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Urinary Elimination System: Structure, Function, and Common Disorders, Study notes of Nursing

Middle Tennessee School of Anesthesia (MTSA)Nursing

An in-depth exploration of the urinary elimination system, including the functions of the kidneys, tubular secretion, ureters, urinary bladder, and urethra. It also covers normal urination patterns, environmental factors affecting urinary elimination, medications, surgery, and pathological conditions. The document concludes with assessment, outcomes, nursing interventions, and patient teaching.

Typology: Study notes

2020/2021

Uploaded on 04/19/2022

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Urinary Elimination
-Kidneys
oFilter metabolic wastes, toxins, excess ions and water from the blood and excretes them as urine
If impaired, these substances can reach toxic levels and damage body cells
oHelps regulate blood volume, blood pressure, electrolyte levels, and acid-base balance by selectively
reabsorbing water and other substances
oSecondary functions
Produce erythropoietin
Secretes the enzyme renin
Activates Vitamin D3
-Nephrons
oThe basic structural and functional unit of the kidney
oActs as a microscopic filter
-Glomerular Filtration
oFiltration occurs in the glomeruli
oThe glomerular filtration rate is the amount of filtrate formed by the kidneys per minute
oAge related changes
-Tubular Reabsorption
oFiltrate moves from Bowman’s capsule into proximal convoluted tubule
oPeritubular capillaries = reabsorption
oCollecting tubule
oDistal and collecting tubules
oADH/aldosterone
oWhen fluid in the body decreases
Posterior pituitary gland
Distal and collecting tubules
The adrenal cortex
What effect does this have?
oWhen water in the body increases
ADH
Urine Changes
Water is eliminated
-Tubular Secretion
oAs blood flows through the peritubular capillaries
Waste removed
Homeostatic pH maintained
-Ureters
oUreters
Transport Urine
oUrinary bladder
Stores urine
oUrethra
Women
3 to 4 cm, opens at the urinary meatus between the clitoris and vaginal opening – why
does it matter?
More prone to UTIs from microorganisms in the vagina and rectum.
Men
Extends about 20 cm from bladder to the urinary meatus at the distal end of the penis.
As it leaves the bladder, passes through a surrounding gland (prostate)
Also carries semen
-Urinary Elimination
oBladder contains 200 to 450 mL of urine
50 to 200 mL in children
oDistention activates stretch receptors
oSensory impulses
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Download Urinary Elimination System: Structure, Function, and Common Disorders and more Study notes Nursing in PDF only on Docsity!

Urinary Elimination

- Kidneys

o Filter metabolic wastes, toxins, excess ions and water from the blood and excretes them as urine

 If impaired, these substances can reach toxic levels and damage body cells

o Helps regulate blood volume, blood pressure, electrolyte levels, and acid-base balance by selectively

reabsorbing water and other substances

o Secondary functions

 Produce erythropoietin

 Secretes the enzyme renin

 Activates Vitamin D

- Nephrons

o The basic structural and functional unit of the kidney

o Acts as a microscopic filter

- Glomerular Filtration

o Filtration occurs in the glomeruli

o The glomerular filtration rate is the amount of filtrate formed by the kidneys per minute

o Age related changes

- Tubular Reabsorption

o Filtrate moves from Bowman’s capsule into proximal convoluted tubule

o Peritubular capillaries = reabsorption

o Collecting tubule

o Distal and collecting tubules

o ADH/aldosterone

o When fluid in the body decreases

 Posterior pituitary gland

 Distal and collecting tubules

 The adrenal cortex

 What effect does this have?

o When water in the body increases

 ADH

 Urine Changes

 Water is eliminated

- Tubular Secretion

o As blood flows through the peritubular capillaries

 Waste removed

 Homeostatic pH maintained

- Ureters

o Ureters

 Transport Urine

o Urinary bladder

 Stores urine

o Urethra

 Women

 3 to 4 cm, opens at the urinary meatus between the clitoris and vaginal opening – why

does it matter?

 More prone to UTIs from microorganisms in the vagina and rectum.

 Men

 Extends about 20 cm from bladder to the urinary meatus at the distal end of the penis.

 As it leaves the bladder, passes through a surrounding gland (prostate)

 Also carries semen

- Urinary Elimination

o Bladder contains 200 to 450 mL of urine

 50 to 200 mL in children

o Distention activates stretch receptors

o Sensory impulses

o Detrusor muscle and internal sphincter

o Triggers the conscious urge to void

o When person is ready to urinate, signal is sent to the brain for the external sphincter to relax, allowing urine

to flow out of the urethra

o Contraction of the detrusor muscle forces out any remaining urine.

- Normal Urination Patterns

o Kidneys produce about 50 to 50 mL of urine per hour (@1500 mL per day)

o Most people can void 5 to 6 times a day

o Urination can be a sign of a medical disorder

 Increased

 Decreased

- Life Span Considerations

o Infants

 Normal specific gravity of a newborn’s urine is 1.

 15 to 60 mL per kg

 Produce 8 to 10 wet diapers per day

 No voluntary control as neuromuscular functioning is immature

o Children

 Toilet training requires

 Problems included

 Enuresis

 Nocturnal enuresis

o Older Adults

 Kidney function and size decreases starting about age 50

 Loss of fluids and electrolytes via vomiting/diarrhea

 Drug toxicity

 Urgency and frequency common

 Loss of bladder elasticity and muscle tone leads to

- Factor affecting urinary elimination

o Personal

o Sociocultural

o Environmental

o Nutrition

o Hydration

o Activity level

o Medications

o Surgery and anesthesia

- Medications including

o Analgesics

o Diuretics

o Anticholinergics

o Antidepressants

o Antispasmodics

o Muscarinic receptor antagonists

 Locks nerve receptors in the smooth muscle of the bladder.

 Control bladder contraction and reduce urinary frequency for those with overactive bladder and

urge frequency

 Estrogen

o Botulinum toxin

- Surgery

o Can affect urinary solutes, normal urine characteristics, and the ability to pass urine normally

o Manipulation leads to trauma, bleeding, and the introduction of bacteria (hence sterile technique)

o Swelling after diagnostic or invasive procedures

o Pubic area, Vagina, or rectum

o Reproductive Organs

o Dipstick Testing

o Specific Gravity

- Assessing the Urine Intake and Output

o Intake

 Kidneys produce approx.. 50 to 60 mL of urine per hour (1,500 mL per day)

o Output fluctuates depending on

 Quality of fluid intake

 Ability of the heart to circulate blood

 Kidney functioning

 Ability of the patient to avoid urine

 Amount of fluid being excreted.

- Measuring Intake and Output

o Record all fluids the pt drinks or receives via IV

o Fluid intake

 Page 1495

o Fluid Output

o Ensure accuracy

o Perform I&O Measurement

 Figure 18-2 pg 394

 Figure 18-7 pg 404

o Practice asepsis

- NANDA-I Nursing Diagnosis

o Infection, Risk for

o Urinary Elimination, Impaired

o Urinary Elimination, Readiness for Enhanced

o Urinary Incontinence (Functional, reflex, stress, urge, risk for urge)

o Urinary retention

o Urinary Tract Injury, Risk for

- Outcomes/Evaluation

o General goal is for the patient to void approx. 1,500 mL of light-yellow urine in 24 hours

 Kidney Function

 Urinary Continence

 Urinary Elimination

 Tissue integrity, skin and mucous membranes

- Nursing interventions

o Promote normal urination

o Prevention or UTIs

o Urinary Incontinence Care

o Urinary Catherization

o Urinary Retention Care

o Bladder Irrigation

o Fluid Monitoring

o Self-Care Assistance: Toileting

o Environmental Management

o Fluid Management

- Promoting Normal Urination

o Provide privacy

o Assist with Positioning

 Men – Standing

 Women – Seated Upright

o Facilitate toileting routines

 Identify the clients pattern

o Promote adequate fluids and nutrition

 Box 30 -4 pg 1076

o Assist with hygiene

- Alterations in Urinary Elimination

o UTIs

o Urinary Retention

o Urinary Incontinence

o Urinary Diversion. /Urostomy

- Urinary catherization

o Introduction of a pliable tube into the bladder, via the urethra, to allow drainage of urine o Performed for the following:  Obtain a sterile specimen  Drain the bladder for surgical or diagnostic purposes  Emptying is incomplete after urination  Prevent/treat bladder overdistention & urinary retention when other measures fail  Measure post-residual void (PRV) if a portable ultrasound device is not available  Protect excoriated skin from contact with urine  Reduce the need for unnecessary movement of patients near death

  • Types of Catheters o Straight catheter  Procedure 30-4 pages 1100 - 1105  Singe-lumen tube inserted for immediate drainage of the bladder  Sterile urine specimen, PVR volume measurement, relief of temporary bladder distention o Indwelling Catheter (Foley or retention catheter)  Procedure 30-5 pages 1106 - 1112  Continuous bladder drainage  Typically a double lumen  Triple lumen is indicated for bladder irrigation o Suprapubic catheter  Continuous urine drainage when the urethra must be bypassed  Gynecological surgery, prostatic obstruction  Inserted via an incision above the symphysis pubis  Initially sutured in place until the stoma tract heals, then a standard indwelling catheter is used and held in place by inflation of a balloon
  • Catheter Sizing o Children  8 to 10 – French (Fr) Catheters o Adults  14 to 16 Fr o Women  Smaller lumen size  22 cm in length is appropriate for women o Men  Usually require larger lumen size  40 cm in length catheter - STUDY THESE!!!!! o Procedure on Inserting an Indwelling Urinary Catheter  30-5 on pg 1106 – 1112 o Procedure on Inserting and Intermittent Urinary Catheter  Straight Catheter  30-4 on pg 1100 – 1105 - Catherization risks and complications o Associated with bacteriuria o UTIs (CAUTI) o Risk or urethral injury  Catheter is too large  Forced through strictures  Inserted at an incorrect angle  Not well lubricated
  • Continent Urinary Reservior o Ileal reservoir, Indiana pouch o Similar to the ileal conduit, expect urine drains into a pouch made from a portion of the large intestine o Stoma on the abdomen contains a valve to keep urine from leaking o Patient inserts a catheter into the stoma to drain urine through the valve o A second valve prevents urine backflow into the kidneys
  • Neobladder o Mimics the function of an urinary bladder o Portion of the intestine is made into a pouch or reservoir that is connected to the urethra o Urine passes along the urethra o Patient voids by bearing down or applying manual pressure over the bladder o May need to perform intermittent self-catherization to fully empty the bladder o Urinary incontinence common after surgery o No external stoma or bag required
  • Nursing Interventions o Assess stoma appearance  Healthy stoma ranges from a deep pink to a brick red  Shiny & moist  Immediately document & report to surgeon if stoma is pale, dusky, or black as this often indicates inadequate blood supply o Assess skin surrounding stoma o Collection device is proper fit o Moisture proof skin barrier o Monitor amount & type of drainage o Empty the collection device frequently o Be available to discuss the patient’s reaction o Provide ample time to explain the stoma care and use of ostomy appliances - STUDY THESE!!!! o Home Care “Managing Nocturnal Enuresis in Children” p. 1063 o Box 30-1 “Common Diuretic Class” p. 1064 o Box 30-2 “Medications Associated with Urinary Retention” p. 1064 o Box 30-3 “Terms Associated with Urination” p. 1074 o Focused Assessment “Urinary Elimination History Questions” pages 1067 - 1068 o Diagnostic Testing “Blood Studies: BUN and Creatinine” p. 1069 o Diagnostic Testing “Studies of the Urinary System” pages 1069 - 1070 o Diagnostic Testing “Urinalysis” pages 1073 – 1074 o Self-care “Teaching Your Client About Clean, Intermittent Self-catheterization (CISC) pages 1077 – 1078 o Self-care “Teaching Patients to Manage Urinary Incontinence” pages 1084 – 1085