urinary elimination Flashcards
the need for urinary elimination
- Urination helps to rid the body of waste products and materials that exceed bodily needs (pg. 1342)
- Primary organs are the kidneys
- Helps to regulate electrolytes, blood volume and blood pressure
across the lifespan
Normal adult bladder can hold up to two cups of urine or 16 oz (~475 ml) during the day and four cups or 32 oz of urine during the night (1 fl oz is about 30 mls)
* Children: Bladder capacity: 30 mL in newborn; increases to adult size by 1 year
* Infants should have at least 6 to 8 wet diapers daily (American Academy of Pediatrics)
* By age 3, most children urinate around a dozen times per day. Urinary frequency typically 4-6 times daily, on average.
* Average adult urinates about 7 times per day
* Depending on the amount of liquid, a healthy bladder can stretch anywhere between 5-15 cm.
kidneys ureters
o Kidneys major function: maintain composition & volume
of body fluids (there about 1 million nephrons in each kidney)
o Ureters: Enter the bladder obliquely.
bladder function
o Normal urine output: (Urine consists of about 95% water & 5% solid substances)
Average adult person is about 0.5ml/kg/hr. About 30 to 40 ml per
hour. (typically 30 ml per hour is what you will see most)
The expected urine output in the infant and child is 0.5 to 2 mL/kg/hr.
urethra
o Transports urine from bladder to the exterior of the body
female urethra
Female Urethra:
About 1.5-2.5
inches long
male urethra
Male Urethra:
About 5.5-6.25
inches long
kidneys and ureters
Maintain composition and volume of body fluids
Filter and excrete blood constituents not needed; retain
those that are needed
o Kidneys regulate blood volume & blood pressure
Can lead to water retention or excretion
Excrete waste product (urine)
o The nephrons maintain and regulate fluid balance
through the mechanisms of selective reabsorption and
secretion of water, electrolytes, and other substances.
o Urine from the nephrons empties into the kidneys.
Kidney (children): large in relation to the stomach; prone to
injury
bladder
Smooth muscle sac innervated by autonomic nervous
system (ANS)
Serves as a temporary reservoir for urine (stores it)
Composed of three layers of muscle tissue called
detrusor muscle
o The inner longitudinal layer, the middle circular layer,
and the outer longitudinal layer
Sphincter guards opening between urinary bladder
and urethra
Urethra conveys urine from bladder to exterior of
body
Bladder capacity: 30 mL in newborn; increases to
adult size by 1 year
the act of urination
micturation
the urinary bladder
The Urinary Bladder
* The first voided urine
of the day is usually
more concentrated than
other urine excreted
during the day
* Less fluid intake
* Newborns: urine is
usually light and without
odor
* Do you know why?
newborns urine is light and w/o odor why?
because of immature kidneys and nephrons
the urethra function in males and females
Conveys urine from the bladder
to the exterior
Male urethra functions in
excretory and reproductive
systems
No portion of female urethra is
external to the body
Urethra (children): shorter;
risk for bacteria into bladder
(UTI)
act of urination
The voluntary control of urination develops as the higher nerve centers
develop after infancy.
o Until that time, voiding is purely a reflex action
o Voluntary control of the urethral sphincters occurs between 18-24 months
of age.
o Process of emptying the bladder
o Detrusor muscle contracts, internal sphincter relaxes, urine enters
posterior urethra
o Muscles of perineum and external sphincter relax
o Muscle of abdominal wall contracts slightly
o Diaphragm lowers, micturition occurs
developmental considerations
Developmental considerations
o At ~6 weeks of age, the infants nephrons are able to control reabsorption of fluids in the tubules
and effectively concentrate urine.
Food and fluid intake: drink ~64 oz a day!
Psychological/cultural variables (Privacy)
o For some people, voiding is a personal and private act—something one does not talk about
factors affecting urination
Activity and muscle tone
o Decreased bladder muscle tone with aging and think about childbirth!
o The diminished ability of the kidneys to concentrate urine may result in nocturia
Pathologic conditions
o Diseases associated with renal problems include congenital urinary tract abnormalities, polycystic kidney
disease, UTI, urinary calculi (kidney stones), hypertension, diabetes mellitus & gout,
Medications
o Diuretics (increase urinary output) Common diuretic: Furosemide (Lasix
what should you monitor for renal disorders
Close monitoring of
serum blood counts
and electrolytes is a
critical component of
nursing care related to
renal disorders.
hematuria
blood in the urine
white blood cells in the urine
can indicate an infection
pyuria
pus in the urine, indicative of a UTI
bacterunia
bacteria in the urine
ketonuria
ketones in the urine, sweet urine, Ketones in the urine is a sign
that your body is using fat for energy instead
of using glucose because not enough insulin
is available to use glucose for energy.
Ketones in the urine is more common in type
1 diabetes.
proteinuria
Proteinuria. Kidney damage
(diabetes, high blood pressure)
glucose in the urine
Glycosuria. Consuming excessive sugar can
raise your blood glucose past the level that your
kidneys can properly reabsorb
Which term describes a condition in which 24-hour
urine output is less than 50 mL?
anuria
dysuria
difficulty urinating.
glycosuria
sweet urine, sugar in the urine
children and the effects of urine
o Toilet training 2 to 3 years old, enuresis
o Must be able to hold urine for 2 hours and recognize the feeling of bladder fullness
o Nocturia (nighttime bedwetting) usually subsides by 6 years of age
Diuretics cause increased urine production, resulting in
the need for increased urination and possibly urge
incontinence.
true
Answer: A. True
Rationale: Diuretics cause
increased urine production,
resulting in the need for increased
urination and possibly urge
incontinence.
adult renal problems
Congenital urinary tract
abnormalities
Polycystic kidney disease
Urinary tract infection
Urinary calculi
Hypertension
Diabetes mellitus
Gout
Connective tissue disorders
BPH
acquired disorders that result in decreased urine function
o Nephrotic syndrome
o Acute glomerulonephritis
o Hemolytic-uremic syndrome
what is the function of diuretics
Diuretics: prevent reabsorption of water and certain
electrolytes in tubules
o Commonly used for hypertension and edema caused by heart failure
o Cause moderate to severe increase in production and excretion of dilute urine.
o Furosemide (Lasix)-most commonly loop diuretic used,
Hydrochlorothiazide
function of cholinergic medications
Cholinergic medications: stimulate contraction of
detrusor muscle, producing urination
o Commonly used for myasthenia gravis, a disease that causes severe
muscle weakness.
o Bethanechol (Duvoid, Urecholine): Treats urinary retention
analgesics and tranquilizers
Analgesics and tranquilizers: suppress CNS, diminish
effectiveness of neural reflex
o Hydrocodone, oxycodone and barbiturates
what color do anticoagulants turn urine
red and pink
what color do diuretics turn urine
pale yellow
some urinary analgesics turn urine what color
dark orange
some antidepressants or vitamins like vitamin B would turn urine what color
green or blue colors
parkinsons drugs make urine what color
brown or black
certain medications can make urine certain colors
Anticoagulants: red urine or blood in urine
Diuretics: pale yellow urine (furosemide)
Pyridium: orange to orange-red urine
The antidepressant amitriptyline or B-complex vitamins: green or
blue-green urine
Levodopa: brown or black urine
characteristics of urine
Color- pale yellow, straw-colored or amber
Odor- Aromatic (usually does not smell very strong)
Ph- Normal Ph is 5-6, with a range of 4.5-8
Specific Gravity- Normal range 1.015-1.025
normal urine output
Normal
Output: 24
hrs X 30
mls= 720
mls
using the nursing process with urine
Assessing data about voiding patterns,
habits, past history of problems
Physical examination of the bladder, if
indicated, and urethral meatus; assessment
of skin integrity and hydration; and
examination of the urine
Correlation of these findings with results of
procedures and diagnostic tests
U/A (urine)
BUN (blood test: Blood Urea Nitogren) Measures protein
Creatinine clearance- how well are the kidneys working
C&S- infection (UTI)
KUB- Kidney, Ureter, Bladder x-ray
assessing problems with voiding
Explore its duration, severity, and
precipitating factors.
Note the patient’s perception of
the problem.
Check the adequacy of the
patient’s self-care behaviors.
Children- Assess:
o Infant: Wet diapers (6-8 per day)
o Young child: assess whether the child has
achieved bladder control during both day
and nighttime.
past medical history
o Maternal polyhydramnios (excessive fluid),
oligohydramnios (too little amniotic fluid), diabetes,
hypertension, or alcohol or cocaine ingestion
neonatal history
Presence of a single umbilical artery, abdominal
mass, chromosome abnormality, or congenital
malformation
family history
o Renal disease or uropathology, chronic UTIs, renal
calculi, or a history of parental enuresis
assessment for gu disorders
Burning on urination
Changes in voiding patterns
Foul-smelling urine
Vaginal or urethral discharge
Genital pain, irritation, or discomfort
Blood in the urine
Edema
Masses in the groin, scrotum, or abdomen
Flank or abdominal pain; cramps
Nausea and/or vomiting
Poor growth; weight gain
Fever
Infectious exposure and/or Trauma
physical assessment of urinary functioning
Kidneys: Palpation of the kidneys is usually
performed by an advanced health care
practitioner as part of a more detailed
assessment.
Urinary bladder: Palpate and percuss the bladder
or use a bedside scanner.
Urethral orifice: Inspect for signs of infection,
discharge, color or odor.
Skin: Assess for color, texture, turgor, and
excretion of wastes.
Urine: Assess for color, odor, clarity, and
sediment.
Tell whether the following statement is true
or false.
Normal fresh urine has an ammonia odor.
false
should have an arrommatic odor
measuring urine intake and output
Ask the patient to void into a bedpan, urinal, or specimen container
in bed or bathroom.
Put on gloves. Pour urine into the appropriate measuring device.
Accuracy is important!
Place the calibrated container on a flat surface and read at eye level.
Note amount of urine voided and record on the appropriate form. (I&O’s)
Discard urine in the toilet unless specimen is needed. If a specimen
is required, pour the urine into an appropriate specimen container
Be sure to document in patients EMR
Measurement of fluid intake & outpatient can be delegated to an
unlicensed personnel (you are responsible for accuracy)
urine specimens
Routine urinalysis (sterile urine not necessary)
o Measures specific gravity, glucose, RBC’s, sediment for casts
Clean-catch or midstream specimens
Sterile specimens from indwelling catheter
o Aspirate from the urine collection port
Urine specimen from a urinary diversion
24-hour urine specimen
o First void is discarded & then documentation starts
Specimens from infants and children
Point-or-care urine testing
Plastic disposable collection bags are available for collecting urine specimens from
infants and young children who have not achieved voluntary bladder control
urinary functioning as the problem
Urinary functioning as the problem
o Incontinence
o Pattern alteration
o Urinary retention
Urine not fully excreted
o Urinary hesitancy
Decrease in the force of stream of urine
Urinary functioning as the etiology
o Anxiety
o Caregiver role strain
o Risk for infection
