Urinary Elimination

Risk Factors for Problems of Elimination Conditions that result in Neurologic impairment (Neurogenic bladder) Trauma to the brain or spinal cord CVA Diabetic neuropathy (R/T metabolic derangements) Altered mobility Severe arthritis Cognitive impairment dementia Immunologic impairment or infection AIDS 2

Urinary System Urinary System Organs Renal Nephron

Additional Kidney Functions Production of erythropoietin is essential to maintaining a normal red blood cell (RBC) volume. Erythropoietin stimulates bone marrow to produce RBCs and prolongs the life of mature RBCs. Production of renin. Renin starts a chain of events that cause water retention, thereby increasing blood volume. Kidneys affect calcium and phosphate regulation

Renin-Angiotensin Mechanism

Kidneys affect calcium and phosphate regulation Vitamin D The Kidneys produces a substance that converts vitamin D into its active form. Intestines absorb more Ca from foods.

Disease Conditions Affecting Urination Prerenal, renal, postrenal classification Conditions of the lower urinary tract Diabetes mellitus and neuromuscular diseases such as multiple sclerosis Benign prostatic hyperplasia Cognitive impairments (e.g., Alzheimer’s) Diseases that slow or hinder physical activity Conditions that make it difficult to reach and use toilet facilities End-stage renal disease, uremic syndrome

Pre-renal, renal, post-renal classification Decrease blood flow Condition of renal tissue Obstruction in the UT that prevents flow from kidneys

Conditions of the Lower Urinary Tract

Diabetes Mellitus and Neuromuscular Diseases

Benign Prostatic Hyperplasia (BPH)

Conditions Affecting Urination Cognitive impairments Diseases that slow or hinder physical activity Conditions that make it difficult to reach and use toilet facilities

End Stage Renal Disease (ESRD) (CKD)

Dialysis Renal Replacement Two methods Peritoneal Hemodialysis 14

Indications for Dialysis Renal failure that can no longer be controlled by conservative management (Conservative management would include dietary modifications and the administration of medications to correct electrolyte abnormalities.) Worsening of uremic syndrome associated with ESRD, which would include nausea, vomiting, neurological changes, and pericarditis) Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures (These abnormalities would include hyperkalemia and pulmonary edema.) by simpler measures

Factors Influencing Urination Disease conditions Socioeconomic factors (need for privacy) Psychological factors (anxiety, stress, privacy) Fluid balance Nocturia, polyuria, oliguria, anuria Diuresis Fever Medications and medical procedures How would you help someone needing to void, but unable to initiate the process?

Factors Influencing Urination Disease conditions Socioeconomic factors Need for privacy Cultural differences Psychological factors Anxiety Emotional Stress Privacy

Factors Influencing Urination Fluid balance Nocturia, polyuria, oliguria, anuria Diuresis Fever Foods Medications and medical procedures How would you help someone needing to void, but unable to initiate the process?

Fluid Balance Symptoms common to urinary disturbances include frequency urgency dysuria polyuria oliguria incontinence difficulty in starting the urinary stream.

Medications and Medical Procedures Surgery (stress)

Alterations in Urinary Elimination Urinary retention An accumulation of urine due to the inability of the bladder to empty Urinary tract infection Results from catheterization or procedure Urinary incontinence Involuntary leakage of urine Urinary diversion Diversion of urine to external source

Urinary Tract Infection Signs and symptoms Pain or burning during urination (dysuria) Fever, chills, nausea, vomiting, and malaise Frequent and urgent sensation of need to void Blood-tinged urine (hematuria) Treatment Medication 22

Urinary incontinence

Nursing Diagnoses Impaired Social Interaction r/t Loss of independence: clothing becomes wet with urine and odor. Impaired body image r/t incontinent of urine. Risk for impaired skin integrity. Impaired urinary elimination Self-care deficit: toileting 24

Physical Assessment Gather nursing history for the patient’s urination pattern and symptoms, and factors affecting urination. Conduct physical assessment of the patient’s body systems potentially affected by urinary change. Assess characteristics of urine. Assess the patient’s perception of urinary problems as it affects self-concept and sexuality. Gather relevant laboratory and diagnostic test data.

Physical Assessment Skin and mucosal membranes Assess hydration. Kidneys Flank pain may occur with infection or inflammation. Bladder Distended bladder rises above symphysis pubis. Urethral meatus Observe for discharge, inflammation, and lesions.

Urine Tests and Diagnostic Examinations Urinalysis Specific gravity Culture Noninvasive procedures Invasive procedures

Urine Drainage Bag

Catheterization

Types of Urinary Catheters

Urinary Drainage System and Infectious Organisms

Restorative Care Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort

Indications for Catheterization Acceptable reasons for insertion of a Foley Catheter Obstruction to urine flow Surgical repair of bladder, urethra and surrounding structures Prevention of urethral obstruction from blood clots after genitourinary surgery Accurate I&O in critical patients Continuous or intermittent bladder irrigations Severe urinary retention Urinary incontinence with stage 3 – 4 pressure ulcers Comfort for terminal patient Bladder decompression for surgery 33

Foley Catheter Kit 34