bowel and urinary elimination (for urinary)

Describe the anatomy of the urinary system.

kidneys

ureters

bladder

urethra

Describe the physiology of the urinary system.

• Reabsorption and excretion of water and electrolytes
• Control of blood composition
• Control of blood pressure
• Maintenance of acid-base balance

what are common nursing problem?

What types of urinary elimination problems exist?

nocturia, dysuria, urinary hesitancy, urinary frequency, urinary retention.

what is the cause for nocturia?

Increased urine output or increased urge (sensation) or need to urinate at night while sleeping.

• Excessive fluid intake prior to bedtime

• Bladder-stimulating foods before bedtime (e.g., coffee, alcohol, chocolate)

• Urethral obstruction (such as prostate enlargement)

• Medications such as diuretics taken late in the evening

• Urinary tract infection

• Poorly controlled diabetes (high blood glucose levels)

what is contributing factors for nocturia?

Excessive fluid intake prior to bedtime

• Bladder-stimulating foods before bedtime (e.g., coffee, alcohol, chocolate)

• Urethral obstruction (such as prostate enlargement)

• Medications such as diuretics taken late in the evening

• Urinary tract infection

• Poorly controlled diabetes (high blood glucose levels)

what is the cause for dysuria?

Inflammation or irritation anywhere within the urinary elimination system.

what are contributing factors for dysuria?

• Urinary tract infection

• Prostate enlargement

• Chemical or physical injury to the urethral meatus or urethra

what is the cause for urinary hesitancy?

Obstruction of the bladder or urethra or anxiety about voiding.

what are contributing factors of urinary hesitancy?

• Prostate enlargement

• Urethral stricture (narrowing)

• Voiding in public

• Voiding in bed using a bedpan or urinal

what is the cause for urinary frequency?

High volume of urine, decreased bladder capacity, or increased bladder stimulation

what are the contributing factors for urinary frequency?

• High fluid intake

• Bladder stimulants such as caffeine, alcohol, or certain medications

• Urinary tract infection

• Pregnancy

• Abdominal tumor

• Enlarged prostate

• Overactive bladder

what is the cause for urinary retention?

Obstruction of the urinary elimination tract or alteration in bladder muscle or ureteral sphincter muscle function

what is contributing factors  for urinary retention?

• Enlarged prostate

• Urethral tumor

• Kidney or bladder stones (renal calculi)

• Neurologic condition affecting bladder or sphincter function, such as stroke, diabetes, or paralysis

• Side effects of certain medications, including anesthesia

Demonstrate a comprehensive assessment of the client with urinary elimination problems. what would a health history look like?

• Onset: When did the problem start?

• Duration/Frequency: How often do you urinate? Any changes?

• Amount: Small or large amounts?

• Appearance: Color, clarity, odor, presence of blood or sediment?

• Associated symptoms: Pain, burning, urgency, dribbling, nocturia, hesitancy, incomplete emptying?

• Precipitating factors: Caffeine intake, fluid restriction, medications, infection, surgery?

• Relieving factors: What helps (e.g., sitting up, voiding in warm bath)?

• health history of UTI?

• lifestyle question like how much do you drink in water?

Demonstrate a comprehensive assessment of the client with urinary elimination problems. what would a physical assessment look like?

Inspection and auscultation- the bladder should not be distended
• Palpation and percussion
• Inspection of urine: color, clarity, odor, amount

what labs and diagnostics will you need?

Laboratory tests: Blood urea nitrogen and creatnine, urinalysis,
culture and sensitivity, 24 hour urine collection
• Diagnostics: Ultrasound, IV Pylography, CT, cystoscopy

identify common nursing problems related to urinary elimination

urinary incontinence, urinary retention, and urinary infection

Implement collaborative interventions to address altered elimination concerns.

provider, lab personnel, radiology - testing

Provider, pharmacist - for medication

Provider (orders), UAP (measure I&O), infection control nurse. - for Catheter or Device Management

Dietitian, provider. - diet

Physical therapist, occupational therapist. - for movement.

Evaluate the effectiveness of interventions to address altered elimination concerns.

• Compare data to baseline assessment:

  • Intake/output records

  • Lab results (BUN, creatinine, electrolytes, urinalysis)

  • Stool/urine appearance and frequency

• Ask the patient: “How are you feeling about your elimination now?”

• Document clearly:

  • Outcome met, partially met, or not met

  • Patient’s response to interventions

  • Any ongoing or new recommendations

Identify signs and symptoms of urinary tract infection

• Dysuria

• Urinary frequency

• Urinary urgency (an immediate urge to urinate)

• Red, pink, or brown urine indicating blood in the urine

• Cloudy urine indicating the presence of mucus or white blood cells

Identify labs results that you will need?

Specific gravity - 1.005 to 1.030

ph - 6

protein - neg

gluose - neg

ketones - neg

Recognize components of a urinalysis.

Color, Clarity, Odor, Gravity → pH, Protein, Sugar, Ketones → Blood, Leukocytes, Nitrites.”

what are you looking for in assessment for UTI?

Fever
• Confusion
• Pain on urination
• Urinary frequency

what do you need to do for intervention for UTI?

Urine sample
• Antibiotics
• Education to prevent
• Hygeine
• Increase fluids

what are you looking for in assessment for urinary retention?

Feel like they need to void after voiding
• Bladder full
• Bladder scan reveals retention

Find out why, may be structural
• May be after surgery, swelling
• After a catheter removed

what are you looking for in incontinence assessment?

Wet
• Smell like urine
• Wear a pad or disposable adult diapers

what are your interventions for incontinence?

Protect the skin, check often
• Bladder training- every 2 hours during the day and every 4 hoursat
night offer to take to the bathroom
• Find out the clients normal pattern of going to the bathroom
• Barrier cream