Urinary Elimination

Urinary Elimination

Overview

  • Topic of discussion: Urinary elimination functions.
  • Course: NUR 155/156, Unit 5 at Galen College of Nursing.

Normal Structure and Function of the Urinary System

Kidneys
  • Function: Urine formation
    • Nephrons: The functional units responsible for urine production.
    • Components of Nephrons:
      • Renal Corpuscle: The initial filtering unit of the nephron.
      • Renal Tubule: The site where reabsorption and secretion occur.
  • Processes involved in urine formation:
    1. Filtration: The process of separating waste and excess substances from the blood.
    2. Reabsorption: The movement of substances from the renal tubules back into the bloodstream.
    3. Secretion: The process of transferring substances from the blood into the renal tubules.
Ureters
  • Function: Carry urine from the kidneys to the bladder.
Bladder
  • Function:
    • Walls relax and expand to store urine.
    • Walls contract and flatten to expel urine.
Urethra
  • Function: Transports urine away from the bladder for elimination.
Characteristics of Normal Urine
  • Normal urine is:
    • Sterile: Free from bacteria, viruses, and fungi.
    • Composition: Contains fluids, salts, and waste products.

Altered Structure and Function of the Urinary System

Abnormal Urination Patterns
Types of Abnormalities
  1. Anuria:
    • Definition: Failure to produce or excrete urine.
  2. Oliguria:
    • Definition: Reduced urine volume.
  3. Polyuria:
    • Definition: Excessive volume of urine.
  4. Nocturia:
    • Definition: Excessive urination at night.
  5. Dysuria:
    • Definition: Painful urination.
  6. Hematuria:
    • Definition: Abnormal presence of red blood cells in urine.
    • Note: The urine color does not reflect the degree of blood loss.
Incontinence Types
  1. Urinary Incontinence: Lack of urine control.
    • Stress Incontinence: Loss of urine during physical activity.
    • Urge Incontinence: Sudden strong urge to void due to rapid bladder contraction.
    • Mixed Incontinence: Combination of stress and urge incontinence.
    • Functional Incontinence: Lack of control without any physical abnormalities.
    • Overflow Incontinence: Incomplete emptying of the bladder leading to dribbling of urine.
    • Temporary Incontinence: Caused by factors such as severe constipation, infections, or medications.
Urinary Retention
  • Definition: Inability of the bladder to empty.
  • Causes:
    • Urinary tract obstruction.
    • Neurologic disorders.
  • Characteristics include:
    • Difficulty starting a urine stream or emptying the bladder.
    • Weak urine flow.
    • Chronic or acute pain.
Factors Affecting Urinary Elimination
  • Developmental factors.
  • Psychosocial factors.
  • Food and fluid intake.
  • Medications.
  • Muscle tone.
  • Surgical and diagnostic procedures.
  • Pathologic conditions (e.g., urinary tract infections, urinary diversion).

Assessment

Initial Assessment
  • Changes in mental status might indicate elevated nitrogenous wastes in the blood due to kidney dysfunction.
  • Symptoms of UTI:
    • Frequent urination.
    • Burning sensation during micturition.
  • Fatigue is a common complaint among clients with kidney disorders.
Abdominal Assessment
  • Methods:
    • Inspection and auscultation.
    • Percussion and palpation.
    • Use of BladderScan for bladder volume assessment.
Inspection of Urine
  • Color: Influenced by food, medication, and pathological conditions.
  • Clarity: Influenced by bacteria, blood, sperm, and other substances.
  • Odor: Influenced by factors such as dehydration and specific foods.
  • Amount: Normal output includes roughly equals fluid intake.
    • Normal Urine Output: Approximately 30extmL/exthr30 ext{ mL}/ ext{hr}.
Laboratory Tests
  1. Blood Urea Nitrogen & Creatinine: Indicators of kidney function.
  2. Urinalysis:
    • Specific Gravity: Represents the balance of water and solutes in urine.
    • pH: Reflects the acidity or alkalinity of urine.
    • Protein Content: Presence indicates fever, exercise, pregnancy, or disease.
    • Glucose: Screens for diabetes and assesses glucose tolerance.
    • Ketones: Indicates fat has been broken down for energy.
    • Microscopic Analysis: Checks for red or white blood cells, casts, plugs, or crystals.
    • UTI Indicators: Nitrates and leukocyte esterase presence.
Culture and Sensitivity Testing
  • Purpose: Used to diagnose UTI.
  • Procedure: If organisms grow, sensitivity testing is conducted.
  • 24-hour Urine Collection:
    • Determines the amount of creatinine cleared through kidneys.
    • Measures protein, hormones, minerals, and other substances.
    • Client preparation is not required.
Diagnostic Examinations
  1. Ultrasound of the Bladder or Kidneys: Assesses size, shape, and location of the kidneys.
  2. Kidney, Ureter, and Bladder X-ray Study: Investigates gastrointestinal conditions and kidney stones.
  3. Intravenous Pyelography:
    • X-ray study of the urinary system.
    • X-ray images taken at timed intervals to identify conditions and measure tumors.
  4. Computed Tomography (CT):
    • Used to diagnose kidney stones, bladder blockages, or other diseases.
  5. Cystoscopy:
    • Direct examination of the bladder and urethra via cystoscope.
    • Helps visualize areas not clearly shown on X-rays.
    • Used to identify causes of hematuria, dysuria, or incontinence.

Nursing Diagnosis Examples

  1. Impaired Urination:
    • Supporting Data: Microorganisms in the urinary tract, urgency, frequency, burning sensation.
  2. Urinary Retention:
    • Supporting Data: Postanesthesia state, absent urinary output, lower abdominal distention.
  3. Impaired Self-Toileting:
    • Supporting Data: Neuromuscular impairment, right-sided paralysis, and inability to perform proper hygiene.

Planning

Short-term Goals
  • Client will report symptom resolution of UTI within 5 days of antibiotic treatment.
  • Client will empty bladder completely unaided within 12 hours post-surgery.
  • Client will demonstrate effective self-wiping ability within 5 days after urination.
Long-term Goals
  • Client reports no UTIs since last outpatient visit (12 months).
  • Client shows no signs of urinary retention at 6-month follow-up.
  • Client will safely perform toileting tasks independently within 9 months post-cerebrovascular accident.

Implementation and Evaluation

Nursing Interventions
  • Assist client in achieving set goals.
  • Ongoing assessment and follow-ups as needed.
  • Ensure quality care and identify further nursing interventions.
  • Client Education: Essential for maintaining urinary tract health.
Promoting Normal Urinary Patterns
  • Integrate client habits into daily care focusing on:
    • Use of bedpan, urinal, or bedside commode.
    • Providing privacy.
    • Establishing a toileting schedule.
    • Monitoring and encouraging fluid intake.
Monitoring Intake and Output
  • Intake: Include food, oral fluids, tube feedings, and IV fluids.
  • Output: Record fluids and drainage volume.
  • Kegel Exercises: Focus on pelvic floor strengthening.
Prevention of Urinary Tract Infections (UTIs)
  • Recommendations:
    • Wear cotton-lined underwear.
    • Avoid tight clothing.
    • Hydrate: Drink at least eight 8-oz glasses of water daily.
    • Urinate when the urge arises.
    • Practice good perineal hygiene.
    • Prefer showers over baths.
  • Treatment: Antibiotics as needed.
Urinary Catheterization Types
  1. Straight Catheter: For short-term use.
  2. Foley Catheter: Indwelling catheter.
  3. Coudé Catheter: Curved tip for difficult cases.
  4. Triple Lumen Catheter: Used for irrigation and drainage.
Indications for Urinary Catheterization
  • Relief of urinary obstruction or retention.
  • Prevention of contamination during surgeries.
  • Accurate urine measurement in critically ill patients.
  • Maintaining dry tissue during perineal or sacral wound healing in incontinent clients.
  • Support of comfort in patients nearing end-of-life care.
External Female Catheters
  • Collection bags are used with wall suction for urine management.
  • Condom catheters should be replaced daily and assessed for complications, maintaining hygiene.
Obtaining Urine Specimens
  • Routine Urinalysis: Client voids into a sterile specimen cup.
  • Culture & Sensitivity Testing: Use the clean-catch or midstream method with sterile cups.
  • Specimens may also be collected via straight catheterization or removed from indwelling catheter tubing.
Evaluation of Nursing Actions
  • Assess achievement of set goals and outcomes.
  • Evaluate the effectiveness of implemented interventions.
  • Continue, modify, or discontinue care plans as needed.
  • Aim is to assist clients back to their previous health state or help them adapt to functional changes.
  • Sharing findings with clients is crucial for recognizing goal achievement and improving urinary elimination patterns.

Knowledge Checks

Scenario Questions

  1. Signs of urinary tract infection based on symptoms:

    • a. Reports of burning with urination.
    • b. Frequent urination.
    • c. Elevated nitrogenous wastes in blood.
    • d. Presence of leukocyte esterase in urine.
    • e. Lack of urine control without abnormalities.

  2. Complete the phrase: A client experiencing failure to produce or excrete urine is documented as: Anuria.

  3. Identify findings in urinalysis indicative of UTI:

    • a. Specific gravity 1.015.
    • b. pH 7.5.
    • c. Positive Nitrates.
    • d. Positive Leukocyte Esterase.
    • e. Negative Protein.
    • f. Negative Ketones.