Transcript Urinary Elimination

JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 28:
Urinary Elimination
Copyright © 2016 F.A. Davis Company
Urinary Elimination
• Known as voiding, micturition
• Process
– Filling of bladder  200 to 450 mL of urine
– Activation of stretch receptors in bladder wall
– Signaling to the voiding reflex center
– Contraction of detrusor muscle
– Conscious relaxation of external urethral sphincter
Copyright © 2016 F.A. Davis Company
Life Span Considerations Related
to Urination
Infants
• 15 to 60 mL per kg
• Produce 8 to 10 wet diapers per day
• No voluntary control
Copyright © 2016 F.A. Davis Company
Life Span Considerations Related to
Urination (cont’d)
Children
• Toilet training requires
– Mature neuromuscular system
– Adequate communication skills
• Problems include
– Enuresis
– Nocturnal enuresis
Copyright © 2016 F.A. Davis Company
Life Span Considerations Related to
Urination (cont’d)
Older adults
• Kidney function decreases
• Urgency and frequency common
• Loss of bladder elasticity and muscle tone
leads to
– Nocturia
– Incomplete emptying
Copyright © 2016 F.A. Davis Company
Factors Affecting Urinary Elimination
• Personal
• Sociocultural
• Environmental
• Nutrition
• Hydration
• Activity level
• Medications
• Surgery and anesthesia
Copyright © 2016 F.A. Davis Company
Factors Affecting Urinary Elimination (cont’d)
Pathological conditions
• Bladder/kidney infections
• Kidney stones
• Hypertrophy of the
prostate (male)
• Mobility problems
• Decreased blood flow
through glomeruli
• Neurological conditions
• Communication
problems
• Alteration in cognition
Copyright © 2016 F.A. Davis Company
Alterations in Urinary Elimination
• Urinary tract infections
• Urinary retention
• Urinary incontinence
• Urinary diversion/urostomy
Copyright © 2016 F.A. Davis Company
Promoting Normal Urination
• Provide privacy―curtains, doors
• Assist with positioning―men  standing,
 seated upright
• Facilitate toileting routines―identify the
client’s pattern
Copyright © 2016 F.A. Davis Company
women
Managing Urinary Retention
Urinary catheterization
• Introduction of a sterile
tube into the bladder
– Straight, intermittent, or in and out
– catheter
– Indwelling catheter: Foley
– Suprapubic catheter
Copyright © 2016 F.A. Davis Company
Managing Urinary Retention (cont’d)
• Nursing care (for urinary catheter)
– Prevent urinary tract infection
– Prevent backflow of urine
– Encourage fluids
– Ensure perineal hygiene
Copyright © 2016 F.A. Davis Company
Managing Urinary Incontinence
• Prevent skin breakdown.
• Encourage/teach lifestyle modifications.
• Implement bladder training.
• Encourage client to perform Kegel exercises.
• Use anti-incontinence devices as needed.
Copyright © 2016 F.A. Davis Company
Managing Urinary Incontinence (cont’d)
• Strategies to promote independent urination
• Pharmacological interventions
• Surgical interventions
• Parental teaching for enuresis
Copyright © 2016 F.A. Davis Company
Common Urine Studies
• Specimens
• Freshly voided specimen
• Clean catch
• Sterile specimen
• 24-hr urine
Copyright © 2016 F.A. Davis Company
Common Urine Studies (cont’d)
Studies
• Urinalysis
• Dipstick testing
• Specific gravity
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
You are caring for a patient who had an indwelling
catheter removed 12 hr ago. The patient has not voided.
What action should you take?
Copyright © 2016 F.A. Davis Company