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Urinary Elimination and Urinary Problems, Study notes of Nursing

Davao Doctors College (DDC)Nursing

Information on urinary elimination, which is the natural process in which the kidneys and bladder eliminate waste products and other materials. It also discusses urinary problems such as urinary retention, UTI, and urinary incontinence. information on the causes, manifestations, and assessment of these problems. It also provides tips on perineal care for women and medications that can affect voiding. useful for students studying nursing, medicine, or related fields.

Typology: Study notes

Pre 2010

Available from 10/25/2022

Olive2019
Olive2019 🇵🇭

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URINARY ELIMINATION
Urinary elimi nation is the natural process in which the kidneys and bladder eliminate waste products and
other materia ls.
☝
Remember:
Volume 500 -2500 ml/day
pH level range of 4.6-8.0
Color clear, light yellow
Odor Aromat ic
Specific Gravity 1.010-1.025
Note:
▪ Protien, bloo d and glucose should not be present in the urine.
▪ Ketones- present in patients who are alcoholic, fasting, starving, on high-protein diet and in DKA
Others:
1. Perineal care for women: front to back after voiding o r defecating.
2. Acidic urine is irritating to the skin.
3. U se disposab le gloves.
4. M edications that can affect voiding: anticho linergics, antidepressan ts, antipsychotic, ant ihistamines,
antihyp ertensive and diuretics.
URIN ARY PROBLEMS:
1. U rinary Retention- inability to empty the bladder; a predecessor of UTI.
• Causes: Pros tate gland enlargement and spinal cord trauma.
• Manifestations : 4D's
Distention of bladder
Discomfort
Diaphoresis
Deficiency of urine for several hours
☝
Because of pressure, >1oom l of urine will possibly leak.
• Assessment: P ost-voiding catheterization
2. U TI- entrance of MO (E. coli) to the urinary tract via urethral meatus .
Predispos ing factors:
1. Urina ry catheter- nu mber one cause of UTI and number one cause of Nos ocomial infection.
2. Frequ ent sexual intercou rse.
3. U rinary Incon tinence- loss of control over micturition, 80 % of incontinence can be cured or improved with
treatment.
Causes:
▪For women : thinning and drying of the skin in the vagina or urethra, especially after
menopau se.
▪For men : enlarged prostate gland or pro state surgery.
▪For bo th sexes: weakened pelvic muscle, not being able to move arou nd, problems such as
diabetes or high calcium levels build up of stools in the bowel, UTI.
Types of incontinence:
▪ Stress incontinen ce
▪ Urge incontinence
▪ Mixed incontinence
▪ Over-flow incontinence
▪ Functional incont inence or environmenta l incontinence
▪ Nocturna l enuresis continence
▪ Reflex incontinence: Involuntary loss of urine that occurs at predictable intervals when b ladder
volume is reached.
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URINARY ELIMINATION

Urinary elimination is the natural process in which the kidneys and bladder eliminate waste products and

other materials.

☝ Remember:

Volume 500-2500 ml/day pH level range of 4.6-8. Color clear, light yellow Odor Aromatic Specific Gravity 1.010-1.

Note: ▪ Protien, blood and glucose should not be present in the urine. ▪ Ketones- present in patients who are alcoholic, fasting, starving, on high-protein diet and in DKA

Others:

  1. Perineal care for women: front to back after voiding or defecating.
  2. Acidic urine is irritating to the skin.
  3. Use disposable gloves.
  4. Medications that can affect voiding: anticholinergics, antidepressants, antipsychotic, antihistamines, antihypertensive and diuretics.

URINARY PROBLEMS:

  1. Urinary Retention- inability to empty the bladder; a predecessor of UTI.
    • Causes: Prostate gland enlargement and spinal cord trauma.
    • Manifestations: 4D's

Distention of bladder Discomfort Diaphoresis Deficiency of urine for several hours

☝ Because of pressure, >1ooml of urine will possibly leak.

  • Assessment: Post-voiding catheterization
  1. UTI- entrance of MO (E. coli) to the urinary tract via urethral meatus.

Predisposing factors:

  1. Urinary catheter - number one cause of UTI and number one cause of Nosocomial infection.
  2. Frequent sexual intercourse.
  3. Urinary Incontinence- loss of control over micturition, 80% of incontinence can be cured or improved with treatment.

Causes: ▪ For women : thinning and drying of the skin in the vagina or urethra, especially after menopause. ▪ For men : enlarged prostate gland or prostate surgery. ▪ For both sexes : weakened pelvic muscle, not being able to move around, problems such as diabetes or high calcium levels build up of stools in the bowel, UTI.

Types of incontinence: ▪ Stress incontinence ▪ Urge incontinence ▪ Mixed incontinence ▪ Over-flow incontinence ▪ Functional incontinence or environmental incontinence ▪ Nocturnal enuresis continence ▪ Reflex incontinence: Involuntary loss of urine that occurs at predictable intervals when bladder volume is reached.

Diagnostic evaluation: ▪ Urinalysis ▪ Measurement of Post-Void Residual (PVR) ▪ Ultrasound ▪ Cystoscopy ▪ Cytometry ▪ Provocative stress test ▪ X-ray ▪ Voiding diary ▪ Pelvic and rectal examination

Treatment: ▪ Behavioral techniques ▪ Scheduling regimen: bladder training; biofeedback ▪ Pelvic muscle exercise (Kegels exercise) ▪ Drug Therapy: Betha Nicol, oxybutynin, estrogen ▪ Surgery ▪ Palliative treatment

Nursing intervention: ▪ Analyze the patient's voiding record ▪ Develop schedule for voiding ▪ Instruct the patient to hold his urine until it is his scheduled time to void ▪ Keep a voiding diary

  1. Polyuria- Production of abnormally large amount of urine by the kidney secondary to alcohol and diuretics.
  2. Oliguria- Low urine output (500 ml/ day or 30 ml/hr.)
  3. Anuria- Absence or lack of urine or no urine output common in renal failure.

DIAGNOSTIC TESTS AND VISUALIZATION PROCEDURES

Test for the constituents of urine:

  1. Specific gravity- measures urine concentration.

Instruments: i. Urinometer or hydrometer- used 20 ml of fresh urine. ii. Spectrometer or refractometer- used one to two drops of urine.

  1. Urine pH- measures the acidity and alkalinity of urine. Provides acid-base status.

Findings: <6 acid; 7=normal; >6 alkaline

  1. Glucose- Normal (-); (+) DM and GD
  2. Ketones- used to determine ketoacidosis (alcoholic, on high-protien diet, starving and fasting); Normal (-); produced by breakdown of fatty acids.
  3. Protien- Normal (-); (+) AGN
  4. Occult blood- Normal (-); (+) Ulceration and cancer of the GI system.

Laboratory test that are used to evaluate urinary and renal function:

  1. Routine Analysis (needs 10-15 ml of urine) A. BUN B. Creatinine clearance-Uses the 24- hour urine collection
  2. Visualization procedure