Lecture 15: Urinary Elimination

Describe the following Kidney functions

• Filtration of blood

• Production of urine

• Regulating fluid and electrolytes

• Producing erythropoietin

• Vitamin D synthesis

Filter blood - filter waste products out of the blood to become urine ( urea, toxins, creatine)

Production of urine - creates urine be removing (waste, excess ater). Urine then travels through the urinary system to leave the body.

Regulation -  keep the body's fluids balanced, helping with homeostasis, regulate sodium, potassium, calcium, and water levels

Producing erythropoietin - produce a hormone called erythropoietin, stimulates the bone marrow, increases red blood cell production, and when the kidneys fail = anemia occur

Vitamin D synthesis - activate vitamin D, absorb calcium, keep bones strong

which organ produce and transport urine?

Upper urinary tract

Includes:

1. Kidneys

2. Ureters

Which organ store and release urine?

Lower urinary tract

Includes:

1. Bladder

2. Urethra

3. Pelvic muscles

Nephron

what do they do ?

About how many?

Describe this formation of urine :

• Filtration

• Reabsorb

• Secretion

nephron is the functional unit of the kidney.

1. Filters blood

2. Removes waste

3. Forms urine

Each kidney contains about 1 million nephrons.

1. Filtration

   • Blood enters kidneys

   • Waste and water are filtered

2. Reabsorption

   • Body reabsorbs useful substances

   • Example: glucose, water, electrolytes

3. Secretion

   • Extra wastes are added to urine

Ureters ; how many , conected to what , movement like what

Urinary bladder ; what does it do , how many ml?

Urethra ; what does it do , difference between male and female ?

Two tubes connect the kidneys to the bladder.; carry urine to the bladder; Urine moves through ureters using peristalsis

muscular sac; stores urine until urination; about 400–600 mL

The urethra is a tube that carries urine from the bladder to the outside.

Female urethra; shorter, no external portion outside the body

Male urethra Has two roles:

1. urinary system

2. reproductive system

3. Prostate gland - right behind the bladder ( gets larger )

How does urination work?

what are some other words for urinating ?

Urination is also called: Micturate; Void; Urinate; Pee

1. Detrusor muscle contracts

   • muscle in bladder wall

2. Internal sphincter relaxes

3. Urine moves into posterior urethra

4. External sphincter relaxes

5. Perineum muscles relax

6. Abdominal muscles contract slightly

7. Diaphragm lowers

Describe how the following Factors Affecting Voiding

Age
Psychosocial factors
Fluid and diet
Exercise and muscle tone
Medications
Pathologic / Disease conditions
Surgical and diagnostic procedures

Age - children ; bladder control Older adults ; weak muscles , high nuctoria

Psychosocial factors - stress, anxiety, embarrassment

Fluid and diet - Drinking more fluids = more urine ; caffien , alcohol, citrus affect urination

Exercise and muscle tone - Weak pelvic muscles can cause incontinence

Medications - increase urination, decrease urination, affect bladder muscles, damage kidney

Pathologic conditions - diabetes, infections, kidney disease, neurological disorders

Surgical and diagnostic procedures - temporarily affect urination - anesthesia, bladder surgery

Define the following terms

Anuria ; less than how mucha day?
Oliguria ; less that how much?
Polyuria ; common in who?
Glycosuria
Proteinuria; indicates ?
Frequency
Nocturia
Urgency
Dysuria; common with
Enuresis

Anuria - Almost no urine production. Less than 50 mL/day
Oliguria ; Very little urine output. Usually less than 500 or less mL/day.
Polyuria ; Excessive urine production. Common in: diabetes and diuretics
Glycosuria - Glucose in urine
Proteinuria - Protein in urine. Often indicates kidney damage.
Frequency - Urinating more often than normal.
Nocturia - Waking up 2 or more times at night to urinate
Urgency - Strong, sudden need to urinate immediately.
Dysuria; Painful urination. Common with UTI.
Enuresis - Involuntary urination in children older than 2. Also called bedwetting.

Urinary Incontinance

what is it ?
Acute Incontinence
Chronic Incontinence

Loss of bladder control.

Acute incontinence - Temporary; infection, medications

Chronic incontinence - Long-term urine loss.

Describe the following types of incontinece

• Stress Incontinence

• Urge Incontinence

• Reflex Incontinence

• Overflow Incontinence

• Functional Incontinence

• Total Incontinence

• Stress Incontinence - Urine leaks when pressure increases , pregnancy ; coughing, sneezing, laugh

• Urge Incontinence - Sudden strong urge to urinate.; Often caused by an overactive bladder. Strong sensation to void

• Reflex Incontinence- Bladder empties automatically without warning. Predictable interval ; Often neurological cause.

• Overflow Incontinence - Bladder becomes too full and leaks. due to urinary retention

• Functional Incontinence - Person cannot reach bathroom in time due to; mobility problem ; cognitive impairment

• Total Incontinence - Continuous urine loss. Absolute loss of baldder muscle, cannot hold anything

Descibe the following characteristics of urine

• how many ml/hr

• daily?

• Color

• Clarity

• Odor

• Sterelity

• PH

• Specific gravity

• glucose

• ketones

• blood

• how many ml/hr - 30 ml/hr

• daily? 1200–1500 mL

• Color - amber yellow, straw colored

• Clarity - clear

• Odor - none ; strong - infection

• Sterelity - Urine should be sterile inside the bladder. No bacteria

• PH - 4.6 – 8.0

• Specific gravity - urine concentration ; 1.010 – 1.025

• glucose - none

• ketones - none

• blood - none

Speciments Testing (what is it and normal ranges)

• Urinalysis -

• Culture and Sensitivity

• Specific Gravity

• BUN (Blood Urea Nitrogen)

• Creatinine

• Creatinine Clearance

• GFR (Glomerular Filtration Rate)

• Urinalysis color, pH, protein, glucose, blood

• Culture and Sensitivity- Used to identify bacteria causing infection, which anibiotic will work

• Specific Gravity - urine concentration

• BUN (Blood Urea Nitrogen) - Hydration status and waste levels in blood; 5-10, High levels may indicate kidney dysfunction.

• Creatinine - kidney function; 0.6 - 1.2 normal; High levels = poor filtration.

• Creatinine Clearance - Measures how well kidneys filter blood

• GFR (Glomerular Filtration Rate) - kidney function; Normal ≈ 90–120 mL/min; Lower numbers = kidney disease.

Describe the following Diagnostic Procedures

• Cystoscopy

• Intravenous Pyelogram (IVP)

• Bladder Scanner

• Renal Biopsy

• Renal Ultrasound

• CT Scan

• Cystoscopy -  camera is inserted into the bladder through the urethra.

• Intravenous Pyelogram (IVP) - X-ray test using contrast dye; detects kidney tumors, urinary blockages, stones, prostate enlargement, urinary tract injuries

• Bladder Scanner - ultrosound , measures how much urine remains in the bladder after voiding, detects urinary retention

• Renal Biopsy - Small sample of kidney tissue removed and examined. To diagnose kidney diseases.

• Renal Ultrasound - Uses sound waves to view kidneys for tumors , stones and cysts

• CT Scan - Detailed imaging of urinary structures.

descibe the following Treatments for urinary incontineece

• Kegel Exercises

• Bladder Training

• Lifestyle Adjustments

• Absorbent Products

• External Condom Catheter
  

• Kegel Exercises - Strengthen pelvic muscles.Sit or stand with legs apart, Tighten rectum, urethra, and vagina

• Bladder Training- encourage urination at regular times, regulate fluid intake, encourage fluids every 30 minutes, diuretics in the morning

• Lifestyle Adjustments - reduce ; citrus drinks, caffeine, carbonated beverages, alcohol

• Absorbent Products - Pads/Briefs

• External Condom Catheter - No doctors order, placed outside the penis,

Describe the following types of Urinary Catheters (DOCTORS ORDER NEEDED)

• Intermittent (straight)

• Indwelling Catheter (foley)

• Suprapubic Catheter

• Intermittent (straight) - temporarily to empty the bladder. Removed immediately after.

• Indwelling Catheter (foley)- Catheter remains in bladder continuously.

• Suprapubic Catheter-  through the abdomen directly into the bladder.; Trauma to the bladder ( accident, bullet wound ) Once a month ( decrease infection)

Describe the following Urinary Diversions - Used when urine cannot pass normally.

• Ileal conduit

• Urostomy

• Nephrostomy

• Ileal conduit - Piece of intestine used to create a new pathway for urine.

• Urostomy - Opening in abdomen where urine exits.

• Nephrostomy - Tube inserted directly into kidney.

What is Antispasmodics Oxybutynin (Ditropan)?

Relaxes bladder muscle.

Used for:

• urgency

• overactive bladder

what is Antimuscarinic / Anticholinergic Tolterodine (Detrol)?

Reduces bladder contractions.

Used for:

• bladder spasms

• incontinence

what is Analgesic Phenazopyridine (Pyridium)?

Relieves urinary pain.

Side effect:

• orange urine

what is Anti-infective drugs Ciprofloxacin (Cipro)?

Treat urinary infections.

Medications Affecting Urine Production

Diuretics

Cholinergic drugs

CNS depressants

Diuretics - Increase urine production.

Cholinergic drugs - Stimulate bladder contraction.

CNS depressants - reduce bladder reflexes.

What color do the following medications change urine to

Anticoagulants

Diuretics

Pyridium

Elavil

Levodopa

Anticoagulants → red urine

Diuretics → pale yellow

Pyridium → orange

Elavil → green/blue-green

Levodopa → brown/black