Urinary elimination

  1. Kidneys remove wastes from
    the blood to form urine
  2. Ureters transport urine from
    the kidneys to the bladder
  3. Urine leaves the body through
    the urethra
  4. nephron
    the functional unit of the kidney, forms the urine. The nephron is composed of the glomerulus, Bowman's capsule, proximal convoluted tubule, loop of Henle, distal tubule, and collecting duct
  5. normal adult urine output
    1500 to 1600 mL/day
  6. output of less than 30 mL/hr indicates possible
    renal alterations
  7. Clients with chronic alterations in kidney function
    do not make sufficient amounts of the active vitamin D. They are prone to develop renal bone disease resulting from the demineralization of bone caused by impaired calcium absorption.
  8. Damage to the spinal cord above the sacral region causes loss of
    voluntary control of urination, but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void. This condition is called a reflex incontinence
  9. If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing
    bladder overactivity, and can cause the bladder to not completely empty.
  10. Diabetes mellitus and multiple sclerosis cause changes in
    nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions.
  11. Degenerative joint disease and Parkinsonism are examples of conditions
    that make it difficult to reach and use toilet facilities.
  12. end-stage renal disease (ESRD)
    • Diseases that cause irreversible damage to kidney tissue
    • *Eventually the client has symptoms resulting from uremic syndrome.
  13. uremic syndrome.
    • An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome
    • *As the uremic symptoms worsen, aggressive treatment is indicated for survival
  14. Indications for Dialysis
    *Renal failure that can no longer be controlled by conservative management (i.e., dietary modifications and administration of medications to correct electrolyte abnormalities)

    *Worsening of uremic syndrome associated with ESRD (i.e., nausea, vomiting, neurological changes, pericarditis)

    *Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures (e.g., hyperkalemia, pulmonary edema)
  15. The common times for urination are
    on awakening, after meals, and before bedtime.
  16. Most people void an average
    • of 5 or more times a day.
    • *Some clients who void frequently during the night may have renal disease, prostate enlargement, or cardiac disease.
  17. Normal pH of Urine
    • pH (4.6-8.0)
    • pH of urine will indicate acid-base balance. An acid pH helps protect against bacterial growth. Urine that stands for several hours becomes alkaline.
  18. Protein in Urine
    • Protein (none or up to 8 mg/100 mL)
    • Normally protein is not present in urine. It is common in renal disease because damage to glomeruli or tubules allows protein to enter urine
  19. Glucose in Urine
    • Glucose (none)
    • Clients with diabetes mellitus often have glucose in urine as a result of inability of tubules to reabsorb high glucose concentrations (>180 mg/100 mL). Ingestion of high concentrations of glucose causes some glucose to appear in urine of healthy persons.
  20. Ketones in Urine
    • Ketones (none)
    • Clients whose diabetes mellitus is poorly controlled experience breakdown of fatty acids. End products of fat metabolism are ketones. Some clients with dehydration, starvation, or excessive aspirin usage also have ketonuria.
  21. Specific gravity in Urine
    • (1.0053-1.030)
    • *Specific gravity measures concentration of particles in urine. High specific gravity reflects concentrated urine, and low specific gravity reflects diluted urine. Dehydration, reduced renal blood flow, and increased ADH secretion elevate specific gravity. Overhydration, early renal disease, and inadequate ADH secretion reduce specific gravity.
  22. Blood in Urine when intact erythrocytes
    A positive test for occult blood occurs when intact erythrocytes, hemoglobin, or myoglobin is present. In women, blood in a routine urine specimen may be a result of contamination with menstrual fluid.
  23. RBCs in Urine
    • (up to 2)
    • *Damage to glomeruli or tubules allows RBCs to enter the urine. Trauma, disease, or surgery of the lower urinary tract also causes blood to be present.
  24. WBCs in Urine
    • (0-4 per low-power field)
    • Greater numbers indicate urinary tract infection.
  25. Bacteria in Urine
    • None
    • *Bacteria indicate urinary tract infection. (Client do not always have symptoms.)
  26. Casts in Urine
    • None
    • *Casts are cylindrical bodies whose shapes take on likeness of objects within the renal tubule. Types include hyaline, WBCs, RBCs, granular cells, and epithelial cells. Their increased presence is always an abnormal finding and indicates renal alterations.
  27. Crystals in Urine
    • None
    • *Crystals are result of food metabolism. Excess crystals such as uric acid or calcium phosphate result in renal stone formation.
  28. Urge to void that causes loss of urine before reaching appropriate receptacle
    INTERVENTIONS would be....
    • Clothing modifications
    • Environmental alterations
    • Scheduled toileting
    • Absorbent products
  29. Loss of urine with increased intraabdominal pressure (coughing, laughing, sneezing, or lifting with a full bladder)
    INTERVENTIONS would be....
    • Pelvic floor exercises (Kegel)
    • Surgical interventions
    • Biofeedback
    • Electrical stimulation Absorbent products
  30. Urinary urgency, often with frequency (more often than every 2 hours); bladder spasm or contraction
    INTERVENTIONS would be....
    • Antimuscarinic agents
    • Behavioral interventions
    • Biofeedback
    • Pelvic floor exercises
    • Lifestyle modifications (smoking cessation, weight loss and fluid modifications)
    • Absorbent products
  31. Lack of urge to void, unawareness of bladder filling, reflex emptying when certain volume reached
    INTERVENTIONS would be....
    • Intermittent catheterization
    • Condom catheter (male)
  32. Catheter size for children
    children require an 8 to 10 Fr,
  33. Catheter size for women
    require a 14 to 16 Fr
  34. Catheter size for men
    men require a 16 to 18 Fr
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Urinary elimination
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