CH31

Chapter 31: Urinary Elimination and Care

Normal Urinary Elimination

• Void: Another term for urinate, also known as micturate.

• Kidney Filtration: Cleanses blood, removing unnecessary substances, leading to urine production.

• Waste Products Removed:

  • Urea: From amino acid metabolism.

  • Uric acid: From the breakdown of RNA and DNA.

  • Creatinine: Waste product from muscle metabolism.

Characteristics of Urine

• Color and Clarity: Typically straw-colored and clear.

• Odor: Slightly aromatic.

• Amount:

  • Oliguria: Low urine output.

  • Polyuria: High urine output.

  • Anuria: No urine output.

• pH: Ranges from 4.5 to 8.

• Specific Gravity: Ranges from 1.005 to 1.030.

Specific Gravity

• Definition: Comparison of the weight of urine to the weight of an equal amount of water.

• Clinical Significance:

  • High specific gravity indicates concentrated urine.

  • Low specific gravity indicates dilute urine.

The Urinary System

• Components: Two kidneys, renal arteries, nephrons, ureters, urinary bladder.

• Function:

  • Nephrons filter blood.

  • Urine exits kidneys via ureters.

  • Normal voiding: 4 to 6 times per day.

Assisting With Toileting

• Assistance Required: Independent patients may need help with personal hygiene in care settings.

• Equipment Used: Bedpans, bedside commodes, urinals, fracture pans.

• Considerations: Privacy and hygiene post-use.

Assessing Urine and Urinary Output

• Focus: Assess urine specimens, and measure intake and output.

Collecting Urine Specimens

• Methods:

  • Clean-catch urine specimen

  • Urinalysis

  • Timed urinary collection (24-hour urine).

  • Reagent testing and straining urine.

Altered Bladder Function

• Conditions:

  • Urinary Retention: Inability to empty bladder.

  • Residual Urine: Urine remaining post-voiding.

  • Nocturia: Frequent night-time urination.

  • Urinary Incontinence: Loss of urine control.

Types of Incontinence

• Categories:

  • Stress

  • Urge

  • Mixed

  • Functional

  • Total

  • Overflow

  • Neuropathic.

Nursing Interventions for Incontinence

• Strategies:

  • Encourage 64 ounces of fluid intake daily.

  • Limit caffeinated beverages.

  • Schedule regular bathroom assistance.

  • Mimic patient's normal voiding pattern.

Assessing Kidney Function and Failure

• Blood Urea Nitrogen (BUN):

  • Normal levels: 8 to 21 mg/dL.

  • High levels may indicate renal impairment.

• Creatinine Levels:

  • Male: 0.6 to 1.21 mg/dL.

  • Female: 0.5 to 1.11 mg/dL.

  • Elevated levels suggest decreased kidney function.

Types of Catheters (Box 31.3)

• Straight Catheter: Single-lumen, used for sterile urine collection or one-time drainage.

• Indwelling Catheter: Double-lumen (Foley), remains in bladder for extended use.

• Three-Way Catheter: Used post-prostate surgery for irrigation.

• Coudé Catheter: Curved tip for patients with enlarged prostates.

• Suprapubic Catheter: Inserted through the abdominal wall post-surgery.

• Condom Catheter: Non-invasive catheter for males, resembles a condom.

Continuous Bladder Irrigation

• Components:

  • Irrigation bag, drip chamber, clamp, and drainage bag.

  • Utilizes a triple-lumen catheter for irrigation purposes.

Nursing Care for Indwelling Catheters

• Focus Areas:

  • Managing urinary drainage bags.

  • Troubleshooting low output and catheter care.

Urinary Diversions

• Definition: Alternative routes for urine elimination.

• Types:

  • Ileal Conduit: Ureters connected to a segment of the intestines.

  • Continent Urostomy: Pouch created for urine storage.

  • Orthotopic Bladder Substitution: Substitute bladder formed from intestinal tissue.

Urinary Tract Infections (UTI)

• Definition: Presence of pathogens in urinary tract.

• Types: Cystitis (bladder), pyelonephritis (kidney).

Symptoms of UTI

• Manifestations:

  • Dysuria, frequency, urgency, nocturia, low abdominal pain, incontinence.

Treatment of UTI

• Interventions:

  • Rest, increased fluid intake, antibiotics, urinary analgesics.