Download Urinary System Organs Renal Nephron

Urinary Elimination
Risk Factors for
Problems of Elimination
 Conditions that result in
 Neurologic impairment (Neurogenic bladder)
 Trauma to the brain or spinal cord
 CVA
 Diabetic neuropathy (R/T metabolic derangements)
 Altered mobility
 Severe arthritis
 Cognitive impairment
 dementia
 Immunologic impairment or infection
 AIDS
2
Urinary System
Urinary System Organs
Renal Nephron
Additional Kidney Functions
 Production of erythropoietin is essential to
maintaining a normal red blood cell (RBC) volume.
 Erythropoietin stimulates bone marrow to produce RBCs and
prolongs the life of mature RBCs.
 Production of renin.
 Renin starts a chain of events that cause water retention,
thereby increasing blood volume.
 Kidneys affect calcium and phosphate regulation
Renin-Angiotensin
Mechanism
Kidneys affect calcium and
phosphate regulation
Vitamin D
The Kidneys produces a substance
that converts vitamin D into its
active form.
Intestines absorb more Ca
from foods.
Disease Conditions Affecting Urination
 Prerenal, renal, postrenal classification
 Conditions of the lower urinary tract
 Diabetes mellitus and neuromuscular diseases such as
multiple sclerosis
 Benign prostatic hyperplasia
 Cognitive impairments (e.g., Alzheimer’s)
 Diseases that slow or hinder physical activity
 Conditions that make it difficult to reach and use toilet
facilities
 End-stage renal disease, uremic syndrome
Pre-renal, renal, post-renal
classification
Decrease blood flow
Condition of renal tissue
Obstruction in the UT
that prevents flow from
kidneys
Conditions of the Lower Urinary
Tract
Diabetes Mellitus and
Neuromuscular Diseases
Benign Prostatic Hyperplasia
(BPH)
Conditions Affecting Urination
Conditions that make
it difficult to reach and
use toilet facilities
Cognitive
impairments
Diseases that slow or
hinder physical activity
End Stage Renal Disease
(ESRD) (CKD)
Dialysis
 Renal Replacement
 Two methods
 Peritoneal
 Hemodialysis
14
Indications for Dialysis
Renal failure that can no longer be controlled by
conservative management (Conservative management
would include dietary modifications and the administration
of medications to correct electrolyte abnormalities.)
Worsening of uremic syndrome associated with ESRD,
which would include nausea, vomiting, neurological
changes, and pericarditis)
Severe electrolyte and/or fluid abnormalities that cannot be
controlled by simpler measures (These abnormalities would
include hyperkalemia and pulmonary edema.) by simpler
measures
Factors Influencing Urination
 Disease conditions
 Socioeconomic factors (need for privacy)
 Psychological factors (anxiety, stress, privacy)
 Fluid balance
 Nocturia, polyuria, oliguria, anuria
 Diuresis
 Fever
 Medications and medical procedures
How would you
help someone
needing to void,
but unable to
initiate the
process?
Factors Influencing Urination
 Disease conditions
 Socioeconomic factors
 Need for privacy
 Cultural differences
 Psychological factors
 Anxiety
 Emotional Stress
 Privacy
Factors Influencing Urination
 Fluid balance
 Nocturia, polyuria, oliguria, anuria
 Diuresis
How would you help
 Fever
someone needing to void,
but unable to initiate the
 Foods
process?
 Medications and medical procedures
Fluid Balance
 Symptoms common to urinary disturbances
include
 frequency
 urgency
 dysuria
 polyuria
 oliguria
 incontinence
 difficulty in starting the urinary stream.
Medications and Medical
Procedures
 Surgery (stress)
Alterations in Urinary Elimination
Urinary retention
Urinary tract infection
An accumulation of urine
due to the inability of the
bladder to empty
Results from catheterization
or procedure
Urinary incontinence
Urinary diversion
Involuntary leakage of urine
Diversion of urine to
external source
Urinary Tract Infection
 Signs and symptoms




Pain or burning during urination (dysuria)
Fever, chills, nausea, vomiting, and malaise
Frequent and urgent sensation of need to void
Blood-tinged urine (hematuria)
 Treatment
 Medication
22
Urinary incontinence
Nursing Diagnoses
 Impaired Social Interaction r/t Loss of
independence: clothing becomes wet
with urine and odor.
 Impaired body image r/t incontinent of
urine.
 Risk for impaired skin integrity.
 Impaired urinary elimination
 Self-care deficit: toileting
24
Physical Assessment
 Gather nursing history for the patient’s urination
pattern and symptoms, and factors affecting
urination.
 Conduct physical assessment of the patient’s body
systems potentially affected by urinary change.
 Assess characteristics of urine.
 Assess the patient’s perception of urinary problems
as it affects self-concept and sexuality.
 Gather relevant laboratory and diagnostic test data.
Physical Assessment
Skin and mucosal
membranes
Kidneys
Assess hydration.
Flank pain may occur with
infection or inflammation.
Bladder
Urethral meatus
Distended bladder rises
above symphysis pubis.
Observe for discharge,
inflammation, and lesions.
Urine Tests and Diagnostic
Examinations
Urinalysis
Specific gravity
Culture
Noninvasive procedures
Invasive procedures
Urine Drainage Bag
Catheterization
Catheter insertion
Closed drainage systems
Catheter care
Perineal hygiene
Fluid intake
Catheter irrigations and instillations
Removal of indwelling catheter
Alternative to urethral catheterization
Types of Urinary Catheters
Urinary Drainage System and
Infectious Organisms
Restorative Care
 Strengthening pelvic floor muscles
 Bladder retraining
 Habit training
 Self-catheterization
 Maintenance of skin integrity
 Promotion of comfort
Indications for Catheterization
 Acceptable reasons for insertion of a Foley
Catheter
 Obstruction to urine flow
 Surgical repair of bladder, urethra and surrounding structures
 Prevention of urethral obstruction from blood clots after






genitourinary surgery
Accurate I&O in critical patients
Continuous or intermittent bladder irrigations
Severe urinary retention
Urinary incontinence with stage 3 – 4 pressure ulcers
Comfort for terminal patient
Bladder decompression for surgery
33
Foley Catheter Kit
34