Transcript CHAPTER 22 Urinary Elimination

CHAPTER 22
Urinary Elimination
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The healthy adult produces 1500 mL of
urine per day
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Urination & micturition & voiding…all
mean to empty urine from the bladder.
 Some substances increase urine production like
coffee, tea, caffeine, alcohol and some
medications
 A diet high in salt causes the body to retain water
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Urinary System
◦ 2 Kidneys
2 ureter’s
bladder
◦ Meatus: opening to outside of the body
urethra
meatus
 Kidneys: made up of million tiny nephron’s. Nephron’s are the
working unit of the kidney. Blood passes through the kidney’s and
the nephron’s then urine is formed.
◦ Kidneys remove waste from the blood and maintain the body’s
water balance
◦ 2 uteter’s:
◦ Bladder:
◦ Urethra: from the bladder to the meatus (opening to outside of
body
FUNCTION: of the URINARY SYSTEM is to maintain fluid
balance and maintain electrolyte balance.
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1. Normal characteristics of urine:
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Output 1500 mL urine daily
Normal color of urine is: amber
Clear with no particles
Has a faint odor
Urination, micturition, voiding: all mean
emptying the bladder
Changes with aging:
 Kidney function decreases
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Bladder weakens and decreases with size
Incontinence
Risk for UTI
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2. Observe urine for:
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Color
Clarity
Odor
Amount
Particles
Report changes to the nurse:
◦ Urgency & frequency
◦ Foul odor
◦ Incontinence
◦ Pain (dysuria) or burning on urination
◦ Decrease or No urine output
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3. Rules for Elimination Box 22-1 pg 334
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Privacy
Safety
Peri-care
Allow enough time
Medical asepsis
Follow persons habits
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4. Abnormal Urinary Problems: Table 22-1 pg 335
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Anuria: no urine (kidney failure)
Polyuria: 3000 mL per day
Dysuria: difficulty or painful urinating
Hematuria: blood in the urine
Nocturia: Urinating during the night
Urinary Incontinence: Not being able to control bladder
function
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5. Urination devices or equipment
You store urination devices in the bottom of the bed stand or bottom drawer:
a.
Bedpans: Fracture pan and regular bedpan Page 335-337
 Bedpan: Bedpan is used when a person cannot get out of bed. Person will use
bedpans for bowel movements
 Fracture pan: Thinner rim and only ½ inch deep. Smaller end is placed under
the buttock. Used for persons with casts, traction, fragile bones from
osteoporosis, arthritis, hip replacement. The fracture pan is more comfortable
for older people and women.
b. Urinal: men can sit or stand. Hook the urinal to bedrail so he can reach it.
- remind men to hang urinals on bedrails and to signal when he is done.
c. Commodes: For people who cannot walk to the bathroom
d. Urine Hat: Placed in the toilet for measuring urine
e. Documenting output – Graphic Sheet form
f. Types of Measuring containers:
- Down drain catheter
- Urinal
- Commode
- Specimen pan/hat
- Estimating when incontinent
g. Clean EQUIPMENT: wash out and clean – swish and dump into the toilet – then
use disinfectant
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6. Elimination Considerations:
◦ A. INCONTINENCE: is the involuntary loss of urine from the
bladder. Can be temporary or permanent. It is common in
older people.
 REMEMBER, Incontinence is beyond the person’s control
◦ Urge Incontinence: Urine is lost in response to a sudden, urgent
need to void.
◦ Stress Incontinence: Urine leaks during exercise, sneezing,
laughing, coughing and lifting
◦ Usually their self esteem is affected. Garments get wet and odor
develops. Skin irritation, infections, and pressure sores can
develop if not taken care of immediately.
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Prevention of Incontinence: Box 22-2
◦ Nursing measures or persons with urinary incontinence
◦ Kaegal exercises (10rep X 10) each day
◦ Bowel and bladder training program (goal: to get voluntary control of
urination) For the person to use the toilet at certain times of the day
◦ Force fluids
◦ Call light within reach
◦ Be patient
◦ Use incontinent pads and briefs
◦ Needs good skin care (peri-care)
◦ B. Urinary Tract Infection: An infection in the bladder caused by the
invasion of disease causing micro-organisms (pathogens)
 Prevent a UTI box 22-2 pg 343
1. Promote fluid intake
2. Have person wear cotton underwear
3. Keep perineal area clean and dry
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7. CATHETERS:
a tube used to drain urine from the bladder
* Catheter’s NEVER TREAT incontinence
* Increases risks of infection in the urine
A. Types of catheters:
Straight Catheter: drains the bladder and is removed
a. used for: sterile specimens, residual urine, pre-op and post-op, Spina
bifida and paraplegics
Foley Catheter: (indwelling catheter) is left in the bladder
a. used for: post-op, acute illness
Condom (external) catheter: males only, applied daily, use elastic
tape because it expands when the penis changes size. *NEVER
USE ADHESIVE TAPE.
a. used for prostate issues, quadraplgics
Suprapubic catheter: inserted into the bladder through a cut in the
stomach. Maybe chosen because more comfortable and causes less
infection.
a. Used for chronic conditions, paraplegics
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B. Care of Catheters Box 22-3 pg 345
◦ 1. Catheters must be below the bladder at all times and tubing over
the leg
◦ 2. Catheter bag is hung on the bed frame never to the side rail or on
the floor
◦ 3. Change down drain bag to leg bag when ambulating or going outside
◦ 4. Urine catheter bags are emptied
1. end of shift
2. changing from leg bag to drainage bag 3. when full
o 5. Catheter care is done: BID and PRN, clean from the meatus to 4-6
inches down the tube.
o 6. No tension on meatus
o 7. No Kinks in tubing
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C. Emptying catheter bag
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Collect equipment and gloves
Clean tip with alcohol pad
Tube should not touch side of graduate
Clean tip with alcohol pad
Re-clamp and reinsert into storage sheath
• D. Measuring Output
• 1. Place on flat surface to measure at flat surface
• 2. Dispose of properly in toilet, rinse and dry container
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8. Chapter 33
pg 503-510
 A. COLLECT SPECIMEN
◦ Wear gloves
◦ Use a clean container – do not touch the inside of the container or lid
◦ Label it: with –Pt Name –DOB –Date –Time –Type of specimen. Label
goes on the container not on the lid.
◦ Place specimen in to transport bag, wash hands and take to designated
location
◦ The specimen must not contain feces or toilet paper
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B. TYPES OF SPECIMENS:
Random: collected at anytime. No special measures are taken
Clean catch (midstream):
A. perineal care is done before collecting specimen
B. Have person start to void in toilet
C. Stop voiding
D. Finish voiding in the container
24 hour urine specimen: all urine voided during a 24 hour period is
collected.
A. Initial voiding is discarded and the clock is started
B. Collect all urine for the next 24 hours
C. Store urine collection per laboratory instructions
D. Document every void
**Always report to nurse abnormalities or urine like: color, odor,
clarity, amount & particles**
C. Kidney Stones:
Calculi, they develop in the kidney,
ureter’s or bladder. They vary in size. All urine is strained. Any
stones are sent to the lab.
S/S: hematuria, acute pain, very painful in the back area and when
urinating.
Tx: Force fluids and may need surgery.
Causes: genetic or too much calcium or magnesium
Risk factors: male 20-40 yrs old, Caucasian
D. Terms:
- Cystitis: inflammation of the bladder, called bladder infection
- Dialysis: procedure that is done to remove waste products from the
body when the kidneys fail. This is done with a dialysis machine.
- Kidney Failure: loss of the kidney’s ability to excrete wastes,
concentrate urine, and conserve electrolytes