Chapter 50

Chapter 50: Care of the Patient With a Urinary Disorder

Lesson 50.1: Anatomy and Physiology of the Urinary System

• Overview of Learning Objectives:

  • Describe the structures of the urinary system.

  • Describe the functions of the urinary structures.

  • List the three processes involved in urine formation.

  • Compare normal and abnormal components of urine.

  • Identify effects of aging on urinary system function.

Urinary System Structures

• Major Structures:

  • Kidneys: Filter blood, remove waste, and concentrate waste into urine.

  • Ureters: Transport urine from kidneys to bladder.

  • Bladder: Collects and stores urine before elimination.

  • Urethra: Conducts urine out of the body during urination.

  • Nephron: Functional unit of the kidney that filters blood and processes urine.

Functions of Urinary Structures

• Kidneys:

  • Remove waste from blood.

  • Balance electrolytes and fluids.

• Ureters:

  • Carry urine to the bladder.

• Bladder:

  • Stores urine until elimination.

• Urethra:

  • Passes urine out of the body.

Three Phases of Urine Formation

• Filtration:

  • Occurs in the glomerulus of Bowman’s capsule; water and small molecules pass into the nephron.

• Reabsorption:

  • Occurs mainly in the proximal convoluted tubules, Henle loop, distal convoluted tubules; water, glucose, and ions re-enter the blood.

• Secretion:

  • Removal of waste products like nitrogenous waste (urea, uric acid) back into the nephron.

Hormonal Influence on Nephron Function

• Antidiuretic Hormone (ADH):

  • Increases water reabsorption in distal convoluted tubules.

  • Raises blood pressure and concentrates urine (dark yellow).

Normal Urine Measurements

• Components:

  • Albumin: None

  • Glucose: None

  • Erythrocytes: None or trace

  • Ketones: None

  • Leukocytes: None or trace

  • pH: 4.6-8

  • Color: Yellow/Clear

  • Clarity: Clear

Abnormal Urine Measurements

• Components and Their Implications:

  • Albumin: May indicate renal disease or hypertension.

  • Glucose: High levels often relate to diabetes.

  • Erythrocytes: Suggests infection, tumors, or renal diseases.

  • Ketones: High levels indicate fatty acid oxidation, often in uncontrolled diabetes.

  • Leukocytes: Indicates urinary tract infection (UTI).

Effects of Aging on Urinary System

• Aging Effects:

  • Up to 50% decline in kidney filtering by age 70.

  • Bladder tone decreases.

  • Relaxation of perineal muscles leads to incomplete bladder emptying.

Lesson 50.2: Nursing Care for the Patient With a Urinary Disorder

• Patient Care Objectives:

  • Describe body image changes due to urinary function alterations.

  • Integrate pharmacotherapeutic and nutritional considerations into care plans.

  • Prioritize care needs of patients with urinary dysfunction.

Effects of Alterations in Urinary Function

• Consequences:

  • Disturbed body image.

  • Low self-esteem.

  • Increased anxiety.

Pharmacologic Agents for Urinary Disorders

• Common Medications:

  • Sulfamethoxazole-trimethoprim (Bactrim, Septra)

  • Ciprofloxacin (Cipro)

  • Amoxicillin/Ampicillin

  • Nitrofurantoin (Furadantin, Macrodantin)

  • Phenazopyridine (Pyridium)

  • Levofloxacin (Levaquin)

Nutritional Therapy for Urinary Disorders

• Dietary Recommendations:

  • Acid-ash foods: meat, whole grains, eggs, cheese, cranberries.

  • Alkaline-ash foods: milk, most vegetables, fruits (excluding cranberries).

  • Recommendations include low sodium intake and high protein diets (meat, eggs, dairy).

  • Public Health Recommendations: Avoid caffeine, alcohol, and spicy foods.

Special Needs of Patients with Urinary Dysfunction

• Medication Considerations:

  • Medications must be tailored to enhance urinary output (e.g., diuretics).

  • Nutritional considerations for acid-ash and alkaline-ash diets.

Catheter Types

• Types of Catheters:

  • Foley Catheter: Inflatable balloon for retention.

  • Robinson Catheter: Multiple openings for intermittent drainage.

  • Ureteral Catheter: Long, slender tubing for ureters.

  • External Catheter: Drainage system attached externally.

  • Self-Catheterization: Patient drains bladder independently.

Bladder Training and Kegel Exercises

• Enhancing Bladder Control:

  • Bladder Training: Involves perineal muscle exercises for improved control.

  • Kegel Exercises: Strengthen pelvic floor muscles.

  • Managing Urinary Incontinence: Includes understanding appliances for drainage (leg bags, urostomy bags).

Lesson 50.3: Urinary Disorders

• Patient Care Objectives:

  • Describe kidney function alterations linked to urinary tract disorders.

  • Address patient concerns regarding altered sexuality due to urinary conditions.

  • Identify community resources for support.

  • Formulate patient problem statements related to urinary function changes.

Alteration in Kidney Function Related to Specific Urinary Disorders

• Common Conditions:

  • Urinary retention.

  • Urinary incontinence.

  • Neurogenic bladder.

  • Urinary tract infections (UTI), cystitis, interstitial cystitis.

  • Prostatitis, pyelonephritis.

  • Urinary obstruction and hydronephrosis.

  • Urolithiasis and renal tumors.

Urinary Disorders and Sexuality

• Supportive Interventions:

  • Encourage patients and families to express feelings regarding sexuality.

  • Practice open listening without judgment.

  • Provide privacy during discussions.

Community Resources for the Patient with a Urinary Disorder

• Available Support:

  • Support Groups: Connect with other individuals facing similar challenges.

  • Home Health Services: Facilitate in-home assistance as needed.

Patient Problems Related to Urinary Disorders

• Common Issues:

  • Impaired urinary elimination.

  • Impaired renal blood flow.

  • Pain in the urinary tract.

  • Sexual dysfunction stemming from urinary disorders.

  • Altered body image perceptions.

  • Ineffective management of therapeutic regimens.