Lecture Notes on Urinary Elimination

Introduction

• Focus on urinary elimination, covered in Chapter 30 of the fundamentals book.
• Corresponds to Module K of Unit 1 in the nursing syllabus.

Components of the Urinary System

• Major Components:
  • Kidneys
  • Ureters
  • Bladder
  • Urethra
• Accessory Structures:
  • Internal and external sphincters

Urinary Elimination Process

• Excess fluids and metabolic wastes are released.
• Normal elimination: 1500 to 3000 ml of urine per day.
• Importance of checking urinary system function during nursing shifts.

Kidney Function

• Kidneys filter the entire blood volume every 30 minutes.
• Nephron: basic functional unit of the kidney, about a million per kidney.
• Functions diminish with age and health conditions.
• Dialysis acts as an artificial kidney.

Urine Formation

• Processes Involved:
  • Filtration by glomerulus
  • Tubular reabsorption and secretion

Anatomy of the Kidneys

• Bean-shaped, located in the back of the upper abdomen.
• Each kidney has up to 18 lobes, composed of nephrons.
• Glomerulus:
  • High-pressure capillary network for filtering blood.
  • Encased in Bowman's capsule.
• Tubular System:
  • Proximal convoluted tubule
  • Loop of Henle
  • Distal convoluted tubule
  • Collecting tubule

Blood Supply

• Blood supply via renal artery, branches into segmental and interlobular arteries.
• Blood flow regulation via afferent and efferent arterioles.

Urine Characteristics Assessment

• COCA: Color, Odor, Clarity, Amount.
• Normal volume: 500 to 3000 ml/day.
• Color: Light yellow; darker indicates possible issues.
• Clarity: Should be transparent; cloudiness could indicate infection.
• Odor: Normally faintly aromatic; strong or foul odors indicate issues.

Factors Affecting Urinary Elimination

• Physiological, emotional, and social factors.
• Examples include paralysis, stress, anxiety, and embarrassment.

Promoting Urinary Elimination

• Provide privacy and normal positioning.
• Adequate fluid intake.
• Techniques to stimulate urination (e.g., running water).

Dehydration and Fluid Overload

• Kidneys adjust urine concentration based on body fluid status.
• Alcohol acts as a diuretic by inhibiting ADH.

Collecting Urine Specimens

• Types:
  • Voided specimens
  • Clean-catch specimens
  • 24-hour urine collection
• Proper technique and handling are crucial to avoid contamination.

Abnormal Urine Characteristics

• Hematuria: Blood in urine.
• Pyuria: Pus in urine.
• Proteinuria: Excess proteins in urine.
• Glycosuria: Glucose in urine.
• Ketonuria: Ketones in urine.

Lab Considerations

• Specific gravity, pH, creatinine, BUN, GFR.
• Indicators of kidney function.

Urinary Disorders

• Anuria: Absence of urine.
• Urinary Retention: Inability to release urine.
• Enuresis: Incontinence beyond toilet training age.
• Oliguria: Low urine output.
• Polyuria: Excessive urine production.
• Nocturia: Nighttime urination.

Urinary Incontinence Types

• Stress Incontinence: Due to weak pelvic muscles.
• Urge Incontinence: Sudden need to urinate.
• Reflex Incontinence: Lack of sensation leads to urine release.
• Functional Incontinence: Inability to reach toilet in time.
• Total Incontinence: Continuous loss of urine.
• Overflow Incontinence: Leakage due to full bladder.

Management of Incontinence

• Scheduled voiding, pelvic floor exercises, dietary changes.
• Use of devices like commodes and urinals.

Catheterization

• Types:
  • Indwelling (Foley)
  • Straight catheter
  • Suprapubic catheter
• Proper techniques to avoid infection.

Urinary Diversions

• Urostomy: Urinary tract diversion to skin surface.
• Types include ileal conduit, nephrostomy, and others.

Conclusion

• Importance of maintaining urinary system health.
• Proper handling and assessment techniques to ensure patient safety.

If any questions arise, consult further resources or contact your instructor for clarification.