Urinary Elimination Chapter_34 1

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Information about Urinary Elimination Chapter_34 1

Published on March 16, 2016

Author: dwanfai

Source: authorstream.com

Slide1: Chapter 34 Urinary Elimination Objectives: Objectives Explain the structures of the urinary system, including function and role in urine formation and elimination. 2. Identify factors that commonly influence urinary elimination. 3. Discuss common alterations associated with urinary elimination. 4. Obtain a nursing history from a patient with an alteration in urination. 5. Perform a beginning physical assessment related to urinary elimination. 2 Objectives: Objectives 6. Describe characteristics of normal and abnormal urine. 7. Describe nursing implications of common diagnostic tests of the urinary system. 8. Identify nursing diagnoses associated with alterations in urinary elimination. 9. Discuss nursing measures to promote normal urination and to control incontinence. 10. Discuss nursing measures to reduce urinary tract infections. 11. Learn how to perform a postvoid residual using a bladder scan. 3 Scientific Knowledge Base: Anatomy and Physiology of the Urinary Tract: Scientific Knowledge Base: Anatomy and Physiology of the Urinary Tract Kidneys Remove waste from the blood to form urine Ureters Transport urine from the kidneys to the bladder Bladder Reservoir for urine until the urge to urinate develops Urethra Urine travels from the bladder and exits through the urethral meatus. Urinary System: Urinary System Act of Urination: Act of Urination Brain structures influence bladder function . Voiding: Bladder contraction + Urethral sphincter and pelvic floor muscle relaxation 1. Stretching of the bladder signals the micturition centers in the spinal cord. 2. Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control. 3. When a person is ready to void, the external sphincter relaxes, the bladder contracts, and the bladder empties. Factors Influencing Urination: Factors Influencing Urination Growth and development Sociocultural factors Psychological factors Personal habits Fluid intake Pathological conditions Surgical procedures Medications Diagnostic examinations Common Urinary Elimination Problems: Common Urinary Elimination Problems Urinary retention An accumulation of urine because of the inability of the bladder to empty Urinary tract infection Results from catheterization or procedure Urinary incontinence Involuntary leakage of urine Urinary diversion Diversion of urine to external source Urinary Diversions: Urinary Diversions Nursing Knowledge Base: Nursing Knowledge Base Infection control and hygiene Developmental considerations Psychosocial considerations Cultural considerations Critical Thinking: Critical Thinking Synthesis Knowledge Experience Attitudes Standards Nursing Process: Assessment: Nursing Process: Assessment Nursing history Pattern of urination Symptoms of urinary alterations Factors affecting voiding Older adult considerations Physical Assessment: Physical Assessment Kidneys Flank pain may occur with infection or inflammation. Bladder Distended bladder rises above symphysis pubis. External genitalia and urethral meatus Observe for discharge, inflammation, and lesions. Perineal skin Observe for erythema . Assessment of Urine: Assessment of Urine Intake and output Characteristics of urine Color Pale-straw to amber color Clarity Transparent unless pathology is present Odor Ammonia in nature Urine testing Specimen collection Urine Hat: Urine Hat Urometer: Urometer Laboratory and Diagnostic Testing: Laboratory and Diagnostic Testing Urinalysis Timed urine tests Clean-catch midstream specimen Urine for culture and sensitivity Diagnostic examinations Nursing Process: Diagnosis: Nursing Process: Diagnosis Functional Urinary Incontinence Reflex Urinary Incontinence Stress Urinary Incontinence Urge Urinary Incontinence Risk for Urge Urinary Incontinence Risk for Infection Toileting Self-Care Deficit Impaired Urinary Elimination Readiness for Enhanced Urinary Elimination Urinary Retention Nursing Process: Planning: Nursing Process: Planning Goals and outcomes Realistic and individualized Setting priorities P hysical and safety needs, patient expectations, and readiness to perform some self-care activities Collaborative care Patient, family, and specialists Implementation : Implementation Health promotion Patient education Promoting normal micturition Maintaining elimination habits Maintaining adequate fluid intake Promoting complete bladder emptying Prevention of infection Types of Urinals: Types of Urinals Catheterization: Catheterization Invasive Type Intermittent Indwelling Time Short term (≤2 weeks) Long term (≥ month) Types of Catheters: Types of Catheters Catheter Sizes and Changes: Catheter Sizes and Changes Closed Drainage Systems: Closed Drainage Systems Routine Catheter Care and Removal: Routine Catheter Care and Removal Suprapubic Catheters: Suprapubic Catheters Condom Catheters: Condom Catheters Condom Catheters (Cont.): Condom Catheters (Cont.) Urinary Diversions: Urinary Diversions Incontinent diversions External pouch Continent diversions C ontinent urinary reservoir B ladder-training schedule Pelvic muscle exercises Medications: Medications Antimuscarinics Potential adverse effects include: dry mouth, constipation, and blurred vision; mental status changes in older adults Mirabegron ( beta 3-adrenoceptor agonist) Potential adverse effects include blood pressure changes Monitoring effectiveness Restorative Care: Restorative Care Life style changes Pelvic floor muscle training Bladder retraining Toileting schedules Intermittent catheterization Skin care Evaluation: Evaluation Patient care Evaluate whether the patient has met outcomes and goals. Help the patient redefine goals if necessary. Revise nursing interventions as indicated. Patient expectations Check how the patient reports progress made . Safety Guidelines: Safety Guidelines Follow principles of medical and surgical asepsis when performing catheterizations, helping patients with their toileting needs, or handling urine specimens Identify patients at risk for latex allergy Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.

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