Unit 6.2 Urinary Elimination

URINARY SYSTEM

  • Functionality of the Kidneys

    • Vital organs for urine formation.

  • Anatomy Components

    • Kidney: Primary organ for urine production.
    • Ureters: Tubes transporting urine from the kidneys to the bladder.
    • Bladder: Storage organ for urine.
    • Urethra: Conducts urine from the bladder out of the body.
    • Other Anatomy Features:
    • Diaphragm
    • Adrenal Gland
    • Renal Artery
    • Renal Vein
    • Aorta
    • Inferior Vena Cava

URINARY ELIMINATION

  • Defined as the process of voiding, also referred to as micturition.
  • Process Summary:
    • Filling of bladder occurs at a volume of 200 to 450 mL of urine.
    • Activation of stretch receptors in the bladder wall.
    • Signals are sent to the voiding reflex center in the brain.
    • Contraction of the detrusor muscle facilitates urine expulsion.
    • Conscious relaxation of the external urethral sphincter allows for urination.

LIFE SPAN CONSIDERATIONS RELATED TO URINATION

  • Infants:

    • Urine production rate: 15 to 60 mL per kg.
    • Typically produce 8 to 10 wet diapers per day.
    • No voluntary control over urination.

  • Children:

    • Need a mature neuromuscular system for toilet training.
    • Adequate communication skills are necessary.
    • Potential problems: Enuresis (bedwetting) and nocturnal enuresis.

  • Older Adults:

    • Decreasing kidney function is common.
    • Urination urgency and frequency may increase.
    • Loss of bladder elasticity and muscle tone can lead to nocturia (nighttime urination) and incomplete emptying of the bladder.

FACTORS AFFECTING URINARY ELIMINATION

  • Personal Factors: Individual differences such as age, gender, and personal habits.

  • Sociocultural Factors: Norms and practices surrounding toileting in different cultures.

  • Environmental Factors: Access to restrooms and privacy issues.

  • Nutrition: Dietary influences on urine production and characteristics.

  • Hydration: Adequate fluid intake's impact on urine volume and concentration.

  • Activity Level: Physical activity enhances urinary health.

  • Medications: Effects on urinary production or elimination.

    • Common drugs affecting urination include diuretics.

  • Surgery and Anesthesia: Can lead to temporary urinary retention or incontinence.

  • Pathological Conditions:

    • Bladder or kidney infections that may interfere with urinary elimination.
    • Kidney stones that can obstruct urine flow.
    • Prostate hypertrophy in males affecting urination.
    • Mobility problems that limit access to bathrooms.
    • Decreased blood flow through the glomeruli affecting kidney function.
    • Neurological conditions that impact control over urination.
    • Communication issues or alterations in cognition can affect one's ability to express needs regarding urination.

ASSESSMENT

  • Nursing History: Gathering patient history related to urinary habits and changes.
  • Physical Examination: Investigation of the abdominal region and urinary system for abnormalities.
  • Diagnostic Procedures:
    • Monitoring urine output can help evaluate kidney function and bladder status.

COMMON URINE STUDIES

  • Specimens Collection Types:

    • Freshly Voided Specimen: Collected directly from the patient.
    • Clean Catch Specimen: Midstream collection technique to avoid contamination.
    • Sterile Specimen: Obtained through catheterization.
    • 24-Hour Urine Collection: Aggregates urine over a 24-hour period for analysis.

  • Common Studies:

    • Urinalysis: Routine examination of urine physical and chemical properties.
    • Dipstick Testing: Quick test for components like glucose and pH.
    • Example readings of dipstick include:
      • Specific Gravity: Measures urine concentration.
      • Glucose: Should be negative; tested at 30 seconds.
      • pH Range: Should be around 5.0; time reading is not critical.

ANALYSIS/NURSING DIAGNOSIS

  • Common diagnoses related to urinary issues include:
    • Infection: Risk for urinary infections due to various factors.
    • Risk for Urinary Elimination Issues: Challenges in normal urination.
    • Impaired Urinary Elimination: Inability to urinate effectively.
    • Readiness for Enhanced Urinary Incontinence: Focusing on prevention strategies for different types:
    • Functional incontinence
    • Reflex incontinence
    • Stress incontinence
    • Urge incontinence
    • Urinary Retention: Difficulty in emptying the bladder.
    • Urinary Tract Injury, Risk for: Potential trauma affecting the urinary tract.

PLANNING, OUTCOMES/EVALUATION

  • Focus on achieving goals related to urinary elimination:
    • Promoting normal urinary function.
    • Maintaining skin integrity and health of mucous membranes.

SAFE, EFFECTIVE NURSING CARE

  • Clinical Scenario:
    • Patient presents with symptoms typical of urinary tract infections, such as: lumbar pain, fever, chills, and painful urination.
    • Clean-Catch Specimen: Observed with strong odor and cloudy appearance, positive for RBCs, leukocytes, and bacteria.
    • Knowledge Requirements for Nurses: Understanding the development of kidney infections from urinary tract infections and managing patient symptoms and emotional support.

COMMON INCONTINENCE CONDITIONS

  • Clicker Check Example: Female patient experiences incontinence during laughter. Identified as Stress Incontinence due to increased abdominal pressure.

PROMOTING NORMAL URINATION

  • Privacy Consideration: Providing curtains and secure environments for patients.
  • Positioning:
    • Male patients advised to stand; female patients recommended to sit upright.
  • Toileting Routines: Recognizing individual client patterns for toileting.
    • Fluid and Nutrition: Ensuring hydration and a balanced diet for proper functioning.
  • Assist with Hygiene: Promoting good practices post-urination.

ALTERATIONS IN URINARY ELIMINATION

  • Common conditions can include:
    • Urinary Tract Infections (UTIs): Infections affecting the urinary system.
    • Urinary Retention: Inability to urinate properly, leading to complications.
    • Urinary Incontinence: Loss of voluntary control over urine release.
    • Urinary Diversion/Urostomy: Surgical alteration of normal urinary process, may include stoma creation.
    • Stoma: Surgically created opening for elimination; may require a pouch and catheter system to drain urine.

MANAGING URINARY RETENTION

  • Techniques:
    • Monitor for bladder distention; important method to assess urinary retention.
    • Measure post-void residual (PVR) to evaluate bladder emptying efficiency.
    • Drain the bladder using appropriate catheterization methods:
    • Straight Catheter: Temporary method to relieve retention.
    • Indwelling Catheter (Foley): Inserted for longer-term use.
    • Suprapubic Catheter: Alternative method for drainage, inserted through the abdominal wall.

TYPES OF CATHETERS

  • Catheter usage may involve:
    • Different types based on purpose: drainage or irrigation.
  • Balloon Inflation: Catheters may have inflated balloons that provide stability in the bladder.

PATIENT TEACHING

  • Instruct patients on techniques such as:
    • Crede’s Maneuver: Manual method to aid in emptying the bladder.
    • Pelvic Floor Muscle Exercises (PFMEs): Strengthening exercises to improve bladder control.
  • Advisory on when to contact a healthcare professional:
    • Inability to urinate, fever, vomiting, pain, blood in urine.

NURSING CARE FOR URINARY CATHETERS

  • Focus on preventive strategies:
    • Avoid urinary tract infections.
    • Maintain free flow of urine through proper management of catheters.
    • Prevent infection transmission by adhering to sterile techniques.
    • Promote normal urine production and manage associated skin integrity.

CLICKER CHECK ON INDWELLING CATHETERS

  • Scenario: Evaluating understanding of nursing intervention regarding indwelling catheters.
  • Correct Answer: Insertion is not a direct treatment for incontinence.

MANAGING URINARY INCONTINENCE

  • Nursing strategies:
    • Prevent skin breakdown from moisture and urine contact.
    • Lifestyle modifications for patients to consider adopting.
    • Implementation of bladder training strategies to retrain urination patterns.
    • Encourage performance of Kegel exercises for pelvic strength improvement.
    • Use anti-incontinence devices as necessary for support.

ADDITIONAL STRATEGIES FOR URINARY INCONTINENCE

  • Promote independent urination among patients.
  • Apply pharmacological interventions where appropriate.
  • Consider surgical interventions as a last resort or when indicated.
  • Educate parents regarding enuresis in children for effective management.

SOCRATIC REASONING

  • Questioning regarding the implications of overflow incontinence in frail, older female patients alongside physical and emotional ramifications expected would comprise part of nursing assessments.

CLICKER CHECK ON 24-HR URINE COLLECTION

  • Given scenario: Missed specimen during urine collection necessitates restarting the collection for accuracy.

  • Correct Action: Dispose of already collected urine and restart another collection.

URINARY DIVERSION

  • Types: Various surgical diversions may occur.
  • Nursing care must encompass all aspects surrounding care and support for psychological needs post-operation.