Lesson 5e
Urinary
Elimination
Anatomy of Kidney
Nephron-Functional
unit of kidney, forms
urine
Each kidney has 1
million nephrons
Nephron composed of
glomerulus, Bowman’s
capsule, proximal
convoluted tubule, loop
of Henle, distal tubule,
& collecting tubule
Physiology of Urine
Formation
Normalglomerular function- Urine formation starts at
glomerulus where blood is filtered
GFR-(Glomerular filtration rate)- amt of blood filtered by
glomeruli in a given time
NormalGFR- 125ml/minute, however only 1 ml per minute
becomes urine, most is reabsorbed
Normal 24 hr urine output is 1500-1600ml
Urethra
Urine travels from the
bladder through the urethra
& passes outside the body
through the urethral meatus
Lined by mucus membranes,
bacteriostatic, forms mucus
plug
Women-1.5-2.5 inches long,
external sphincter allows
voluntary flow of urine,
prone to infection
Urethra
Men-Urethra is both a urinary canal and a
passageway for secretions form
reproductive organs
20cm in length
Selected Urinary Problems
• Polyuria
Production of abnormally large amounts of urine by the kidneys,
often several liters more than the client’s usual daily output.
• Oliguria
low urine output usually less than 500 ml a day or 30 ml per hour
for an adult
• Anuria
lack of urine output
• Urinary Frequency
is voiding at frequent intervals, that is more than 4 to 6 times per
day.
• Nocturia
voiding 2 or more times at night.
Selected Urinary Problems
• Urgency
the sudden strong desire to void.
• Dysuria
voiding that is either painful or difficult
• Urinary hesitancy
associated with dysuria, a delay & difficulty in initiating
voiding
• Enuresis
Involuntary urination in children beyond the age when
voluntary bladder control is normally acquired, usually 4 or 5
years of age
Act of Urination
Controlled by brain
Coordination
of cerebral cortex,
thalamus, hypothalamus, & brain stem
Suppress contraction of bladder’s
detrusor until person is ready to void
Bladder normally holds as much as 600
ml of urine
Desireto void is felt(sensed) when
bladder contains a smaller amount
(150-200ml in adult)
Asbladder volume increases, bladder
walls stretch, sending sensory impulses
to micturition center in sacral spinal
cord
Act of Urination
Parasympathetic impulses
from the micturition
center stimulate detrusor
muscle to contract
Internal sphincter relaxes
so urine can enter urethra
As bladder contracts,
nerve impulses travel up
spinal cord to the cerebral
cortex, now you are aware
of the urge to void
Factors Influencing
Urination
Disease
Growth & Development
Socio-cultural factors
Psychological Factors
Muscle Tone
Fluid Balance
Surgery
Medications
Dialysis
Peritoneal-Indirect
method of cleansing
blood of waste
products using the
process of osmosis
and diffusion
Hemodialysis-
machine process
utilizes osmosis,
diffusion, &
ultrafiltration
through a vascular
graft (Udall,
TESIO, Permcath,
Shiley)
UTI Symptoms
Pain or burning on urination (dysuria)
Fever, chills, n/v, malaise (later signs)
Hematuria-irritation of bladder & urethral mucosa
resulting in blood-tinged urine
Pyelonephritis-infection spreads up to kidney-
flank pain, fever
Nursing Process
Alterations in Urinary Function
Assessment: Nursing history
Physical Assessment-inspection,
percussion, palpation
Assessment of Urine- color, clarity,
odor
Urine testing & specimen collection
Diagnostic tests: KUB, IVP, renal
ultrasound, renal CT scan
Urine Specimen Collection
Random
Clean-voided or midstream
Sterile
Timed specimens (24 hour collection)
Urine Testing
Uninalysis
Specific Gravity
Urine Culture
Characteristics of Urine
Characteristic Normal Abnormal
Amt in 24 hrs 1,200-1,500 ml > Or <
Color, Clarity Straw, amber Dark amber, Cloudy,
Transparent Dark orange, Red or
dark brown
Odor Faint aromatic Offensive
Sterility No mcroorganisms Microorganisms present
present
pH 4.5-8 Over 8, under 4.5
Specific gravity 1.010-1.025 Over 1.025
Under 1.010
Characteristics of Urine
Characteristic Normal Abnormal
Glucose Not present Present
Ketone Bodies Not present Present
(acetone)
Blood Not present Occult
(microscopic)
Bright red
Nursing Diagnosis
Incontinence
Self-Care deficit
Skin Integrity
Altered Urinary Elimination
Pain
Body Image Disturbance
Implementation
Promoting Normal Micturition
Medications
Catheterization (Indwelling vs. straight)
Routine Catheter Care/Perineal Care
External Urinary Cathethers (Condom
caths)
Female Urinals
Maintaining Skin Integrity
Preventing Infection
Last Updated: April 1, 2005
Foley catheter
Illustration copyright 2004 Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.com
An indwelling Foley catheter remains in place continuously. To keep the catheter from slipping out, there is a balloon on one end that is inflated with sterile water once that end is inside
the bladder.
Medical Review: Adam Husney, MD - Family Medicine
Nancy Greenwald, MD - Physical Medicine and Rehabilitation
Last Updated: April 1, 2005
Clicker Question
A young girl is having problems urinating
postoperatively. You remember that children may
have trouble voiding:
A. In bathrooms other than their own
B. In a urinal
C. While lying in bed
D. In the presence of person other than their
parents
45 - 31
Clicker Question
1. A client with long-standing history of
diabetes mellitus is voicing concerns about
kidney disease. The client asks the nurse where
urine is formed in the kidney. The nurse’s
response is the:
A. Glomerulus
B. Kidney
C. Nephron
D. Ureter
45 - 32
Clicker Question
A health care provider may suspect that a client
is experiencing urinary retention when the client
has:
A. Large amounts of voided cloudy urine
B. Pain in the lower abdomen
C. Small amounts of urine voided 2 to 3 times
per hour
D. Pain during urination
45 - 33
