stressors affecting elimination urinary nur101 fall 2009 lecture # 22 k. burger, msed, msn, rn, cne...
TRANSCRIPT
Stressors Affecting EliminationUrinary
NUR101 Fall 2009Lecture # 22K. Burger, MSED, MSN, RN, CNE
PPP BySharon Niggemeier RN, MSN
AnatomyAnatomy & PhysiologyPhysiology
KidneysUretersBladderUrethra
Nephron FunctionFunctional unit of kidney1 million per kidney1200 ml blood pass through the
kidney/minWastes cannot be excreted as solids;
must be excreted in solutionNormal urine production = 1 ml / minute Kidneys must produce 30 ml/hr minimum
Nephron FunctionBlood filtered through glomerulusthis filtrate moves into Bowman’s capsulesproceeds into proximal tubule where water
/electrolytes/glucose & protein are reabsorbedLoop of Henley – water and solutes such as Na
& Cl, are reabsorbed (urine becomes more concentrated)
distal convoluted tubules allows for water and NA reabsorbtion. Controlled reabsorption (by ADH antidiuretic hormone) regulates F/E balance…..collecting duct
Act of Micturition
Urine moves from the kidneys through ureters via peristaltic waves into bladder.
Bladder fills & detrusor muscles sense pressureStructures and functions for voluntary control of
voiding:
-External sphincter- restrain or interrupt act
-Conscious brain- starts act
-Intact spinal cord- needed or else message from the brain is not received.
Alterations in Urinary Function
Incontinence- brain is not receiving impulse or loss of external sphincter control
Retention- distended bladder due to nerve impulses not perceived or muscles unable to function
Characteristics of UrineAmount
1200 ml/day average
Color
OdorSee Next Slide
pH 4.6 – 8.0
Turbidity
Specific gravity1.010 – 1.025
Constituents
Factors That Affect Voiding
Food/fluid intake + loss
Developmental factorsSee Next Slide
StressActivity/Muscle
tone
Life styleMedications
???
Geriatric Considerations
Decreased ability of kidneys to concentrate urine and decreased bladder capacity = nocturia
Decreased muscle tone of bladder = increased frequency
Decreased bladder contractility & stasis= increased frequency of UTI
Changes in cognition and mobility (in some)= increased incontinence issues
Assessing Urinary Status
Usual patternsRecent changesDifficultiesArtificial Orifices
Physical AssessmentKidneys:R kidney located
12 ribL kidney lowerTenderness during
palpation at costoverterbral angle?
Bladder:Below symphysis
pubisSupine position to
examineObserve-roundnessPalpate-tenderness,
how high it distendsPercussion- full
bladder dull sound
Assessment: Lab Results
Urinalysis- WBC, RBC, protein, glucose, bacteria
= abnormal constituents BUN (blood urea nitrogen) end product of protein
metabolism… 10-20 mg/dLIncreased BUN (azotemia) signifies impaired kidney function… affected by diet (hi protein intake) and fluids (dehydration)
Decreased BUN signifies impaired liver function
Many drugs elevate BUN (antibiotics, lasix +++)
Assessment: Lab ResultsSerum creatinine - by product of muscle
metabolism…excreted entirely by kidneys… Normal = 0.5-1.2 mg/dLIncreased levels signify renal impairment
BUN: Creatinine ratio- 20:1… when both rise together indicates kidney failure or disease
Altered Urinary Functioning Terms to Know
AnuriaDysuriaEnuresisFrequencyGlycosuriaHematuriaHesitancyFrequency
IncontinenceNocturiaOliguriaPolyuriaPyuriaRetentionUrgencyProteinuria
Assessing Urinary RetentionFeeling of fullnessVoiding small amounts
< 50 ml
Normal intake/inadequate output
Distended bladderDiscomfortBladder Scan
If > 300 ml should catheterize
Nursing Dx R/T Urinary Elimination
Impaired urinary elimination
Urinary retention
Functional urinary incontinence
Overflow urinary incontinence
Stress urinary incontinence
Reflex urinary incontinence
Urge urinary incontinence
Total urinary incontinence
Risk for infection r/t urinary retention and/or urinary catheterization
Risk for impaired skin integrity r/t urinary incontinence
Situational low self esteem r/t incontinence
Outcome CriteriaPatient will:Empty bladder completely at regular
intervalsDecrease episodes of incontinenceMaintain regular urinary elimination
patternDevelop adequate Intake/OutputHave decreased dysuria
Nursing Interventions
Maintain voiding habitsPromote fluid intake Strengthen muscle tone
Kegels 30-80/day Stimulate urination
AuditoryTactile
Interventions: Toileting
ToiletCommodeBedpanUrinalDisposable“ Hat” Fx pan
Safety Concerns
Female Hygiene
Interventions for Urinary Incontinence
Bladder training/ Habit training
External urinary device- Condom Catheter
Indwelling catheter-LAST resort
Condom Catheter (Texas Cath)Rubber condom placed on penis of
incontinent malesConnects to drainage bag to collect
urineEasy to apply and observeComfortableDoesn’t require intubationPrevents skin irritation from
incontinence
Condom CatheterCheck every 2-4 hrs.Remove and replace every 24 hrs.Maintain free urinary drainageNever tape to skinLeave 1-2 inch space at tip of penisSecure snuggly but not too tightFollow manufacturer instructions
Urinary Catheterization
Used to:Keep bladder deflated during surgeryMeasure residual urine
PVR (post void residual) should be < 50 mlRelieve retentionObtain sterile urine specimen
May use either:Straight catheter or indwelling catheter
Indwelling catheter Refer to Lab Worksheet
Catheter inserted into urinary meatus through urethra into bladder to drain urine
Last resort as it introduces microbes into bladder…leading to UTI (urinary tract infection)
Performed using sterile technique...MD order needed Remains in place via inflated balloon
ALSOSuprapubic Catheter – diverts urethraUrologic Stents- temporary in ureters permanent in urethraIleal Conduit – diversion of ureters to ileum and stoma; requires appliance
Medications Affecting Urinary Elimination
Antibiotics …work against infectionBactrim, Levaquin, Cipro
Urinary antispasmotics …relieve spasms with UTIDitropan, Pro-Banthine
Diuretics….increase urinary outputLasix, Diuril
Cholinergics…increase muscle tone & functionUsed for urinary retention, neurogenic bladderUrecholine
Urinary Specimen CollectionRefer to Lab Worksheet
Routine urinalysisClean-catch/midstream urineSterile specimen ( catheterization
or from indwelling catheter)24 hr. urine
Evaluating Urinary Elimination
FrequencyAmountEase/Difficulty
Color AppearanceOdor