152-Wk7 Urinary Elimination - Kara Wiebe

Front 1

What is all included in the urinary system?

Back 1

Upper urinary tract
- Kidneys
- Ureters

Lower urinary tract
- Bladder
- Urethra

Front 2

Functions of the Kidney

Back 2

- Filtration
- Excretion
- Fluid and electrolyte balance
- RBC production
- BP regulation
- Bone mineralization

Front 3

Functions of the Kidney (continued)

Back 3

- kidney receives 20-25% of cardiac output

- the functional unit is the nephron, which has a glomerulus which actually filters the blood and begins to form urine

- 99% of filtrate is reabsorbed

- key method for fluid and electrolyte balance

-produce erythropoietin = RBC production

- Vit D conversion = bone mineralization

- produce renin = BP regulation

Front 4

Renin – Angiotensin Pathway

Back 4

regulation of BP

- Renal ischemia >> release of renin

- Renin conversion pathway results in Angiotensin II

-Angiotensin II >> vasoconstriction and release of aldosterone

- Aldosterone >> sodium and water retention, potassium and hydrogen excretion

- Result is increase in arterial BP and renal bloodflow

Front 5

Anti-Diuretic Hormone (ADH)

Back 5

BP Regulation

- Osmoreceptors in hypothalamus

- Trigger release of ADH by posterior pituitary

- ADH causes renal tubules and collecting ducts to be more permeable

-ADH also triggers thirst center

Front 6

Urination(Voiding)

Back 6

- Involves voluntary muscles (external sphincter) and involuntary muscles of urethra, plus voluntary muscles of pelvic floor, plus muscles of bladder

-Bladder muscles constrict and urethral muscles relax to permit voiding

- Involves upper and lower CNS control: micturition centre in sacral SC, and pontine centre in cerebral cortex

Front 7

Oliguria

Back 7

diminished urinary output relative to intake (usually 400mL/24 hours)

Front 8

Anuria

Back 8

no urine

Front 9

Polyuria

Back 9

voiding large amounts of urine

Front 10

Diuresis

Back 10

increased formation of urine by the kidney

Front 11

Nocturia

Back 11

frequent or excessive urination at night

Front 12

Bacteruria

Back 12

bacteria in urine

Front 13

Urosepsis

Back 13

bacteria from urine gets into blood

Front 14

Proteinuria

Back 14

protein in the urine

Front 15

Ketonuria

Back 15

ketones in urine

Front 16

Residual urine

Back 16

volume of urine remaining after voiding (>100mL)

Front 17

Hematuria

Back 17

Blood in the urine

this could be due to trauma

Front 18

Glycosuria

Back 18

sugar in the urine

Front 19

Cystitis

Back 19

infection of bladder

Front 20

Dysuria

Back 20

painful or difficult urination

Front 21

Pyelonephritis

Back 21

kidney infection

Front 22

Urinary retention

Back 22

accumulation of urine inthe bladder, with inability of bladder to empty fully

Front 23

Hydronephrosis

Back 23

enlargement of the kidneys due to back pressure

Front 24

Factors Influencing Urination

Back 24

-Fluid balance
-medications
-pelvic floor muscle tone
-diagnostic examinations and surgical procedures
-psychological factors
-disease conditions

Front 25

Disease Conditions Influencing Urination
(Renal Function Affected)

Back 25

- Prerenal – decreased bloodflow to kidneys

- Renal – damage to renal tissues

-Postrenal – obstruction of urine flow in upper UT system

Front 26

Disease Conditions Influencing Urination
(Urination Affected)

Back 26

-Neurological impairment (MS, diabetes, stroke, parkinson’s disease)

-BPH (benign prostatic hypertrophy)

-Cognitive impairment (dementia – don’t know)

-Impaired mobility – impaired ability to get to bathroom, manipulate clothing, etc.

Front 27

End Stage Renal Disease(ESRD)

Back 27

-Severe metabolic disturbance

-Fatal if not treated

-Uremic syndrome: nitrogenous wastes in blood, marked fluid & electrolyte imbalance >> nausea, vomiting, headache, convulsions, coma

-Hyperkalemia is most severe risk of renal failure

-Tx:
Conservative: meds, diet & fluid restrictions (b4 dialysis)
Daily weight: 1 kg = 1 L of retained fluid
Ultimately peritoneal dialysis, then hemodialysis
Organ transplant

Front 28

Problems in Urinary Elimination

Back 28

Urinary tract infection (UTI)

Urinary incontinence

Urinary retention – BPH, cannot pee out, cant sense the pee (neuro or muscular)

Renal calculi (kidney stone) – extreme pain; drink lots of water(prevent)

Front 29

Urinary Tract Infection

Back 29

Causative organisms – ecoli(80%);

Contributing factors – BPH (M); shorter urethra in females; ABs; anything causing retention;

Females versus males - more frequent in females

Signs/Symptoms – burning, more often urination, (urgency/frequency); nausea vomiting, fever
Urine – cloudy, darker, odour,
Kidney infection is painful, elevated temp, fever/chills

Front 30

Infection Control and Catheters

Back 30

Nursing measures:
-Prevent reflux
-Prevent obstruction of tubing
-Maintain sterility of system
-Acidify/dilute urine

Front 31

Types of Urinary Incontinence

Back 31

-Functional – impairs your ability to go to the bathroom, able to walk or get ready; dementia, osteoarthritis

-Overflow – bladder is still full and it spills out a little bit at a time (overextention of bladder)

-Reflex – impaired spinal function & neuro function; can still pee, but you have to get to the toilet – SC still maintains the peeing, but you can’t feel it (ability to void present/ no sensation)

-Stress – women who have lots of children; cough and pee

-Urge – sudden urge to void now! Usually often

-Mixed - usually mix b/w stress and urge

-Total – no control

Front 32

Urinary Changes due to Aging

Back 32

Prostate enlargement in males

Older adults
-Older adults have lots of reasons why they can’t control their urine : cant concentrate urine as effectively; despite some of problems that they have, incontinence is still not considered to be ‘normal’ in aging

Front 33

Nursing Assessment

Back 33

-Health history
-Physical assessment
-Assessment of urine
-Urine testing
-Diagnostic examination

Front 34

Assessment

Back 34

text p 1091

Nursing health history

-Pattern of urination >> bladder diary
-Symptoms of urinary alterations
-Factors affecting urination
-Psychological impact – limit social activities because of incontinence, embarrassment

Front 35

Physical assessment

Back 35

-Skin – may have skin breakdown
-Kidneys – ask about pain
-Bladder – palpation to assess distension
-Female perineum
-Male perineum

Front 36

Assessment of urine

Back 36

-Intake and output:
Normal adult output – 1500 to 1600 mL / day if drinking adequately
Alert if:
< 30 mL/hour or
no void in 6 to 8 hours or
volume > 2000 – 2500 mL/day

-Characteristics: color, clarity, odor

-Urine testing: specimen collection

Front 37

Common urine tests

Back 37

-Urinalysis (U/A)

-Specific gravity – concentration of urine, high specific graviity – concentrated urine means decreased blood flow to kidney, low specific gravity – dilute urine, overhydration, renal disease

-Culture – sterile specimen

Front 38

Blood Tests

Back 38

- Blood urea nitrogen (BUN) – blood sample, level of urea & nitrogen
- Serum creatinine – increased level means renal dysfunction

Front 39

Normal Urinalysis Values

Back 39

pH: 4.6 – 8.0; average 6.0
Protein: none or up to 8 mg/100 mL
Glucose: none
Ketones: none
Blood: up to 2 RBC’s
Specific gravity: 1.01. – 1.025
WBC’s: 0 – 4 per low-power field
Bacteria: none

Front 40

Diagnostic Tests

Back 40

Nursing Care:
-Consents – make sure its signed & on the chart
-Allergies – ask for allergy to dye or shellfish
-Pre- and post-procedure care
--Pre: sometimes NPO, need bowel prep
--Post: monitoring condition
Notify physician if any abnormalities following invasive procedures

-Ultrasound – need to fill bladder prior to
-Renal scan – radioisotope tracer used – double flush urine, caution for radioactivity
-Endoscopy procedures – eg. nephroscopy, cystoscopy – usually general anesthetic thus precautions with anaesthetic i.e urine output, vitals at regular intervals, encourage fluids

Front 41

Renal Arteriogram (Angiography)

Back 41

- Radio-opaque contrast injected through femoral artery into renal arteries >> x-rays taken

- Pre-test: Ask re: allergies to shellfish or iodine

- Post-test care:
-Watch injection site for bleeding
-Monitor vital signs – in case of hemorrhage
-Bed rest
-Push fluids to flush contrast
-Monitor CSM of affected limb

Front 42

Tests Using Iodine Dye

Back 42

Intravenous pyelogram (IVP), Retrograde pyelogram, Retrograde urethrogram (males), renal arteriogram, CT scan with contrast

Ask re: allergies to shellfish/iodine

Advise re: flushing, metallic taste

Post-test: Push fluids to flush dye out, observe for allergic reaction

Front 43

Continuous Bladder Irrigation (CBI)

Back 43

- Used after some urological surgeries or procedures

-Triple lumen catheter permits irrigation fluid to enter catheter and flush UT system, then drain out

Nursing care:
-Maintain flow of irrigation
-Maintain sterility of system
-Monitor for signs of obstruction or hemorrhage

Front 44

Nursing Interventions: Restorative Care

Back 44

-Lifestyle modification – avoiding caffeine, smoking, weight loss, use of incontinence products

-Bladder training – establishing a voiding schedule > every 3-4 hours, goal is increase bladder capacity

-Habit retraining and prompted voiding – prompt them to go, take them to the toilet like reminding a kid to go

-Self-catheterization – at home clean procedure is used rather than sterile

-Kegel exercises

Front 45

Kegel Exercises

Back 45

- Improve strength of pelvic floor muscles
- Stress incontinence
-Other causes of urinary incontinence

- Client tightens/raises pelvic floor and holds for ten seconds, then relaxes, repeating x 10

-Do not do while voiding