Urinary Elimination (PowerPoint)

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					Urinary Elimination
  Teresa V. Hurley, MSN, RN
                Urinary System
   Kidneys filter nitrogen, metabolic wastes, excess
    ions and water
   Urine produced at a rate of 60 mL/hour
   Bladder stores average 500 mL or more
    Void: detrusor muscle contracts and urine is
    pushed through internal urethral sphincter into
   Urine: clear, yellow, aromatic, without pathogens
    or parasites

   Specific Gravity: 1.025 (concentrate urine)
     Increases with dehydration
     Decreases with increased fluid intake
   Abnormal
       Protein: renal disease, 2nd to exercise and stress
       Glucose: elevated BS; diabetes
       Ketones: CHO metabolism
            Diabetes, fever, fasting, starvation, high protein intake, vomiting,
       Hemoglobin: UTI, nephritis, trauma, lithiasis, hemolytic rx
       Bilirubin: liver disease
       Urobilinogem: cirrhosis, heart failure, pernicious anemia,
       Nitrates: bacteria
       Leukocyte esterase: bacteria, fungal, parasitic, tumor,
 BUN 8-16 mg/dL (end product protein
 Creatinine 0.6-1.2mg/dL (muscle metabolism of

   Increased: renal failure, infection, obstruction,
    dehydration, increase protein intake, TPN
   Decreased: liver disease, decrease protein intake
     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
     Effects of Medications on Urine
      Production and Elimination
   Diuretics — prevent              Analgesics and
    reabsorption of water             tranquilizers — suppress
    and certain electrolytes in       CNS diminish
    tubules                           effectiveness of neural
   Cholingeric medications
    — stimulate contraction
    of detrusor muscle,
    producing urination
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
   Note client’s perception of the problem.
   Check adequacy of client’s self-care behaviors.
            Physical Assessment of
             Urinary Functioning
   Kidneys — check for            Urethral meatus —
    costovertebral tenderness       inspect for signs of
   Urinary bladder —               infection, discharge, or
    palpate and percuss the         odor
    bladder or use bedside         Skin — assess for color,
    scanner                         texture, turgor, and
                                    excretion of wastes
                                   Urine — assess for color,
                                    odor, clarity, and
         Measuring Urine Output
   Ask client to void into      Place calibrated container
    bedpan, urinal, or            on flat surface and read
    specimen container in         at eye level.
    bed or bathroom.             Note amount of urine
   Pour urine into               voided and record on
    appropriate measuring         appropriate form.
    device.                      Discard urine in toilet
                                  unless specimen is
              Urine Specimens
   Routine urinalysis
   Specimens from infants and children
   Clean-catch or midstream specimens
   Sterile specimens from indwelling catheter
   24-hour urine specimen
           Promoting Urination
   Maintaining voiding habits
   Promoting fluid intake
   Strengthening muscle tone
     Kegel Exercises (PFME) to Tx stress, urge mixed
     Imagine voiding, stop flow, tighten rectal muscles

     Hold 5-10sec and rest 5-10sec

     Daily 40-60 PFME doing 2-4 sets of 15 each time
        Client’s 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
   Functional — caused by factors outside the
    urinary tract
       Client Education for Urinary
   Explain reason for diversion and rationale for
   Demonstrate effective self-care behaviors
   Describe follow-up care and support resources
   Report where supplies may be obtained in
   Verbalize related fears and concerns
   Demonstrate a positive body image
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
   Correct unhealthy urinary habits
       Hazards of Catheterization
   UTI.                      DO NOT USE FORCE!
   Sepsis.                   USE STERILE
   Trauma- specially in       ASEPTIC
    men.                       TECHNIQUE!
                              Research
                                  clean technique can be
                                   used for self
                                   catheterization at home.
        Reasons for Catheterization
   Relieving urinary retention.
   Obtaining a sterile urine specimen..
   Emptying the bladder
      before,
     during,

     after surgery or diagnostic procedures.

   Monitoring of critically ill patients.
Types of Catheters
            Indwelling catheter
                 remains in place for
                 continuous drainage.
            Intermittent catheter
                 used to drain bladder for
                 short periods of time.
            Suprapubic catheter
                 inserted surgically above
                 the pubic bone for
                 continuous drainage.
             Urinary Diversions
   Ureterostomy
     Bladder is removed
     One or both ureters redirected from kidney through
      the abdominal wall
                 Ileal Conduit
   Bladder removed and small intestine (ileum)
    used as conduit between ureters and skin
    surface. Urine collects continuously
              Client Care Goals:
      Interventions Indwelling Catheter
   Prevent UTI (meatus burning, cloudy, foul, chills, fever)
        Maintain closed system
        Cleanse catheter soap/H2O; pat dry
        Alcohol swab for contamination
        Empty bag q 8 h or more
        Bag below bladder level
        Maintain urine acidity: cranberry juice, prunes, plums, tomatoes, eggs,meat,
         cheese, citrus fruits
        Change only sediment collects, sandy particles, trouble draining

   Maintain Urine Flow ( prevent urinary stasis and backflow)
        Gravity drainage
        Check for kinks, coils, lying on tube
        Clamp if higher than bladder
        Do not allow on floor
                       Client Goals
   Prevent Infection Transmission
       Wash hands before and after
       Wear gloves

   Promote Urine Production (pathogen flushing; tube
    irrigation; prevents stasis)
       Oral intake 8-10 glasses (3000 mL/day) unless contra-
       Parenteral or Enteral feedings
       Monitor I & O q 8 h
       Check for blood, sediments, color, odor
                   Client Goals
   Maintain Skin and Mucosal Integrity
     Prevent fecal and encrustation to catheter and
      perineal area
     Cleasnse: soap/H2O

     Sandy particle encrustation at the meatus (catheter