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Urinary Elimination
SCCC
73
Nursing
Undergraduate 3
11/15/2013

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Term
Urinary elimination is
Definition
a precise system of filtration, reabsorption and excretion.
Term
Kidneys do what?
Does what with water?
Involved in what kinds of balances?
Involved in production of?
Secretes what?
Definition
filter blood (nephrons perform filtration and excretion)
rid the body of metabolic wastes and toxins. (like medications, ammonia, creatinine)
Reabsorbs or excrete water as necessary.
Also involved in electrolyte and acid/base balance (K+, Na+, Cl- and H+)
Involved in RBC production and secretes Renin.
Term
Ureters are? Have?
Definition
tubes from the kidneys to the bladder that have a valve at the end that prevents flow from bladder back into ureters
Term
Bladder does what? How much? what signals that the bladder is full and what happens?
Definition
stores urine: at 200 – 450 mL stretch receptors signals ctx of bladder and relaxation of internal sphincter
Term
Urethra what is it?
How long is it?
What does it have in it?
Problem for women/men?
Definition
women= 3-4inches, men= 8inches
tube from the bladder to out the body. There is an internal sphincter near the bladder (body relaxes when bladder is full)and an external sphincter (we control)near the outside.
Women more prone to UTI (placement and shortness), but men have prostate gland (retention)
Term
Urinary Meatus
Definition
Point where urine exits the urethra.
Term
Function of the Urinary System is to?
Definition
Urine Formation
Filtration
Reabsorption
Secretion
Urine Secretion
The elimination of fluid waste from the body.
Term
Normal Urination
called?
*how many mL and hour?
How many mL a day?
how many times a day?
how much residual should be left in the bladder?
Normal color?
Smell?
Going should be a?
Definition
Voiding or Micturition
60 mL/hour or 1500 - 2000 mL/day
6 – 8 times/day
250 – 400 mL per void
< 50 mL residual
Transparent or clear pale yellow
Pungent but not foul odor
Steady stream/Without pain
Term
Factors Affecting Urinary Elimination?
Definition
Fluid Intake
Loss of Body Fluid
Nutrition
Gender
Body Position
Cognition
Psychological Factors
Pathologic Conditions and Medications
Term
Fluid intake impacts urine by?
Definition
determines volume, color, frequency, flushes out micro-organisms so keep out of bladder.
Term
Loss of Body Fluid, what will happen?
Definition
Dehydration causes the kidneys to retain fluid: urine looks dark (concentrated)
Term
Nutrition impacts urine by?
Definition
Caffeine acts as a diuretic and increases urine production
Alcohol impairs the release of antidiuretic hormone (ADH) causing increase in urine production
Salt causes water retention/less urine
Term
Gender impacts urine by?
Definition
women= urethra smaller and closer to anus (UTI easier to get)
Men= prostate gland more prone to BPH makes urinary retention more likely.
Term
BPH?
Definition
benign prostatic hypertrophy =enlargement of the prostate gland.
Term
Position to urinate?
Definition
woman = sit or squat
men = stand
Term
Cognition to urinate
Definition
recognize need.
Term
psychological factors affecting urinary elimination?
Definition
kinked foley, hydronephrosis anything that causes urinary stasis, cardiovascular issues.
Term
What is hydronephrosis?
Definition
"water inside the kidney"
obstruction of free flow from the kidney.
Term
Medications affecting urinary elimination?
Definition
diuretics, antihistamines, opioids, anticholinergics (atrovent, atropine), Tricyclic antidepress (Elavil)
Term
Illnesses affecting urinary elimination?
Definition
renal disease, kidney stones, prostate, cardiovascular, neurologic
Term
Medical practices affecting urinary elimination?
Definition
anesthetics affect GFR and loss of sensation. Lower abdominal causes inflammation.
Term
Issues in the hospital of urinary elimination?
Definition
-Lack of Time, Lack of Privacy and Loss of Dignity can all negatively affect a hospitalized patient’s ability to void.
-Some cultures prohibit being seen by opposite sex
Term
Urination with Advanced Age
Definition
-Decline in filtration rate
-Loss of tone and elasticity in the bladder wall decreases it’s potential volume.
Leads to:
-Need to void more frequently (Noicturia/Frequency/Urgency)
-Inability of bladder to empty completely (Retention/UTI)
Females: Childbearing may have weakened pelvic muscles (Leaking/Incontinence)
Drying of the urethra and vaginal mucosa as a result of decreased estrogen levels (UTI)
Males: Enlarged prostate (Hestitancy/Dribbling)
-Cognitive impairment or generalized clinical deterioration (UTI)
-Self management of incontinence
Term
Nocturia?
Frequency?
Urgency?
Definition
-Going at night
-many times have to go
-Right away have to go
Term
Leaking?
Incontinence?
Definition
-leaking small amount of urine.
-not able to hold urine.
Term
Hestitancy?
Dribbling?
Retention?
Definition
-inablility to start, stop, empty
-dribbling small amount of urine
-Inability to empty bladder
Term
Tell whether the following statement is true or false:
Men are less susceptible to lower UTIs because of the longer length of the male urethra.
Definition
T
Term
Urinary Tract Infection
Definition
Infection that can happen anywhere along the urinary tract.
Term
Urinary Incontinence
Definition
Involuntary loss of urine from the bladder
Term
Urinary Retention
Definition
inablility to empty bladder of urine
Term
Urinary Diversion
Definition
surgical procedure to reroute utrine frol from its normal pathway.
Term
Dysuria
Definition
Painful voiding
Term
Polyuria
Definition
formation and excretion of excessive amounts of urine in the absence of a concurrent increase in fluid intake.
Term
Oliguria
Definition
formation and excretion of decreased amounts of urine, or urinary output less than 500mL in 24 hours.
Term
Urgency
Definition
feeling of being unable to delay voiding voluntarily
Term
Frequency other name for it?
Definition
voids more often than normal, without a significant increase in fluid intake.
overactive bladder.
Term
Nocturia
Definition
voiding during normal sleeping hours.
Term
Hematuria (can be?)
Definition
blood in the urine, can be gross, seen with the human eye, or occult not visible by the human eye.
Term
What is a UTI?
Definition
Infection that can happen anywhere along the urinary tract.
Term
What is a UTI usually caused from?
Definition
Usually caused by microorganisms from the colon that travel up the urinary tract. (usually ecoli from stool)
Term
What are the places called it can occur?
Definition
-Urethritis= in urethra
-Cystitis= In the bladder
-Ureteritis=in ureters
-Pyelonephritis=In kidneys
Term
Risk factors for UTI?
Definition
Risk Factors include:
-advanced age
=menopause cause drop in estrogen which in turn causes drying of the urethra and vaginal mucosa
=BPH cause retention, stagnation, dribbling
=kidney stones cause blockage, backflow or urine into kidneys, stagnation, irritation.
=enlarged prostate
=Gender (female= shorter tract, closer proximity of orifices, pregnancy, prolapse, sexually active women (frequent)/spermicidal gel)(male= uncircumsized men are greater risk)
=catheters
=obesity
=diabetes b/c bacteria love glucose
=constipation
=poor personal hygiene
=history of UTI’s
=hospitalization
Term
CAUTI?
Definition
Catheter Associated Urinary Tract Infections
Term
What is urinary incontinence? Types of Urinary Incontinence?
Definition
-unintentional leakage of urine
Stress Incontinence
Urge Incontinence or “Overactive Bladder”
Reflex (neurogenic)Incontinence
Functional Incontinence
Total Incontinence
Term
What is Stress Incontinence? Causes?
Definition
Increased abdominal pressure causes involuntary loss of small amounts of urine.
Causes: pregnancy, sneeze, cough, obese
Term
What is Urge Incontinence or “Overactive Bladder”
Causes?
Definition
Random involuntary passage of urine after a strong urege to void.
causes: bladder decreased capacity, diuretics, caffiene, alcohol
Term
What is Reflex (neurogenic)Incontinence
Causes?
Definition
Involuntary loss of urine occuring at somewhat predictable intervals when a specific bladder volume is reached. No control of sphincter
Causes: spinal cord injury, brain injury
Term
What is Functional Incontinence
Causes?
Definition
Inability of a normally continent person to reach the bathroom in time to avoid unintentional loss of urine.
Causes: Pain, mobility,
Term
What is Total Incontinence Causes?
Definition
person experiences continuous, unpredictable loss of urine. Continued leakage not at specific volume.
causes: trauma or born with malformation of spinal cord or brain, brain issue, cognitive deficit
Term
What do the elderly do if they are experiencing incontinence?
Definition
-embarrased,
-decrease fluid intake
-wear pads
-wear powders, perfumes, colognes
-stay at home
-fall risk from running to bathroom
Term
What is urinary retention? Causes of urinary intention?
Definition
-An inability to empty the bladder completely < 100 mL (less than 100 every time so go small amount)
Visible or palpable bladder
Causes are: obstruction, inflammation, neurologic, medications, loss of bladder tone, spinal anesthesia, opioid analgesics pain/anxiety.
Term
Medical treatment of urinary retention?
Definition
=surgery (remove obstruction/ prostate , uterine prolapse, or catheterize)
=or prescribe medications
Term
Medications for urinary retention?
Definition
=Cholenergics: increase tone and motility of bladder. Used for bladder distension and urinary retention.
now we want to stimulate the bladder to contract. side-effects are other cholinergic respponses like bradycardia, ^ salivation, bronchospasm, diarrhea

=Neostigmine: also used in myasthenia gravis.
An autoimmune disorder occurs when the immune system mistakenly attacks healthy tissue. In people with myasthemia gravis, the body produces antibodies that block the muscle cells from receiving messages (neurotransmitters) from the nerve cell. Extreme weakness.
cholenergics are Not to be used if retention is caused by obstruction.
Flomax and Proscar: will talk about again. reduces prostate. given at night because can lower b/p
Term
What is Urinary Diversion? Due to?
Definition
-One of several procedures that reroute urine from its normal pathway.
-Most common is result of Cystectomy.
Term
Cystectomy.
Definition
bladder removed
Term
Ureterostomy
Definition
one or both ureters to the abdominal surface
Term
Nephrostomy
Definition
a tube from the renal pelvis to the abdominal surface
Term
SUBJECTIVE DATA
Definition
-Medical & Surgical History/ UTI’s/
-Medications
-Usual Pattern
-Incontinence
-Hesitancy, Frequency, Urgency
-Nocturia
-Color, Odor, Amount
-Pain or Burning
-Intake of fluids
-Bowel Pattern
-Ability to get to bathroom and manage clothing
Term
OBJECTIVE DATA
Definition
-Inspection
=Color
=Clarity
=Constituents
=Odor
=Perineum
-Palpation
=Bladder
=Kidneys(Costovertebral Angle)
-Measure
=Intake and Output
=Postvoid Residual (Bladder Ultrasonic Scanner)
Term
Urinary Tract Infection Assessment (S/S)
Definition
=SUBJECTIVE
-Frequency
-Urgency
-Chills and Fever
-Back (Flank) Pain
-Burning with urination
-Suprapubic discomfort
-Foul-smelling urine

=OBJECTIVE
-^WBC’s and Bacteria
-Hematuria
-Pyuria
-Sediment or Cloudy appearance
Term
S/S UTI in Elderly
Definition
-Nonlocalized abdominal discomfort rather than dysuria and suprapubic pain.
-Cognitive impairment or generalized clinical deterioration
-Less likely to have a fever, maybe even slight decline in temperature
Term
Methods of Urine Collection
Definition
=Toilet
=Bedside Commode
-Toilet receptacle (“hat” or “nun’s cap”)
=Bedpan/Fracture Pan
=Urinal
-Graduated Cylinder
=Specimen Bag with adhesive for infants
Term
Types of collection of urine
Definition
=Random (toilet, bedside commode, bedpan, urinal, specimen bag for infants, etc)
=Sterile
-Clean Catch or Midstream Specimen
-Catheter (Indwelling or One-Time)
Term
Laboratory Data
Definition
=Urine
-Bedside Testing (Dipstick)
-Routine Urinalysis (with Microscopic)
-Culture and Sensitivity
-24 hour Urine Collection
=Serum
-BUN (Blood Urea Nitrogen): 8 – 20 mg/dL
-Creatinine 0.5 – 1.1 mg/dL
=Creatinine Clearance
=Glomerular Filtration Rate
Term
Specific gravity of urine?
Definition
1.015->1.025
Term
Assessment of Urinary Elimination (Diagnostics)
Definition
=Imaging Studies
-Ultrasonography
-Intravenous Pyelogram
-X-ray (KUB)
=Cystoscopy
=Urodynamic Studies
Term
cystscopy?
Definition
right into bladder look at what's going on, can take biopses and treat pathology.
Term
pyleogram
Definition
xray with contrast medium injected and excreted by urinary tract. (visualize kidneys, ureters, bladder and renal pelvis
Term
Nursing diagnosis?
Definition
Urinary Incontinence
Urinary Retention
Readiness for Enhanced Urinary Elimination
Term
Urinary Problems as the etiology (examples?)
Definition
Anxiety related to urinary urgency and recent episode of incontinence
Disturbed Body Image r/t urinary ostomy or incontinence
Social Isolation r/t frequent periods of incontinence
Fall Risk r/t urgency (rushing to get to the bathroom)
Risk for Impaired Skin Integrity r/t incontinence or poor hygeine
Term
Medications?
Antiinfectives?
Antibiotics?
Analgesic?
Definition
-stop bacteria from working properly.
-kill the bacteria
-systematic relief
Term
Kegels?
Definition
pelvic floor muscle exercises
Term
crede's maneuver?
Definition
massaging bladder
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