UrinaryUrinary EliminationElimination Dr.KarimaDr.Karima ElshamyElshamy
FacultyFaculty ofof NursingNursing MansouraMansoura UniversityUniversity EgyptEgypt LearningLearning Objectives:Objectives:
AtAt the the end end of of this this lecture, lecture, the the studentstudent willwill bebe ableable to:to:
DefineDefine related related terms: terms: micturation, micturation, urine, urine, Ployuria,Ployuria, Oliguria, Oliguria, Anuria, Anuria, Urinary Urinary incontinence,incontinence, Retention, Retention, Retention Retention with with overflow,overflow, Dysuria, Dysuria, Enuresis, Enuresis, Nocturia, Nocturia, Urgency,Urgency, ResidualResidual urine.urine. DiscussDiscuss thethe characteristicscharacteristics ofof normalnormal urine.urine.
DifferentiateDifferentiate betweenbetween urinaryurinary problems.problems.
IdentifyIdentify abnormalabnormal findingsfindings ofof urineurine ..
DiscussDiscuss the the factors, factors, which which affect affect the the individual'sindividual's urinaryurinary elimination.elimination. DiscussDiscuss the the nursing nursing measures measures for for patient patient withwith urinaryurinary incontinence.incontinence.
DiscussDiscuss the the nursing nursing measures measures for for patient patient sufferingsuffering retentionretention.. Outlines:Outlines:
AnatomyAnatomy and and physiology physiology of of the the urinary urinary system.system.
CharacteristicsCharacteristics ofof normalnormal urine.urine.
SignsSigns andand symptomssymptoms ofof urinaryurinary problems.problems. AbnormalAbnormal findingsfindings ofof urine.urine.
FactorsFactors which which affect affect the the individual's individual's urinaryurinary elimination.elimination.
NursingNursing measures measures for for patient patient with with urinary urinary incontinence.incontinence. NursingNursing measures measures to to promote promote proper proper urinaryurinary elimination elimination for for patients patients suffering suffering fromfrom urinaryurinary retention.retention.
UrinaryUrinary catheterization.catheterization. AnatomyAnatomy and and physiology physiology of of the the urinaryurinary system:system:
TheThe urinary urinary system system is is composed composed ofof 2 2 kidneys kidneys,, 2 2 ureters ureters,, the the bladderbladder andand thethe urethra.urethra.
TheThe Kidneys:Kidneys:
TheThe right right and and left left kidneys, kidneys, they they are are complexcomplex organ organ whose whose chief chief function function isis the the elimination elimination of of waste waste products products ofof body body metabolism metabolism and and the the control control ofof concentration concentration of of the the various various constituentsconstituents of of the the body body fluid, fluid, includingincluding thethe blood.blood. BloodBlood reaches reaches the the kidneys kidneys through through the the renal renal arteriesarteries and and is is filtered filtered in in the the glomeration glomeration of of the the nephrons.nephrons. TheThe nephrons nephrons are are the the functioning functioning unit unit of of the the kidney.kidney. ItIt isis estimatedestimated thatthat eacheach kidneykidney hashas aboutabout oneone andand halfhalf millionmillion nephrons.nephrons.
TheThe filtrate filtrate contains contains water, water, the the waste waste products products of of metabolism,metabolism, electrolytes electrolytes and and glucose. glucose. This This filtrate filtrate isis knownknown asas urine.urine.
KidneyKidney Functions:Functions:
ExcretionExcretion of of metabolic metabolic wastes wastes (urea, (urea, uric uric acid,acid, creatininecreatinine andand amonia).amonia).
RegulationRegulation of of acid acid --basebase balance balance of of the the blood.blood.
RegulationRegulation of of the the amount amount of of extracellular extracellular fluidfluid throughthrough eliminationelimination ofof excessexcess fluidfluid oror fluidfluid retention.retention. RegulationRegulation of of osmotic osmotic pressure pressure of of extracellularextracellular fluidfluid byby regulatingregulating thethe amountamount ofof sodiumsodium chloridechloride andand water.water.
RegulationRegulation of of extracellular extracellular electrolytes electrolytes by by eithereither selective selective reabsorption reabsorption of of important important electrolyteselectrolytes or or excretion excretion of of excess excess such such as as glucose.glucose. RegulationRegulation ofof bloodblood pressurepressure :: TheThe kidneykidney producesproduces an an enzyme enzyme like like substance substance called called reninrenin thatthat cancan raiseraise bloodblood pressure.pressure.
RegulationRegulation of of red red blood blood cell cell production: production: UnderUnder stress, stress, the the kidney kidney produces produces erythropoietin,erythropoietin, which which stimulates stimulates the the productionproduction or or red red blood blood cells cells in in bone bone marrow.marrow.
ControlControl ofof waterwater excretion:excretion: TheThe reassertionreassertion ofof water water in in the the tubules tubules is is controlled controlled by by pituitarypituitary andand hypothalamichypothalamic action.action. TheThe Ureters:Ureters:
AreAre 2 2 tubes, tubes, each each one one is is connected connected to to the the pelvispelvis ofof thethe kidney.kidney.
ItsIts chief chief function function is is to to convey convey the the urine urine formedformed inin thethe kidneykidney pelvispelvis toto thethe bladder.bladder. ItIt isis aboutabout 2525 --3030 cmcm longlong andand itit hashas aa narrownarrow diameter.diameter.
TheThe Bladder:Bladder:
IsIs aa hollow,hollow, muscularmuscular organorgan thatthat servesserves asas aa reservoirreservoir forfor urine.urine.
TheThe bladderbladder cancan retainretain urineurine untiluntil itit cancan bebe excreted.excreted.
TheThe averageaverage adultadult bladderbladder holdsholds fromfrom 300300 -- 500500 cccc ofof urine.urine.
ThisThis depends depends upon upon the the efficient efficient musclemuscle tone tone of of the the bladder bladder wall wall andand upon upon the the integrity integrity of of the the nervousnervous system system enervating enervating the the bladderbladder and and the the condition condition of of the the internalinternal sphincter sphincter which' which' controls controls thethe passage passage of of urine urine from from the the bladderbladder toto thethe urethra.urethra. StimulationStimulation of of the the bladder bladder is is transmittedtransmitted by by the the sympathetic sympathetic nervousnervous systemsystem throughthrough thethe hypohypo gastricgastric nerves nerves and and by by the the parasympatheticparasympathetic nervous nervous system system throughthrough thethe pelvicpelvic nerves,nerves, i.e.i.e. thethe smoothsmooth muscle muscle wall wall of of the the bladderbladder has has a a double double nerve nerve supply.supply. TheThe sympathetic sympathetic nervous nervous system system relaxes relaxes thethe bladder bladder wall wall to to permit permit filling filling and and it it alsoalso contracts contracts the the internal internal sphincter sphincter to to preventprevent urineurine escapingescaping toto thethe exterior.exterior.
TheThe externalexternal sphinctersphincter isis underunder voluntaryvoluntary controlcontrol soso that that urine urine can can be be held held in in until until thethe toilet toilet is is reached reached and and the the person person is is readyready toto void.void. TheThe parasympathetic parasympathetic nervous nervous system system stimulatesstimulates contraction contraction of of the the bladder bladder musclemuscle to to squeeze squeeze urine urine out, out, at at the the samesame time time relaxing relaxing the the internal internal sphinctersphincter to to permit permit flow flow of of urine urine alongalong thethe urethra.urethra. TheThe Urethra:Urethra:
IsIs a a short, short, hollow hollow muscular muscular tube tube approximatelyapproximately 3.73.7 cmcm.. longlong inin thethe femalefemale andand 2020 cm cm.. in in the the male; male; the the chief chief function function of of the the urethraurethra is is to to provide provide a a passage passage --wayway through through whichwhich urineurine cancan bebe voidedvoided fromfrom thethe bladder.bladder.
TheThe entireentire urinaryurinary tracttract isis linedlined withwith mucousmucous membrane.membrane.
MicturationMicturation oror Voiding:Voiding:
ItIt is is the the act act by by which which urine urine is is expelledexpelled from from the the bladder. bladder. The The acts acts ofof initiatinginitiating andand stoppingstopping maturationmaturation areare normallynormally underunder voluntaryvoluntary controlcontrol viavia externalexternal sphinctersphincter muscle.muscle. Urine:Urine:
IsIs thethe wastewaste productproduct ofof metabolism.metabolism.
ItIt is is a a complex complex aqueous aqueous solution solution of of organicorganic andand inorganicinorganic substances.substances. CharacteristicsCharacteristics ofof NormalNormal Urine:Urine:
AmountAmount :: 12001200 -- 18001800 cc/24cc/24 hh..
ColourColour :: Clear,Clear, straw,straw, amberamber yellow.yellow.
TransparencyTransparency :: Transparent.Transparent. ReactionReaction:: SlightlySlightly AcidicAcidic phph 4.54.5 -- 6.6.
Odor:Odor: AromaticAromatic odor.odor.
SpecificSpecific gravity:gravity: 1.0051.005 --1.0301.030
Constituents:Constituents: UrineUrine contains contains creatinine,creatinine, uric uric acid, acid, urea urea and and a a few few whitewhite bloodblood cells.cells. FrequencyFrequency ofof Voiding:Voiding:
TheThe frequency frequency of of voiding voiding varies varies withwith the the bladder bladder capacity, capacity, sensation,sensation, acceptability acceptability and and availabilityavailability ofof toilettoilet facilities.facilities.
VoidingVoiding 5 5--1010 times times a a day day is is common.common. SignsSigns andand SymptomsSymptoms ofof UrinaryUrinary Problem:Problem:
1.1. Polyuria:Polyuria: voidingvoiding aa largelarge amountamount ofof urine.urine.
2.2. Oliguria:Oliguria: VoidingVoiding a a scanty scanty amount amount of of urine.urine. (Less(Less thanthan 600600 cc/day)cc/day)
3.3. Anuria:Anuria: oror urinary urinary suppression: suppression: Total Total absenceabsence or or marked marked deficiency deficiency i.e. i.e. absence absence ofof urineurine emergedemerged fromfrom thethe kidneys.kidneys.
4.4. UrinaryUrinary incontinence: incontinence: InvoluntaryInvoluntary voidingvoiding oror constantconstant dribblingdribbling ofof urine.urine. TypesTypes ofof urinaryurinary incontinenceincontinence::
AA constantconstant incontinence.incontinence.
OccasionalOccasional incontinence.incontinence.
StressStress incontinence.incontinence.
OverflowOverflow incontinenceincontinence . 5.5. Retention:Retention: Retention:Retention: TheThe urine urine is is formed formed in in the the kidneys,kidneys, but but the the patient patient is is unable unable to to excreteexcrete it it from from his his urinary urinary bladder. bladder. RetentionRetention isis recognizedrecognized byby palpatingpalpating thethe distendeddistended bladder bladder above above the the symphysis symphysis pubispubis asas thethe urineurine isis stagnatedstagnated in.in. it.it.
RetentionRetention withwith over over flow: flow: the the patients patients voidvoid small small amounts amounts of of urine urine frequently frequently butbut continuecontinue toto havehave distendeddistended bladder.bladder. 6.6. Dysuria:Dysuria: DifficultyDifficulty inin voidingvoiding oror painpain inin voiding.voiding.
7.7. Nocturia:Nocturia: ItIt is is the the need need to to get get up up from from sleepsleep inin orderorder toto void.void.
8.8. Enuresis:Enuresis: ItIt is is involuntary involuntary lossloss ofof urineurine atat nightnight (bed (bed wetting). wetting). It It persist persist in in some some childrenchildren asas latelate asas 1010 yearsyears oldold oror more.more.
9.9. Urgency:Urgency: IsIs the the sensation sensation that that one one must must void.void.
1010.. ResidualResidual urine: urine: WhenWhen a a bladder bladder emptiesempties normally,normally, itit retainsretains littlelittle amountamount ofof urineurine ..
AbnormalAbnormal FindingsFindings ofof Urine:Urine:
Hematuria:Hematuria: PresencePresence ofof bloodblood inin thethe urine.urine.
Pyuria:Pyuria: PresencePresence ofof puspus inin thethe urine.urine.
Albuminuria:Albuminuria: PresencePresence of of albumin albumin inin thethe urine.urine. PalePale urine:urine: MeansMeans diluteddiluted urineurine maymay bebe duedue toto excessive excessive fluid fluid intake intake or or intake intake of of diuretics.diuretics.
Glycosuria:Glycosuria: PresencePresence ofof sugarsugar inin thethe urine.urine.
Casts:Casts: PresencePresence of of coagulated coagulated protein protein from from thethe kidneykidney tubule.tubule. DarkDark urine: urine: Means Means urine urine is is concentrated, concentrated, maymay bebe duedue to:to: Dehydration,Dehydration, oror lowlow fluidfluid intake,intake, PresencePresence of of bile bile pigments pigments (urobilin (urobilin or or bilirubin)bilirubin) due due to to disease disease of of the the liver liver or or gallgall bladder.bladder. IntakeIntake of of certain certain drugs drugs such such as as antibioticsantibiotics turnsturns thethe colourcolour ofof urineurine intointo orangeorange oror red.red. IntakeIntake of of certain certain food, food, vegetables vegetables and and fruitsfruits such such as as carrots, carrots, beetroot beetroot and and blackberries.blackberries. PresencePresence ofof bloodblood. FactorsFactors whichwhich affectaffect thethe individual'sindividual's urinaryurinary elimination:elimination:
•• ChangeChange inin thethe patient'spatient's environment:environment: SuchSuch asas improperimproper toilet toilet facilities, facilities, unclean unclean toilets toilets or or lacklack of of privacy. privacy. The The hospital hospital routine routine might might affectaffect patient'spatient's habits.habits.
•• AmountAmount ofof fluidfluid intakeintake :: ItIt cancan eithereither increaseincrease oror decreasedecrease amountamount ofof urine. •• IntakeIntake of of drugs: drugs: MightMight lead lead to to change change colorcolor of of urine, urine, or or can can increase increase urinary urinary out out putput (diuretics).(diuretics).
•• PsychologicalPsychological factors: factors: SuchSuch as as stress, stress, fear,fear, anxietyanxiety andand emotionalemotional factors.factors.
•• PathologicPathologic conditions: conditions: SuchSuch as as fever, fever, diabetes,diabetes, infectioninfection ofof thethe urinaryurinary tract.tract. •• DiseaseDisease of of the the nervous nervous system system or or injuries injuries whichwhich mightmight leadlead toto urinaryurinary incontinence.incontinence.
•• PhysicalPhysical activities:activities: SuchSuch asas immobility.immobility.
•• BloodBlood pressure: pressure: LowLow blood blood pressure pressure (Hemorrhage)(Hemorrhage) lead lead to to low low production production of of urine.urine. •• Obstruction:Obstruction: WillWill cause cause stasis stasis of of urine. urine. ObstructionObstruction may may be be due due to to congenital congenital defect,defect, calculi,calculi, tumor,tumor, etc.etc.
•• HormonalHormonal influences influences :: AntiAnti diuretic diuretic hormonehormone secreted secreted by by the the posterior posterior lobe lobe of of pituitarypituitary glandgland andand suppressessuppresses thethe amountamount ofof urineurine produced.produced. NursingNursing measures measures for for patient patient with with urinaryurinary incontinence:incontinence:
•• SkinSkin care care to to prevent prevent irritation irritation and and breakdown.breakdown.
•• CleanlinessCleanliness ofof linenlinen andand clothes.clothes.
•• FrequentFrequent turning turning of of patient patient to to prevent prevent decubitusdecubitus ulcerulcer ..
•• PerinealPerineal andand abdominalabdominal exercisesexercises .. •• StrengtheningStrengthening the the abdominal abdominal muscle muscle by by usingusing it it to to aid aid air air inhalation, inhalation, Tightening Tightening andand relaxingrelaxing thethe perinealperineal musclesmuscles 1010 timestimes (3(3 timestimes daily)daily)..
•• BladderBladder retrainingretraining programs.programs.
•• AdjustingAdjusting thethe fluidfluid intakeintake schedule.schedule.
•• EmotionalEmotional support.support. MeasuresMeasures toto promotepromote properproper urinaryurinary eliminationelimination for for patients patients Suffering Suffering fromfrom urinaryurinary retention:retention:
•• RestrictRestrict fluid fluid intake intake because because urine urine is is accumulatedaccumulated in in the the urinary urinary bladder bladder be be awareaware ofof fluidfluid intakeintake ofof patientpatient duringduring thethe firstfirst 2424 hours.hours.
•• ProvideProvide privacy privacy to to the the patient patient by by using using curtainscurtains oror closedclosed doors.doors. •• HelpHelp the the patient patient to to assume assume a a sitting sitting positionposition toto helphelp himhim void.void.
•• ProvideProvide a a bedside bedside commode commode if if the the patient patient cannotcannot useuse thethe bedpanbedpan oror urinal.urinal.
•• ListeningListening to to the the sound sound of of running running water, water, willwill helphelp thethe patientpatient toto void.void.
•• PourPour warmwarm waterwater overover thethe perineumperineum ofof thethe femalefemale patient,patient, oror helphelp thethe patientpatient toto sitsit inin aa warmwarm bathbath tub.tub. •• ProvideProvide aa warmwarm bedpanbedpan oror urinal.urinal.
•• SupplySupply aa warmwarm hothot waterwater bottlebottle toto thethe patientpatient oror lowerlower abdomen.abdomen.
•• PutPut thethe patientpatient handshands inin warmwarm water.water.
•• Catheterization:Catheterization: ShouldShould bebe orderedordered byby thethe physician physician if if the the pervious pervious MeasuresMeasures areare notnot successful.successful. UrinaryUrinary Catheterization:Catheterization:
UrinaryUrinary catheterization catheterization consists consists of of inserting inserting a a thinthin hollow hollow tub tub through through the the urethra urethra into into the the bladderbladder toto removeremove urineurine fromfrom thethe bladderbladder oror toto establishestablish aa patientpatient urineurine drainagedrainage method.method.