Urinary Elimination (NURS 3125) Student Notes PDF

1 Urinary Elimination NURS 3125  2 Questions ► We covered a lot last week ► Syllabus ► Clinical ► EAQ’s ► What questions do you have?? ► I didn’t talk about your paper so a few minutes on that….. ...

1 Urinary Elimination NURS 3125  2 Questions ► We covered a lot last week ► Syllabus ► Clinical ► EAQ’s ► What questions do you have?? ► I didn’t talk about your paper so a few minutes on that…..  3 Class Objectives ► Reading: Fundamentals of Be familiar with common Nursing, P&P, Chapters 46 diagnostic tests of the urinary & 47 system. (CO 1,2) Explain the function and role Know the role of the of urinary system structures gastrointestinal organs and in urine formation and their physiological function in elimination. (CO 1) digestion and elimination. (CO 1) Understand factors that commonly impact urinary Understand how elimination. (CO 1,7) psychological and physiological factors may Know common alterations alter the elimination process. associated with urinary (CO 4,5) elimination. (CO 8) Discuss Nursing interventions Interpret features of normal to promote normal and abnormal urine. (CO 2) elimination and reduce the  4 Assigned Reading You do not need to know catheter insertion techniques and/or straight cath techniques for this lecture Pages 1255-1273 That is lab content Urinary tract 5 organs ►Urinary tract organs: ► Kidneys ► Ureters ► Bladder ► Urethra ► Upper urinary tract ► kidneys & ureters ► Lower urinary tract ► bladder, urethra Is the urinary tract  6 Kidneys Nephrons-are the functional unit contain cluster of capillaries called the glomerulus glomerulus act as the filter large proteins do not normally filter so when present suspect injury or infection 99% of glomerular filtrate is reabsorbed 1% excreted as waste  7 Kidneys Essential role in Decreased blood supply - production of renin is released, enzyme Erythropoietin that converts angiotensinogen into stimulates red blood Angiotensin I cell production and Angiotensin I is converted maturation in the to Angiotensin II in the bone marrow lungs Blood Pressure Control Stimulates aldosterone Renin-angiotensin release by the adrenal System cortex which results in retention of water, thus increasing blood  8 Ureters Function is to carry urine to the bladder This urine is sterile Obstruction by a stone can cause backflow of urine in the ureters and the kidney causing distention-hydronephrosis  9 Bladder Distensible muscular organ that acts as a reservoir Expands as it fills Pressure is low during filling to prevent back flow which can cause infection  10 Urethra Urine travels from the bladder through the urethra Female urethra is 3-4 cm (1-1.5 inches) shorter length increases risk for UTI Male urethra is 18-20 cm (7-8 inches)  11 Nurse’s Role in Urinary Elimination Management ► Urinary elimination is a basic human function ► Can be compromised by illness and certain procedures. ► Urination involves interaction between the bladder, urinary sphincter, and CNS. ► Most people experience a strong urge to urinate when the bladder accumulates approx. 400-600 milliliters of urine. ► Nurses’ role is to assess patients' urinary tract functions and provide support for bladder emptying. ► What is considered the minimum hourly urinary output for an adult? __________  12 Common Urinary Elimination Problems ► Urinary retention ► An accumulation of urine due to the inability of the bladder to empty ► Use a bladder scanner to check for post void residual ► Urinary tract infection (UTI) – what is it? ► characterized by location ► upper-kidney ► lower-bladder or urethra  13 UTI’s ► What causes UTI? ► CAUTI ► E. coli  14 UTI’s ► Who is at risk? ____________ ► Atypical presentation: Elderly persons with an infection (UTI) can have nonspecific symptoms such as delirium, confusion, fatigue, loss of appetite, decline in function, incontinence, falls, temperature  15 Urinary Incontinence Involuntary loss of urine. Common problem in both men and women of older adults and elderly. ► Transient incontinence ► Functional incontinence ► Overflow incontinence (due to retention) ► Stress incontinence ► Urge/Urgency incontinence ► Reflex incontinence See Table 46.1 for definitions, characteristics and nursing interventions  16 Urinary Catheterization ► Urinary catheterization- when should a catheter be used? ► Minimize risk of infection ► CDC infection control guidelines ► More about Healthcare associated Infections: CDC HAIs  17 Urinary Catheterization Catheter Types ► Indwelling catheter ► Foley- a balloon filled ► Suprapubic with water keeps one catheter- a catheter end inside the bladder is inserted through an ► External female incision in the lower catheter- PureWick abdomen, just above system symphysis pubis into the bladder Less risk ► https://youtu.be/1rn QaHvIMBc of infection; long term ► Condom catheter ► Intermittent male external- an catheters- aka straight option for some men. cath-may use several Requires a lot of times a day at scheduled maintenance (they slip times or when the off and leak) bladder feels full Urinary Catheters 18 ► Catheter changes ► Every 4-6 weeks for long- term catheter use ► Closed drainage system ► Catheter irrigations and installations ► Acetic acid: ► Used to cleanse and irrigate the inside of the bladder ► Continuous bladder irrigation: ► Flushes the bladder with normal saline for removal of clots from bleeding during or after surgery  19 Things to watch for when using catheters (recognizing cues): Potential ► Infection- this is the most Complication common problem. s of Urinary ► The catheter lets in Catheterizati bacteria that can cause infection in the bladder, on urethra, urinary tract, or kidneys ► Biofilm ► Cues: list some  20 ► Leaks Potential ► Bladder Spasms Complications ► Pain of Urinary ► Bladder stones/Renal calculus Catheterizatio ► Injury to urethra n ► Kidney damage (with long term use)  21 Nursing measures to prevent CAUTI ► The Joint Commission- National Patient Safety Goals (NPSG) – prevent infection ► Prevention of inappropriate short-term catheter use ► Nurse-driven timely removal of urinary catheters ► Appropriate sterile technique during placement ► Meticulous catheter care while patient has indwelling cath  22 Urinary Diversions Why might a patient need a urinary diversion?  23 Urinary Diversion ► Diversions can be: ► Temporary or permanent ► Continent or incontinent ► Continent ► Continent urinary reservoir ► A catheter is inserted into the stoma to empty urine from the pouch. ► Patients must be able and willing to catheterize 4-6 times a day ► Orthotopic neobladder ► Ileal pouch is used to replace the bladder. ► In the same anatomical position as the bladder. ► Allows patient to void through the urethra using a valsalva technique  24 ► 2) Incontinent urinary diversion: ► Ureterostomy (aka ileal conduit) ► A permanent urinary diversion ► Ureters come out the abdominal wall ► No sensation or control over the continuous flow of urine through the ileal conduit ► Nephrostomy tubes (posterior) ► Small tubes tunneled through the skin ► Tubes are placed to drain the renal pelvis when the ureter is obstructed. ► Patient education needed for home care.  25 Knowledge Base ► Infection control and hygiene ► Use infection control principles to help prevent the development and spread of UTIs ► Growth and development ► Age ► Nocturnal enuresis (nighttime incontinence) ► Pregnancy ► Normal aging ► Psychosocial implications ► culturally a private event ► self image and self esteem related to incontinence- can be embarrassing to ask for help as an adult ► body image/sexuality-urinary diversions 26  27 Assessment ► Intake and output measurement ► Intake measurements-what should be included??? ► Output measurements-what should be included??? ► Kidneys- where exactly are the kidneys? ► percuss for flank pain/costovertebral angle ► Bladder ► palpate for distention and assess for tenderness and pain. ► use a Bladder scanner if retention is suspected.  28 Assessment ► External genitalia and urethral meatus ► retract labial folds and inspect for drainage, inflammation, swelling, rash, lesions etc.. ► Perineal skin ► look at the skin for areas exposed to moisture. Observe for erythema and skin erosion, itching, or burning pain.  29 Common ► Urinalysis diagnostic ► Normal values tests of ► pH 4.6-8 ► Specific gravity 1.005-1.030 urinary ► Glucose-not normally present system ► Ketones-none ► Blood-up to 2 RBCs ► WBC- 0-4 ► Bacteria-none ► Crystals- not normally present NCLEX pearl: if a specific lab value is listed, then reference ranges are provided  30 Diagnostic Tests ► Imaging: ► Pyelogram-x-ray of urinary tract ► Cystography-contrast dye injected into the bladder and then an x-ray is done ► CT scan or Ultrasound of the kidney ► Prostate/rectal sonogram-uses sound waves to image the prostate or rectum ► Renal angiogram-imaging to look at the blood vessels in the kidneys  31 Recognize features of normal and abnormal urine Characteristics of urine: ► Color ► “ normal” is pale straw color to amber ► red, pink tinged, amber, tea colored-usually abnormal ► Can be caused by certain medications ► Clarity-normally transparent ► Cloudy or milky urine can be sign of infection(1st morning void may be cloudy) ► Clots-abnormal ► Debris-can be normal or abnormal ► Odor- normal to have characteristic smell of ammonia ► This can become stronger as urine stands i.e.. In a bedside commode or brief ► Foul odor is abnormal  32 Nursing Responsibilities ► Providing education- about what? ____________ ► Laboratory ► Label all specimens ► Preserve according to laboratory protocol ► Infection control policies ► Diagnostic examinations ► Obtain signed consent (refer to agency policy) ► Assess for allergies to iodine or contrast dye. ► Adherence to appropriate diet (clear liquids) ► Assess I&O after procedure ► Assess voiding and urine ► Encourage fluid intake especially if using radiopaque dye. May need to flush kidneys with IV fluids.  33 Evaluation ► Through the patient’s eyes ► Assess the patient’s self-image, social interactions, sexuality, and emotional status ► Patient outcomes- what do we expect to be the result of our interventions? ► Use the expected outcomes developed during planning to determine whether interventions were effective ► Evaluate for changes in the patient’s voiding pattern and/or presence of symptoms ► Evaluate patient/caregiver compliance with the plan  34 Safety Guidelines for Nursing Skills pg. 1255 ► Follow principles of surgical and medical asepsis as indicated. ► Identify patients at risk for latex allergies. ► Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.  35 The End