1. Urinary elimination Dr. Dergham M. Hameed

2. Urinary System Kidneys and ureters Bladder Urethra

4. Kidneys and Ureters Maintain composition and volume of body fluids Filter and excrete blood constituents not needed, retain those that are needed Excrete waste product (urine) Nephrons remove the end products of metabolism and regulate fluid balance Urine from the nephrons empties into the kidneys

7. Bladder Smooth muscle sac Serves as a reservoir 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 in excretory and reproductive system No portion of female urethra is external to the body

9. Act of Micturition 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, micturition occurs

10. Factors Affecting Micturition 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

14. 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

15. Medications Affecting Color of Urine Anticoagulants — red color Diuretics — lighten urine to pale yellow Pyridium — orange to orange-red urine Elavil — green or blue-green Levodopa — brown or black

16. Using the Nursing Process Assessing data about voiding patterns, habits, past history of problems Physical examination of urinary system, skin hydration, urine Correlation of these findings with results of procedures and diagnostic tests

17. Assessing a Problem With Voiding Explore its duration, severity, and precipitating factors. Note patient’s perception of the problem. Check adequacy of patient’s self-care behaviors.

19. 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

22. 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.

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

25. Diagnoses Urinary functioning as the problem –Incontinence, pattern alteration, urinary retention Urinary functioning as the etiology –Anxiety, caregiver role strain, risk for infection

26. 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

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

28. Maintaining Normal Voiding Habits Schedule Privacy Position Hygiene

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

30. 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

31. 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

32. Reasons for Catheterization Relieving urinary retention Obtaining a sterile urine specimen Measuring amount urine in bladder Obtaining a urine specimen Emptying bladder before during or after surgery Monitoring of critically ill patients

33. 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