1 Second semester Chapter 30 Urinary Elimination Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination

2 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Overview of Urinary Elimination  Components of the urinary system: kidneys, ureters, bladder, and urethra  Accessory structures of the urinary system: ring- shaped muscles called the internal and external sphincters  Components, along with accessory structures, work together to produce urine, collect it, and excrete it from the body

3 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Major Structures of Urinary System

4 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Overview of Urinary Elimination (cont’d)  Urinary elimination: process of releasing excess fluid and metabolic wastes  Normal conditions: average person eliminates approximately 1500 to 3000 mL of urine each day  Need to urinate becomes apparent when the bladder distends with approximately 150 to 300 mL of urine

5 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Factors affecting urinary elimination  Patterns of urinary elimination depend on  Physiologic  Emotional  Social o Examples: amount of food consumed, volume of fluid intake, and the amount of fluid losses o Degree of neuromuscular development o Integrity of the spinal cord o Circadian rhythm, habits, opportunities, anxiety

6 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Factors affecting urinary elimination (cont’d)  Measures to promote urination  Providing privacy; assuming a natural position for urination  Maintaining an adequate fluid intake  Using stimuli such as running water from a tap to initiate voiding

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8 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Urine Specimen Collection Purpose: to identify microscopic or chemical constituents of client’s urine 1. Voided Specimens Is a sample of fresh urine collected in a clean container. (The first voided specimen of the day is preferred because it is most likely to contain substantial urinary components that have accumulated during the night). 2. A clean-catch specimen Is a voided sample of urine considered sterile called a mid-stream specimen because of how it is collected. As soon as the specimen is collected, it is labeled and taken to the laboratory. Factors affecting urinary elimination (cont’d)

9 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Urine Specimen Collection (cont’d) 3) Catheter Specimens A urine specimen can be collected under sterile conditions using a catheter, which is usually done when clients are catheterized for other reasons such as to control incontinence in an unconscious client 4) 24-Hour Specimens collection of all urine produced in a full 24-hour period

10 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Abnormal Urinary Elimination Patterns Identifying abnormal urine characteristics Laboratory analysis is a valuable diagnostic tool  Hematuria: urine containing blood  Pyuria: urine containing pus  Proteinuria: urine containing plasma proteins  Albuminuria: urine containing albumin, a plasma protein  Glycosuria: urine containing glucose  Ketonuria: urine containing ketones

11 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Abnormal Urinary Elimination Patterns 1. Anuria Anuria means absence of urine or a volume of 100 mL or less in 24 hours. It indicates that the kidneys are not forming sufficient urine. Note: Urinary retention: the client produces urine but does not release it from the bladder 2. Oliguria Urine output less than 400 mL per 24 hours, indicates inadequate elimination of urine. Residual urine : more than 50 mL of urine that remains in the bladder after voiding Urinary stasis: lack of movement of urine from bladder

12 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Abnormal Urinary Elimination Patterns (cont’d) 3. Polyuria Greater than normal urinary volume and may accompany minor dietary variations, such as increased fluid intake For example, consuming higher than normal amounts of fluids, especially those with mild diuretic effects (e.g., coffee, tea), or taking certain medications actually can increase urination. 4. Nocturia Nocturia (nighttime urination) is unusual because the rate of urine production is normally reduced at night.

13 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Abnormal Urinary Elimination Patterns (cont’d) 5. Dysuria Dysuria is difficult or uncomfortable voiding and a common symptom of trauma to the urethra or a bladder infection. Frequency :need to urinate often. Urgency :strong feeling that urine must be eliminated quickly often accompany dysuria. 6. Incontinence Incontinence means the inability to control either urinary or bowel elimination and is abnormal after a person is toilet-trained.

14 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Assisting Clients with Urinary Elimination  Clients who are weak or cannot walk to the bathroom may need a commode; clients confined to bed use a urinal or bedpan 1. Commode: chair with an opening in the seat under which a receptacle is placed 2. Urinal: cylindrical container for collecting urine; mostly used for males

15 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination C.Using a Bedpan A bedpan (seat like container for elimination) is used to collect urine or stool. Figure 30-5 Two types of bedpans: fracture pan)left (and conventional bedpan )right).

16 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination 6 types of urinary incontinence Stress, urge, reflex, functional, total, and overflow Continence training: to restore control of urination involves teaching the client to refrain from urinating until an appropriate time and place Managing Incontinence

17 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Types of urinary incontinence

18 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Catheterization  Catheterization: act of applying or inserting a hollow tube  Types of catheters  External catheters: urine-collecting device applied to the skin o Example: condom catheter o Are more effective for male pts..

19 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Catheterization (cont’d)  Straight catheters: urine drainage tube inserted but not left in place  Retention catheters (also called indwelling catheters): left in place for a period of time  Example: Foley catheter A. Retention (Foley) catheter with a balloon B. Straight catheter

Various Reasons for Urinary Catheter Use 1.Keeping incontinent clients dry (last resort, when all other continence measures have been tried) 2.Relieving bladder distention when clients cannot void 3.Assessing fluid balance accurately 4.Keeping the bladder from becoming distended during procedures such as surgery 5.Measuring the residual urine 6.Obtaining sterile urine specimens 7.Instilling medication within the bladder Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B 20

21 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Types of Catheters (cont’d) Unlike straight catheters, retention catheters are secured with a balloon that is inflated once the distal tip is within the bladder. Both straight and retention catheters Available in various diameters, sized according to the French scale: for adults, sizes 14, 16, and 18 F are commonly used.

 Inserting a catheter: techniques for inserting straight and retention catheters are similar, although the steps for inflating the retention balloon do not apply to a straight catheter  Closed drainage system:  Device used to collect urine from a catheter 22 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Catheterization (cont’d)

Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B23 Figure Techniques for suspending a drainage system below the bladder: ( A) wheelchair patient; (B) ambulating patient with and without an IV pole.

24 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination

 Catheter irrigation: flushing the lumen of a catheter for restoring or maintaining patency 1. Open system: retention catheter is separated from the drainage tubing to insert the tip of an irrigating syringe (least desirable) 2. Closed system: irrigated without separating the catheter from the drainage tubing  Continuous irrigation: ongoing instillation of solution using a 3-way catheter 25 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Catheterization (cont’d)

26 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination

27 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Catheterization (cont’d) Indwelling catheter removal: catheter is removed when it needs to be replaced or when its use is discontinued

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29 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Urinary Diversions  Urinary diversion: one or both ureters are surgically implanted elsewhere  This procedure is done for various life- threatening conditions  Urostomy: urinary diversion that discharges urine from an opening on the abdomen o Peristomal skin: skin around the stoma o Difficult to maintain skin integrity due to frequent appliance changes and ammonia in urine

30 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination Figure Examples of urinary diversions. (A) Ileal conduit. (B) Cutaneous ureterostomy.

Nursing Implications Self-Care Deficit: Toileting Impaired Urinary Elimination Risk for Infection Stress Urinary Incontinence Urge Urinary Incontinence Reflex Urinary Incontinence Total Urinary Incontinence Functional Urinary Incontinence Situational Low Self-Esteem Risk for Impaired Skin Integrity 31 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Urinary Elimination