Nursing 160 W5 D2

Urinary Elimination Process

• Kidney Functions

  • The kidneys are responsible for filtering blood, removing waste, and regulating electrolytes, fluid balance, and blood pressure.

  • Urinary elimination involves multiple structures: kidneys, ureters, bladder, and urethra.

  • Urinary System Pathway:

    • Kidneys 👉 Ureters 👉 Bladder 👉 Urethra

  • An adult bladder can hold about 300 to 500 milliliters of urine at one time.

Reabsorption and Filtration

• Blood passes through the kidneys and gets filtered for necessary components.

  • Reabsorption: Good elements (e.g., potassium, ammonia) are sent back to the bloodstream.

  • Waste products are excreted, including drug metabolites and excess electrolytes.

Digestive System Overview

• The gastrointestinal (GI) tract is responsible for food breakdown and nutrient absorption.

  • Key Structures:

    • Starts at the esophagus, continues to the stomach, small intestine, and ends at the anus.

  • Accessory organs: liver, gallbladder, pancreas assist digestion but are not part of the main GI tract.

  • Waste formation occurs in the colon (large intestine), specifically the cecum, colon, rectum, and anus.

  • Major functions include the absorption of water and electrolytes from waste to form stool.

Peristalsis and Stool Formation

• Peristalsis: Refers to the motility of the gut.

  • Fast peristalsis results in diarrhea due to less water absorption.

  • Slow peristalsis can lead to constipation as more water is absorbed, making stools harder.

Elimination Issues

• Various problems can affect urinary and gastrointestinal elimination including:

  • Incontinence (loss of control)

  • Retention (inability to expel urine or stool)

  • Inflammation and neoplasms

  • Organ failure

  • Incontinence can be due to:

    • Underdeveloped elimination mechanisms

    • Cognitive alterations affecting control over elimination (e.g., confusion or fear).

  • Risks of skin breakdown associated with incontinence due to prolonged exposure to urine or feces.

Urinary Retention

• Urinary retention is characterized by incomplete emptying of the bladder or an inability to urinate, leading to:

  • Increased bladder volume and risk of backflow into the ureters and kidneys.

  • Causes of retention:

    • Obstruction (e.g., enlarged prostate)

    • Inflammation or neuromuscular impairment

  • Medications (e.g., antidepressants) may also contribute to urinary retention.

  • Common symptoms include urinary frequency, nocturia, and feeling of incomplete bladder emptying.

Bowel Retention

• Refers to the inability to pass stool, often leading to problems like:

  • Loss of appetite and discomfort.

  • Commonly caused by:

    • Ignoring the urge to defecate, medications (especially opioids), or bowel obstructions.

  • Excessive retention impacts health and may require interventions like manual disimpaction.

Assessment and History Taking

• Assessment involves:

  • Inquiry about normal urinary and bowel patterns (frequency, appearance, associated symptoms).

  • Current medications and dietary changes that may impact elimination.

• A physical exam includes:

  • Inspecting for distention, tenderness, or abnormal discharge.

  • Listening for bowel sounds and palpating the abdomen to identify distension.

  • Testing urine for color and clarity which indicates hydration status or possible infection.

Diagnostic Tests

• Common diagnostic procedures include:

  • Urinalysis: Checks for bacteria or blood indicating infection or trauma.

  • Blood tests: BUN and creatinine to assess renal function.

  • Occult blood tests: To screen for invisible blood, indicating possible gastrointestinal issues.

  • Imaging tests (e.g., ultrasound, CT) to visualize urinary structures.

Benign Prostatic Hyperplasia (BPH)

• BPH is an enlargement of the prostate common in men over 50 years.

  • Symptoms include:

    • Increased frequency of urination, nocturia, urinary hesitancy, and a feeling of incomplete emptying.

  • Untreated, can lead to complications like UTIs or renal issues from urinary retention.

  • Diagnostic methods: Digital rectal exam, post void residual measurement, and cystoscopy to visualize prostate enlargement.

Treatment for BPH

• Medications:

  • Alpha-blockers (e.g., Cardura, Flomax) help relax prostate muscles.

  • 5-alpha-reductase inhibitors (e.g., Proscar) reduce prostate size by blocking testosterone conversion.

  • Surgical interventions (TURP) for severe cases to relieve obstruction by removing excess prostate tissue.

Renal Failure

• Renal failure can be acute (AKI) or chronic (ESRD).

• Acute Renal Injury (AKI):

  • Sudden loss of function from obstruction, trauma, or medications (e.g., NSAIDs).

  • Characterized by fluid overload and electrolyte imbalances.

• Chronic Renal Failure:

  • Progresses over time, often from diseases like diabetes or hypertension.

  • Manifests with fatigue, headaches, and decreased urine production.

  • Requires dialysis or transplantation for management.

Neurogenic Bladder

• Loss of voluntary control of urination, often due to neurological damage.

• Two types:

  • Spastic neurogenic bladder: Overactive, spasms lead to involuntary urination.

  • Flaccid neurogenic bladder: Incomplete emptying due to reduced bladder tone, high risk of infections.

• Management includes medications, bladder retraining strategies, and possible catheterization.

Ostomy Care

• Ostomy: An artificial opening for waste elimination.

• Types:

  • Colostomy: Diverts stool from the colon.

  • Ileostomy: More fluid waste from small intestine.

  • Urostomy: Diverts urine from the urinary system.

• Proper care is crucial to prevent skin breakdown around the stoma due to irritation from waste.