate effective self-care behaviors n Describe follow-up care and support resources n Report where supplies may be obtained in community n Verbalize related fears and concerns n Demonstrate a positive body image n

Evaluating Effectiveness of Plan Maintain fluid, electrolyte, and acid-base balance n Empty bladder completely

Evaluating Effectiveness of Plan Maintain fluid, electrolyte, and acid-base balance n Empty bladder completely at regular intervals with no discomfort n Provide care for urinary diversion and when to notify physician n Develop a plan to modify factors contributing to problem n Correct unhealthy urinary habits n

Hazards of Catheterization n UTI. Sepsis. Trauma- specially in men. n n n DO

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

Reasons for Catheterization Relieving urinary retention. n Obtaining a sterile urine specimen. . n

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

Types of Catheters n Indwelling catheter n n Intermittent catheter n n remains in

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

Urinary Diversions n Ureterostomy Bladder is removed n One or both ureters redirected from

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

Ileal Conduit n Bladder removed and small intestine (ileum) used as conduit between ureters

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

Client Care Goals: Interventions Indwelling Catheter n Prevent UTI (meatus burning, cloudy, foul, chills,

Client Care Goals: Interventions Indwelling Catheter n Prevent UTI (meatus burning, cloudy, foul, chills, fever) n n n n Maintain closed system Cleanse catheter soap/H 2 O; 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) n n Gravity drainage Check for kinks, coils, lying on tube Clamp if higher than bladder Do not allow on floor

Client Goals n Prevent Infection Transmission n Wash hands before and after Wear gloves

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

Client Goals n Maintain Skin and Mucosal Integrity Prevent fecal and encrustation to catheter

Client Goals n Maintain Skin and Mucosal Integrity Prevent fecal and encrustation to catheter and perineal area n Cleasnse: soap/H 2 O n Sandy particle encrustation at the meatus (catheter change) n