Transcript Urinary elimination

Fundamental Nursing
Chapter 30
Urinary Elimination
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The urinary system (Fig. 30-1) consists of the
kidneys, ureters, bladder, and urethra. These
major components, along with some accessory
structures such as the ring-shaped muscles
called the internal and external sphincters,
work together to produce urine (fluid within
the bladder), collect it, and excrete it from the
body.
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Figure 30-1 • Major structures of the urinary system.
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Urinary elimination (the process of releasing
excess fluid and metabolic wastes), or
urination, occurs when urine is excreted.
Under normal conditions, the average person
eliminates approximately 1500 to 3000 mL of
urine each day. The consequences of impaired
urinary elimination can be life-threatening.
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The need to urinate becomes apparent when
the bladder distends with approximately 150 to
300 mL of urine. The distention with urine
causes increased fluid pressure, stimulating
stretch receptors in the bladder wall and
creating a desire to empty it of urine.
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Patterns of urinary elimination depend on
 physiologic
 emotional,
 social factors.
 degree of neuromuscular development
 and integrity of the spinal cord;
 the volume of fluid intake and
 the amount of fluid losses,
 the amount and type of food consumed;
 the person's circadian rhythm,
 habits,
 opportunities for urination,
 and anxiety.
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General measures to promote urination
include:
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providing privacy,
assuming a natural position for urination
(sitting for women, standing for men),
maintaining an adequate fluid intake, and
using stimuli such as running water from a tap
to initiate voiding.
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Characteristics of Urine
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Urine Specimen Collection
Voided Specimens
 A voided specimen is a sample of fresh urine
collected in a clean container. The first voided
specimen of the day is preferred because it is
most likely to contain substantial urinary
components that have accumulated during the
night.
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Clean-Catch Specimens
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A clean-catch specimen is a voided sample of
urine considered sterile and is sometimes
called a mid-stream specimen because of how
it is collected.
As soon as the specimen is collected, it
is labeled and taken to the laboratory.
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Catheter Specimens
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A urine specimen can be collected under
sterile conditions using a catheter, the nurse
can aspirate a sample through the lumen of a
latex catheter or from a self-sealing port (Fig.
30-2).
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Figure 30-2 • Location for collecting a catheter specimen .
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24-Hour Specimens
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The nurse collects, labels, and delivers a 24hour specimen (collection of all urine
produced in a full 24-hour period) to the
laboratory for analysis.
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Abnormal Urine Characteristics
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Hematuria: urine containing blood
Pyuria: urine containing pus
Proteinuria: urine containing plasma proteins
Albuminuria: urine containing albumin, a
plasma protein
Glycosuria: urine containing glucose
Ketonuria: urine containing ketones
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Abnormal Urinary Elimination Patterns
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Anuria
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Anuria means absence of urine or a volume of 100
mL or less in 24 hours. It indicates that the kidneys
are not forming sufficient urine.
Oliguria
Oliguria, urine output less than 400 mL per 24
hours, indicates inadequate elimination of urine.
 Residual urine, or more than 50 mL of urine that
remains in the bladder after voiding
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Polyuria
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Polyuria means greater than normal urinary
volume and may accompany minor dietary
variations. For example, consuming higher than
normal amounts of fluids, especially those with
mild diuretic effects (e.g., coffee, tea), or taking
certain medications actually can increase urination.
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Nocturia
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Nocturia (nighttime urination) is unusual because
the rate of urine production is normally reduced at
night.
Dysuria
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Dysuria is difficult or uncomfortable voiding and
a common symptom of trauma to the urethra or a
bladder infection. Frequency (need to urinate
often) and urgency (strong feeling that urine must
be eliminated quickly) often accompany dysuria.
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Incontinence
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Incontinence means the inability to control either
urinary or bowel elimination and is abnormal after
a person is toilet-trained.
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Assisting Clients with Urinary
Elimination
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Commode
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A commode (chair with an opening in the seat
under which a receptacle is placed) is located
beside or near the bed (Fig. 30-3).
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Figure 30-3 • A bedside commode
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Urinal
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A urinal is a cylindrical container for collecting
urine. It is more easily used by males.
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Using a Bedpan
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A bedpan (seatlike container for elimination) is
used to collect urine or stool.
Figure 30-5 • Two types of bedpans: fracture pan( left )and conventional bedpan( right .)
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Catheterization
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Catheterization (act of applying or inserting a
hollow tube), A urinary catheter is used for
various reasons:
Keeping incontinent clients dry (catheterization is
a last resort that is used only when all other
continence measures have been exhausted)
 Relieving bladder distention when clients cannot
void
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 Assessing
fluid balance accurately
 Keeping
the bladder from becoming
distended during procedures such as surgery
 Measuring the residual urine
 Obtaining sterile urine specimens
 Instilling medication within the bladder
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Types of Catheters
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External Catheters
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An external catheter (urine-collecting device
applied to the skin) is not inserted within the
bladder; instead, it surrounds the urinary meatus.
Examples of external catheters are a condom
catheter (Fig. 30-7) External catheters are more
effective for male clients.
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Figure 30-7 • A condom catheter is an example of an external urine collection device .
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Straight Catheters
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A straight catheter is a urine drainage tube
inserted but not left in place. It drains urine
temporarily or provides a sterile urine specimen
(Fig. 30-9).
Retention Catheters
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A retention catheter, also called an indwelling
catheter, is left in place for a period of time (see
Fig. 30-9). The most common type is a Foley
catheter.
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Figure 30-9 • Types of urinary catheters
A )Retention (Foley) catheter with balloon( .B )Straight catheter .
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Unlike straight catheters, retention catheters
are secured with a balloon that is inflated once
the distal tip is within the bladder. Both
straight and retention catheters are available in
various diameters, sized according to the
French scale: for adults, sizes 14, 16, and 18 F
are commonly used.
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Inserting a Catheter
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Providing Catheter Care
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“Catheters left in place for more than a few
weeks become encrusted or obstructed, and
lead to infection. In addition, bacteria that
adhere to the urinary catheter develop a
complex biologic structure, which protects
them from antibiotics”
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Catheter care (hygiene measures used to keep
the meatus and adjacent area of the catheter
clean) helps to prevent the growth and spread
of colonizing pathogens.
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Figure 30-11 • Techniques for suspending a drainage system below the bladder( :
A )wheelchair patient( ;B )ambulating patient with and without an IV pole.
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Continuous Irrigation
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A continuous irrigation (ongoing instillation
of solution) instills irrigating solution into a
catheter by gravity over a period of days (Fig.
30-12).
Continuous irrigations keep a catheter patent
after prostate or other urologic surgery in
which blood clots and tissue debris collect
within the bladder.
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Figure 30-12 • Bladder irrigation using a three-way catheter
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Urinary Diversions
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In a urinary diversion, one or both ureters are
surgically
implanted
elsewhere.
This
procedure is done for various life-threatening
conditions. The ureters may be brought to and
through the skin of the abdomen. A urostomy
(urinary diversion that discharges urine from
an opening on the abdomen), or implanted
within the bowel (called an ileal conduit) (Fig.
30-14).
SPC
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Figure 30-14 • Examples of urinary diversions( .A )Ileal conduit( .B )Cutaneous ureterostomy .
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Nursing Implications
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Self-Care Deficit: Toileting
Impaired Urinary Elimination
Risk for Infection
Stress Urinary Incontinence
Urge Urinary Incontinence
Reflex Urinary Incontinence
Total Urinary Incontinence
Functional Urinary Incontinence
Situational Low Self-Esteem
Risk for Impaired Skin Integrity
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