Urinary elimination Flashcards
Job of Kidneys 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)
What do nephrons do to excrete waste product (urine)
The nephrons maintain and regulate fluid balance through the mechanisms of selective reabsorption and secretion of water, electrolytes, and other substances
Where do urine from nephrons empty?
Urine from the nephrons empties into the kidneys
What is the bladder made up of?
Smooth muscle sac innervated by ANS
What does bladder serve as?
Serves as a temporary reservoir for urine
What is the bladder composed of?
Composed of three layers of muscle tissue called detrusor muscle
What are the three layers the bladder is made up of
Composed of three layers of muscle tissue called detrusor muscle
The inner longitudinal layer, the middle circular layer, and the outer longitudinal layer
What opens between urinary bladder and sphincter
Sphincter guards opening between urinary bladder and urethra
What does Urethra do?
Urethra conveys urine from bladder to exterior of body
How are male urethras?
Male urethra functions in excretory and reproductive systems
How are women urethras?
No portion of female urethra is external to the body
Act of urination is also called?
Act of Urination (Micturition, Voiding)
Steps to emptying the bladder: What do detrusor, internal sphincters and urine do?
Detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra
Steps to emptying the bladder: what do muscles perineum and external sphincters do?
Muscles of perineum and external sphincter relax
Steps to emptying the bladder: what do muscles abdominal wall do?
Muscle of abdominal wall contracts slightly
Steps to emptying the bladder: What does diaphragm do?
Diaphragm lowers, micturition occurs
Factors Affecting Micturition
Developmental considerations
Food and fluid intake
Psychological variables
Activity and muscle tone
Pathologic conditions
Medications
What is included in development considerations affecting micturition
Toilet training
Effects of aging
More specific developmental considerations having to do with children?
Toilet training 2 to 3 years old, enuresis
More specific developmental considerations having to do with effects of aging?
Nocturia
Increased frequency
Urine retention and stasis
Voluntary control affected by physical problems
Diseases 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 Elimination: Three medications to consider
- Diuretics
- Cholinergic meds
- Analgesics and tranquilizers
Diuretics:
prevent reabsorption of water and certain electrolytes in tubules
Cholinergic medications:
stimulate contraction of detrusor muscle, producing urination
Analgesics and tranquilizers:
suppress CNS, diminish effectiveness of neural reflex
Medications Affecting Color of Urine
Anticoagulants:
Diuretics:
Pyridium:
The antidepressant amitriptyline or B-complex vitamins:
Levodopa:
Nursing History for urinary elimination
Usual patterns of urinary elimination
Recent changes in urinary elimination
Aids to elimination
Present or past occurrence of voiding difficulties
Presence of urinary diversion
Physical Assessment of Urinary Functioning: What parts of the body are focused on
Kidneys:
Urinary bladder:
Urethral orifice:
Skin:
Urine:
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
Physical Assessment of Urinary Functioning:Urinary bladder:
Palpate and percuss the bladder or use a bedside scanner
Physical Assessment of Urinary Functioning:Urethral orifice:
Inspect for signs of infection, discharge, or odor
Physical Assessment of Urinary Functioning:Skin:
Assess for color, texture, turgor, and excretion of wastes
Physical Assessment of Urinary Functioning:Urine:
Assess for color, odor, clarity, and sediment
Additional Assessment Techniques
- Measuring urinary output
- Routine urinalysis
Measuring urinary output
Continent patients
Incontinent patients
Indwelling catheter
What is included in routine urinalysis
Clean-catch or midstream specimen
Sterile specimen
Urinary diversion specimen
24-hour specimens
Measuring Urine Output: What do you ask pt to void in?
Ask the patient to void into a bedpan, urinal, or specimen container in bed or bathroom
Measuring Urine Output: After pt pees what do you do?
Put on gloves. Pour urine into the appropriate measuring device
Measuring Urine Output: How do you measure it?
Place the calibrated container on a flat surface and read at eye level
Note amount of urine voided and record on the appropriate form
Measuring Urine Output: What do you do with urine after measuring?
Discard urine in the toilet unless specimen is needed. If a specimen is required, pour the urine into an appropriate specimen container
Patient Health Problems having to do with urine
Urinary functioning as the problem
Urinary functioning as the etiology
Urinary functioning as the problem
Incontinence
Pattern alteration
Urinary retention
Urinary functioning as the etiology
Anxiety
Caregiver role strain
Risk for infection
Promoting Urinary Elimination
- Maintaining regular voiding habits
- Promoting fluid intake
- Strengthening muscle tone
- Assisting with toileting
Planned Patient Goals:
Produce 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
Demonstrate appropriate self-care behaviors
Patients at Risk for UTIs
Sexually active people with female genitalia
People who use diaphragms for contraception
Postmenopausal people
People with indwelling urinary catheter in place
People with diabetes mellitus
Older adults
Types of Urinary Incontinence
Transient:
Mixed:
Overflow:
Functional:
Reflex:
Total:
Stress:
Types of Urinary Incontinence: Transient
appears suddenly and lasts 6 months or less
Types of Urinary Incontinence: Mixed:
urine loss with features of two or more types of incontinence
Types of Urinary Incontinence: Overflow:
overdistention and overflow of bladder
Types of Urinary Incontinence: Functional:
caused by factors outside the urinary tract
Types of Urinary Incontinence: Reflex:
emptying of the bladder without sensation of need to void
Types of Urinary Incontinence: Total:
continuous, unpredictable loss of urine
Types of Urinary Incontinence: Stress:
involuntary loss of urine related to an increase in intra-abdominal pressure
Reasons for Catheterization
Relieving acute urinary retention
Obtaining a sterile urine specimen when patient is unable to void voluntarily
Accurate measurement of urinary output in critically ill patients
Assisting in healing open sacral or perineal wounds in incontinent patients
Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations
Providing improved comfort for end-of-life care
Prolonged patient immobilization
Types of Catheters
Intermittent urethral catheters
Indwelling urethral catheter
Suprapubic catheter
Nursing Interventions
Urethral catheter insertion and care for patients with an indwelling catheter
Caring for a patient with a urologic stent
Caring for a patient with a urinary diversion
Caring for a patient receiving dialysis
