Transcript Urinary elimination

Chapter 30
Urinary Elimination
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
1
Overview of Urinary Elimination
Components of the urinary system: kidneys,
ureters, bladder, and urethra
Accessory structures of the urinary system: ring-
shaped muscles called the internal and external
sphincters
Components, along with accessory structures,
work together to produce urine, collect it, and
excrete it from the body
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
2
Major Structures of Urinary System
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
3
Overview of Urinary Elimination (cont’d)
Urinary elimination: process of releasing
excess fluid and metabolic wastes
Normal conditions: average person
eliminates approximately 1500 to 3000
mL of urine each day
Need to urinate becomes apparent when
the bladder distends with approximately
150 to 300 mL of urine
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
4
Factors affecting urinary elimination
 Patterns of urinary elimination depend on
 Physiologic
 Emotional
 Social
o Examples: amount of food consumed, volume
of fluid intake, and the amount of fluid losses
o Degree of neuromuscular development
o Integrity of the spinal cord
o Circadian rhythm, habits, opportunities, anxiety
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
5
Factors affecting urinary elimination (cont’d)
Measures to promote urination
Providing privacy; assuming a natural position
for urination
Maintaining an adequate fluid intake
Using stimuli such as running water from a tap to
initiate voiding
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
6
2014 - 12 - 2
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing - B
7
Factors affecting urinary elimination (cont’d)
Urine Specimen Collection
 Purpose: to identify microscopic or chemical
constituents of client’s urine
1. Voided Specimens
 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).
2. A clean-catch specimen
 Is a voided sample of urine considered sterile

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.
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
8
Urine Specimen Collection (cont’d)
3) Catheter Specimens
 A urine specimen can be collected under sterile
conditions using a catheter, which is usually done
when clients are catheterized for other reasons
such as to control incontinence in an unconscious
client
4) 24-Hour Specimens
 collection of all urine produced
in a full 24-hour period
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
9
Abnormal Urinary Elimination Patterns
 Identifying abnormal urine characteristics
 Laboratory analysis is a valuable diagnostic
tool
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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
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
10
Abnormal Urinary Elimination Patterns
1. Anuria
 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.
Note: Urinary retention: the client produces urine but
does not release it from the bladder
2. Oliguria
 Urine output less than 400 mL per 24 hours,
indicates inadequate elimination of urine.
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Residual urine : more than 50 mL of urine that remains
in the bladder after voiding
Urinary stasis: lack of movement of urine from bladder
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
11
Abnormal Urinary Elimination Patterns (cont’d)
3. Polyuria
 Greater than normal urinary volume and may
accompany minor dietary variations, such as
increased fluid intake
 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.
4. Nocturia
 Nocturia (nighttime urination) is unusual because
the rate of urine production is normally reduced at
night.
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
12
Abnormal Urinary Elimination Patterns (cont’d)
5. Dysuria
 Dysuria is difficult or uncomfortable voiding
and a common symptom of trauma to the
urethra or a bladder infection.
 Frequency :need to urinate often.
 Urgency :strong feeling that urine must be
eliminated quickly often accompany dysuria.
6. Incontinence
 Incontinence means the inability to control
either urinary or bowel elimination and is
abnormal after a person is toilet-trained.
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
13
Assisting Clients with Urinary Elimination
Clients who are weak or cannot
walk to the bathroom may need
a commode; clients confined
to bed use a urinal or bedpan
1. Commode: chair with an
opening in the seat under
which a receptacle is
placed
2. Urinal: cylindrical
container for collecting
urine; mostly used for
males
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
14
C. Using a Bedpan
 A bedpan (seat like container for elimination) is used
to collect urine or stool.
Figure 30-5 • Two types of bedpans: fracture pan)left( and conventional bedpan) right) .
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
15
Managing Incontinence
 6 types of urinary incontinence
 Stress, urge, reflex, functional, total, and
overflow
 Continence training: to restore control of
urination involves teaching the client to
refrain from urinating until an appropriate
time and place
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
16
Types of urinary incontinence
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
17
Catheterization
Catheterization: act of applying or inserting a
hollow tube
Types of catheters
 External catheters: urine-collecting device
applied to the skin
o Example: condom catheter
o Are more effective for male pts..
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
18
Catheterization(cont’d)
Straight catheters: urine drainage tube inserted
but not left in place
Retention catheters (also called indwelling
catheters): left in place for a period of time
Example: Foley catheter
A. Retention (Foley) catheter with
a balloon
B. Straight catheter
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
19
Various Reasons for Urinary Catheter Use
1. Keeping incontinent clients dry (last resort, when
all other continence measures have been tried)
2. Relieving bladder distention when clients cannot
void
3. Assessing fluid balance accurately
4. Keeping the bladder from becoming distended
during procedures such as surgery
5. Measuring the residual urine
6. Obtaining sterile urine specimens
7. Instilling medication within the bladder
2014 - 12 - 2
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing - B
20
Types of Catheters (cont’d)
 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
 Available in various diameters, sized according
to the French scale: for adults, sizes 14, 16, and
18 F are commonly used.
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
21
Catheterization(cont’d)
Inserting a catheter: techniques for inserting
straight and retention catheters are similar,
although the steps for inflating the retention
balloon do not apply to a straight catheter
Closed drainage system:
 Device used to collect urine from
a
catheter
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
22
Figure 30-11 • Techniques for suspending a drainage system below the bladder( :
A )wheelchair patient( ;B )ambulating patient with and without an IV pole.
2014 - 12 - 2
Bader A. EL Safadi BSN , MSc
Fundamental of Nursing - B
23
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
24
Catheterization(cont’d)
Catheter irrigation: flushing the lumen of a
catheter for restoring or maintaining patency
1.
Open system: retention catheter is separated
from the drainage tubing to insert the tip of an
irrigating syringe (least desirable)
2. Closed system: irrigated without
separating the catheter from the drainage
tubing
Continuous irrigation: ongoing instillation
of solution using a 3-way catheter
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
25
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
26
Catheterization(cont’d)
• Indwelling catheter removal: catheter
is removed when it needs to be replaced
or when its use is discontinued
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
27
Catheter removal
2014 - 12 - 2
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing - B
28
Urinary Diversions
Urinary diversion: one or both ureters are
surgically implanted elsewhere
This procedure is done for various life-
threatening conditions
Urostomy: urinary diversion that discharges
urine from an opening on the abdomen
o Peristomal skin: skin around the stoma
o Difficult to maintain skin integrity due to
frequent appliance changes and
ammonia in urine
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
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Figure 30-14 • Examples of urinary diversions( .A )Ileal conduit( .B )Cutaneous ureterostomy .
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
30
Nursing Implications
 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
Second semester 15 - 16
Bader A. EL Safadi
BSN , MSc
Fundamental of Nursing – B
Urinary Elimination
31