Week 9: Key Concepts of Urinary Elimination

concepts of urinary elimination

retention and hesitancy, incontinence and urgency, dysuria, geriatric changes

examples of urinary elimination

urinary diversion systems, urolithiasis and BPH, adrenergic/anticholinergic agents, pyelonephritis

normal bladder capacity

500mL

PVR (post void residual)

<50-100mL (more with older age); >200mL is pathologic/straight cath

normal urine output

1000-2000 mL/24hrs (>=30mL/hr); within 500-1000 mL < intake volume

urolithiasis nursing considerations

assess and manage renal colic pain, N/V, UA, diaphoresis, VS, prep for IV pyelogram, cystoscopy, and other imaging; encourage hydration and low oxalate, protein, and sodium diet; prep for lithotripsy or Sx

pain management for urolithiasis

NSAIDs, oxybutynin, propantheline, opioids

maintain hydration for urolithiasis to

flush out stones

diet recommendations for urolithiasis

spinach, black tea, rhubarb, low Na leads to decreased Ca in urine, low purines prevents uric acid stones

anticipate these procedures in urolithiasis

lithotripsy; noninvasive use of shock waves to shatter stones

BPH nursing considerations

assess for hematuria, BUN, PSA, US, biopsy results, and PVR; administer alpha reductase inhibitor (finasteride) and blockers (tamsulosin); periop care

prostate resection types

TURP, suprapubic, retropubic

TURP

transurethral resection of prostate

suprapubic resection

incision through bladder

retropubic resection

incision through abdomen

postop care for BPH

assess for shock and hemorrhage (urine may be red for 12hrs); I/Os; encourage physical activity but avoid strenuous activity until bleeding subsides

adrenergic/ACh agents nursing considerations

medication review: antipsychotics (clozapine, quetiapine), TCAs (nortriptyline, amitryptyline), opioids, benzos, ipratropium

pyelonephritis nursing considerations

assess S/Sx infection, frequency, dysuria, flank pain, serial urine culture, labs, bedrest during acute phase, antibiotics, analgesics

geriatric physiologic changes to the urinary system

renal atrophy; decreased tone and elasticity of bladder, ureter, and urethra; decreased bladder capacity; glomerular sclerosis; decreased renal perfusion; decreased ability to concentrate

geriatric nursing considerations for the urinary system

incontinence care (schedule voiding, pelvic exercises, skin care, condom catheters and incontinence pads); monitor I/Os, encourage cranberry w/o added sugar

altered urinary elimination pt education

hydration (~3L/day); diet recommendations and drug therapy; regular voiding habits and bladder training; physical activity and pelvic exercises to maintain muscles control

in pts with altered urinary elimination, notify provider when

med changes, flank pain (hydronephrosis, pyelonephritis), infection cues, weight changes, or swelling

bladder training for pts with altered urinary elimination

schedule voiding every 45min-2hrs and go at that time regardless of urge, slowly increase periods between voids by 15-30min

goal of bladder training

work up to voiding interval of 3-4 hours; provide privacy and perhaps start running water while voiding if pt experiences hesitancy; do not leave pt on toilet/bedpan longer than 5 min

foley key considerations

clamp intermittently prior to removal

straight intermittent catheter used for

neurogenic bladder; BPH; postop

nephrostomy key considerations

temporary; anchored in renal pelvis through flank incision; never clamp; pt may still void if unilateral

ureterostomy key considerations

never irrigate

subrapubic key considerations

placed in bladder via abdominal incision; voiding may still occur

maintaining flow for urinary diversion systems

avoid kinks; keep bag below level of kidneys/bladder; monitor output; irrigate towards pt; avoid removing >1L at a time; promote hydration

preventing and monitoring for infection for urinary diversion systems

keep catheter connected to drainage system except during irrigations; use sterile technique to obtain samples from the drainage port