Elimination System

OBJECTIVES

1. Describe factors that can alter urinary function

2. Discuss common problem of Urinary Elimination

3. Identify nursing intervention for common urinary problems

Bladder Quiz

To test your knowledge, answer the following true or

false questions.

1.The bladder of a healthy adult can hold up to 2 cups of

urine comfortably for 2 to 5 hours.

True / False

True

2. Holding urine in the bladder too long can lead to

infections.

True / False

True

Regular urination flushes away bacteria and helps keep

the urinary tract sterile.

3. Diabetes is one of the diseases that can affect the

bladder

True / False

True

Over time, diabetes can affect the nerves that control the

bladder and intestinal tract. The bladder can become

paralyzed and stop responding to signals that it is filling

4. All kids are ready to start toilet training by 18 months.

True / False

False

It's true that kids are bladders and digestive systems

ready for toilet training at 18 months—But

(understanding the urge to go to the bathroom, resisting

distractions and remembering)are learnt at different

pace.

5. There are several types of urinary incontinence

True / False

True

Urinary incontinence is only a general term used.

6. Bladder control problems are common in older

people

True / False

True

With age, tissues in the urinary tract change, muscles

weaken and nerves can be damaged.

7. Urinating more than 8 or 10 times a day is normal.

True / False

False

Urinating more than 8 times in 24 hours—or more than

twice each night—can be a sign of an overactive bladder.

This condition can affect people's self-esteem and

confidence, sometimes making them afraid to be far

from home,

8. Healthcare team can't do much about an overactive

bladder

True / False

False

most problems can be improved with treatment.

exercises to strengthen the pelvic muscles, lifestyle

changes, medicines to calm the bladder's muscles and

nerves, or devices to hold up the bladder could be

helpful

9. Prostate problems can affect bladder control in men

True / False

True

Men with this problem may have a weak flow or have to

urinate often during the day and night.

10. Caffeine can affect the bladder

True / False

True

Caffeinated drinks such as coffee, cola irritate the

bladder and cause the bladder to fill quickly. This, in

turn, can increase the urge to urinate and sometimes can

lead to leaking. Medications, infection, being overweight,

nerve damage, weak muscles and various health

conditions can cause urine to leak as well

Result

• Those who scored 10/10. welldone!

• Those who scored 7-9/10. Great!

• Those who scored 1-7/10. Good try!

Pay attention to the class to get more knowledge

about maintaining bladder function.

Urinary elimination system

The act of bodily system consisting of the organs that

eliminate urine which includes the kidneys, ureters,

urinary bladder, and urethra.

Urination:

Micturation, voiding and urination all refer

to the process of emptying the urinary

bladder. urine collects in the bladder until

the pressure stimulates special sensory nerve

ending in the bladder wall called stretch

receptors.

FACTORS INFLUENCING URINARY

ELIMINATION

Growth & Development

• Infants and children: urine appears light yellow, not concentrated.

• Voluntary control of urine begins at 18–24 months of age and full control at 4–5 yrs.

• After 50yrs: kidney shrinks

• Elderly adults: increased frequency because of loss of muscle tone. Residual urine may increase leading to high risk of infection

Psychosocial Factors • Privacy

• Sufficient time

• Appropriate position

• Anxiety, stress

Fluid intake • Increase fluid intake

• Fruits & vegetable

• Caffeine increases urinary frequency

Medications • Diuretics

• Certain drugs changes color of urine

Muscle tone • Regular exercise lead to strong muscle contraction and control of the

external sphincter.

Pathological Conditions • Fever

• Renal failure

• Diabetes Mellitus

• Calculus

• Hypertrophy of prostate gland

Surgical procedures • Anesthesia reduces output

• Local trauma

ALTERED URINE PRODUCTION:

• Polyuria or Diuresis-- 2500-4000mls/day (too much) increase intake—

• Diuresis—more production, more excretion of urine

• Polydipsia—intense thirst(associated with diuresis)

• Oliguria--scant urine output-- less than 500 cc/day—in renal failure, nephrons not

functioning.

• Anuria—less than 100.

• Complete kidney shutdown ,renal failure and urinary

shutdown-- have the same meaning

ALTERED IN URINARY ELIMINATION: • Frequency. Void at frequent intervals due to cystitis ,stress pressure on

bladder are some of the causes listed.

• Nocturia/ Nycturia—increased frequency at night—Don’t give diuretics at night. Take by 5 p.m.

• Urgency—Urgent need to void

• Dysuria—Painful voiding, injury, infection, structural problems

• Enuresis—involuntary passage of urination after age 4-5 years (primary and secondary)

• Urinary Incontinence—urine overflows or dribbles

Types: total, stress, urge, functional and reflex incontinence

Types of Urinary incontinence

1. Functional Urinary incontinence-Inability of usually

continent person to reach toilet in time to avoid

unintentional loss of urine.

2. Reflex Urinary Incontinence-Involuntary loss of

urine at somewhat predictable intervals when a

specific bladder volume is reached.

3. Stress Urinary Incontinence-Sudden leakage of

urine occurring with activities that increase

abdominal pressure,

4. Total Urinary Incontinence-Continuous and

unpredictable passage of urine.

5. Urge Urinary Incontinence- lnvoluntary passage of

urine occurring soon after a strong sense of urgency

to void.

37-23 Copyright 2004 by Delmar

Learning, a division of Thomson

Learning, Inc.

Common Alterations in Elimination

• Urinary Elimination

– Acute urinary incontinence

– Chronic urinary incontinence

37-24 Copyright 2004 by Delmar

Learning, a division of Thomson

Learning, Inc.

Common Alterations in Elimination

Stress Urinary Incontinence (SUI)

– Uncontrolled loss of urine caused by physical

exertion in the absence of a detrusor muscle

contraction

– Associated with urethral hypermobility or intrinsic

sphincter deficiency

37-25 Copyright 2004 by Delmar

Learning, a division of Thomson

Learning, Inc.

Common Alterations in Elimination

• Urgency and Urge Urinary Incontinence

(overactive bladder syndrome)

– Involuntary leakage accompanied by urge to void

• Functional Urinary Incontinence

– Altered mobility, manual dexterity

– Ability to access toilet

– Cognitive changes

37-26 Copyright 2004 by Delmar

Learning, a division of Thomson

Learning, Inc.

Common Alterations in Elimination

• Extraurethral Incontinence

– Uncontrolled loss of urine that exists when the

sphincter mechanism has been bypassed

• Retention—accumulation of urine in the bladder. Urine accumulates in

bladder as much as 3000ml. Prolonged retention increases the

possibility of UTI. On percussion a kettle drum (dull sound) can be

heard

• Hematuria--blood in urine

• Residual—what’s left in the bladder after voiding

• Calculi: - can occur in the kidney, bladder, or urethra.

• Infections mean that disease producing bacteria are present in the

urinary tract..

• Cyctitis :-is an inflammation of the bladder. Symptoms include frequent

need to urinate, slow dribbling urination, burning during urination,

pain, and blood in the urine.

Subjective data

• Normal Pattern Identification

– client description for alteration in urine

output

– Specific question regarding

last voiding

how many times per day

Quantity of urine each time you void

any night wakeup for micturation (be sensitive to the clients

privacy and embarrassment)

Assessment

Cont.

• Risk Identification

– Any previous problem related elimination i.e. renal

calculi, UTI

– How it was treated or resolved?

– Any GU related previous surgery ?

– Evaluate any other clinical problems?

– Recent changes in daily routine

(Increase activity, exercise, , fluid intake)?

- Any significant changes in oral intake of beverages that contain alcohol or caffeine?

– Medication that can effect on micturation such as diuretics ?

– Assess motor or cognitive dysfunction ?

– Visual impairment or communication impairment ?

Cont.

Dysfunction Identification

-Ask open ended questions

– Have u notice any problem with voiding lately, is a good

way to begin.

– Do u have any pain or burning with urination?

– Have u noticed any pink or radish color in your urine?

– Do u feel you are able to empty your bladder completely

every time you urinate?

– Do u accidentally loose any urine when u cough and

sneeze?

– Do u have any difficulty in stopping and starting urine

stream?

Cont. Objective Data • Assessment of urine

• I/O, Bladder ultrasound

• Physical Assessment

– Inspection

– Percussion

– palpation

• Diagnostic test and procedures

– Collection of urine specimen

• Random specimen

• midstream specimen

• 24 hr Specimen

• Specimen from a catheter

• Urine test

• Blood test

Nursing Diagnosis

Stress incontinence

Self esteem disturbance

Social Isolation

Self care deficit: Toileting

High risk for impaired skin integrity

High risk for infection

Implementation

Maintaining Normal Urinary Elimination

Promoting fluid intake

Maintaining normal voiding habits

Assisting with toileting

Managing Urinary Incontinence

Continence training

Pelvic muscle exercises

Positive reinforcement

Maintaining skin integrity

Kegal exercises to strengthen muscles.

Wellness Teaching

1. Respond as soon as possible to the urge to void

2. Drink 8 to 10 glasses of water a day

3. After urination, females should wipe from the urinary meatus

towards the anus

4. Maintain perineal-genital cleanliness

5. Avoid any harsh soap.

6. Avoid foods and fluids that contain excessive sodium which can

lead to fluid retention

7. Empty the bladder completely at each voiding

8. Obtain medical assistance if burning accompanies voiding or if

the urine changes color, clarity, odor or amount.