Chapter 30 Urinary Elimination - Islamic University of...
Transcript of Chapter 30 Urinary Elimination - Islamic University of...
Chapter 30
Urinary Elimination Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 1 First semester 19 - 20
Islamic University of Gaza Faculty of Nursing
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Overview of Urinary Elimination
Components of the urinary system: kidneys,
ureters, bladder, and urethra
Accessory structures of the urinary system: ring-
shaped muscles called the internal and external
sphincters
Components, along with accessory structures,
work together to produce urine, collect it, and
excrete it from the body
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Major Structures of Urinary System
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Overview of Urinary Elimination ……..cont’d
Urinary elimination: the process of releasing
excess fluid and metabolic wastes
Normal conditions: average person
eliminates approximately 1500 to 3000 mL of
urine each day
Need to urinate becomes apparent when the
bladder distends with approximately 150 to
300 mL of urine
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Factors affecting urinary elimination
Patterns of urinary elimination depend on
Physiologic
Emotional
Social
o Examples: amount of food consumed, volume of
fluid intake, and the amount of fluid losses
o Degree of neuromuscular development
o Integrity of the spinal cord
o Circadian rhythm, habits, opportunities, anxiety
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Factors affecting urinary elimination (cont’d)
Measures to promote urination
Providing privacy; assuming a natural position for
urination
Maintaining an adequate fluid intake
Using stimuli such as running water from a tap to
initiate voiding
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Urine Specimen Collection
Health care professionals collect urine specimens, or
samples of urine, to identify microscopic or chemical
constituents.
Common urine specimens that nurses collect include
voided specimens, clean-catch specimens , catheter
specimens, and 24-hour specimens.
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Voided Specimens
Is a sample of fresh urine collected in a clean container.
The first voided specimen of the day is preferred because
it is most likely to contain substantial urinary components
that have accumulated during the night.
If the specimen cannot be examined in less than 1 hour
after collection, it is labeled and refrigerated.
A clean-catch specimen
Is a voided sample of urine considered sterile.
Sometimes called a mid-stream specimen because of
how it is collected.
As soon as the specimen is collected, it is labeled and
taken to the laboratory. First semester 19 - 20
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Catheter Specimens
A urine specimen can be collected under sterile
conditions using a catheter, which is usually done
when clients are catheterized for other reasons such
as to control incontinence in an unconscious client
24-Hour Specimens
Collection of all urine produced in a full 24-hour period
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Abnormal Urine Characteristics
Laboratory analysis is a valuable diagnostic tool for identifying
abnormal characteristics of urine.
Hematuria: urine containing blood
Pyuria: urine containing pus
Proteinuria: urine containing plasma proteins
Albuminuria: urine containing albumin, a plasma
protein
Glycosuria: urine containing glucose
Ketonuria: urine containing ketones
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Abnormal Urinary Elimination Patterns
Assessment findings may indicate abnormal urinary
elimination patterns.
Some common problems include anuria, oliguria,
polyuria, nocturia, dysuria, and incontinence.
1. Anuria
Anuria means absence of urine or a volume of 100 mL
or less in 24 hours.
It indicates that the kidneys are not forming sufficient
urine.
Note: Urinary retention: the client produces urine but
does not release it from the bladder
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2. Oliguria
Urine output less than 400 mL per 24 hours,
indicates inadequate elimination of urine.
Residual urine : more than 50 mL of urine that
remains in the bladder after voiding
Urinary stasis: lack of movement of urine from
bladder
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3. Polyuria
Greater than normal urinary volume and may
accompany minor dietary variations, such as
increased fluid intake
For example, consuming higher than normal amounts
of fluids, especially those with mild diuretic effects
(e.g., coffee, tea), or taking certain medications
actually can increase urination.
4. Nocturia
Nocturia (nighttime urination) is unusual because the
rate of urine production is normally reduced at night.
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5. Dysuria
Dysuria is difficult or uncomfortable voiding and a
common symptom of trauma to the urethra or a
bladder infection.
Frequency :need to urinate often.
Urgency :strong feeling that urine must be
eliminated quickly often accompany dysuria.
6. Incontinence
Incontinence means the inability to control either
urinary or bowel elimination and is abnormal after
a person is toilet-trained.
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Assisting Clients with Urinary Elimination
Stable clients who can ambulate are assisted to the
bathroom to use the toilet .
Clients who are weak or cannot walk to the bathroom
may need a commode; clients confined to bed use a
urinal or bedpan
1. Commode: chair with an opening in the seat
under which a receptacle is placed
2. Urinal: cylindrical container for collecting urine;
it is more easily used by males
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Urinal and urinal
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3. Using a Bedpan
A bedpan (seat like container for elimination) is used
to collect urine or stool.
Figure 30-5 • Two types of bedpans: fracture pan)left ( and conventional bedpan ) right) .
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Urinary incontinence, depending on its type, may be
permanent or temporary.
The six types of urinary incontinence are stress, urge,
reflex, functional, total, and overflow (Table 30-2).
Continence training: to restore control of urination
involves teaching the client to refrain from urinating
until an appropriate time and place.
Managing Incontinence
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Types of urinary incontinence
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Catheterization
Catheterization: act of applying or inserting a hollow
tube
Various Reasons for Urinary Catheter Use
Keeping incontinent clients dry (last resort, when all
other continence measures have been tried)
Relieving bladder distention when clients cannot void
Assessing fluid balance accurately
Keeping the bladder from becoming distended during
procedures such as surgery
Measuring the residual urine
Obtaining sterile urine specimens
Instilling medication within the bladder First semester 19 - 20
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Types of Catheters
Various Reasons for Urinary Catheter Use
An external catheter (urine-collecting device applied
to the skin) is not inserted within the bladder; instead, it
surrounds the urinary meatus.
Examples of external catheters are a condom
catheter (Fig. 30-7) and a urinary bag or U-bag.
External catheters are more effective for male clients.
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Straight catheters: urine drainage tube inserted but
not left in place. It drains urine temporarily or provides
a sterile urine specimen
Retention catheters (also called indwelling catheters),
left in place for a period of time
Example: Foley catheter
A. Retention (Foley) catheter
with a balloon
B. Straight catheter
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Unlike straight catheters, retention catheters are
secured with a balloon that is inflated once the distal
tip is within the bladder. Both straight and retention
catheters
Available in various diameters, sized according to the
French scale: for adults, sizes 14, 16, and 18 F are
commonly used.
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Inserting a catheter:
The techniques for inserting straight and retention
catheters are similar, although the steps for inflating
the retention balloon do not apply to a straight
catheter
The best position for urinary catheterization is
Dorsal recumbent position
Closed drainage system:
Device used to collect urine
from a catheter
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Figure 30-11 • Techniques for suspending a drainage system below the bladder( :
A )wheelchair patient ;( B )ambulating patient with and without an IV pole.
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A catheter irrigation
A catheter irrigation (flushing the lumen of a catheter)
is a technique for restoring or maintaining catheter
patency.
A catheter that drains well, however, does not need
irrigating.
1. Open system: retention catheter is separated
from the drainage tubing to insert the tip of an
irrigating syringe (least desirable).
2. Closed system: irrigated without separating the
catheter from the drainage tubing.
3. Continuous irrigation: ongoing instillation of
solution using a 3-way catheter First semester 19 - 20
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Attaching irrigation tubing to a port on a
three-way catheter.
Bladder irrigation using a three-way catheter
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Indwelling catheter removal:
Catheter is removed when it needs to be replaced or
when its use is discontinued
The best time to remove a catheter is in the morning
when there is more opportunity to address any
urination difficulties without depriving a client of
sleep.
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Urinary Diversions
Urinary diversion: one or both ureters are surgically
implanted elsewhere
This procedure is done for various life-threatening
conditions
Urostomy: urinary diversion that discharges urine
from an opening on the abdomen
o Peristomal skin: skin around the stoma
o Difficult to maintain skin integrity due to
frequent appliance changes and ammonia in
urine
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