Transcript Urinary System

Urinary elimination
Dr. Dergham M. Hameed
Urinary System
• Kidneys and ureters
• Bladder
• Urethra
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)
• Nephrons remove the end products of metabolism and
regulate fluid balance
• Urine from the nephrons empties into the kidneys
Bladder
• Smooth muscle sac
• Serves as a reservoir for urine
• Composed of three layers of muscle tissue called
detrusor muscle
• Sphincter guards opening between urinary bladder and
urethra
• Urethra conveys urine from bladder to exterior of body
Urethra
• Conveys urine from the bladder to the exterior
• Male urethra functions in excretory and reproductive
system
• No portion of female urethra is external to the body
Act of Micturition
• Process of emptying the bladder
– Detrusor muscle contracts, internal sphincter relaxes,
urine enter posterior urethra
– Muscles of perineum and external sphincter relax
– Muscle of abdominal wall contracts slightly
– Diaphragm lowers, micturition occurs
Factors Affecting Micturition
• Developmental considerations
• Food and fluid intake
• Psychological variables
• Activity and muscle tone
• Pathologic conditions
• Medication
Developmental Considerations
• Children
– Toilet training 18 to 24 months, enuresis
• 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
• Diuretics — prevent reabsorption of water and certain
electrolytes in tubules
• Cholingeric medications — stimulate contraction of
detrusor muscle, producing urination
• Analgesics and tranquilizers — suppress CNS diminish
effectiveness of neural reflex
Medications Affecting Color of Urine
• Anticoagulants — red color
• Diuretics — lighten urine to pale yellow
• Pyridium — orange to orange-red urine
• Elavil — green or blue-green
• Levodopa — brown or black
Using the Nursing Process
• Assessing data about voiding patterns, habits, past
history of problems
• Physical examination of urinary system, skin hydration,
urine
• Correlation of these findings with results of procedures
and diagnostic tests
Assessing a Problem With Voiding
• Explore its duration, severity, and precipitating factors.
• Note patient’s perception of the problem.
• Check adequacy of patient’s self-care behaviors.
Physical Assessment of
Urinary Functioning
• Kidneys — check for costovertebral tenderness
• Urinary bladder — palpate and percuss the bladder or
use bedside scanner
• 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
• Ask patient to void into bedpan, urinal, or specimen
container in bed or bathroom.
• Pour urine into appropriate measuring device.
• 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
• Specimens from infants and children
• Clean-catch or midstream specimens
• Sterile specimens from indwelling catheter
• 24-hour urine specimen
Diagnoses
• Urinary functioning as the problem
– Incontinence, pattern alteration, urinary retention
• Urinary functioning as the etiology
– Anxiety, caregiver role strain, risk for infection
Planned Patient Goals
• 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
Promoting Normal Urination
• Maintaining normal voiding habits
• Promoting fluid intake
• Strengthening muscle tone
• Stimulating urination and resolving urinary retention
Maintaining Normal Voiding Habits
• Schedule
• Privacy
• Position
• Hygiene
Patients at Risk for UTIs
• Sexually active women
• Postmenopausal women
• Individuals with indwelling urinary catheter
• Individual with diabetes mellitus
• Elderly people
Four Types of Urinary Incontinence
• Stress — increase in intraabdominal pressure
• Urge — urine lost during abrupt and strong desire to void
• Mixed — symptoms of urge and stress incontinence
present
• Overflow — overdistention and overflow of bladder
• Functional — caused by factors outside the urinary tract
Factors to Consider With
Use of Absorbent Products
• Functional disability of the patient
• Type and severity of incontinence
• Gender
• Availability of caregivers
• Failure with previous treatment programs
• Patient preference
Reasons for Catheterization
• Relieving urinary retention
• Obtaining a sterile urine specimen
• Measuring amount urine in bladder
• Obtaining a urine specimen
• Emptying bladder before during or after surgery
• Monitoring of critically ill patients
Evaluating Effectiveness of Plan
• Maintain fluid, electrolyte, and acid-base balance
• Empty bladder completely at regular intervals with no
discomfort
• Provide care for urinary diversion and when to notify
physician
• Develop a plan to modify factors contributing to problem
• Correct unhealthy urinary habits