P&P Chapter 46: Urinary Elimination

P&P Chapter 46: Urinary Elimination

1. Functions and roles of urinary system structures in urine formation and elimination

   • Kidneys: Where nephrons fllter the blood's waste, electrolyte balance is established, glomerulus filters water glucose amino acids urea uric acid creatinine and major electrolytes. Ureters: carries sterile waste from kidneys to bladder. Bladder: Muscular organ which holds urine. Urethra: Passage where urine travels from bladder to outside of body

2. Factors that commonly impact urinary elimination

   • Growth and development: involuntary control in 18-24m children, older adults may experience decrease in bladder capacity. Sociocultural factors: private facilities, social norms. Psychological: anxiety, stress, depression. Fluid intake: alcohol increases urine production, coffee increases urgency. Pathological conditions: DM, stroke, arthritis, spinal cord injury, prostatic enlargement. Surgical procedures, medications, diagnostic exam

3. Compare and contrast common alterations associated with urinary elimination

   • urinary retention: inability to partially or completely empty bladder. Stretches bladder, pressure, discomfort/pain, tender pubis, restlessness. Patients have no urine output or frequency urgency, small volume voiding.
     • Urinary Tract Infections: Escherichia coli is most common pathogen. Pt @ risk with indwelling catheter, incontinence. UTIs are characterized by location (upper-kidney, or lower-bladder. Pyelonephritis: severe upper UTI. If left untreated could lead to bacteremia. Symp: dysuria, cystisis- irritation of bladder characterized by frequency, urgency, incontinence, tenderness, foul smelling urine. Older adults often experience delirium. Catheter Associated UTIs
       • Urinary Incontinence: complaint of any involuntary loss of urine, chronic retention of urine and leakage caused by overfull bladder.
         • Urinary Diversions: can be temporary or permanent, continent or incontinent.

4. Characteristics of normal and abnormal urine

   • normal: equal intake and output, color:pale straw to amber, clear, ammonia odor
   • abnormal: pain while urinating, abdominal/flank pain, fever/chills, change in color (red) or odor, foggy, change in frequency, strain, incomplete emptying on bladder, leakage during cough/excercize

5. Nursing implications of common diagnostic tests of the urinary system

   • Abdominal roentgenogram: Detect/measure size of urinary calculi. Computerized axial tomography scan: cleanse bowel, restrict food and fluid up to 4 hours prior, after encourage fluids, patient teaching of procedure. Intravenous pyelogram: cleanse bowel, restrict food up to 4hrs, after encourage fluids, assess urine output. Ultrasound renal bladder: patients must come with full bladder. Endoscopy-cystoscopy: agency protocol, patient teaching pink urine after first test

6. Nursing diagnoses associated with alterations in urinary elimination

   • Social isolation Disturbed body image Urinary incontinence (functional, stress, urge, overflow) Pain (acute, chronic) Risk for infection Toileting self-care deficit Impaired skin integrity Impaired urinary elimination Constipation Urinary retention.

7. Nursing measures to promote normal micturition and improve bladder control

   • Stimulation: micturition reflex, normal position to void, sensory stimuli (running water). Habit training: encouraging complete bladder emptying, scheduled toileting, maintain optimal fluid intake; 2200-2700 mL/day. Procedures: manual compression, meds- cholinergic drugs increase bladder contractions and improve emptying, catheterization, strengthening of pubic floor muscles

8. Nursing measures to reduce UTIs

   • Good perineal hygiene that includes cleaning the urethral meatus after each voiding or bowel movement is essential, drinking enough fluids high in acid ash such as apple or cranberry juice.

9. post-void residual with a bladder scanner

   • Bladder scan or straight/intermittent cath - amount of urine left in the bladder after pt voids - bladder scan=noninvasive