ATI Fundamentals For Nursing Chapter 44 - Urinary Elimination
- helps in regulating your water volume, concentrations, and pH levels
- helps in influencing your red blood cell production and blood pressure
- is a precise system of filtration, reabsorption, and excretion.
- These process help maintain fluid and electrolyte balance while filtering and excreting water-soluble waste
- is surgery that creates a new way for urine to pass out of the body.
- it is performed to treat:
- Bladder cancer
- Neurogenic bladder
- Congenital anomalies
- Trauma to the bladder
- Chronic infections with deterioration of renal function
Type of Urinary Diversion
Incontinent Urinary Diversion
- urine drains through a hole (stoma) in the abdomen into a bag.
- it drains through a hole made in your lower belly called a stoma. Urine then passes through the stoma and drains into a bag worn outside the body, under your clothes.
Continent Urinary Diversion
- involves the creation of a pouch or bladder inside the body, usually using part of the digestive tract.
- the surgeon creates a pouch, or reservoir, inside your body from a section of your stomach or small or large intestine.
- an incontinent urinary diversion for which the surgeon attaches one of both ureters via a stoma to the surface attaches one or both ureters via a stoma to the surface of the abomnal wall.
an incontinent urinary diversion for which the surgeon attaches a tube from the renal pelvis via a stoma to the surface of the abdominal wall
Factors affecting urinary elimination
- poor abdominal and pelvic muscle tone
- acute and chronic disorders
- spinal cord injury
- psychosocial factors
- surgical procedures
DIAGNOSTIC TESTS Bedside sonography with a bladder scanner
noninvasive portable ultrasound scanner for measuring bladder volume and residual volume after urination.
DIAGNOSTIC TESTS Kindeys, ureters, ballader
x-ray to determine size, shape, and position of these structures
DIAGNOSTIC TESTS Intravenous pyelogram
Injection of contrast media (iodine) for viewing of ducts, renal pelvis, ureters, bladder, and urethra
- ! Allergy to shellfish contraindicates
the use of this contrast medium.
DIAGNOSTIC TESTS Renal scan
View of renal blood flow and anatomy of the kidneys without contrast
DIAGNOSTIC TESTS Renal ultrasound
View of gross renal structuresand structural abnormalities using
DIAGNOSTIC TESTS Cystoscopy
Use of a lighted instrument to visualize, treat, and obtain specimens from the bladder and urethra
DIAGNOSTIC TESTS Urodynamic testing
Test for bladder muscle function by filling the bladder with CO2 or 0.9% sodium chloride and comparing pressure readings with reported sensations
Usual size and type of catheter
- Children: 8 to 10 Fr
- Women: 14 to 16 Fr
- Men: 16 to 18 Fr
- use silicone or teflon products for clients who have latex allergies
LABORATORY TEST Urinalysis and urine culture and sensitivity
To identify UTI (presence of RBCs, WBCs, micro‑organisms)
LABORATORY TEST Serum creatinine and BUN
To assess renal function (elevated with renal dysfunction)
DIAGNOSTIC PROCEDURES Ultrasound
Detects bladder abnormalities and/or residual urine
DIAGNOSTIC PROCEDURES Voiding cystourethrography
Identifies the size, shape, support, and function of the urinary bladder, obstruction (prostate), residual urine
DIAGNOSTIC PROCEDURES Urodynamic testing
- Cystourethroscopy: Visualizes the inside of the bladder
- Uroflowmetry: Measures the rate and degree of bladder emptying
DIAGNOSTIC PROCEDURES Electromyography
Measures the strength of pelvic muscle contractions
- an excessive amount of urine production in excess of 2.5 liters over a 24 hour period of time.
- frequently occurring causes
- consumption of large amounts of fluids
- the use of diuretic medications
- renal disease
- psychogenic polydipsia which is a psychiatric mental disorder causing excessive thirst
- sickle cell
- anemia diabetes mellitus
- diabetes insipidus.
- Excessive and prolonged polyuria can lead to dehydration which can cause fluid and electrolyte imbalances in the client.
- The normal urinary output is about 2 liters per day.
- less than the normal amount of urinary output at less than 400 mLs over the course of 24 hours.
- commonly occurring causes
- impaired renal blood flow
- renal disease
- decreased fluid intake and dehydration
- hypovolemic shock and other diseases and disorders associated with excessive bodily fluid losses
- anatomical urinary stricture.
- lack of the production of urine or a severely scant amount of urine less than 50 mLs in a 24-hour period of time.
- painful burning upon urination.
- It often occurs as the result of a urinary tract infection and trauma.
- is the involuntary leakage of urine and a loss of bladder control.
- The types of urinary incontinence include:
- functional urinary incontinence
- reflex urinary incontinence
- stress urinary incontinence
- urge urinary incontinence
- total urinary incontinence.
- The causes of urinary incontinence are numerous and
they can include:
- neurological deficit
- lack of sphincter control musculature
- overactive bladder.
- the accumulation of urine in the bladder because, for one reason or another, the patient is not able to effectively empty their bladder.
- defined as strong, sudden and relentless need to immediately urinate without delay.
are for one-time use and are removed immediately after the insertion and drainage of urine.
are used short-term and provide a closed drainage system for urine.
are most commonly used postoperatively because they have multiple lumens to allow for the drainage of urine, irrigation of the bladder, and instillation of medications into the bladder.
are used for patients who have prostatic hyperplasia (enlargement); this type of catheter has a curved tip to allow for easier insertion.
are similar to indwelling catheters except that they are placed through a surgical opening in the abdomen rather than through the urethra.
have a latex or silicone sheath to place over the penis.