Urinary EliminationUrinary Elimination

Functions of Urinary Functions of Urinary SystemSystem

Remove wastes from blood to form urineRemove wastes from blood to form urine Remove nitrogenous waste products of Remove nitrogenous waste products of

cellular metabolismcellular metabolism Regulates fluid and electrolyte balanceRegulates fluid and electrolyte balance

The nephron = functional unit of the The nephron = functional unit of the kidney and forms the urinekidney and forms the urine

Goal of Urinary SystemGoal of Urinary System

To maintain chemical homeostasis of the To maintain chemical homeostasis of the blood. blood. Filtration by the NephronsFiltration by the Nephrons

H2O, glucose, amino acids, urea, creatinine, H2O, glucose, amino acids, urea, creatinine, major electrolytesmajor electrolytes

Not normally large proteins or blood cellsNot normally large proteins or blood cells Proteinuria is a sign of glomerular injuryProteinuria is a sign of glomerular injury

Normal adult 24hr output = 1500-1600ml. Normal adult 24hr output = 1500-1600ml.

Overview of Urinary Overview of Urinary SystemSystem

KidneysKidneys Bean shaped organsBean shaped organs Either side of vertebral columns T12 – Either side of vertebral columns T12 –

L3L3 Right kidney lower due to liverRight kidney lower due to liver Urine produced with filtration of blood Urine produced with filtration of blood

through nephronsthrough nephrons Major role in fluid & electrolyte balance Major role in fluid & electrolyte balance

Anatomy of the KidneyAnatomy of the Kidney

NephronNephron

UretersUreters Connect kidneys to bladderConnect kidneys to bladder 10 -12 in length, ½ in diameter in adult10 -12 in length, ½ in diameter in adult Peristaltic wavesPeristaltic waves

Renal colicRenal colic

BladderBladder Distensible, muscular sacDistensible, muscular sac Reservoir for urine ( approx. capacity = Reservoir for urine ( approx. capacity =

600mls )600mls ) Organ of excretion ( norm. voiding= 300mls)Organ of excretion ( norm. voiding= 300mls) Lies in pelvic cavity behind symphysis pubisLies in pelvic cavity behind symphysis pubis

UrethraUrethra Short, muscular tubeShort, muscular tube Urine from bladder to meatus and from the Urine from bladder to meatus and from the

bodybody Female 4-6.5cm (1 ½ - 2 ½ in.) lengthFemale 4-6.5cm (1 ½ - 2 ½ in.) length Male 20cms ( 8 in.)Male 20cms ( 8 in.)

Urinary and reproductive systemsUrinary and reproductive systems

MeatusMeatus External opening of the urethra, male & External opening of the urethra, male &

femalefemale

The need to void is a conscious The need to void is a conscious awarenessawareness

Formation of urine STAGES IN URINE FORMATION:STAGES IN URINE FORMATION:

1. (Glomerular) Filtration1. (Glomerular) Filtration 2.Reabsorption2.Reabsorption 3.Secretion3.Secretion

NephronNephron

1. Filtration1. Filtration

-blood pressure forces small molecules

from the glomerulus to the capsule

Filtrates:glucose, amino acids

uric acid, urea

2. Tubular Reabsorption2. Tubular Reabsorption

-return of filtrates from blood

at the proximal tubule through diffusion

and active transport

3. Tubular Secretion3. Tubular Secretion

-movement of molecules from blood

into the distal convoluted tubule

Molecules:drugs and toxins

Reabsorption of waterReabsorption of water

-return of H20 via osmosis along the

loop of Henle and collecting duct

ExcretionExcretion

Excretion of urine formedExcretion of urine formed

Life Cycle Changes Life Cycle Changes

Infants & childrenInfants & children Unable to concentrate urine - kidneys are Unable to concentrate urine - kidneys are

immatureimmature Urine is light yellowUrine is light yellow Void frequentlyVoid frequently Voluntary control at 24mos. when Voluntary control at 24mos. when

neuromuscular structures develop neuromuscular structures develop

AdultAdult 1500 – 1600 mls urine/24hrs1500 – 1600 mls urine/24hrs Concentrates urine – normal is amber Concentrates urine – normal is amber

coloredcolored NocturiaNocturia

Not usuallyNot usually Decreased renal blood flow during restDecreased renal blood flow during rest Ability to concentrate urineAbility to concentrate urine

ElderlyElderly Micturition impairedMicturition impaired mobility mobility Diseases, alzheimer’s, CVADiseases, alzheimer’s, CVA Physiological age related changesPhysiological age related changes

Bladder loses muscle tone and capacityBladder loses muscle tone and capacity Kidneys lose ability to concentrate urineKidneys lose ability to concentrate urine Bladder loses muscle strength Bladder loses muscle strength

Alterations in Urinary Alterations in Urinary Elimination PatternsElimination Patterns

Urinary RetentionUrinary Retention Accumulation of urine in the bladderAccumulation of urine in the bladder Inability to emptyInability to empty Pressure, discomfort and tendernessPressure, discomfort and tenderness

Residual Urine = urine retained in the Residual Urine = urine retained in the bladder after voidingbladder after voiding

IncontinenceIncontinence Loss of voluntary control to voidLoss of voluntary control to void

Infection, nerve damage to bladder or brain, spinal cord Infection, nerve damage to bladder or brain, spinal cord injury, or aging processinjury, or aging process

Total incontinence = no controlTotal incontinence = no control Stress incontinence = small amount, Urine excreted Stress incontinence = small amount, Urine excreted

involuntarily with coughing or laughinginvoluntarily with coughing or laughing

At risk for skin breakdown related to acid urine At risk for skin breakdown related to acid urine next to skin. next to skin.

Adult Diapers or AttendsAdult Diapers or Attends

Frequency & UrgencyFrequency & Urgency NocturiaNocturia Enuresis – involuntary discharge of urineEnuresis – involuntary discharge of urine Nocturnal Enuresis Nocturnal Enuresis

During sleepDuring sleep Bed-wetting children 5yrs and olderBed-wetting children 5yrs and older

OliguriaOliguria 30mls/hr or 720 mls/24hrs30mls/hr or 720 mls/24hrs

Renal anuriaRenal anuria cessation of urine production 100mls/24h cessation of urine production 100mls/24h

Promoting Healthy Promoting Healthy Urinary EliminationUrinary Elimination

Urinate as soon as the urge is feltUrinate as soon as the urge is felt Avoids stasis and distentionAvoids stasis and distention Prevents urgency, infection, and Prevents urgency, infection, and

incontinenceincontinence

Drink about 2liters fluid/dayDrink about 2liters fluid/day Limit Na, caffeine, and alcoholLimit Na, caffeine, and alcohol

For people with NocturiaFor people with Nocturia fld. Intake in the p.m.fld. Intake in the p.m. caffiene and alcoholcaffiene and alcohol Void before bedtimeVoid before bedtime

For Women For Women Wipe perineum front to backWipe perineum front to back Void soon after intercourseVoid soon after intercourse Wash handsWash hands Pelvic – floor strengthening exercises (Kegel Pelvic – floor strengthening exercises (Kegel

Exercises)Exercises)

Client EducationClient Education

S & S of infectionS & S of infection Fluid intake ( if no restrictions 2-5 L/day )Fluid intake ( if no restrictions 2-5 L/day ) Perineal hygienePerineal hygiene Medicines & side effects on urination, Medicines & side effects on urination,

color, and volumecolor, and volume

What is Micturition?What is Micturition?

It is the physiological term of "urination" i.e. the dispersion of urine from urinary bladder to the outside through urethra

Facilitating MicturitionFacilitating Micturition Nursing Measures to promote voiding in Nursing Measures to promote voiding in

people who are having difficulty:people who are having difficulty:1.1. Privacy and natural positionPrivacy and natural position

2.2. Providing commode or bathroomProviding commode or bathroom

3.3. Running waterRunning water

4.4. Warm water to dangle fingersWarm water to dangle fingers

5.5. Warm water over perineum (measure if on I&O)Warm water over perineum (measure if on I&O)

6.6. Gently stroking inner thighs or pressure Gently stroking inner thighs or pressure to symphysis pubisto symphysis pubis

7.7. Pain reliefPain reliefWarmth to the bladder & perineum relaxes Warmth to the bladder & perineum relaxes

muscles & facilitates voiding. ( Sitz bath muscles & facilitates voiding. ( Sitz bath or warm tub )or warm tub )

If unsuccessful- If unsuccessful- urinary catheterization urinary catheterization may be indicatedmay be indicated

Promoting complete bladder emptyingPromoting complete bladder emptying Prevention of infectionPrevention of infection

Good perineal hygieneGood perineal hygiene Adequate fld. IntakeAdequate fld. Intake

Dilutes urine & flushes urethraDilutes urine & flushes urethra

Acidifying urine ( inhibits microorganisms)Acidifying urine ( inhibits microorganisms) Cranberry juice, whole grain breads, meats, Cranberry juice, whole grain breads, meats,

eggs, prunes and plums.eggs, prunes and plums.

Urinary Catheter A urinary catheter is any tube system A urinary catheter is any tube system

placed in the body to drain and collect urine placed in the body to drain and collect urine from the bladder.from the bladder.

A catheter can be used for short-term or A catheter can be used for short-term or long-term use.long-term use.

Catheters come in many sizes, materials Catheters come in many sizes, materials (latex, silicone, Teflon), and types (Foley, (latex, silicone, Teflon), and types (Foley, straight, coude tip). straight, coude tip).

Indications of Urinary CatheterIndications of Urinary Catheter Urinary incontinence (leakage of urine or the Urinary incontinence (leakage of urine or the

inability to control when you urinate)inability to control when you urinate) Urinary retention (being unable to empty the Urinary retention (being unable to empty the

bladder when you need to)bladder when you need to) Surgery that made a catheter necessary, Surgery that made a catheter necessary,

such as prostate or gynecological surgerysuch as prostate or gynecological surgery Other medical conditions such as multiple Other medical conditions such as multiple

sclerosis, spinal cord injury, or dementiasclerosis, spinal cord injury, or dementia

Types of Urinary CathetersTypes of Urinary Catheters

A A Foley catheterFoley catheter (indwelling urinary (indwelling urinary catheter)/catheter)/3-Way Catheter 3-Way Catheter is retained by is retained by means of a balloon at the tip that is inflated means of a balloon at the tip that is inflated with sterile water. with sterile water.

A 3-way catheter has A 3-way catheter has 3 passageways 3 passageways – one – one is for urine to pass, one is for the inflation of is for urine to pass, one is for the inflation of the balloon and the other one is for instilling the balloon and the other one is for instilling medications and therapeutic irrigations medications and therapeutic irrigations directly into the bladder. directly into the bladder.

The balloons typically come in two The balloons typically come in two different sizes: 5 cmdifferent sizes: 5 cm33 and 30 cm and 30 cm33. .

They are commonly made in silicone They are commonly made in silicone rubber or natural rubber.rubber or natural rubber.

An indwelling urinary catheter is one that An indwelling urinary catheter is one that is left in place in the bladder. Indwelling is left in place in the bladder. Indwelling catheters may be needed for only a short catheters may be needed for only a short time, or for a long time. time, or for a long time.

These catheters attach to a drainage bag These catheters attach to a drainage bag to collect urine. A newer type of catheter to collect urine. A newer type of catheter has a valve that can be opened to allow has a valve that can be opened to allow urine to flow out, when needed. An urine to flow out, when needed. An indwelling catheter may be inserted into indwelling catheter may be inserted into the bladder in two ways:the bladder in two ways:

(Most often) The catheter is inserted through the (Most often) The catheter is inserted through the urethra, which is the tube that brings urine from the urethra, which is the tube that brings urine from the bladder to the outside of the bodybladder to the outside of the body

Sometimes, the doctor will insert a tube, called a Sometimes, the doctor will insert a tube, called a suprapubic catheter, into your bladder from a small suprapubic catheter, into your bladder from a small hole in your belly. This is done as an outpatient hole in your belly. This is done as an outpatient surgery.surgery.

An indwelling catheter has a small balloon inflated on An indwelling catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out the end of it. This prevents the catheter from sliding out of the body. When it's necessary to remove the of the body. When it's necessary to remove the catheter, the balloon is deflated.catheter, the balloon is deflated.

An An intermittent catheter/Robinson intermittent catheter/Robinson catheter/Straight cathetercatheter/Straight catheter is a flexible is a flexible catheter used for short term drainage of catheter used for short term drainage of urine.urine.

Unlike the Foley catheter, it has no Unlike the Foley catheter, it has no balloon on its tip and therefore cannot balloon on its tip and therefore cannot stay in place unaided. These can be non-stay in place unaided. These can be non-coated or coated (e.g., hydrophilic coated coated or coated (e.g., hydrophilic coated and ready to use).and ready to use).

An external, Texas, urisheat, or condom An external, Texas, urisheat, or condom catheter is used for incontinent males catheter is used for incontinent males and carries a lower risk of infection than and carries a lower risk of infection than an indwelling catheter.an indwelling catheter.

A coudé catheter is designed with a curved A coudé catheter is designed with a curved tip that makes it easier to pass through the tip that makes it easier to pass through the curvature of the prostatic urethra.curvature of the prostatic urethra.

A hematuria (or haematuria) catheter is a A hematuria (or haematuria) catheter is a type of Foley catheter used for Post-TURP type of Foley catheter used for Post-TURP hemostasis. This is useful following hemostasis. This is useful following endoscopic surgical procedures, or in the endoscopic surgical procedures, or in the case of gross hematuria. case of gross hematuria.

Condom catheters are most frequently Condom catheters are most frequently used in elderly men with dementia. There used in elderly men with dementia. There is no tube placed inside the penis. is no tube placed inside the penis. Instead, a condom-like device is placed Instead, a condom-like device is placed over the penis. A tube leads from this over the penis. A tube leads from this device to a drainage bag. The condom device to a drainage bag. The condom catheter must be changed every daycatheter must be changed every day

Sometimes urine can leak around the catheter. This may be caused by:

Catheter that is blocked or that has a kink in it

Catheter that is too small Bladder spasms Constipation The wrong balloon size Urinary tract infections

Complications Allergy or sensitivity to latex Bladder stones Blood infections (septicemia) Blood in the urine (hematuria) Kidney damage (usually only with long-term,

indwelling catheter use) Urethral injury Urinary tract or kidney infections

Bladder IrrigationBladder Irrigation Bladder irrigation is flushing out the bladder.Bladder irrigation is flushing out the bladder. A tube called a urinary catheter is put into A tube called a urinary catheter is put into

the bladder through the urethra.the bladder through the urethra. The catheter is connected to a bag of sterile The catheter is connected to a bag of sterile

water or salt solution which flushes out any water or salt solution which flushes out any clots of blood after surgery.clots of blood after surgery.

Types of bladder irrigationTypes of bladder irrigation

1.1. Closed methodClosed method Preferred technique for catheter or bladder Preferred technique for catheter or bladder

irrigation.irrigation. May either be continuous or intermittent.May either be continuous or intermittent. A 3-way or triple lumen catheter is generally A 3-way or triple lumen catheter is generally

used.used.

2. Open method2. Open method There is an increased risk of injecting There is an increased risk of injecting

microorganism into the urinary tract.microorganism into the urinary tract. It is performed with double-lumen indwelling It is performed with double-lumen indwelling

catheter.catheter. Strict precautions should be employed to Strict precautions should be employed to

maintain sterility of the drainage tubing maintain sterility of the drainage tubing connector & interior of indwelling catheterconnector & interior of indwelling catheter

Purposes in performing Purposes in performing bladder irrigation:bladder irrigation: To maintain the patency of a urinary To maintain the patency of a urinary

catheter & tubing (continuous irrigation)catheter & tubing (continuous irrigation) To free a blockage in a urinary catheter or To free a blockage in a urinary catheter or

tubing (intermittent irrigation)tubing (intermittent irrigation)

Reasons of alteration of urinary system functions CancerCancer Conditions affecting the structures near the Conditions affecting the structures near the

urinary tracturinary tract InfectionInfection InflammationInflammation InjuryInjury Nervous system diseasesNervous system diseases Scarring of UTScarring of UT Urine crystallizationUrine crystallization

Major manifestations of urinary system disorder

Abdominal, pelvic, or lower back pain or Abdominal, pelvic, or lower back pain or discomfort;discomfort;

Blood in the urine; Blood in the urine; Changes in the urine; difficulty producing Changes in the urine; difficulty producing

urine; urine; Fever and chills;Fever and chills; Frequent urination; Frequent urination; Leaking of urine; and urgent need to urinate.Leaking of urine; and urgent need to urinate.