GenitoUrinary ppt st.pptx

Urinary Elimination By Kim Stiles, PhD, RN, CNE, AHN-BC 1 Urinary System Kidneys Ureters Bladder Urethra https:// www.youtube.com/ watch?v=CkGqp5tr-Qk 2 Renal Functions 3 20-25% of cardiac output perfuses the kidneys Renal Parenchyma 4 Nephron Functioning unit of the kidney 5 http://vzajic.tripod.co...

Urinary Elimination By Kim Stiles, PhD, RN, CNE, AHN-BC 1 Urinary System Kidneys Ureters Bladder Urethra https:// www.youtube.com/ watch?v=CkGqp5tr-Qk 2 Renal Functions 3 20-25% of cardiac output perfuses the kidneys Renal Parenchyma 4 Nephron Functioning unit of the kidney 5 http://vzajic.tripod.com/nephron.jpg Bowman’s Capsule & Glomerulus 6 GU System Male 7 Retrieved from https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh3220 GU System: Female 8 Urination “Bladder function (urination) controlled by Cerebral cortex, thalamus, hypothalamus, & brain stem (Potter & Perry)” Normal bladder capacity varies 9 Micturition Urge to urinate can occur with as little as 150 mls. Bladder stretches – sends message to spinal cord Detursor muscles stimulated to contract Individual feels the urge to void Individual either elects to void or not by voluntarily controlling the external sphincter https://www.youtube.com/watch?v=DlqyyyvTI3k 10 Micturition Output 0.5 to 1 mL per Kg per hour Minimal output indicating renal function 30 mls per hour or 100 mls in 4 hours Healthy individuals can suppress urge Difficulties may be a result of pathology Obstructions / infections/ etc. I & O Review: Normal Intake – approximately 2000- 2500 mls in 24 hours Includes water found in foods and oxidation 30 mL per Kg per day Output urine 1500 mls + Insensible water loss – 600 – 800 mls in 24 hours GI – via feces 11 Factors Affecting Urinary Elimination Growth & development Psychological factors Fluid and food intake Medications Muscular & Neurological conditions Underlying health problems 12 Relevant Terminology Oliguria Anuria Nocturia Dysuria Urinary hesitancy Enuresis Overflow inconstancy Urinary Reflux Reflux incontinence Urinary Diversion Polyuria Polydipsia Polyphagia 13 Urinary System assessment Nursing History Pattern of urination Symptoms Medications Physical assessment Skin, mucous membranes (hydration status) Kidneys (costal vertebral angle) (lab tests) Bladder Urethral Meatus 14 Geri Considerations Decreased renal blood flow and GFR Lower urine concentrating ability Decreased bladder capacity Females- loss of elastic and muscle support (bladder, urethra, vagina, pelvic floor) More prone to bladder infections and incontinence Males- prostate enlarges May cause hesitancy, retention, slow stream, bladder infections Differences in assessment findings See table 44.2 on page 1012 in Lewis 15 Palpation & Percussion Palpation of bladder height / fullness Percussion Dullness To umbilicus (500 mLs) Well above umbilicus (1000 mLs) 16 Note: Testicular exams & STI’s– covered next semester Bladder scan http://www.us-tip.com/devgifs/bvi6500.gif http://www.uchealth.com.au/ healthwise/images/stories/ bladderscan.jpg 17 Urine Inspection 18 Lab Analysis Urine Occult blood Color Clarity C&S UA Blood BUN Creatinine 19 URINALYSIS PH 4.6-8.0 Protein None or up to 8mg/100ml Glucose None Ketones None WBCs & RBCs Specific Gravity Negative 1.005-1.030 Specimen Collection Clean catch urine Cath. for residual Cath. for culture & sensitivity Obtain specimen from indwelling catheter Get specimens to lab ASAP or refrigerate 21 Creatinine Clearance 22 Diagnostic Exams IVP CT scan Cystoscopy Ultrasound KUB Arteriogram See table 46.5 Potter & Perry for nursing considerations KUB Kidneys, Ureter & Bladder x-ray (note kidney stone) Google images 24 Cystoscopy Invasive, requires consent Follow agency bowel cleansing protocol. Pts may need to drink a lot of fluids preprocedure. Pink tinged urine afterwards is normal, teach S/S UTI. If surgical procedure done, may have continuous bladder irrigation afterwards to prevent blood clots from obstructing urethra. See table 44.11, page 1019 in Lewis or table 46.5, page 1163 in Perry & Potter 25 Bowel preps: use caution with Magnesium citrate and Fleet enema—do not use with kidney failure Iodine-based contrast can cause contrast-induced kidney injury (CIN) and allergic reactions: What lab value will you check? NPO—avoid dehydration; insulin adjustment for diabetics Assess for allergies to contrast dyes. What question will you ask patient before giving contrast? Post studies: push fluids to flush dyes. See table 44.11, page 1019 in Lewis or table 46.5, page 1163 in Perry & Potter Copyright © 2020 by Elsevier, Inc. All rights reserved. Radiologic Studies of Urinary System: CT and IVP 26 Common GU Conditions Incontinence Urinary retention Urinary retention with overflow Stress incontinence Benign prostatic hypertrophy 27 Incontinence Transient Functional Associated with retention (overflow urinary incontinence) Stress Urgency Reflex See Table 46.1, pp 1153-1154 Potter & Perry 28 Stress Incontinence Involuntary loss of urine during physical exertion or upon coughing, sneezing, or laughing. (Lewis et al) Due to Pelvic floor weakness (following vaginal birth, weight gain, etc.) Detrusor over activity (malfunction – resulting in involuntary contraction) Estrogen depletion Not automatically due to aging 29 Dribbling fixes: Nonsurgical Penile Clamp Pessaries 30 OR: Pelvic floor exercises! Urinary Retention An accumulation of urine due to the inability of the bladder to empty Question: A health care provider may suspect that a patient is experiencing urinary retention when the patient has: A. large amounts of voided cloudy urine. B. pain in the suprapubic region. C. spasms and difficulty during urination. D. small amounts of urine voided two to three times per hour. 31 Benign Prostatic Hypertrophy 32 Symptoms of BPH Early Decreased stream Increased frequency of urination – remember as we get older our bladders become less able to hold urine Late Inability to empty bladder Straining to urinate More coming on this in future classes! 33 Urinary Reflux Can lead to renal damage Often associated with Paraplegia and quadriplegia Patients may not be able to control urine d/t loss of voluntary control and this can lead to Reflex incontinence 34 UTI Can be a result of the microbes filtered from the blood Streptococci E. Coli AGN Can be d/t the entry of bacteria via urethra Pyeleonephritis 35 UTI Common Symptoms Pain on urination Feeling like one was unable to empty the bladder Urgency Geri: confusion! 36 Nursing Assessments I&O Percuss and palpate bladder Document characteristics of urine (smell, color, quantity) Urinary catheters assessment and documentation Monitor serum creatinine levels Check for UA and/or urine culture results Patient teaching done to promote continence or to get lab specimens. If incontinent, assess and document perineal skin condition 37 Nursing Diagnoses Urinary incontinence (functional, reflex, stress, urge) Infection Self care deficit, toileting Impaired skin integrity Urinary retention (See page 1055 Potter & Perry 10th ed.) ( p. 1161) 38 Nursing Actions Bladder training Pelvic Floor Muscle exercises (teaching) Health Promotion/ Teaching clients Nonsurgical options Importance of fluid intake Proper cleaning technique UTI – prevention Bowel elimination measures Medication use Catheterization if necessary (including teaching) Pre and post diagnostic exam care 39 Catherization (Lab) Insertion of sterile tube via sterile technique into the bladder Be sure and document cath size, amount obtained, appearance Indwelling (foley) Straight cath. (one time use) Cath care at least once a shift 40 Nursing Measures (Lab) Cath. Care continued Promote fluid intake (2000 to 2500 mL per day) Foley bag – must remain below the bladder / free of kinks Preventing infection Bag is not to touch floor Keep system sterile Emptied QS Potter & Perry Box 45-10 Use stat lock to decrease urethral trauma 41 Nursing Measures (Lab) Condom catheters Change daily – q shift optimal Caution with kinks Do not use masking tape Caution with application – if not applied correctly might cut off circulation 42 Quick Quiz What is a CAUTI? What measures are used for prevention? Table 46.10, page 1171 in Perry & Potter Toolkit AHRQ https://www.ahrq.gov/hai/cauti-tools/guides/ implguide-pt3.html 43 Application of Nursing diagnosis for alternate GU elimination routes 44 Urinary Diversion http://www.ajronline.org/content/184/1/131.figures-only? related-urls=yes&legid=ajronline;184/1/131 Temporarily or permanent surgical bypass of the bladder and the urethra Or The bladder is removed and the outlets of the ureters are placed inserted into openings made in the abdominal wall 45 NANDAs for clients with Urinary Diversions and related issues Risk for impaired skin integrity Disturbed body image Acute pain Risk for infection 46 Suprapubic catheters Surgical placement of a catheter into the urinary bladder through the abdominal wall Temporary or permanent 47 Nursing Care See NANDAs (to urinary diversion) Care would include Adequate fluid intake Ensure patency Protect from infection Monitor for infection 48 References Adams, M.P., & Urban, C.Q., (2013) Pharmacology: connections to nursing practice (2nd ed.) Boston: Pearson Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2010). Nurse’s Pocket Guide (8th ed.) Philadelphia: Davis. Lewis, S.L. , Dirksen, S.R., Heitkemper, M. M., Bucher, L., & Camera, I. M. Medical surgical nursing. St. Louis, MO Mosby. Perry, A. G., Potter, P.A., & Elkin, M.K. (2012) Nursing interventions & clinical skills (5th ed.) St. Louis, MO: Mosby Potter, P.A. & Perry, A.G. Fundamentals of nursing., St. Louis, MO: Mosby Google Images 49