Urinary Elimination Chp 41

Front 1

Nephron

Back 1

functional unit of the kidney

Front 2

Ureters

Back 2

narrow (1.25cm), smooth muscle tubes that serve as passageways for uring to flow from kidneys to the bladder.

Front 3

Bladder

Back 3

storage compartment for urine.

Front 4

Location of Bladder
(Female & Male)

Back 4

Female - located in front of the uterus & vagina.

Male - localed in front of rectum & above prostate gland.

Front 5

Detrusor Muscle

Back 5

3 layers of smoothe muscle which the body of bladder is composed of.

Front 6

Urethra

Back 6

exit passageway for urine from the bladder.

Female - short about 3-5cm (1 to 2 inches)
Male - longer about 20cm (8 inches)

Front 7

Major Function of Kidney

Back 7

* Regulate vol. & composition of the body's ECF
* Filter waste products from metabolism in the blood
* 20-30% of cardiac output goes to kidneys

Front 8

Urine Formation

Back 8

*Filtration - begins @ glomerulus, RBC & protein too large remain in capillary, remaining plasma filtered
*Reabsorption - 99% Na, K, Cl, HCO, glucose, amino acids reabsorbed, 1% = urine
*Secretion - H, K iona, NH3, creatine, uric acid & other metabolites

Front 9

Urine Excretion /
Micturition

Back 9

Process of excreting urine from the body, urination, voiding and micturition.

250ml - 400ml

Front 10

Characteristics of Urine

Back 10

* Volume - 250-400mL, catherized pt drain min. of 30mL/hr,
<30mL/hr = inadequate BF to kidneys
* Color - light yellow to dark yellow to dark yellow-brown,
state of hydration or meds affects color
* Clarity - transparent, clear w/o sediment
* Odor - aromatic

Front 11

Normal Pattern of Urine Elimination

Back 11

Total amt voided during 24 hour period ranges bet. 1200 - 1500 mL
Each void min of 200 mL and max 500 mL

Front 12

Factors Affecting Urination

Back 12

* Fluid Intake
* Loss of Body Fluid
* Nutrition
* Body Position
* Cognition
* Psychological Factors
* Obstruction of Urine Flow
* Infections of the Urinary Tract
* Hypotension
* Neurologic Injury
* Decreased Muscle Tone
* Pregnancy
* Surgery
* Medications
* Urinary Diversion

Front 13

Fluid Intake

(factors affecting urination)

Back 13

increase fluid intake = increase fluid excretion

Front 14

Loss of Body Fluid

(factors affecting urination)

Back 14

kidneys increase reabsorption of water to maintain proper osmolarity of ECF

Front 15

Nutrition

(factors affecting urination)

Back 15

alcohol & caffeine increase urine output when ingested in large amt

Front 16

Cognition

(factors affecting urination)

Back 16

impairement interferes w/ person's abiltiy to maintain urinary continence

Neurologic condition: Alzheimer, brain tumor, stroke
Meds: cause delirium

Need to be alert, cognitively intact, motivated to maintain urinary continence

Front 17

Psychological Factors

(factors affecting urination)

Back 17

stress, anxiety, privacy

Front 18

Obstruction of Urine Flow

(factors affecting urination)

Back 18

tumors agn urinary tract, renal stones, prostatic enlargement, hydronephrosis

Front 19

Infections of the Urinary Tract

(factors affecting urination)

Back 19

caused by microorganisms found in GI tract - E. Coli, Klebsiella, proteus

Common UTI:
* Lower UTI urethritis (infection of urethra), cystitis (bladder infection)
* Upper UTI - uretitis (infection of ureters, kidney pelvis, tubule system)

Front 20

Hypotension

(factors affecting urination)

Back 20

When arterial BP drops, renal arteries don't have enough pressure to cause glomerular filtration.

Front 21

Neurologic Injury

(factors affecting urination)

Back 21

Stroke or spinal cord injury disrupt patterns of urination.
Injury by trauma, hemorrhage, or tumor to frontal lobes which control voluntary nature of voiding => incontinence

Injury to spinal cord at sacral level of spinal cord

Reflex arc injured, bladder fill w/o bladder stretch = urinary retention => autonomous neurogenic bladder

Front 22

Decreased Muscle Tone

(factors affecting urination)

Back 22

Weakened abdominal & perineal muscle impair bladder contraction & control of ext urinary sphincter
- due to obesity, multiple pregnancy, menopausal atrophy, chronic constipation

Front 23

Pregnancy

(factors affecting urination)

Back 23

Compression of bladder by uterus lead to urinary flow & incomplete emptying of bladder.

Front 24

Surgery

(factors affecting urination)

Back 24

Stress of surgery triggers release of ADH which decrease urinary output.
Anesthesia slow glomerular filtration rate, reduce urinary output.

Front 25

Medications

(factors affecting urination)

Back 25

Diuretics increase urine output by reabsorption of Na & water in tubules of nephron ex. chlorothiazide, hydrochlorothiazide, furosemide, spironolactone, triamterne

Front 26

Urinary Diversion

(factors affecting urination)

Back 26

Surgical procedure where normal pathway of urine elimination is altered.

Front 27

Altered Urinary Function

Back 27

* Dysuria
* Polyuria
* Oliguria
* Urgency
* Frequency
* Nocturia
* Hematuria
* Pyuria
* Urinary Retention
* Urinary Incontinence
* Enuresis

Front 28

Dysuria

Back 28

painful voiding associated w/ UTI
- burning sensation

Front 29

Polyuria

Back 29

Formation & excretion of excesive amt of urine in the absense of concurrent increase in fluid intake.
- ingestion of diuretics, caffeine, alcohol

Front 30

Oliguria

Back 30

Formation & excretion of decreased amt of urine < 500 mL in 24 hours
- severe decreased in fluid intake, excessive loss of body fluids, excessive vomiting, diarrhea, diaphoresis, burns, bleeding

Front 31

Anuria

Back 31

As kidney approaches complete failure, formation & excretion less than 100 mL in 24 hours.

Front 32

Urgency

Back 32

Subjective feeling of being unable to delay voiding voluntarily.

Front 33

Frequency

(altered urinary function)

Back 33

Voiding at frequent intervals = frequency.
Frequency + Urgency = Overactive Bladder

Front 34

Nocturia

(altered urination)

Back 34

Voiding during normal sleeping hours.
Ppl w/ congestive heart failure experience nocturia.

Front 35

Hematuria

(altered urination)

Back 35

Blood in urine; gross (visible on visual exam) or occult (not visible)
- UTI, urinary tract tumors, renal calculi, poisoning, trauma to urinary mucosa

Front 36

Pyuria

(altered urination)

Back 36

Urine contain pus, accumulation of end products of an inflammatory response
-WBC give urine a cloudy color, strong unpleasant odor

Front 37

Urinary Retention

(altered urination)

Back 37

Inability to empty bladder of urine
- unable to relax bladder neck & ext urethral sphincter to allow urine to pass from body
- extreme 2000 mL to 3000 mL = bladder distention palpated in suprapubic area of abdomen

Front 38

5 Types of Urinary Incontinence

Back 38

1. Stress Incontinence - involuntary loss of small amt of urine due to sudden increase in intra-abdominal pressure
2. Urge Incontinence - loss of urine after strong urge
3. Reflex incontinence - involuntary loss of urine
4. Functional incontinence - inability to reach bathroom in time to void
5. Total incontinence - continuous, involuntary, unpredictable loss of urine from a nondistended bladder

Front 39

Eurnesis

Back 39

Involuntary voiding w/ no underlying pathophysiologic origin

Front 40

URINE TESTS

Back 40

* Specific Gravity
* Reagent Strips
* Urinalysis
* Urine Culture & Sensitivity
* Blood Test - BUN
* Bladder Ultrasound
* Radiologic Examination
* Cystoscopy
* Urodynamic Studies

Front 41

URINALYSIS PARAMETERS

Back 41

* Color - Lt yellow-amber
* Turbidity - Clear
* pH - Normal 6 Range 4.6-8
* Specific Gravity - 1.015-1.025
* Protein - None
* Glucose - None
* Ketones - None
* RBC - 0-3, WBC 0-5, Bacteria/yeast None, Cast None