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Urinary Eliminationelimination Dr.Karimadr.Karima Elshamyelshamy

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Urinary Eliminationelimination Dr.Karimadr.Karima Elshamyelshamy UrinaryUrinary EliminationElimination Dr.KarimaDr.Karima ElshamyElshamy FacultyFaculty ofof NursingNursing MansouraMansoura UniversityUniversity EgyptEgypt LearningLearning Objectives:Objectives: AtAt thethe endend ofof thisthis lecture,lecture, thethe studentstudent willwill bebe ableable to:to: DefineDefine relatedrelated terms:terms: micturation,micturation, urine,urine, Ployuria,Ployuria, Oliguria,Oliguria, Anuria,Anuria, UrinaryUrinary incontinence,incontinence, Retention,Retention, RetentionRetention withwith 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 thethe factors,factors, whichwhich affectaffect thethe individual'sindividual's urinaryurinary elimination.elimination. DiscussDiscuss thethe nursingnursing measuresmeasures forfor patientpatient withwith urinaryurinary incontinence.incontinence. DiscussDiscuss thethe nursingnursing measuresmeasures forfor patientpatient sufferingsuffering retentionretention.. Outlines:Outlines: AnatomyAnatomy andand physiologyphysiology ofof thethe urinaryurinary system.system. CharacteristicsCharacteristics ofof normalnormal urine.urine. SignsSigns andand symptomssymptoms ofof urinaryurinary problems.problems. AbnormalAbnormal findingsfindings ofof urine.urine. FactorsFactors whichwhich affectaffect thethe individual'sindividual's urinaryurinary elimination.elimination. NursingNursing measuresmeasures forfor patientpatient withwith urinaryurinary incontinence.incontinence. NursingNursing measuresmeasures toto promotepromote properproper urinaryurinary eliminationelimination forfor patientspatients sufferingsuffering fromfrom urinaryurinary retention.retention. UrinaryUrinary catheterization.catheterization. AnatomyAnatomy andand physiologyphysiology ofof thethe urinaryurinary system:system: TheThe urinaryurinary systemsystem isis composedcomposed ofof 22 kidneyskidneys,, 22 uretersureters,, thethe bladderbladder andand thethe urethra.urethra. TheThe Kidneys:Kidneys: TheThe rightright andand leftleft kidneys,kidneys, theythey areare complexcomplex organorgan whosewhose chiefchief functionfunction isis thethe eliminationelimination ofof wastewaste productsproducts ofof bodybody metabolismmetabolism andand thethe controlcontrol ofof concentrationconcentration ofof thethe variousvarious constituentsconstituents ofof thethe bodybody fluid,fluid, includingincluding thethe blood.blood. BloodBlood reachesreaches thethe kidneyskidneys throughthrough thethe renalrenal arteriesarteries andand isis filteredfiltered inin thethe glomerationglomeration ofof thethe nephrons.nephrons. TheThe nephronsnephrons areare thethe functioningfunctioning unitunit ofof thethe kidney.kidney. ItIt isis estimatedestimated thatthat eacheach kidneykidney hashas aboutabout oneone andand halfhalf millionmillion nephrons.nephrons. TheThe filtratefiltrate containscontains water,water, thethe wastewaste productsproducts ofof metabolism,metabolism, electrolyteselectrolytes andand glucose.glucose. ThisThis filtratefiltrate isis knownknown asas urine.urine. KidneyKidney Functions:Functions: ExcretionExcretion ofof metabolicmetabolic wasteswastes (urea,(urea, uricuric acid,acid, creatininecreatinine andand amonia).amonia). RegulationRegulation ofof acidacid --basebase balancebalance ofof thethe blood.blood. RegulationRegulation ofof thethe amountamount ofof extracellularextracellular fluidfluid throughthrough eliminationelimination ofof excessexcess fluidfluid oror fluidfluid retention.retention. RegulationRegulation ofof osmoticosmotic pressurepressure ofof extracellularextracellular fluidfluid byby regulatingregulating thethe amountamount ofof sodiumsodium chloridechloride andand water.water. RegulationRegulation ofof extracellularextracellular electrolyteselectrolytes byby eithereither selectiveselective reabsorptionreabsorption ofof importantimportant electrolyteselectrolytes oror excretionexcretion ofof excessexcess suchsuch asas glucose.glucose. RegulationRegulation ofof bloodblood pressurepressure :: TheThe kidneykidney producesproduces anan enzymeenzyme likelike substancesubstance calledcalled reninrenin thatthat cancan raiseraise bloodblood pressure.pressure. RegulationRegulation ofof redred bloodblood cellcell production:production: UnderUnder stress,stress, thethe kidneykidney producesproduces erythropoietin,erythropoietin, whichwhich stimulatesstimulates thethe productionproduction oror redred bloodblood cellscells inin bonebone marrow.marrow. ControlControl ofof waterwater excretion:excretion: TheThe reassertionreassertion ofof waterwater inin thethe tubulestubules isis controlledcontrolled byby pituitarypituitary andand hypothalamichypothalamic action.action. TheThe Ureters:Ureters: AreAre 22 tubes,tubes, eacheach oneone isis connectedconnected toto thethe pelvispelvis ofof thethe kidney.kidney. ItsIts chiefchief functionfunction isis toto conveyconvey thethe urineurine 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 dependsdepends uponupon thethe efficientefficient musclemuscle tonetone ofof thethe bladderbladder wallwall andand uponupon thethe integrityintegrity ofof thethe nervousnervous systemsystem enervatingenervating thethe bladderbladder andand thethe conditioncondition ofof thethe internalinternal sphinctersphincter which'which' controlscontrols thethe passagepassage ofof urineurine fromfrom thethe bladderbladder toto thethe urethra.urethra. StimulationStimulation ofof thethe bladderbladder isis transmittedtransmitted byby thethe sympatheticsympathetic nervousnervous systemsystem throughthrough thethe hypohypo gastricgastric nervesnerves andand byby thethe parasympatheticparasympathetic nervousnervous systemsystem throughthrough thethe pelvicpelvic nerves,nerves, i.e.i.e. thethe smoothsmooth musclemuscle wallwall ofof thethe bladderbladder hashas aa doubledouble nervenerve supply.supply. TheThe sympatheticsympathetic nervousnervous systemsystem relaxesrelaxes thethe bladderbladder wallwall toto permitpermit fillingfilling andand itit alsoalso contractscontracts thethe internalinternal sphinctersphincter toto preventprevent urineurine escapingescaping toto thethe exterior.exterior. TheThe externalexternal sphinctersphincter isis underunder voluntaryvoluntary controlcontrol soso thatthat urineurine cancan bebe heldheld inin untiluntil thethe toilettoilet isis reachedreached andand thethe personperson isis readyready toto void.void. TheThe parasympatheticparasympathetic nervousnervous systemsystem stimulatesstimulates contractioncontraction ofof thethe bladderbladder musclemuscle toto squeezesqueeze urineurine out,out, atat thethe samesame timetime relaxingrelaxing thethe internalinternal sphinctersphincter toto permitpermit flowflow ofof urineurine alongalong thethe urethra.urethra. TheThe Urethra:Urethra: IsIs aa short,short, hollowhollow muscularmuscular tubetube approximatelyapproximately 3.73.7 cmcm.. longlong inin thethe femalefemale andand 2020 cmcm.. inin thethe male;male; thethe chiefchief functionfunction ofof thethe urethraurethra isis toto provideprovide aa passagepassage --wayway throughthrough whichwhich urineurine cancan bebe voidedvoided fromfrom thethe bladder.bladder. TheThe entireentire urinaryurinary tracttract isis linedlined withwith mucousmucous membrane.membrane. MicturationMicturation oror Voiding:Voiding: ItIt isis thethe actact byby whichwhich urineurine isis expelledexpelled fromfrom thethe bladder.bladder. TheThe actsacts 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 isis aa complexcomplex aqueousaqueous solutionsolution ofof 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 containscontains creatinine,creatinine, uricuric acid,acid, ureaurea andand aa fewfew whitewhite bloodblood cells.cells. FrequencyFrequency ofof Voiding:Voiding: TheThe frequencyfrequency ofof voidingvoiding variesvaries withwith thethe bladderbladder capacity,capacity, sensation,sensation, acceptabilityacceptability andand availabilityavailability ofof toilettoilet facilities.facilities. VoidingVoiding 55--1010 timestimes aa dayday isis common.common. SignsSigns andand SymptomsSymptoms ofof UrinaryUrinary Problem:Problem: 1.1.
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