ATI Fundamentals For Nursing Chapter 44 - Urinary Elimination

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1

Kidneys

  • helps in regulating your water volume, concentrations, and pH levels
  • helps in influencing your red blood cell production and blood pressure
2

Urinary elimination

  • is a precise system of filtration, reabsorption, and excretion.
  • These process help maintain fluid and electrolyte balance while filtering and excreting water-soluble waste
3

Urinary Diversion

  • 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
    • Strictures
    • Trauma to the bladder
    • Chronic infections with deterioration of renal function
4

Type of Urinary Diversion

  • Incontinent
  • Continent
5

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.
6

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.
7

Ureterostomy

  • 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.
8

Nephrostomy

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

9

Factors affecting urinary elimination

  • poor abdominal and pelvic muscle tone
  • acute and chronic disorders
  • spinal cord injury
  • age
  • pregnancy
  • diet
  • immobility
  • psychosocial factors
  • pain
  • surgical procedures
  • medications
10

DIAGNOSTIC TESTS Bedside sonography with a bladder scanner

noninvasive portable ultrasound scanner for measuring bladder volume and residual volume after urination.

11

DIAGNOSTIC TESTS Kindeys, ureters, ballader

x-ray to determine size, shape, and position of these structures

12

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.
13

DIAGNOSTIC TESTS Renal scan

View of renal blood flow and anatomy of the kidneys without contrast

14

DIAGNOSTIC TESTS Renal ultrasound

View of gross renal structuresand structural abnormalities using high‑frequency
sound waves

15

DIAGNOSTIC TESTS Cystoscopy

Use of a lighted instrument to visualize, treat, and obtain specimens from the bladder and urethra

16

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

17

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
18

LABORATORY TEST Urinalysis and urine culture and sensitivity

To identify UTI (presence of RBCs, WBCs, micro‑organisms)

19

LABORATORY TEST Serum creatinine and BUN

To assess renal function (elevated with renal dysfunction)

20

DIAGNOSTIC PROCEDURES Ultrasound

Detects bladder abnormalities and/or residual urine

21

DIAGNOSTIC PROCEDURES Voiding cystourethrography

Identifies the size, shape, support, and function of the urinary bladder, obstruction (prostate), residual urine

22

DIAGNOSTIC PROCEDURES Urodynamic testing

  • Cystourethroscopy: Visualizes the inside of the bladder
  • Uroflowmetry: Measures the rate and degree of bladder emptying
23

DIAGNOSTIC PROCEDURES Electromyography

Measures the strength of pelvic muscle contractions

24

Polyuria

  • 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.
25

Oliguria

  • 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.
26

Anuria

  • lack of the production of urine or a severely scant amount of urine less than 50 mLs in a 24-hour period of time.
27

Dysuria

  • painful burning upon urination.
  • It often occurs as the result of a urinary tract infection and trauma.
28

Urinary Incontinence

  • 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.
29

Urinary Retention

  • the accumulation of urine in the bladder because, for one reason or another, the patient is not able to effectively empty their bladder.
30

Urgency

  • defined as strong, sudden and relentless need to immediately urinate without delay.
31

Straight catheters

are for one-time use and are removed immediately after the insertion and drainage of urine.

32

Indwelling catheters

are used short-term and provide a closed drainage system for urine.

33

Retention catheters

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.

34

Coude catheters

are used for patients who have prostatic hyperplasia (enlargement); this type of catheter has a curved tip to allow for easier insertion.

35

Suprapubic catheters

are similar to indwelling catheters except that they are placed through a surgical opening in the abdomen rather than through the urethra.

36

Condom catheters

have a latex or silicone sheath to place over the penis.