Elimination

Elimination: Key Concepts

  • Overview of elimination issues related to the GU system:

    • Renal Calculi (Kidney Stones)

    • Enuresis

    • Benign Prostatic Hyperplasia (BPH)

  • Student: NURS1200, 2025, Misty Smith, DNP, MSN, FNP-C

Understanding the GU System (Page 2)

  • Key considerations for the Genitourinary (GU) system's function and anatomy.

Scientific Knowledge Base (Page 3)

  • Components of the GU system:

    • Kidneys: Produce approximately 1-2 liters of urine daily.

    • Ureters, Bladder, Urethra: Involved in urine transport and excretion.

  • Bladder Capacity: Average bladder holds around 500-600 mL.

  • Urine output less than 30 mL/hr may indicate renal dysfunction.

Diagnoses Related to Elimination Problems (Page 4)

  • Common diagnoses:

    • Disturbed body image

    • Urinary incontinence

    • Constipation

    • Diarrhea

    • Nausea/Vomiting

    • Deficit knowledge regarding nutrition

Factors Influencing Urination (Page 5)

  • Physical: Growth and development changes in children and older adults.

  • Sociocultural Factors: Cultural background influencing habits.

  • Psychological Factors: Stress and anxiety affecting urinary patterns.

  • Personal Habits: Regularity in toilet use.

  • Fluid Intake and Medical Conditions: Impact of diseases and medications.

Assessment Protocols (Page 6)

  • Conduct physical assessment of:

    • Kidneys

    • Bladder and external genitalia

    • Perineal skin and abdomen.

Assessment of Urine (Page 7)

  • Evaluate:

    • Intake and output

    • Characteristics of urine:

      • Color

      • Clarity

      • Odor

      • Strain for stones.

  • Presence of hematuria may indicate stones or UTIs.

Laboratory Assessment for Elimination (Page 9)

  • Important labs:

    • BUN (Blood Urea Nitrogen)

    • Creatinine

    • GFR (Glomerular Filtration Rate)

    • Urinalysis: Key to assess renal function and abnormalities.

Urinalysis Findings (Pages 10-17)

  • pH: Indicates acid levels; abnormalities can show renal issues.

  • Concentration (SG): Normal range 1.005-1.030, higher may indicate dehydration.

  • Protein: Low levels typical; high levels can signify renal pathologies.

  • Glucose: Typically undetectable; presence indicates further testing needed.

  • Ketones: High levels suggest ketoacidosis, often in diabetes (DKA).

  • Bilirubin: Presence may indicate liver disease.

  • Nitrites and Leukocyte Esterase: Indicate UTIs confirmed with urine culture.

  • Blood: Requires investigation; signifies possible serious underlying conditions.

Renal Calculi Overview (Pages 18-20)

  • Kidney stones (Nephrolithiasis) can vary in size and composition, commonly calcium oxalate or phosphate.

  • Urethrolithiasis pertains to stones in the urethra.

Clinical Insight on Nephrolithiasis (Page 21)

  • Prevalence: 1-2 million U.S. adults, predominantly in men ages 20-55.

  • Risks associated with genetics, climate, and dietary habits.

Risk Factors for Renal Calculi (Page 23)

  • Metabolic Changes: High levels of various substances leading to crystallization.

  • Dietary Influences: High protein, excessive calcium, and low hydration levels.

  • Lifestyle Factors: Sedentary habits increase risk.

Pathophysiology (Page 24)

  • Urinary obstruction can lead to acute renal damage and severe pain as crystals accumulate.

Clinical Manifestations (Pages 27-29)

  • Symptoms can include:

    • Pain in the renal and flank area

    • Hematuria and tenderness

    • Inability to void effectively due to obstruction.

Diagnostic Studies (Pages 30-31)

  • Techniques include:

    • Non-contrast CT, Ultrasound, KUB (X-Ray), IVP; urinalysis to check for hematuria.

  • Retrieval and analysis of stones when necessary.

Treatment Methods (Pages 32-34)

  • Management includes:

    • Increased fluid intake to help pass stones.

    • Medications (Tamsulosin) to facilitate urine flow.

    • Surgical interventions when stones cannot be passed naturally.

Interprofessional Care (Pages 33-37)

  • Pain management and treating underlying infections necessary.

  • Surgical options include various forms of lithotripsy and nephrolithotomy.

Follow-up Care After ESWL (Page 39)

  • Ensure adequate hydration post-procedure, monitor for complications, and educate on dietary adjustments to prevent recurrence.

Prevention of Stone Formation (Pages 40-42)

  • Emphasis on hydration, dietary monitoring, and lifestyle adjustments to avoid future stones.

Enuresis Overview (Pages 49-51)

  • Diurnal and nocturnal enuresis, with distinctions in primary vs. secondary types.

  • Causes range from physiological factors to psychological impacts.

Assessment for Enuresis (Page 52)

  • Always rule out potential underlying issues like abuse or developmental anomalies.

Treatment Strategies (Pages 56-60)

  • Options vary:

    • Behavioral modifications for younger patients

    • Alarms and medications (Desmopressin) for older children.

BPH Overview (Page 62-70)

  • Benign Prostatic Hyperplasia and its ramifications in older adult males.

  • Recognized risk factors, symptoms categorized into irritative and obstructive types, and treatment pathways (including medication and surgical interventions).

Nursing Education and Monitoring (Page 70)

  • Essential patient education includes lifestyle modifications to manage symptoms and improve health outcomes.