Urinary elimination

the blood to form urine

the kidneys to the bladder

the urethra

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

1500 to 1600 mL/day

renal alterations

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.

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

bladder overactivity, and can cause the bladder to not completely empty.

nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions.

that make it difficult to reach and use toilet facilities.

• Diseases that cause irreversible damage to kidney tissue
• *Eventually the client has symptoms resulting from 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

*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)

on awakening, after meals, and before bedtime.

• of 5 or more times a day.
• *Some clients who void frequently during the night may have renal disease, prostate enlargement, or cardiac disease.

• 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.

• 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

• 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.

• 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.

• (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.

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.

• (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.

• (0-4 per low-power field)
• Greater numbers indicate urinary tract infection.

• None
• *Bacteria indicate urinary tract infection. (Client do not always have symptoms.)

• 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.

• None
• *Crystals are result of food metabolism. Excess crystals such as uric acid or calcium phosphate result in renal stone formation.

• Clothing modifications
• Environmental alterations
• Scheduled toileting
• Absorbent products

• Pelvic floor exercises (Kegel)
• Surgical interventions
• Biofeedback
• Electrical stimulation Absorbent products

• Antimuscarinic agents
• Behavioral interventions
• Biofeedback
• Pelvic floor exercises
• Lifestyle modifications (smoking cessation, weight loss and fluid modifications)
• Absorbent products

• Intermittent catheterization
• Condom catheter (male)

children require an 8 to 10 Fr,

require a 14 to 16 Fr

men require a 16 to 18 Fr