Urinary Elimination

Body function related to the production of urine

a.     Convert and remove EXCESS waste and fluids 

b.     Regulates ELECTROLYTES and RBC production

c.     Produces hormones for regulating BP

d.     Helps maintain BONE strength

Production of urine: Influencing factors

Diet, age, breathing/oxygenation, sweating, medications

clear/odorless urine =

increase in amount of fluid intake

increased urine odor =

eating asparagus - byproduct of breaking down asparagusic acid

Increased urine production =

increase in amount of fluid intake, drinking alcohol or caffeine, eating foods high in sodium

dark brown urine =

eating aloe or fava beans

reddish urine =

eating blackberries, beets, rhubarb

blue/green urine =

food dyes can change urine color

Loss of kidney tissue, nephrons, blood

leads to what…

Decreased kidney function —> Reduced urine production

Loss of bladder tone leads to what…

Altered urinary elimination —> Urine leakage, incontinence, or retention

Frequency

frequent urinating

Urgency

sudden feeling of needing to urine

Hesitancy

hesitant to release urine

Anuria

absent urine

Dysuria

difficulty/pain urinating

polyuria

excess urinating

oliguria

minimal urinating

hematuria

blood in urine

enuresis

involuntary urination during HS

dribbling

constant leak of urine

Acute/Chronic retention

inability to remove all urine from bladder

Urinary incontinence

inability to control urine - results in involuntary passage of urine (leaking)

pathophysiology of Urinary Incontinence

D – Delirium/Demetia/Diabetes
I – Infection/Inflammation

A – Atrophy of vaginal tissue

P – Pharmacology/Psychological

E – Endocrine/Excess urine output

R – Restricted mobility

S – Stool impaction/Sacral nerve

Urinary incontinence: STRESS

Coughing, sneezing, laughing, or physical activity that increases bladder pressure, which causes leaks

Urinary incontinence: URGE

Strong urge to urinate, but leaking starts before reaching toilet

Urinary incontinence: REFLEX

Leaking from nerve damage

Urinary incontinence: OVERFLOW

Incomplete bladder emptying which leads to overfilling and leaking

Urinary incontinence: FUNCTIONAL

Leaking from not being able to reach toilet in time

Urinary incontinence: NOCTURNAL

Nighttime leakage which occurs mostly in children but can happen in adults

Interventions for Urinary Incontinence

*ASSESS for SKIN BREAKDOWN related to moisture

-Equipment/products during care

-Educate on lifestyle modifications

-Diagnostics

-Medications/medical devices

-Surgery: sling with artificial or stitch to pull up bladder; urinary diversions

Urinary retention

incomplete emptying of urine in the bladder (holding)

Treatments/Interventions for Urinary retention

-Catheters

-Drain bladder

-CT scan

-Bladder scan (ultrasound)

What medications can alter urine production?

-Diuretics

-Anticholinergics

-Topical estrogen

-Alpha adrenergic agonists

Causes of dehydration

-Vomiting/Diarrhea

-Sweating

-Inadequate fluid intake

-Fever

-Age – elderly more vulnerable

-Comorbidities – DM, Kidney failure, cystic fibrosis

Symptoms for dehydration

-increased thirst

-Dry mouth/tongue

-Fatigue

-fever

-dizziness

-dark-colored urine

-decreased out or sweat

Pathophysiology of UTI

-Wiping in wrong direction

-Holding urine

-Sexual activity

-Foreign objects

-Menopause

-Catheterization

Acute uncomplicated cystitis

lower UTI

Acute uncomplicated polynephritis

upper UTI

Asymptomatic bacteriuria

no symptoms of UTI but UTI is present

UTI interventions

-UA

-Urine culture

-non-pharmacological

-pharmacological: Abx & Phenazopyridine (Pyridium): helps relax bladder and prevents bladder spasms/pain

-Patient education

UTI complications

-Urethritis: inflammed urethra

-Cystitis: inflammed bladder

-Pyelonephritis: kidney infection

-Risk for antibiotic (abx) resistance

-Diabetics

-Immobility

Urinary diversions

urine flow interrupted/damaged (can be temporary or permanent)

Urinary catheterization

Flexible tube in the bladder from the urethra or surgically created opening

Ureteral stent

Allows passage of urine when the ureter is blocked from stone, mass, scar, tissue, inflammation, edema

Urostomy

Surgically created diversions, may involve, the small intestine

Nephrostomy

drain directly from kidney to external pouch

Cystotomy

catheter inserted directly into the bladder and attached to a drainage bag outside of the patient’s abdomen

KUB

kidney, urine, bladder; flat film X-ray

CT scan

                                               i.     evaluate shape, size, structure or UT (use if pt. is allergic to dyes from CT or pyelogram)

Pyelogram

X-ray with contrast dye to enhance structures

Ultrasound

scan collected using sound waves

Cystoscopy

Scope with light & camera, used for direct visualization; most invasive test but gives most accurate information

External catheterization

1. Purewick: urine suction underneath pt

2. Condom: urine collector

CAUTI/UROSEPSIS

Infection means toxins in the bloodstream which cause vasodilation, decreased organ circulation (decreased O2), and can lead to systemic shock and death

CAUTI early prevention

-proper catheter insertion technique

-Ensure catheter patency

-Empty bag regularly

-Secure to prevent trauma

-Perineal care as ordered

-Maintain adequate hydration

CAUTI: monitor Pt. for…

-Tachycardia

-Tachypnea

-Hypotension

-Even in absence of other symptoms!!

s/s of UTI

-burning/painful urination

-severe lower back pain

-fever

-nausea

-vomiting

-blood in the urine.

Kidney stones (renal calculi) pathophysiology:

-dietary (CALCIUM), genetics, environmental, and lifestyle

-comorbidities

-medications: diuretics, calcium carbonate (TUMS)

-LEADING CAUSE: DEHYDRATION

Kidney stones (renal calculi) manifestations:

-pain

-positioning (hunched over)

-nausea/vomiting

-lab trends: BUN & CREATININE

-blood in urine

-tachycardia

-hypertension

-tachypnea

-glossy eye

Kidney stones (renal calculi) interventions

-Diagnostic test: CT scan (most reliable)

-KUB

-US

-UA

-Meds

-Surgery

-lithotripsy: breaking stones into small pieces to help it pass

-Pt. education: hydrate, diet, movement

Kidney stones (renal calculi) complications:

-fever

-UTI

-Urinary retention

-Polynephritis

bladder cancer pathophysiology:

-uncontrolled cell growth

-SMOKING*

-radiation

bladder cancer manifestations:

-pain

-PAINLESS HEMATURIA*

-nausea/vomiting

bladder cancer interventions:

-cystoscopy

-Blood tests: RNA or inflammation markers

-Imaging

-Chemo/radiation

-Surgery