Urinary Elimination Chapter 48

Urination Micturition, voiding, urinating

Factors Developmental Psychosocial Fluid/Food intake Medications

Factors (cont.) Muscle tone Pathological conditions Surgery & diagnostic procedures

Altered Urine Production Polyuria Oliguria Anuria

Altered Urinary Elimination Urinary frequency Nocturia Urgency Dysuria, associated with urinary hesitancy Enuresis

Altered Urinary Elimination (cont’d) Urinary incontinence Transient (acute) Established (chronic) Psychosocial aspects

Altered Urinary Elimination (cont’d) Urinary retention Neurogenic bladder

Assessing Nursing history Physical assessment and hydration status Assessment of urine Diagnostic tests and procedures Urine specimens in lab

Assessing Urine Tab 48-4 pg. 1183 Volume Color, clarity Odor Sterility pH Specific gravity

Assessing Urine (cont’d) Glucose Ketones Blood Measure residual urine Diagnostic tests Blood urea nitrogen (BUN) Creatinine clearance

Nursing Diagnoses (Pg. 1184) Impaired Urinary Elimination Functional Urinary Incontinence Overflow Urinary Incontinence Reflex Urinary Incontinence Stress Urinary Incontinence Urge Urinary Incontinence

Nursing Process (Pg. 1186) Goals Interventions

Implementing In small groups discuss how you would help your client maintain normal urinary elimination. What teaching would be performed to prevent UTIs? Interventions focus on: Maintaining normal urinary elimination Practice guidelines pg. 1187 Preventing urinary tract infections (UTI)

Managing Urinary Incontinence Continence training Bladder training Habit training Prompted voiding Pelvic muscle exercises Maintaining skin integrity Use of external draining devices

Managing Urinary Retention Interventions to promote normal urinary elimination as discussed Catheters Cause of healthcare associated infection

Catherization Indications Types Complications Indwelling or foley Straight (intermittent) Suprapubic Complications

Catheter insertion & removal as discussed in learning lab Straight catheter Foley catheter

Nursing Care for Clients with Indwelling Catheters Fluids Dietary measures Perineal care Change catheter and tubing when necessary Maintain sterile closed-drainage system

Nursing Care for Clients with Indwelling Catheters (cont’d) Remove catheter as soon as possible Bladder retraining if needed Follow good handwashing techniques Preventing catheter associated urinary infections pg. 1192

Clean Intermittent Self-Catheterization Performed by clients with neurogenic bladder dysfunction Clean or medical aseptic technique

Suprapubic catheter

Urostomy

QUESTIONS????