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ATI Fundamentals For Nursing Chapter 44 - Urinary Elimination

front 1

Kidneys

back 1

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

front 2

Urinary elimination

back 2

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

front 3

Urinary Diversion

back 3

  • 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

front 4

Type of Urinary Diversion

back 4

  • Incontinent
  • Continent

front 5

Incontinent Urinary Diversion

back 5

  • 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.

front 6

Continent Urinary Diversion

back 6

  • 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.

front 7

Ureterostomy

back 7

  • 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.

front 8

Nephrostomy

back 8

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

front 9

Factors affecting urinary elimination

back 9

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

front 10

DIAGNOSTIC TESTS Bedside sonography with a bladder scanner

back 10

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

front 11

DIAGNOSTIC TESTS Kindeys, ureters, ballader

back 11

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

front 12

DIAGNOSTIC TESTS Intravenous pyelogram

back 12

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.

front 13

DIAGNOSTIC TESTS Renal scan

back 13

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

front 14

DIAGNOSTIC TESTS Renal ultrasound

back 14

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

front 15

DIAGNOSTIC TESTS Cystoscopy

back 15

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

front 16

DIAGNOSTIC TESTS Urodynamic testing

back 16

Test for bladder muscle function by filling the bladder with CO2 or 0.9% sodium chloride and comparing pressure readings with reported sensations

front 17

Usual size and type of catheter

back 17

  • 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

front 18

LABORATORY TEST Urinalysis and urine culture and sensitivity

back 18

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

front 19

LABORATORY TEST Serum creatinine and BUN

back 19

To assess renal function (elevated with renal dysfunction)

front 20

DIAGNOSTIC PROCEDURES Ultrasound

back 20

Detects bladder abnormalities and/or residual urine

front 21

DIAGNOSTIC PROCEDURES Voiding cystourethrography

back 21

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

front 22

DIAGNOSTIC PROCEDURES Urodynamic testing

back 22

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

front 23

DIAGNOSTIC PROCEDURES Electromyography

back 23

Measures the strength of pelvic muscle contractions

front 24

Polyuria

back 24

  • 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.

front 25

Oliguria

back 25

  • 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.

front 26

Anuria

back 26

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

front 27

Dysuria

back 27

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

front 28

Urinary Incontinence

back 28

  • 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.

front 29

Urinary Retention

back 29

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

front 30

Urgency

back 30

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

front 31

Straight catheters

back 31

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

front 32

Indwelling catheters

back 32

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

front 33

Retention catheters

back 33

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.

front 34

Coude catheters

back 34

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

front 35

Suprapubic catheters

back 35

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

front 36

Condom catheters

back 36

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