Transcript Urinary System Organs Renal Nephron

Urinary Elimination
Concept: Elimination
• Definition:
The term elimination is defined as the excretion
of waste products.
• Bowel Elimination
Bowel elimination is defined as the passage of stool
through the intestinal tract and dispelling the stool by
means of intestinal smooth muscle contraction.
• Urinary Elimination
Urinary elimination is defined as the passage of urine
through the urinary tract by means of the urinary
sphincter and urethra.
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Risk Factors for
Problems of Elimination
• Conditions that result in
– Neurologic impairment (Neurogenic bladder)
• Trauma to the brain or spinal cord
• CVA
• Diabetic neuropathy (R/T metabolic derangements)
– Altered mobility
• Severe arthritis
– Cognitive impairment
• dementia
– Immunologic impairment or infection
• AIDS
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Scientific Knowledge Base:
Organs of Urinary Elimination
Kidneys
Ureters
Remove waste from the blood
to form urine
Transport urine from the
kidneys to the bladder
Bladder
Urethra
Reservoir for urine until the
urge to urinate develops
Urine travels from the bladder
and exits through the urethral
meatus.
Urinary System
Urinary System Organs
Renal Nephron
Additional Kidney Functions
• Production of erythropoietin is essential to maintaining a
normal red blood cell (RBC) volume.
– Erythropoietin stimulates bone marrow to produce RBCs and
prolongs the life of mature RBCs.
• Production of renin.
– Renin starts a chain of events that cause water retention, thereby
increasing blood volume.
• Kidneys affect calcium and phosphate regulation
Renin-Angiotensin Mechanism
Kidneys affect calcium and
phosphate regulation
Vitamin D
The Kidneys produces a substance that
converts vitamin D into its active form.
Intestines absorb more Ca from
foods.
Factors Influencing Urination
• Disease conditions
• Socioeconomic factors (need for privacy)
• Psychological factors (anxiety, stress,
privacy)
• Fluid balance
– Nocturia, polyuria, oliguria, anuria
– Diuresis
– Fever
• Medications and medical procedures
Disease Conditions Affecting Urination
• Prerenal, renal, postrenal classification
• Conditions of the lower urinary tract
• Diabetes mellitus and neuromuscular diseases such as
multiple sclerosis
• Benign prostatic hyperplasia
• Cognitive impairments (e.g., Alzheimer’s)
• Diseases that slow or hinder physical activity
• Conditions that make it difficult to reach and use toilet
facilities
• End-stage renal disease, uremic syndrome
Pre-renal, renal, post-renal classification
Decrease blood flow
Condition of renal tissue
Obstruction in the UT
that prevents flow from
kidneys
Conditions of the Lower Urinary Tract
Diabetes Mellitus and
Neuromuscular Diseases
Benign Prostatic Hyperplasia (BPH)
Conditions Affecting Urination
Conditions that make it
difficult to reach and
use toilet facilities
Cognitive
impairments
Diseases that slow or
hinder physical activity
End Stage Renal Disease
(ESRD) (CKD)
Dialysis
• Renal Replacement
• Two methods
– Peritoneal
– Hemodialysis
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Indications for Dialysis
Renal failure that can no longer be controlled by conservative
management (Conservative management would include dietary
modifications and the administration of medications to correct
electrolyte abnormalities.)
Worsening of uremic syndrome associated with ESRD,
which would include nausea, vomiting, neurological changes, and
pericarditis)
Severe electrolyte and/or fluid abnormalities that cannot be
controlled by simpler measures (These abnormalities would include
hyperkalemia and pulmonary edema.) by simpler measures
Factors Influencing Urination
• Disease conditions
• Socioeconomic factors
– Need for privacy
– Cultural differences
• Psychological factors
– Anxiety
– Emotional Stress
– Privacy
Factors Influencing Urination
• Fluid balance
– Nocturia, polyuria, oliguria, anuria
– Diuresis
– Fever
– Foods
• Medications and medical procedures
Fluid Balance
• Symptoms common to urinary disturbances
include
– frequency
– urgency
– dysuria
– polyuria
– oliguria
– incontinence
– difficulty in starting the urinary stream.
Medications and Medical
Procedures
• Surgery (stress)
Alterations in Urinary Elimination
Urinary retention
Urinary tract infection
An accumulation of urine due
to the inability of the bladder
to empty
Results from catheterization
or procedure
Urinary incontinence
Urinary diversion
Involuntary leakage of urine
Diversion of urine to external
source
Urinary Retention
An accumulation of urine due to the
inability of the bladder to empty
• Signs and Symptoms
– Bladder distention
– No UO in several hours
– May void small amounts of
urine 2-3 times an hour
• Treatment
– Residual urine
– Bladder scan
– I & O catheter
Urinary Tract Infection
Results from catheterization or
procedure
CAUTIs
(Catheter-associated UTIs)
• Increased
hospitalization
• Increased morbidity
and mortality
• Longer hospital stay
• Increased hospital cost
Urinary Tract Infection
• 7 reasons for insertion of a Foley Catheter
– Urinary retention
– To relieve urinary obstruction
– Accurate I&O in critical patients
– Bladder decompression for surgery
– Urinary incontinence with stage 3 – 4 pressure
ulcers
– Comfort for terminal patient
– Urological procedurss
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Urinary Tract Infection
• Signs and symptoms
– Pain or burning during urination (dysuria)
– Fever, chills, nausea, vomiting, and malaise
– Frequent and urgent sensation of need to void
– Blood-tinged urine (hematuria)
• Treatment
– Medication
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Urinary incontinence
CVA, Heat injury, spinal cord
injury, diabetic neuropathy,
irritating factors
Nursing Diagnoses
– Impaired Social Interaction r/t Loss of
independence: clothing becomes wet with urine
and odor.
– Impaired body image r/t incontinent of urine.
– Risk for impaired skin integrity.
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Nursing Knowledge Base &
Assessment
Infection control and hygiene
Growth and development
Muscle tone
Psychosocial considerations
Cultural considerations
Physical Assessment
• Gather nursing history for the patient’s urination pattern
and symptoms, and factors affecting urination.
• Conduct physical assessment of the patient’s body
systems potentially affected by urinary change.
• Assess characteristics of urine.
• Assess the patient’s perception of urinary problems as it
affects self-concept and sexuality.
• Gather relevant laboratory and diagnostic test data.
Physical Assessment
Skin and mucosal
membranes
Kidneys
Assess hydration.
Flank pain may occur with
infection or inflammation.
Bladder
Urethral meatus
Distended bladder rises above
symphysis pubis.
Observe for discharge,
inflammation, and lesions.
Assessment of Urine
• Intake and output (I&O)
• Characteristics of urine
– Color
• Pale-straw to amber color
– Clarity
• Transparent unless pathology is present
– Odor
• Ammonia in nature
• Urine testing
• Specimen collection
Urine Tests and Diagnostic Examinations
Urinalysis
Specific gravity
Culture
Noninvasive procedures
Invasive procedures
Catheterization
Catheter insertion
Closed drainage systems
Catheter care
Perineal hygiene
Fluid intake
Catheter irrigations and instillations
Removal of indwelling catheter
Alternative to urethral catheterization
Types of Urinary Catheters
Urinary Drainage System and Infectious
Organisms
Applying a Condom Catheter
Applying a Condom Catheter (cont’d)
External Urinary Device
Restorative Care
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Strengthening pelvic floor muscles
Bladder retraining
Habit training
Self-catheterization
Maintenance of skin integrity
Promotion of comfort