Class 10: Urinary Elimination

what is the purpose of the kidney in the urinary tract?

to filter out the blood and create urine

what is the purpose of the bladder

it is a smooth muscle sac that temporarily stores urrine

what is the purpose of the urethra

it transports urine from the bladder to the exterior of the body

micturition

act of passing urine

how many mL of urine stimulates the sensory nerve endings (stretch receptors) to let someone know they need to pee

150ml to 250 ml

What are stretch receptors in bladder?

sensors in blood vessels that identify internal pressure

stretch receptors transmit impulses to where?

the 2nd-4th spinal sacral vertebrae

what sphincter relaxes voluntary and involuntary?

voluntary: external sphincter

involuntary: internal sphincter

when the internal sphincter relaxes, it stimulates what?

the urge to void!

if appropriate, the brain relaxes then ________ and the _______ muscle contracts which allows urination to occur.

internal sphincter

detrusor muscle

detrusor muscle

the smooth muscle layers of the bladder wall

allows the bladder to expand as it fills with urine and contract as it releases urine during voiding

most healthy people do not

void during sleeping sessions

the more urine that is produced

the more voiding that will occur

What is a diuretic?

A medicine/substance that increases urine formation

May increase urine formation and output

voluntary sphincter control begins at age

18-24 months

nocturia

excessive urination at night

increased fluid intake means

increase fluid output

normal output range is

1200 mL to 1500 mL

foods that can affect odor and color

beets and asparagus

foods that cause fluid retention are

high in sodium food

how does exercise help to urinate?

it increases metabolism and optimal urine production and elimination

what can result in poor urinary control and stasis

immobility

decreased bladder and sphincter tone

what makes the bladder muscles weaker

indwelling catheter

muscle trauma

why do ladies have a voiding difficulties

pregnancy- baby puts pressure on bladder

old ladies- decrease in estrogen (menopause)

if the kidneys can't make urine then

toxins stay in the body

if the kidney functions are poor then the

heart functions will be poor

neurogenic bladder

a urinary problem caused by interference with the normal nerve pathways associated with urination

Impaired neurologic function interfering with urination

BPH

benign prostatic hypertrophy

when the prostate wraps around urethra in men causing retention

retention

inability to empty the bladder

incontience

inability to control urination

calculus

a urinary stone

Anticoagulants

treats blood clots

may cause possible hematuria (affects urinary elimination)

hematuria

blood in the urine

Phenazopyridine

Urinary Tract Analgesic

can cause orange urine

Antidepressants, antipsychotics, antihistamines, and opioids can

increase urinary retention and overflow incontinence

sedatives may

used slows brain activity

may worsen urge incontinence (urinary elimination factor)

NSAIDS may

decrease blood flow to kidneys leading to renal failure (factor influencing urinary elimination)

rifampin

cause urine to be orange

cystoscopy

visual examination of the urinary bladder, urinary bladder wall and urethra

Small kidney stones can be removed

sample tissues taken for biopsy

Retro pyelography can be done simultaneously

Glomerular Filtration Rate (GFR)

the amount of filtrate formed per minute by the two kidneys combined

anuria

absence of urine

glycosuria

glucose in the urine

oliguria

Decreased urine output.

Scant Urine Output

Oliguria output is USUALLY ___ mL

less then 400 ml/day or 30ml/hour for an adult

KNOW THESE NUMBERS (park said)

Polyuria (diuresis)

excessive urination

may be associated with diabetes mellitus/insipidus, and chronic nephritis

proteinuria

presence of protein in urine

pyuria

pus in the urine

aka white blood cells urine

aka cloudy urine

polydipsia

excessive thirst

leads to compulsive intake of excessive amounts of fluid

urinary frequency

voiding at frequent intervals

urinary urgency

sudden, compelling urge to urinate

dysuria

painful or difficult urination

urinary hesitancy

difficulty in starting a urinary stream

common in bph

describe urine

color, odor, volume

why is the bladder scanner important?

it is the best way to measure urine in the bladder and is a good way to see urine in bladder and to know what is really going on

urinating on yourself can cause

skin breakdown due to the acidity

urethral meatus

external opening of the urethra

Assessing Urine output for continent patients

use a bedpan, urinal, or specimen hat in bed or bathroom

Assessing Urine output for Incontinent patients

note number of incontinent episodes and have weight absorbent pads

indwelling catheter

remains inside the body for a prolonged time based on need

Assess every time before bag is emptied. Measure urine before flushing down the toilet

Types of urine samples

clean catch or midstream

sterile by catheterization

what does a urinalysis describe

description of urine

blood, ph, cloudiness, WBC, etc

urine culture and sensitivity

diagnostic lab procedure that identifies bacterial infection of urinary system and determines best antibiotic to treat it

Ultrasonic bladder scan

used to estimate and evaluate the volume of urine in the bladder.

Evaluate bladder emptying and post void bladder volume

what is the BUN and creatinine test for the bladder?

a blood test used to look at kidney functions. if the levels are high then the kidneys are not functioning right

Creatinine levels are usually

men: 0.6-1.2 mg

women:0.5-1.1 mg

BUN levels

7-20mg

IV pyelography

a radiographic study of the kidneys and ureters

Uses contrast dye for radiologic examinations

Visualize structural and functional abnormalities

retrograde pyelogram (RP)

x-ray image of the renal pelvis and ureters after injection of contrast through a urinary catheter into the ureters from the bladder.

Visualize fistulas, tumors, or ruptures

renal arteriography

radiographic study to assess the arterial blood supply to the kidneys

Assess renal blood flow

fistula

an abnormal passage, usually between two internal organs or leading from an organ to the surface of the body

intake and output (I&O)

term for measurements of all the fluids that enter and leave the body

REVIEW HOW TO DO IT

when do you clean a catheter

3 times a day

once a shift

after every bowel movement

what if the balance is positive or negative for I&O?

positive- more intake

negative- more output

the balance for I&O is

intake minus output

retention causes

weight gain

every 1000 ml you retain, you will gain

1 kg

urinarystasis

a stop in urinary flow

what is a good exercise to strengthen pelvic floor

kegel exercises

multiple times a day for at least three months

contract for 10 seconds, relax for 10 seconds, repeat

risk factors for catheters that are unnecessary

loss of muscle tone

uti

infection

when should you review catheter needs

daily

what is a straight catheter

A catheter that is inserted and removed after urine has been drained out or specimen collected

What is an indwelling/foley catheter?

retained for longer periods in the bladder by means of a small balloon that anchors it against the bladder neck

remains in place until pt is able to void completely and voluntarily or for as long as accurate measurements are needed

either two lumen or three lumen (one for drainage, one to inflate ballon and the third for irrigation)

they can be used on short-term or long-term basis

suprapubic catheter

catheter inserted into the bladder through a small abdominal incision above the pubic area

Long term continuous drainage that is surgically inserted

double lumen catheter

Designed for indwelling catheters, provides one lumen for drainage and second to inflate the balloon

triple lumen catheter

used for bladder irrigation (1), urinary drainage (2), and inflation of the balloon (3)

where should the catheter bag be placed?

below the bladder

back flow of urine

urinary reflux

Bladder irrigation

Removes mucus, blood clots, and other tissue from the bladders

Introduces medication into the bladder

Open intermittent bladder irrigation

Insert syringe into lumen of catheter and instill solution into catheter. With syringe still connected, aspirate back to remove clots/debris. Disconnect syringe and discard returned solution and repeatedly irrigate with solution until returned solution comes back clear (e.g. without mucous, debris or clots)

Closed continuous bladder irrigation

Continuous bladder irrigation (CBI) is a medical procedure that flushes your bladder with a sterile liquid. It also removes urine (pee) from your body at the same time. Healthcare providers often use it to prevent or remove blood clots after surgery on the urinary system.

triple lumens are only really used for

surgical procedures

the urge to pee is from

pressure on the bladder

a client has an indwelling catheter and complains that he feels like he needs to urinate? what should you do?

see if the catheter is patent

what does it mean if a catheter is patent

it means the catheter is open with no kinks or anything closing it