N5400- URINARY ELIMINATION'24 (1).pptx

URINARY ELIMINATION Gunawan et al, Fundamentals Textbook Chapter 38 2018 NURSN 5400 Dr. Ashley Graham-Perel, EdD, RN, NPD-BC, MEDSURG-BC, CNE Dr. Kiera Hirayama, DNP, MSN, RN July 2, 2024 ...

URINARY ELIMINATION Gunawan et al, Fundamentals Textbook Chapter 38 2018 NURSN 5400 Dr. Ashley Graham-Perel, EdD, RN, NPD-BC, MEDSURG-BC, CNE Dr. Kiera Hirayama, DNP, MSN, RN July 2, 2024  Learning Objectives Identify variables that influence urination. Assess urinary elimination, using appropriate interview questions and physical assessment skills. Develop nursing diagnoses that correctly identify urinary problems amenable to nursing therapy. Demonstrate how to promote normal urination; facilitate use of the toilet, bedpan, urinal, and commode; perform catheterizations; and assist with urinary diversions. Describe nursing interventions that can be used to manage urinary incontinence effectively. Describe nursing interventions that can prevent the development of urinary tract infections. Plan, implement, and evaluate nursing care related to selected nursing diagnoses associated with urinary problems. Urinary Tracts  Factors Affecting Micturition Developmental considerations Food and fluid intake Psychological variables Activity and muscle tone Pathologic conditions Medications  Developmental Considerations Children Toilet training 2 to 3 years old, enuresis Effects of aging Nocturia Increased frequency Urine retention and stasis Voluntary control affected by physical problems  Urinary Vocab Which three terms from previous slide relate to UO? 1. 2. 3. Which three terms from previous slide relate to urine composition? (We will add two) 1. 2. 3. 4. 5.  UO 1. Know normal UO levels & when we start to worry 2. For I & Os, should I=O? 3. On the flip side: how much should we drink/day? ~3L of intake, but doesn’t have to be straight water; does this match with recommendation of 6-8 cups of water per day? Add a footer 8 10  Using the Nursing Process Assessing data about voiding patterns, habits, past history of problems Physical examination of the bladder, if indicated, and urethral meatus; assessment of skin integrity and hydration; and examination of the urine Correlation of these findings with results of procedures and diagnostic tests  Assessing a Problem With Voiding Explore its duration, severity, and precipitating factors Note the patient’s perception of the problem Check the adequacy of the patient’s self-care behaviors  Physical Assessment of Urinary Functioning Kidneys: Palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment Urinary bladder: Palpate and percuss the bladder or use a bedside scanner Urethral orifice: Inspect for signs of infection, discharge, or odor Skin: Assess for color, texture, turgor, and excretion of wastes Urine: Assess for color, odor, clarity, and sediment  From “Nursing Assessment Phrasing” Genitourinary Voiding: within normal pattern (quantity sufficient) / incontinent / stress incontinence difficulty / discomfort / frequency / hesitancy / urgency / burning / pain / dribbling Urine: Color: straw colored / yellow / amber (concentrated) / tea colored / blood (hematuria) Consistency: clear / cloudy / thick / sediment Odor: faint / strong / foul-smelling Bladder: not distended / distended Catheter: Type: indwelling / straight / 3-way / suprapubic secured? Patency: patent / occluded  Urinary Incontinence An underdiagnosed and underreported problem that can have significant impact on the quality of life and decrease independence Urinary incontinence is not a normal consequence of aging  Types of Urinary Incontinence Functional: caused by factors outside the urinary tract Overflow: overdistention and overflow of bladder Reflex: emptying of the bladder without sensation of need to void Stress: involuntary loss of urine related to an increase in intra-abdominal pressure Urge: overactive bladder, sudden desire to urinate  Types of Urinary Incontinence Total Mixed Transient  From “NANDA Nsg Dx” Domain 5 – ELIMINATION AND EXCHANGE CLASS: URINARY FUNCTION Impaired urinary elimination Functional urinary incontinence Overflow urinary incontinence Reflex urinary incontinence Stress urinary incontinence Urge urinary incontinence Risk for urge urinary incontinence Urinary retention * And once the catheter is in? Risk for _______________ Devices for Collecting and Measuring Urine A Suprapubic Catheter Positioned in the Bladder  Planned Patient Goals Produce sufficient quantity of urine to maintain fluid, electrolyte, and acid–base balance. Empty bladder completely at regular intervals without discomfort. Provide care for urinary diversion and know when to notify physician. Develop plan to modify factors contributing to current or future urinary problems. Correct unhealthy urinary habits.  Promoting Normal Urination Maintaining normal voiding habits Promoting fluid intake Strengthening muscle tone Assisting with toileting  Maintaining Normal Voiding Habits Schedule Urge to void Privacy Position Hygiene  Reasons for Catheterization Urinary retention Prolonged patient immobilization Obtaining urine specimen when patient is unable to void voluntarily Accurate measurement of urinary output in critically ill patients Assisting in healing open sacral or perineal wounds in incontinent patients Surgery Providing improved comfort for end-of-life care  Who is at risk for UTIs? Female Sexually Active ( + Diaphragm) Menopause Catheters Comorbidities that affect immune system Anything leading to urinary stasis in bladder  Patient Education for Urinary Diversion Explain reason for diversion and rationale for treatment Demonstrate effective self-care behaviors Describe follow-up care and support resources Report where supplies may be obtained in the community Verbalize related fears and concerns Demonstrate a positive body image  Urine Color What could color changes indicate? - Pink - Tea colored - Orange - Black - Blue 28