Urinary Elimination SV Slides PDF
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Uploaded by UltraCrispWalnutTree
Shae Flores MSN, RN
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Summary
This document provides a detailed overview of the urinary elimination process. It covers topics such as the anatomy and physiology of the urinary system, common problems, assessment techniques, and nursing interventions for patients with urinary issues. The presentation style includes illustrations to visually aid understanding of the different components.
Full Transcript
Chapter 46: Urinary Elimination SHAE FLORES MSN, RN Scientific Knowledge Base v Kidneys v Ureters v Bladder v Urethra Kidneys v Anatomy Nephrons Glomerulus v Erythropoietin v Renin-angiotensin system Major role in blood pressure Ureters v Attached to each kidney pelvis v...
Chapter 46: Urinary Elimination SHAE FLORES MSN, RN Scientific Knowledge Base v Kidneys v Ureters v Bladder v Urethra Kidneys v Anatomy Nephrons Glomerulus v Erythropoietin v Renin-angiotensin system Major role in blood pressure Ureters v Attached to each kidney pelvis v Carries urinary waste to bladder Bladder v Hollow, distensible, muscular organ that holds urine v Expands Urethra v Hollow tube Transports urine from bladder to the outside of the body Risks for infection men vs women Act of Urination v Micturition: Bladder holds urine until volume triggers a sensation of urge Brain gives the bladder permission to empty Bladder contracts Urinary sphincter relaxes Urine leaves through the urethra Factors Influencing Urination v Growth and development v Pathological conditions v Sociocultural factors v Surgical procedures v Psychological factors v Medications v Personal habits v Diagnostic Examinations v Fluid intake Box 46.1 pg. 1229 Common Urinary Elimination Problems v Urinary retention Inability to partially or completely empty the bladder v Urinary tract infection Results from catheterization or procedure (CAUTI) v Urinary incontinence Involuntary leakage of urine v Nocturnal enuresis Children who wet the bed at night without waking from sleep v Urinary diversion Diversion of urine to external source Table 46.1 pg. 1230 Common Urinary Elimination Problems v Nephrostomy Tubes Nursing Knowledge Base v Infection Control and Hygiene Urinary tract is sterile v Growth and Development Infants/Children/Elderly v Psychosocial Implications Need for privacy Self-image and self-esteem Critical Thinking v Successful critical thinking requires synthesis of: Knowledge Experience Information gathered from patients Critical thinking attitudes Intellectual and professional standards Nursing Process/CJM v Through the patient’s eyes Box 46.5 pg. 1236 – Nursing Assessment Questions Understanding Table 46.2 pg. 1237 – Common Symptoms Expectations of treatment v Self-care ability v Cultural considerations v Health literacy v Nursing history Pattern of urination Symptoms of urinary alterations Nursing Process/CJM v Physical assessment Inspection and Palpation Ø Kidney Ø Bladder External genitalia and urethral meatus Ø All patients with urinary catheter Ø Catheter related trauma/damage o Securing catheter tubing to leg Perineal skin Nursing Process/CJM v Assessment of urine Intake and output Characteristics of urine Ø Color Ø Clarity Ø Odor Normal characteristics of urine pg. 1237 Laboratory Diagnostic Testing v Laboratory Tests Urinalysis Culture and sensitivity v Collect Samples for Urine Analysis Random specimen Midstream UA Sterile specimen Double voided specimen 24-hour time collected Diagnostic Examinations v Indirect visualization Radiographic studies o Intravenous pyelogram v Direct visualization Cystoscopy Cystourethroscopy Diagnostic Examinations v Nursing responsibilities before testing: Ensure a signed consent is completed (Invasive/Contrast) Assess the patient for any allergies Administer bowel-cleansing agents as ordered Ensure that the patient adheres to the appropriate pretest diet or nothing by mouth (NPO) v Responsibilities after testing include: Assessing I&O Assessing voiding and urine Encouraging fluid intake Nursing Process/CJM v Nursing diagnoses/problems common to patients with urinary elimination problems: Impaired urinary elimination Self-care deficit, toileting Risk for infection Urinary retention Urinary incontinence Impaired skin integrity Pain Nursing Process/CJM v Goals and outcomes Set realistic and individualized goals along with relevant outcomes Collaborate with the patient v Setting priorities Patient’s immediate physical and safety needs Patient expectations and readiness to perform some self-care activities v Teamwork and collaboration Nursing Process/CJM v Health promotion Patient education Promoting normal micturition Ø Maintaining elimination habits Ø Maintaining adequate fluid intake Promoting complete bladder emptying Ø Encourage a 2nd void Ø Aid in assuming normal position of voiding Ø Use sensory stimuli Preventing infection PureWick System Nursing Process/CJM v Acute care Catheterization Ø Types of catheters Ø Sizes § 5 Fr vs 18 Fr Nursing Process/CJM v Catheterization Catheter drainage systems Routine catheter care Nursing Process/CJM v Catheterization Preventing catheter associated infection Ø Hygiene Ø Back flow of urine in the bladder Ø Drainage bag and nozzle should never touch the floor Catheter irrigations and instillations Nursing Process/CJM v Removal of indwelling catheters Reduce risk of HAUTI v Alternatives to catheterization Suprapubic catheters § Blockage of urethra (BPH) § Long term External catheters § Condom catheters Nursing Process/CJM v Medication Classes Anticholinergics – decrease bladder irritation Cholinergics – increase bladder ability to contract Antimuscarinics – treat urgency, frequency, nocturia and urgency UI Antibiotics: treat urinary tract infections v Be familiar with the medications and indications for all medications your patient is taking. Pg. 1252 Nursing Process/CJM v Continuing and restorative care Lifestyle changes Pelvic floor muscle training Ø Kegel exercises Bladder retraining Toileting schedules Intermittent catheterization Ø Skin care Catheterization v Types of Catheters to Review Intermittent Indwelling Ø Short term = < 2 weeks Ø Long term = > 1 month Suprapubic Condom Indications for Catheterization v Need accurate measurement of urine Post surgery, critically ill patients v Relief of bladder distention v Sterile specimen – intermittent catheterization v Measure residual v Long term management of incompetent bladders Key Points with Catheter Insertion v Verify provider’s orders v Appropriate size v Sterile technique v Ensure catheter is in the bladder v Proper care to prevent UTIs Nursing measures with drainage system Appropriate peri care for clients with indwelling catheters v Measuring output from drainage system Removal of Indwelling Catheter v Don’t cut balloon tip v Remove inflation solution with syringe v Check label on catheter for solution quantity v Connect syringe and ensure complete removal of solution before withdrawing v Ask client to take a deep breath, let it out, and remove catheter. v Measure urine in drainage bag and record as output Evaluation v Through the patient’s eyes Assess the patient’s self-image, social interactions, sexuality, and emotional status v Patient outcomes 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 Safety Guidelines for Nursing Skills v Follow principles of surgical and medical asepsis as indicated v Identify patients at risk for latex allergies v Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.