URINARY ELIMINATION – COMMON URINARY PROBLEMS

URINARY ELIMINATION – COMMON URINARY PROBLEMS

Urinary elimination, a natural process in which the body excretes waste products and materials those exceeded bodily needs, usually is taken for granted. When the urinary system fails to function properly, virtually organ systems can be affected. Persons with alternations in urinary elimination may also suffer emotionally from body image changes. The proper functioning of the urinary system is vital to the body’s physical well being, to life itself, and a person’s general sense of well bring.

Nursing therapies promote or minimize factors that influence urinary elimination. Each client has a different pattern of elimination. The nurse must assess this pattern and design therapies to promote normal urinary elimination when necessary. The nurse uses devices such as a condom or an indwelling catheter to assist the client with urinary elimination. The nurse assisting a client with urination or intervening to resolve health related to urinary needs may have specialized abilities

DEFINITION

Urinary elimination is defined as expulsion of waste products from the body through the urinary system.

Elimination from the urinary tract helps to remove the waste products from body. It is essential to the body’s physical well-being

PHYSIOLOGY

Urinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove waste from the blood to form urine. ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops

Growth and development of individual: it influences urination. Usually infants or children with 6 to 8 kg excrete 400 to 500 ml per day and child cannot withhold urination. The adult normally voids 1500 to 1600 ml per day and has normal urine color; also has control over urination. Aging impairs urination, e.g. elder adults

Food and fluid: foods high in water content increased urine production. Certain foods affect the color and odor of urine. Certain fluid needed to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes

The process of emptying the bladder is known as micturition or voiding or urination. The bladder normally holds as much as 600 ml of urine. However, the desire to urinate can be sensed when the bladder contains only a small amount of urine (150 to 200 ml in adults and 50 to 200 ml in a child). As the volume increases, the bladder walls stretch, sending sensory impulses to micturition center in the sacral spinal cord. Parasympathetic impulses from the micturition center stimulate the detrusor muscle to contract rhythmically. The internal sphincter also relaxes so that urine may enter the urethra, although voiding does not yet occur. As the bladder contracts, nerve impulses travel up the spinal cord to the midbrain and cerebral cortex. A person is thus conscious of the need to urinate. If the person chooses not to void, the external urinary sphincter remains contracted, and the micturition reflex is inhibited. However, when a person is ready to void, the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract and urination occurs. The act of micturition normally is painless

Factors Influencing

Developmental Considerations: infants are born without voluntary control of urination and with the little ability to concentrate urine. Older children and adults have general control of urination voluntarily. Physiological may affect urination

Lifestyle: many individual’s families and sociocultural variables influence a person’s normal voiding habits. For some individuals voiding is a very personal and private act

Fluid and food intake: the healthy body maintains a sensitive balance between the amount of fluid ingested and the amount of fluid eliminated. When fluid intake increases, the output also increases

Environment: during summer, due to excessive perspiration urine output is less. During winter, due to lack of perspiration, urine output is more

Psychological factors: stress can also interfere with the ability to relax external urethral sphincter as a result, emptying the bladder completely becomes difficult or impossible

Medication: Many medications interfere with the normal urination process and may cause retention. Diuretics, e.g. frusemide, increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidney into the bloodstream

Muscle tone and activity: People who exercise regularly will have good muscle tone increased body metabolism and good urine production

Pathological conditions: endocrine disorders such as diabetes insipidus increase urine formation. Diseases of the kidney themselves can reduce kidney function and perhaps eventually result in renal failure

Surgical and diagnostic procedure: surgery on structures adjacent to the urinary tract can also voiding because of swelling in the lower abdomen and often necessitates the use of retention catheter for a short time

DIAGNOSTIC EXAMINATION

Diagnostic examination of the urinary system can also influence micturition, for example, intravenous pyelogram

Conditions Which Alter Urinary Elimination

The most common conditions which alter urine elimination encountered by the nurse, involve disturbance in the act of micturition. These disturbances result from impaired bladder function, obstruction to urine outflow, or inability or voluntary control of micturition. The common renal conditions causing alternation in urinary elimination are as follows:

Prerenal Conditions

  • Decreased intravascular volume, dehydration, hemorrhage, and burns shock
  • Altered peripheral vascular resistance; sepsis, anaphylactic shock and reactions
  • Cardiac pump failure; congestive heart failure, myocardial infarction, hypertensive heart disease, valvular disease, and pericardial tamponade

Renal Conditions

  • Use of nephrotoxic agents (e.g. gentamicin)
  • Transfusion reactions
  • Diseases of the glomeruli (e.g. nephritis)
  • Neoplasms
  • Systemic diseases (e.g. diabetes)
  • Hereditary diseases (e.g. polycystic kidney)
  • Infections

Postrenal Conditions

  • Ureteral, bladder or urethral obstructions, due to calculi, blood clot, tumors, and strictures
  • Prostatic hypertrophy
  • Neurogenic bladder
  • Pelvic tumor
  • Retroperitoneal fibrosis

ROLE OF NURSE

The role and responsibilities of nurse, when managing the urinary elimination in their clients include the following:

  • Taking nursing history pertaining to client with partial emphasis on urinary elimination
  • Conducting or assessing physical assessment of kidneys, bladder, urethral orifice, skin integrity and hydration and urine
  • In addition, carrying out the following assessment measures like measuring urine output, collecting urine specimens, determining the presence of abnormal constituents, assisting with diagnostic procedure

COMMON URINARY PROBLEMS

Anuria: technically, no urine is voided for 24-hour-urine output is less than 100 ml

Dysuria: difficulty in voiding, may or may not be associated with pain, a feeling of warm local irritation occurring during voiding is called “burning”

Frequency: increased incidence of voiding

Glycosuria: presence of sugar in the urine. it may be due to an unusually large intake of sugar or to marked emotional disturbance and is temporary

Hematuria: presence of blood in the urine

Incontinence: inability to voluntarily control the discharge of urine

Nocturia: frequency of urination during the nights

Oliguria: scanty or greatly diminished amount of urine voided in a given time (24 hours urine output is 100-400 ml)

Orthostatic albuminuria: presence of albumin in urine that is voided after periods of standing, walking or running. It is the phenomenon of circulatory systems

Pneumaturia: passage of urine containing gas

Polyuria: excessive output of urine (diuresis)

Proteinuria: presence of protein, usually albumin, in the urine

Pyuria: pus in the urine. Urine appears cloudy.

Enuresis: it is defined as repeated involuntary urination in children beyond 4 to 5 years of age, when voluntary bladder control is normally acquired

Enuresis can be nocturnal (night time) and diurnal (day time) or both

Urinary incontinence: it is the ability to control passage of urine to continence may be caused by stress. Neurological impairment and injury to urethral sphincter

Urinary retention: it is the accumulation of urine in the bladder associated with inability of the bladder to empty itself

BLADDER IRRIGATION
INSERTION OF A FLATUS TUBE
USE OF URINAL
CATHETERIZATION OF THE URINARY BLADDER
URINARY ELIMINATION - COMMON URINARY PROBLEMS - Definition, Physiology, Factors, Diagnostic Examination, Prerenal, Renal, Post renal - conditions, Role of Nurse
URINARY ELIMINATION – COMMON URINARY PROBLEMS – Definition, Physiology, Factors, Diagnostic Examination, Prerenal, Renal, Post renal – conditions, Role of Nurse

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