urinary elimination

factors influencing urinary elimination muscle tone

Strength of Abdominal muscles Weak abdominal and perineal muscles can impair bladder contraction and/or urethral control Common in women after childbirth, menopause, and in elders with muscle wasting Possible after long term indwelling catheter use Can also happen if indwelling catheter in for a long period of time The capacity of the bladder may decrease with age but the muscle is weaker and can cause urine to be retained.

factors influencing urinary elimination surgical procedures

Stress of hospital may cause increased secretion of ADH-Antidiuretic Hormone: increased urine output Surgery in the lower abdomen and perineal area can cause edema which will interfere with voiding. EX: vaginal hestorectomy. opemning tissue and inflammed. any abdominal tissue will cause edema and difficulty voiding Anesthesia Diagnostic tests and surgery-NPO prior to procedures can decrease urine output. ???? Bowel prep prior Direct visualization (cystoscopy) can cause edema or spasms: may cause retention Anesthesic and narcotic analgesics slow the GFR

common urinary elimination problems

The most common urinary elimination problems involve the inability to store urine or to fully empty urine from the bladder. Problems can result from infection, irritable or overactive bladder, obstruction of urine flow, impaired bladder contractility, or issues that impair innervation to the bladder resulting in sensory or motor dysfunction. Patients may have no urine output over several hours, and in some cases will experience frequency, urgency, small volume voiding or incontinence of small volumes of urine. Postvoid residual (PVR) is the amount of urine left in the bladder after voiding and is measured either by ultrasound or straight catheterization. Incontinence caused by urinary retention is called overflow incontinence or incontinence associated with chronic retention of urine. The pressure in the bladder exceeds the ability of the sphincter to prevent the passage of urine and the patient will dribble urine. [Review Table 46-1, Urinary Incontinence, with students.] Urinary tract infections (UTIs) are usually caused by Escherichia coli. Urinary tract infections are characterized by location; upper urinary tract (kidney) or lower urinary tract (bladder, urethra) and have signs and symptoms of infection. Bacteriuria, or bacteria in the urine, does not always mean that there is an infection. Symptomatic infection of the bladder should be treated with antibiotics and can lead to a serious upper urinary tract infection (pyelonephritis) and life-threatening blood stream infection (bacteremia or urosepsis). Symptoms of a lower urinary tract infection (bladder) can include: burning or pain with urination (dysuria), irritation of the bladder (cystitis) characterized by urgency, frequency, incontinence, suprapubic tenderness, and foul-smelling cloudy urine. Catheter-associated UTIs (CAUTIs) are associated with increased hospitalizations, increased morbidity and mortality, longer hospital stays, and increased hospital costs. Because a CAUTI is common, costly, and believed to be reasonably preventable, as of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) chose it as one of the complications for which hospitals no longer receive additional payment to compensate for the extra cost of treatment. Consequently, there has been a shift in reimbursement practices from its traditional focus on early recognition and prompt treatment to one of prevention. Common forms of UI are urge or urgency UI (involuntary leakage associated with urgency) and stress UI (involuntary loss of urine associated with effort or exertion, on sneezing or coughing. Mixed UI is when stress and urgency type symptoms are both present. Overactive bladder is defined as urinary urgency, often accompanied by increased urinary frequency and nocturia that may or may not be associated with urgency incontinence and is present without obvious bladder pathology or infection. Urinary incontinence associated with chronic retention of urine (formally called Overflow UI) is urine leakage caused by an overfull bladder. Functional UI is caused by factors that prohibit or interfere with a patient's access to the toilet or other acceptable receptacle for urine. In most cases, there is no bladder pathology. It is a significant problem for older adults who experience problems with mobility or the dexterity to manage their clothing and toileting behaviors. A recently added category of incontinence is identified as Multifactorial incontinence. This describes incontinence that has multiple interacting risk factors, some within the urinary tract and others not, such as multiple chronic illnesses, medications, age-related factors, and environmental factors.

urinary retention

an accummulation of urine due to the inability of bladder to empty Emptying of the bladder is impaired Urine accumulates Bladder distends Stretches the bladder walls and causing feelings of pressure, discomfort, tenderness over the symphysis pubis, restlessness and diaphoresis Over distention-poor contractility of detrusor muscle Severe cases 2000-3000 ml Overflow-voiding 25-50 ml at frequent intervals Pressure builds to point where external sphincter can no longer hold urine back. If incontinent called overflow incontinence Assess for distention in anyone who has not voided in several hours. Need to know last time patient voided!!! may occur obstruction (BPH), surgical trauma (GYN surgery), medication side effects (Pain meds), motor or sensory alteration (post CVA) May occur post procedure-ie after cystoscopy Crede (massage bladder must be ordered) DO BLADDER SCAN TO CHECK

TX for UTI

anti micorbials high fluid intake and prevention prevention: Cranberry juice-prevents adherence of bacteria to bladder wall

nocturia

awakening 1 or more times per night. if annoyance than bad

factors influencing urinary elimination circulatory disorders

cardiocascular and metabolic disorders can affect urine output such as hypertension heart failure shock D.M.

DX for UTI

dipstick for leukocyte esterase usually nitrates will be positive for UTI UA/ C&S high risk in older adults (muscle tone, forgetfulness)

polyuria

extra pee production. seen alot in diabetics (have 3 p's)

pyelonephritis kidney UTI symtpoms

flank pain dsyuria pain at costovertebral angle same signs and symptoms as cystitis

cystitis bladder UTI symptoms

frequency urgency suprapubic pain dsyuria hematuria fever confusion in older adults

Nursing goals for UTI

pyridium: orange pee, helps with pain teaching and prevention: know signs shower not bath

factors influencing urinary elimination spinal analgesics

reduces the perception for the need to void anathesics decreases BP and GFR

factors influencing urinary elimination

Growth and Developmental factors Psychosocial factors Fluid balance Medications Muscle tone Pathologic conditions Surgical and diagnostic procedures Disease condition activity and exercise: increased urinary blood flow, prevents urinary stasis

normal urine output

30-50 ml per hour 400 cc per shift bladder can hold up to 600 ml

factors influencing urinary elimination fluid balance I&O

Diuresis- Increased urine excretion Caffeine, ETOH-decreases ADH which causes increased fluid loss Dehydration-body attempts to retain fluid so output decreases and concentration increases. dark amber urine. sodium intake produces water retention-decreased urine check weight is gain/lost

considerations of older adults with urinary system

Arteriosclerosis-decreasing blood flow impairs renal function Nephrons-# of functioning nephrons decrease with age Illness or surgery- it takes longer to return to normal functioning Decreased renal function-increases the risk for med toxicity of meds that are excreted via kidneys Medications may cause urinary retention/ may increase urine formation, Muscle tone-bladder may not fill adequately, or empty completely. Elders: glomerular filtration and ability to concentrate urine declines. Result is nocturia and frequency. Loss of bladder tone in women and BPH in men can cause incomplete emptying (residual) and increased risk of UTI antibiotics given every 2-3 days in renal failure

factors influencing urinary elimination kidney disease blocked flow portein or blood cells

BPH: benign protestic hypertrophy (men) calculi and enlarged prostate can interfere with urine flow

Act of urination

Brain structures influence bladder function. Voiding: Bladder contraction + urethral sphincter and pelvic floor muscle relaxation 1. Bladder wall stretching signals micturition center. 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 central nervous system sends a message to the micturition centers, the external sphincter relaxes and the bladder empties. 500-600ml strong sensation to pee urge to urinate is 200-250 mL Urination, micturition, and voiding are all terms that describe the process of bladder emptying. Micturition is a complex interaction between the bladder, urinary sphincter, and central nervous system. Several areas in the brain are involved in bladder control; cerebral cortex, thalamus, hypothalamus and brainstem. There are two micturition centers in the spinal cord; one that coordinates inhibition of bladder contraction and the other that coordinates bladder contractility. As the bladder fills and stretches, bladder contractions are inhibited by sympathetic stimulation from the thoracic micturition center. When the bladder fills to approximately 400 to 600mL, most people experience a strong sensation of urgency. When in the appropriate place to void, the central nervous system sends a message to the micturition centers, stopping sympathetic stimulation and starting parasympathetic stimulation from the sacral micturition center. The urinary sphincter relaxes and the bladder contracts. When the time and place is inappropriate, the brain sends messages to the micturition centers to contract the urinary sphincter and relax the bladder muscle.

factors influencing urinary elimination medications

Diuretics-Increase urine output by preventing reabsorption of water and electrolytes. Example: Lasix(will be placed on potassium) Cholinergics-increase contractions of bladder-improve emptying (Acetylcholine) Anticholinergics and decongestants- can cause urinary retention Example: Atropine-(anticholinergic) Sudafed-(decongestant) Muscarinic receptors blockers-suppress bladder contractions i.e. Vesicar, Ditropan (reduce incontinence) Anesthesia (esp. epidural) and Opiod analgesics can slow glomerular filtration Can change the color of urine (can have retention) phenazopyridine (pyridium): can cause bright red/orange pee. given for dysteria and UTI

factors influencing urinary elimination psychosocial

Need for privacy. Some European countries accept communal toilets Rural areas may not have indoor plumbing May need distraction to relax Anxiety can cause urgency or prevent bladder emptying cathaterization can cause emotional distress

process of urinary elimination depends on

Upper urinary tract (kidneys, ureters) Lower urinary tract (bladder, urethra, pelvic floor) Cardiovascular system Nervous system

factors influencing urinary elimination growth and development

infants: develop voluntary control 18-24 months. 8-10 wet diapers daily need verbal communication skills to tell to void recognition of sensation of baldder filling/ hold pee 1-2 hours Childen: may experience enuresis Older adults: decline in urinary function. less able to filter waste and maintain acid/base electrolyte balance less bladder tone

anuria

lack of urine kidneys shutting down

oliguria

low urine output less than 500 mL a day have 20 mL or less per hour tell DR