Professional Documents
Culture Documents
Pretest:
The urinary system consists of organs that produce and excrete urine from the body. Urine contains waste: mostly excess water, salts and nitrogen compounds. Primary organs are the kidneys Normal adult bladder can store up to .5 liters. Also responsible for regulating blood volume and blood pressure. Regulates electrolytes.
Kidneys
The kidneys are bean-shaped organs located at the back of the abdominal cavity. They lie on either side of the spinal column. This area is known as the flank area and is against the muscles of the back. The external kidney has a notch at the concave border known as the hilum. The hilum is the entrance for renal artery, veins, nerves and lymphatic vessels.
Nephrons
1 million nephrons The functional unit of the kidney Remove waste products of metabolism from the blood plasma. Waste products are urea, uric acid, creatinine, sodium, potassium chloride and ketone bodies.
Urine formation:
Urine
The formation of urine has 3 processes, filtration, reabsorption and tubular secretion. Urine consists of 95% water and 5% solid substances. The need to urinate is usually felt at 300-350ml of urine in the bladder. Typically 1000-1500 mL is voided daily.
Odor
Fresh urine is slightly aromatic Standing urine develops an ammonia odor Some drugs and vegetables (asparagus) alter the usual odor
pH
Slightly acidic (pH 6) with a range of 4.5 to 8.0 Diet can alter pH
Specific gravity
Ranges from 1.010 to 1.025 Dependent on solute concentration
Lifespan considerations
Child At 10 weeks gestation the kidney begin to form Newborns kidneys are not able to concentrate urine Kidneys are more susceptible to trauma Diapers- more susceptible to UTI
Older Adult
Kidney lose mass and the blood vessels degenerate Kidneys lose their ability to filter Dehydration can happen more quickly Electrolyte balance happens more quickly Loss of muscles tome in urinary structures Decreased bladder capacity
Urination
Micturation, voiding, and urination all refer to the process of emptying the urinary bladder Stretch receptors- special sensory nerve endings in the bladder wall that is stimulated when pressure is felt from the collection of urine
Adult: 250-450mL of urine Children: 50-200mL of urine
Oliguria
Anuria
Voiding less than 100mL/day
May result from low fluid intake, kidney disease, severe heart failure, burns and shock
Usually accompanied by fever and heavy respiration
Urgency- feeling that the person must void. Usually accompanies psychologic stress, and irritation of the urethra Common in young children who have poor external sphincter control Dysuria- voiding that is either painful or difficult May result from stricture of the urethra, urinary infections, injury to the bladder and/ or the urethra. Described as a burning sensation during voiding Burning during micturation if often due to an irritated urethra. Burning following urination may be a result of bladder infection Often associated with urinary hesitancy (delay and difficulty in initiating voiding)
Enuresis- repeated involuntary urination in children beyond the age when voluntary bladder control in normally acquired (4-5yrs)
Assessment
Nursing history a. Data about voiding patterns and habits, any problems voiding, and past or present problems involving the urinary system b. Data about any problems that may affect urination
Diagnostic tests
Urinalysis Blood tests: (BUN and Creatinine clearance) Cystoscopy Intravenous pyelogram (IVP)/ excretory pyelogram Retrograde pyelogram CAT scan UTZ
Diagnosing:
Altered urinary elimination Urinary retention High risk for infection Self-esteem disturbance High risk for impaired skin integrity Social isolation Self care deficit: toileting
Implementing
Maintaining Normal Urinary Elimination Promoting normal fluid intake Maintaining normal voiding habits
Relaxation Provide privacy Allow client sufficient time to void Suggest the client to read or listen to music Provide sensory stimuli Pour warm water over perineum or have the client sit in a warm bath to promote muscle relaxation Apply hot-water bottle to the lower abdomen Turn on running water within hearing distance Relieve physical or emotional discomfort Timing Assist clients to have the urge to void immediately Offer toileting assistance at usual times of voiding Positioning Assist client in a normal position for voiding Use bedside commodes as necessary for females and urinals for males standing at bedside Encourage client to push over the pubic area with hands or to lean forward
Continence (bladder) training Bladder training- requires that the client postpone voiding, resist or inhibit the sensation urgency, and void according to a timetable rather than according to the urge to void. The goal is to lengthen the intervals between urination to correct the clients habit of frequent urination Habit training- also referred to as timed voiding or scheduled toileting. There is no attempt to motivate the client to delay voiding is the urge occurs. Prompt voiding- supplements the habit training by encouraging the client to use the toilet and reminding the client when to void
Urinary catheterization