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Urinary System Ch 43.

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Presentation on theme: "Urinary System Ch 43."— Presentation transcript:

1 Urinary System Ch 43

2 Vocabulary Micturation Sphincter Detrusor muscle Nephron Enuresis
Nocturia

3 Overview: Urinary System
Kidneys Ureters Bladder Urethra

4 Kidneys Maintain composition and volume of body fluids
Filter blood constituents Eliminate what is not needed, retain those that are needed Excrete waste product (urine)

5 Nephrons Tiny, complex structures within the kidney
Remove the end products of metabolism Regulate fluid balance Urine from the nephrons empties into the kidney pelvis

6 Ureters Drainage ‘tubes’ from kidneys to bladder

7 Bladder Smooth muscle sac Collection place for urine
Composed of three layers of muscle tissue called detrusor muscle Sphincter guards opening between urinary bladder and urethra Urethra conveys urine from bladder to exterior of body

8 Urethra Conveys urine from the bladder to the exterior
Male urethra functions excretory reproductive Female urethra is completely inside the body

9 Act of Micturation Process of emptying the bladder
Detrusor muscle contracts, internal sphincter relaxes, urine enter posterior urethra Muscles of perineum and external sphincter relax Muscle of abdominal wall contracts slightly Diaphragm lowers, micturation occurs

10 Factors Affecting Micturation
Developmental considerations Food and fluid intake Psychological variables Activity and muscle tone Pathologic conditions Medication

11 Developmental Considerations
Children Toilet training 18 to 24 months, enuresis Effects of aging Nocturia, increased frequency Urine retention and stasis Voluntary control affected by physical problems

12 Diseases Associated With Renal Problems
Congenital urinary tract abnormalities Polycystic kidney disease Urinary tract infection Urinary calculi Hypertension Diabetes mellitus Gout Connective tissue disorders

13 Effects of Medications on Urine Production and Elimination
Diuretics — prevent reabsorption of water and certain electrolytes in tubules Cholingeric medications — stimulate contraction of detrusor muscle, producing urination Analgesics and tranquilizers — suppress CNS diminish effectiveness of neural reflex

14 Medications Affecting Color of Urine
Anticoagulants — red color Diuretics — lighten urine to pale yellow Pyridium — orange to orange-red urine  Hint: these are significant to remember  Elavil — green or blue-green Levodopa — brown or black

15 Using the Nursing Process
Assess Voiding patterns Habits Past history of problems Physical examination Urinary system Skin hydration Urine Compare to results of procedures and diagnostic tests

16 Physical Assessment of Urinary Functioning
Kidneys — check for costovertebral tenderness Urinary bladder — palpate and percuss the bladder or use bedside scanner Urethral meatus — inspect for signs of infection, discharge, or odor Skin — assess for color, texture, turgor, and excretion of wastes Urine — assess for color, odor, clarity, and sediment

17 Measuring Urine Output
Ask patient to void into bedpan, urinal, or specimen container in bed or bathroom. Pour urine into appropriate measuring device. Place calibrated container on flat surface and read at eye level. Note amount of urine voided and record on appropriate form. Discard urine in toilet unless specimen is needed.

18 Urine Specimens Routine urinalysis Specimens from infants and children
Clean-catch or midstream specimens Sterile specimens from indwelling catheter 24-hour urine specimen

19 Nursing Diagnoses Urinary functioning as the problem
Incontinence Pattern alteration Urinary retention Urinary functioning as the etiology Anxiety Caregiver role strain Risk for infection

20 Planned Patient Goals Urine output about equal to fluid intake
Maintain fluid and electrolyte balance Empty bladder completely at regular intervals Report ease of voiding Maintain skin integrity

21 Promoting Normal Urination
Maintaining normal voiding habits Promoting fluid intake Strengthening muscle tone Stimulating urination and resolving urinary retention

22 Maintaining Normal Voiding Habits
Schedule Privacy Position Hygiene

23 Patients at Risk for UTIs
Sexually active women Postmenopausal women Individuals with indwelling urinary catheter Individual with diabetes mellitus Elderly people

24 Four Types of Urinary Incontinence
Stress — increase in intraabdominal pressure Urge — urine lost during abrupt and strong desire to void Mixed — symptoms of urge and stress incontinence present Overflow — overdistention and overflow of bladder Functional — caused by factors outside the urinary tract

25 Factors to Consider With Use of Absorbent Products
Functional disability of the patient Type and severity of incontinence Gender Availability of caregivers Failure with previous treatment programs Patient preference

26 Reasons for Catheterization
Relieving urinary retention Obtaining a sterile urine specimen Measuring amount of PVR (post-void retained) urine in bladder (understand this) Obtaining a urine specimen (sterile) Emptying bladder before during or after surgery Monitoring of critically ill patients

27 Catheterization THE most common cause of nosocomial infection
Maintain strict sterile technique when inserting a catheter

28 Patient Education for Urinary Diversion
Explain reason for diversion and rationale for treatment Demonstrate effective self-care behaviors Describe follow-up care and support resources Report where supplies may be obtained in community Verbalize related fears and concerns Demonstrate a positive body image

29 Evaluating Effectiveness of Plan
Maintain fluid, electrolyte, and acid-base balance Empty bladder completely at regular intervals with no discomfort Provide care for urinary diversion and when to notify physician Develop a plan to modify factors contributing to problem Correct unhealthy urinary habits


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