Urinary Elimination Overview

Good day students! You may find yourself exhausted, anxious, or confused nowadays, but know that you will pass through this and everything you do and give will be credited to you. Be proud of yourself. Today is another day of learning, but before our lecture proper, allow me to start this class with a prayer. So let us put ourselves in the presence of the Lord in the name of the Father and of the Son and of the Holy Spirit. Lord and Father of all, thank you for today. Thank you for ways in which you provide for us. For your protection and love, we thank you. Help us to focus our hearts and minds now on what we are about to learn. Inspire us by your Holy Spirit as we listen. and right. Guide us by your eternal light as we discover more about the world around us. We ask this in the name of Jesus. Amen. In the name of the Father and of the Son and of the Holy Spirit. Amen. Once again, my dear students, a very pleasant morning, afternoon, and evening to you. Whichever time you chose to partake in this class, I always hope that you are safe. Our topic in this lecture is called the window to our overall health. The end product is 95% water and is actually sterile. Ancient Roman doctors support that it can actually whiten the teeth. So students, good luck finding the courage to use and to swish it over your mouth and this is called urine or in other terms p and we will be discussing about urinary elimination so to start with our lesson let us get to know the learning outcomes for the topic urinary elimination So our learning outcomes are the following. 1. Describe the process of urination from urine formation through micturition. 2. Identify factors that influence urinary elimination. 3. Identify common causes of selected urinary problems. Number four. Identify normal and abnormal characteristics and constituents of urine. And number five, develop nursing diagnosis and desired outcomes related to urinary elimination and to maintain normal urinary elimination, prevent urinary tract infection, and manage urinary incontinence. So that's a lot of urinary. Elimination from the urinary tract is usually taken for granted. So only when a problem arises do most people become aware of their urinary habits and any associated symptoms. So students, remember that the most important and effective measure in preventing urinary infection is actually increasing oral fluid intake or water one liter to two liters. two liters per day so this is a preventive measure so for cases that we experience pain on urination or we see blood upon urination of course that is just the only time we seek and consult a doctor so only when we experience something out of the unusual urinary elimination is essential to health Voiding can be postponed for only so long before the urge normally becomes too great to control. Students, remember that a person's urinary habits depend on social culture, person's habits, and physical abilities. Personal habits regarding urination are affected by the social politeness of leaving to urinate, the availability of a private clean facility, initial bladder training so I think you can agree on this with me students that it is very important that a clean facility is available. The physiology of urinary elimination depends on the effective functioning of the following. First, we have the upper urinary tract which includes the kidneys and the ureters. Second is the lower urinary tract which includes the bladder, urethra, and pelvic floor. And of course, there are two other systems that involve in the physiology of urinary elimination, which are the cardiovascular system and the nervous system. So in this slide, students, you will see an overview of the anatomic structures of the urinary tract. This will be further discussed in your anatomy and physiology. But for now, I will just give you an overview of the structures. Of course, first are the kidneys, so left and the right. Above the kidneys, you can find the adrenal gland. Attached to the kidneys, there are two ureters. So we will get to know them again later. Also, one more important structure is the orifice. course the bladder where the urine is stored and the urethra so again this will be discussed further in your anatomy and physiology so students on the next slide you will be an audio video presentation in relation to the anatomic structures of the urinary tract if in case there will be no video link is attached on the instruction box you may refer to the link This video is very informative, so I encourage everybody to take down notes. Human Urinary System The kidneys are a pair of bean-shaped organs that are part of the urinary system. The kidneys are dark red, slightly flattened, bean-shaped organs. Each about 10 cm long, 5 cm wide and 2 to 3 cm thick with an average weight of 120 to 170 g. The other components of this system are the ureters, urinary bladder and the urethra. One of the main jobs of the kidney is to filter. the waste out of the blood. The urinary system regulates the quantity and composition of fluids by removing metabolic wastes from our body. The system helps in retaining proper amounts of water, salts and nutrients in the body. The kidneys are placed against the back wall of the abdominal cavity just below the diaphragm. on either side of the vertebral column. Their position is slightly asymmetrical. The left kidney is placed a little higher than the right. The outer surface of a kidney is convex and the inner surface is concave. The inner surface has a deep notch. Here you can see the ureter, renal artery and renal vein. entering the kidney through this notch. A fibrous capsule surrounds the kidney. Inside the kidney, there are two zones, the cortex and the medulla. The cortex is a reddish-brown layer of tissue below the capsule, whereas medulla is a form of pale conical-shaped striations. The main function of the kidneys is to remove you waste products and excess water from the blood. The kidney does it with the help of tiny filters present in it. These filters are called nephrons. The cortex and medulla together comprise millions of such nephrons, all packed together. The nephron is the structural and functional unit of a kidney. Each nephron consists of a renal corpuscle and a renal tubule. A renal corpuscle is is composed of two structures, a tangled cluster of blood capillaries called glomerulus and a thin walled sac-like structure called the Bowman's capsule which surrounds the glomerulus. The glomerulus is actually a miniature filtering or sieving device which consists of a tightly coiled network of capillaries. Waste is filtered from the blood and collected as urine. Healthy kidneys act like a strong filter to make sure the right amount of wastes and fluids are removed from our body. As each kidney makes urine, the urine slides down through a long tube called ureter. Ureters from both the kidneys open into a storage sac. known as urinary bladder here urine is stored until the bladder is emptied by urinating the bladder is connected to another tube like structure called the urethra for the removal of urine out of the body every day our kidneys process around 200 liters of blood and around 1 to 2 liters of waste is removed as urine. So there you go students you have learned about the physiology of urinary elimination, the process of maturation, and the end product which is the urine. So allow me to include some pointers to remember. First we have nephron. So nephrons are a functional unit of the kidney and this is where urine is formed. Glomerulus fluids and solutes move across endothelium of capillaries into the capsule. Baumann's or Baumann's capsule, this is where filtrate moves from here into the tubules of the nephron. proximal convoluted tubule Most of water and electrolytes are absorbed. So in this slide, presenting the figure 48-2, I would just like to reiterate that again, the nephrons are the functional unit of the kidneys. And actually, it has six parts, as discussed in the previous slide. So the glomerulus, the Baumann's capsule, the proximal convoluted tubule, the loop of Henle. distal cumulated tubule, and the collecting dog, which again will be discussed further in your anatomy and physiology. So, in addition to the parts of the urinary tract that we have already discussed are the following. Ureters. They are 25 to 30 cm long and 1.25 cm in diameter. The upper end funnel shape enters the kidney. while the lower end enters the bladder at the posterior corners. Also, we have the bladder, which is a hollow organ serving as a reservoir for urine. So basically, the bladder is where we store urine for a certain period of time. Urethra, it extends from the bladder to the meatus. And last, we have the pelvic floor. This includes the vagina, the urethra, and rectum. And now we will discuss the process. It's actually called urination, also known as micturition and voiding. This refers to the process of emptying the bladder. The urge to void happens when an adult bladder contains 250 to 450 ml of urine Thank you. And in children, 50 to 200 ml of urine. So I have a question, students. Do you believe or would you agree that in one urination, the bladder will be fully emptied? The answer is no. So it will be discussed later on. So older adults whose cognition is impaired. may not be aware of the need to urinate or able to respond to this urge by seeking toilet facility so of course to those of you who has lolos already or lolas or anybody who has problem with their urinary elimination of course this happens to them so we call them urinary incontinence we're in mostly older adults does not feel or does not identify that they have the urge to void instead freely voids so I'm sure those of you who has lolas and lolas who have urinary incontinence you are well aware of this. In relation to the slide that we have discussed previously, we will now discuss the factors that affect micturition or urination. So actually we have seven factors and the first are developmental factors. So first are infants. Infants urinate more or less 20 times a day. So students remember that urine out... actually varies according to the fluid intake but gradually this increases to 250 to 500 ml a day during the first year remember always that the urine of the neonate is colorless and other less why is this so do you have something in mind students well it is because newborns have immature kidneys they are unable to concentrate urine very effectively. Infants are born without control, so most infants will develop this between ages 2 to 5 years old, wherein control during the daytime normally precedes nighttime control. Next are preschoolers. This is the stage that we develop or encourage independent toileting. At this stage, the child is actually taught to wipe from front to back to prevent infection so up until now students you are being taught about this so parents need to realize that accidents do occur and the child should never be punished for this children often forget to wash their hands and flush the toilet and needs instructions in wiping themselves just remember to always allow the child to do this on her or his own and be patient so as parents it is encouraged to not do this or to not um do it for the child instead to allow the child to do it for himself so the key there as parents in the near future students is to just be patient so this is a crucial stage next are school-aged children. At this stage, the child's elimination system reaches maturity. The kidney doubles in size between 5 and 10 years old. So the child urinates 6 to 8 times a day. We have here a term called enuresis or the involuntary passing of urine. And one example is nocturnal enuresis which is Also known to us as bedwetting. It is the involuntary passing of urine during sleep. So since control should have been established at age 5, and some problems occur for some, for some only school-aged children. So they cannot control. Sometimes, mostly actually, sorry, this happens during the night. But of course, course there are instances that and uresis also happens in the morning I'm not sure if somebody here experienced this when they were where five to ten years old so about 10% of all six year old experience difficulty of controlling bladder so the key to this is constant practice and patience to the parents and bladder timing. At certain point, inform the parents to allow the child to urinate before going to bed, wake the child in the middle of the night and upon waking up so to establish bladder control and timing. It is as many causes but basically because the client fails to awaken when the bladder empties. So that's it. Last are older adults. respiratory function decreases of course you are well aware older adults arise during the night to void which is what we call nocturnal frequency and retention of residual urine predisposing to bladder infections so second factor that affects voiding are psychosocial factors so set conditions like privacy normal conditions sufficient time in running water helps stimulate the micturition reflex voluntary suppression of urination due to time pressure may also increase urinary tract infection so one example would be nurses so i can say that it's a normal habit for nurses to actually suppress urination because of factors like um trying to complete the tasks or responsibilities that we need to do throughout the day and of course pressure and maybe the thought that we are busy so we tend to forget to actually take care of ourselves Second factor are fluid and food intake. So healthy body maintains a balance between the amount of fluid ingested and the amount of fluid eliminated. So bear in mind students that when the amount of fluid intake increases, the output normally increases. So the problem would arise if you have Increased oral fluid intake but you have decreased output or the other way around. You have decreased fluid intake but the output is more than your fluid intake. So maybe there's leakage in the cells if that happens. So fluids such as alcohol and caffeine increases urine production while sodium-rich foods and fluids cause Retention, of course, because of sodium reabsorption. Fourth factor are medications. So those affecting the autonomic nervous system interfere with normal urination process and causes retention. Medication such as diuretics increases urine formation by preventing reabsorption of water and electrolytes fifth factor are is muscle tone so remember children that good muscle tone maintains the stretch and contractility of the trusor muscle so bladder can fill and empty completely so if you have a loss of muscle tone this is where urinary incontinence comes or happens. The sixth factor is pathologic condition. So we have four. We identified four here. First are diseases of the kidneys. So this affects the ability of the nephrons, which is the functional unit of the kidney, to produce urine. Second, we have heart and circulatory disorders. So this affects blood flow, of course, interfering with urine production. We also have urine stones. Of course, this obstructs the ureter. And last, we have the hypertrophy of the prostate gland, which obstructs the urethra. Last, we have surgical and diagnostic procedures. So we have identified three. One is cystoscopy, or this results to the swelling of the urethra. Another is surgery, so post-operative bleeding, turning the urine pink or red. Actually, there are also medications that can turn the urine pink or red. And I... It's rifampicin, a medication that is given for anti-TB. It's an anti-TB drug. It's given for tuberculosis. And last, we have spinal anesthetics. This decreases awareness of need to void. That's why for mothers who underwent cesarean section, of course, they were given spinal anesthetics. So um it is sorry um foley catheter is actually used when you undergo cesarean section because of this of this rationale that it decreases awareness of the need to void. Next, we will be discussing about alterations in urine production. So there are many actually, but we will be discussing three. So first is polyuria or diuresis. It's the production of abnormally large amounts of urine by the kidneys. So in relation to this is polydipsia or the excessive fluid intake that results to polyuria another is oliguria oliguria is the low urine output which is less than 500 ml a day and anuria is the lack of urine production so when you say students poly it simply means many if it's only it's low if and it means it lacks So those are just some of the terms you need to understand because aside from urine, you will also encounter a lot of poly, a lot of oly, and a lot of an. So we have discussed about alterations in urine production. So now we will discuss about alterations in urinary elimination. So first we have frequency. It is the voiding at frequent intervals more than four to six times per day. So what I have been mentioning to you students that increase in oral fluid intake means increase in elimination. Doctoria, it is the voiding of two or more times at night. So this happens to our older adults. Urgency, it is the sudden strong desire to void. Dysphoria. From the word die, meaning difficulty. So it is the voiding that is either painful or difficult. So difficulty in urination. Enuresis. We've discussed this earlier as one of the factors under development. Developmental factors, I mean. It is the involuntary urination in children when voluntary bladder control is normally acquired. Usually 4 to 5 years of age. Second to the last, we have urinary retention. It is the accumulation of urine and over-distension of the bladder caused by impairment in the emptying capacity of the bladder. In other terms, a full bladder. Lastly, we have urinary incontinence. It is the involuntary leakage of urine or loss of bladder. So we have four. We have stress urinary incontinence. This occurs due to the weak pelvic floor muscles causing urine leakage when laughing, coughing, sneezing, etc. We also have urge urinary incontinence or the sudden if you can remember it. in the previous slide it is the urgent need to void and the inability to stop micturition so one factor here is of course um full bladder already you you already have a full bladder so mixed urinary incontinence of course it is a mixture of stress urinary incontinence and urgency urinary incontinence Lastly, we have overflow incontinence. It is a continuous involuntary leakage or dribbling of urine resulting to incomplete bladder and team. So in this slide, we will be discussing an overview about the characteristics of normal and abnormal urine. Actually, we have two slides for this. And in this slide, we will be discussing four. First character. is the amount in 24 hours. So for normal individuals, it is expected to have 1,200 to 1,500 ml of urine, while abnormal individuals will have under 1,200 ml. But also let's put to consideration against students, as what I've mentioned, that increased oral fluid intake results in increased elimination. So a nursing consideration for this is of course to increase again oral fluid intake. For color and clarity. Normal, straw, and amber, and transparent. For abnormal, we have dark amber, cloudy, dark orange, red, or dark brown, buccal splugs. So for cloudy-colored urine, of course, this is an indication of infection. For red or dark brown, so actually this is an indication of hematuria or blood, sorry. blood in the urine but of course for women it is expected that monthly we have menstruation so please do not confuse yourself with this so it's different for odor normal is faint aromatic while abnormal is of course offensive but take note students that there are also food that may affect the order of urine for example asparagus may cause a musty odor and urine high in glucose so those of you who likes to eat sweets it is expected that your urine output will have a sweet odor for sterility normally it is expected that no microorganisms will be present for abnormal Of course, there is presence of microorganisms. So you will see this abnormal finding for urinary tract infections. So always remember, students, that urine in the bladder is always sterile. That's why it is expected that there are no microorganisms. So sometimes when we collect urine or when we teach our patients to collect urine, We ask them to urinate first midstream and then in the middle of the urination that is the time that they should collect their urine for laboratory testing further characteristics involves pH normal pH is 4.5 to 8 while abnormal pH is over 8 and under 4.5 For specific gravity, normal is 1.010 to 1.025 while abnormal will be over 1.025 and under 1.010. Glucose. Glucose should not be present in urine. So if it is present, it is an abnormal finding and actually it is an indication of diabetes mellitus. Ketones, bodies, or acetone, it should not be present also in urine because if it is present, it is an indication of one of the complications of diabetes mellitus or mellitus. Ketones in the urine could be an indication of diabetic ketoacidosis. for blood It is not normal that blood is present in urine except for women who has menstruation. And that's why it is abnormal if it is present. So in this slide, you will see normal urine and abnormal urine. For normal urine here, as you can see, it is here. While abnormal urine, of course, this one indicates kidney failure. This indicates hematuria. And this is cloudy urine, which indicates infection in the urine. Furthermore, let's discuss urine color chart. So we have six here. For brown urine, it is indicative actually that The client is taking antibiotics such as metronidazole. So a brown urine is a side effect of this antibiotic. And also those who are taking over-the-counter laxatives, which specifically Sena. For light brown urine, this may be indicative of kidney failure, students. And also muscle breakdown from extreme exercise also can cause a light brown urine. for orange urine as what i've said one of the factors will be medication so if you are taking vitamin c um this your urine can turn orange and also for antibiotics as what i've mentioned rifampicin it could turn your urine into orange or red actually and mind you for those orange urine it it may be also an indication of liver disease so it it may be normal it may be normal so it would really depend fourth is a red or pink urine so this could be indicative of blood so hematuria or It may be possible that your client or your patient just took beads or berries that turned his or her urine into paint. We have blue-green urine. It could be also a side effect of medications such as propofol or indomethacin, which are antibiotics also. And lastly, of course, cloudy urine, as what we've mentioned. indicative of urinary tract infection. So what are the possible nursing diagnosis for urinary elimination? So we have impaired urinary elimination, readiness for enhanced urinary elimination, functional urinary incontinence, overflow urinary incontinence, reflex urinary incontinence. So there are also nursing diagnoses for problems indicative of urinary elimination. We have disturbed body image, deficient knowledge, risk for caregiver role strain, and risk for social isolation. So I encourage you students to read more on possible nursing diagnoses. So what are the nursing interventions? So first, maintain normal urinary elimination. So promoting fluid intake. So increase oral fluid intake, one liter to two liters per day. Maintaining normal voiding habits. Assisting with toileting. Number two, preventing urinary tract infection. So you drink eight eight ounce glasses of water per day Practice frequent voiding every two to four hours. Avoid harsh soaps, bubble baths, powder or sprays in the perennial area. Avoid tight-fitting clothing and wear cotton, not nylon, under clothes. And so, dear students, I want to leave this quote to you. Healthy is an outfit that looks different on everybody. So remember that your perception of healthy may not be actually a healthy person. And your perception of a not healthy person may actually be a healthy person. So it really depends. So we do not judge a healthy person based from our own perceptions. So that's the end of this audio video lecture. If you have honestly reached this end of the video, I have a bonus question for you. If you get the answer correctly, you will have the chance to get one bonus point to be credited in your quiz under urinary elimination. Are you ready? The question is, what is the content in the urine that is found to whiten teeth? Again, what is the content in the urine that is found to whiten teeth. So please send me your answers in my Hangout. I have indicated it in the message before this audio-video presentation. And indicate your section and wait for the lucky student upon selection using Snowball method. So thank you students for listening and actually reaching this end of the slide. Thank you again and good luck everybody.

Lord and Father of all, thank you for today. Thank you for ways in which you provide for us. For your protection and love, we thank you.

Help us to focus our hearts and minds now on what we are about to learn. Inspire us by your Holy Spirit as we listen. and right.

Guide us by your eternal light as we discover more about the world around us. We ask this in the name of Jesus. Amen. In the name of the Father and of the Son and of the Holy Spirit.

Amen. Once again, my dear students, a very pleasant morning, afternoon, and evening to you. Whichever time you chose to partake in this class, I always hope that you are safe. Our topic in this lecture is called the window to our overall health. The end product is 95% water and is actually sterile.

Ancient Roman doctors support that it can actually whiten the teeth. So students, good luck finding the courage to use and to swish it over your mouth and this is called urine or in other terms p and we will be discussing about urinary elimination so to start with our lesson let us get to know the learning outcomes for the topic urinary elimination So our learning outcomes are the following. 1. Describe the process of urination from urine formation through micturition. 2. Identify factors that influence urinary elimination.

3. Identify common causes of selected urinary problems. Number four. Identify normal and abnormal characteristics and constituents of urine. And number five, develop nursing diagnosis and desired outcomes related to urinary elimination and to maintain normal urinary elimination, prevent urinary tract infection, and manage urinary incontinence. So that's a lot of urinary.

Elimination from the urinary tract is usually taken for granted. So only when a problem arises do most people become aware of their urinary habits and any associated symptoms. So students, remember that the most important and effective measure in preventing urinary infection is actually increasing oral fluid intake or water one liter to two liters.

two liters per day so this is a preventive measure so for cases that we experience pain on urination or we see blood upon urination of course that is just the only time we seek and consult a doctor so only when we experience something out of the unusual urinary elimination is essential to health Voiding can be postponed for only so long before the urge normally becomes too great to control. Students, remember that a person's urinary habits depend on social culture, person's habits, and physical abilities. Personal habits regarding urination are affected by the social politeness of leaving to urinate, the availability of a private clean facility, initial bladder training so I think you can agree on this with me students that it is very important that a clean facility is available. The physiology of urinary elimination depends on the effective functioning of the following. First, we have the upper urinary tract which includes the kidneys and the ureters.

Second is the lower urinary tract which includes the bladder, urethra, and pelvic floor. And of course, there are two other systems that involve in the physiology of urinary elimination, which are the cardiovascular system and the nervous system. So in this slide, students, you will see an overview of the anatomic structures of the urinary tract. This will be further discussed in your anatomy and physiology. But for now, I will just give you an overview of the structures.

Of course, first are the kidneys, so left and the right. Above the kidneys, you can find the adrenal gland. Attached to the kidneys, there are two ureters. So we will get to know them again later. Also, one more important structure is the orifice.

course the bladder where the urine is stored and the urethra so again this will be discussed further in your anatomy and physiology so students on the next slide you will be an audio video presentation in relation to the anatomic structures of the urinary tract if in case there will be no video link is attached on the instruction box you may refer to the link This video is very informative, so I encourage everybody to take down notes. Human Urinary System The kidneys are a pair of bean-shaped organs that are part of the urinary system. The kidneys are dark red, slightly flattened, bean-shaped organs. Each about 10 cm long, 5 cm wide and 2 to 3 cm thick with an average weight of 120 to 170 g. The other components of this system are the ureters, urinary bladder and the urethra.

One of the main jobs of the kidney is to filter. the waste out of the blood. The urinary system regulates the quantity and composition of fluids by removing metabolic wastes from our body.

The system helps in retaining proper amounts of water, salts and nutrients in the body. The kidneys are placed against the back wall of the abdominal cavity just below the diaphragm. on either side of the vertebral column. Their position is slightly asymmetrical. The left kidney is placed a little higher than the right.

The outer surface of a kidney is convex and the inner surface is concave. The inner surface has a deep notch. Here you can see the ureter, renal artery and renal vein.

entering the kidney through this notch. A fibrous capsule surrounds the kidney. Inside the kidney, there are two zones, the cortex and the medulla.

The cortex is a reddish-brown layer of tissue below the capsule, whereas medulla is a form of pale conical-shaped striations. The main function of the kidneys is to remove you waste products and excess water from the blood. The kidney does it with the help of tiny filters present in it.

These filters are called nephrons. The cortex and medulla together comprise millions of such nephrons, all packed together. The nephron is the structural and functional unit of a kidney. Each nephron consists of a renal corpuscle and a renal tubule.

A renal corpuscle is is composed of two structures, a tangled cluster of blood capillaries called glomerulus and a thin walled sac-like structure called the Bowman's capsule which surrounds the glomerulus. The glomerulus is actually a miniature filtering or sieving device which consists of a tightly coiled network of capillaries. Waste is filtered from the blood and collected as urine.

Healthy kidneys act like a strong filter to make sure the right amount of wastes and fluids are removed from our body. As each kidney makes urine, the urine slides down through a long tube called ureter. Ureters from both the kidneys open into a storage sac.

known as urinary bladder here urine is stored until the bladder is emptied by urinating the bladder is connected to another tube like structure called the urethra for the removal of urine out of the body every day our kidneys process around 200 liters of blood and around 1 to 2 liters of waste is removed as urine. So there you go students you have learned about the physiology of urinary elimination, the process of maturation, and the end product which is the urine. So allow me to include some pointers to remember.

First we have nephron. So nephrons are a functional unit of the kidney and this is where urine is formed. Glomerulus fluids and solutes move across endothelium of capillaries into the capsule. Baumann's or Baumann's capsule, this is where filtrate moves from here into the tubules of the nephron.

proximal convoluted tubule Most of water and electrolytes are absorbed. So in this slide, presenting the figure 48-2, I would just like to reiterate that again, the nephrons are the functional unit of the kidneys. And actually, it has six parts, as discussed in the previous slide.

So the glomerulus, the Baumann's capsule, the proximal convoluted tubule, the loop of Henle. distal cumulated tubule, and the collecting dog, which again will be discussed further in your anatomy and physiology. So, in addition to the parts of the urinary tract that we have already discussed are the following.

Ureters. They are 25 to 30 cm long and 1.25 cm in diameter. The upper end funnel shape enters the kidney. while the lower end enters the bladder at the posterior corners.

Also, we have the bladder, which is a hollow organ serving as a reservoir for urine. So basically, the bladder is where we store urine for a certain period of time. Urethra, it extends from the bladder to the meatus.

And last, we have the pelvic floor. This includes the vagina, the urethra, and rectum. And now we will discuss the process. It's actually called urination, also known as micturition and voiding. This refers to the process of emptying the bladder.

The urge to void happens when an adult bladder contains 250 to 450 ml of urine Thank you. And in children, 50 to 200 ml of urine. So I have a question, students. Do you believe or would you agree that in one urination, the bladder will be fully emptied?

The answer is no. So it will be discussed later on. So older adults whose cognition is impaired.

may not be aware of the need to urinate or able to respond to this urge by seeking toilet facility so of course to those of you who has lolos already or lolas or anybody who has problem with their urinary elimination of course this happens to them so we call them urinary incontinence we're in mostly older adults does not feel or does not identify that they have the urge to void instead freely voids so I'm sure those of you who has lolas and lolas who have urinary incontinence you are well aware of this. In relation to the slide that we have discussed previously, we will now discuss the factors that affect micturition or urination. So actually we have seven factors and the first are developmental factors.

So first are infants. Infants urinate more or less 20 times a day. So students remember that urine out...

actually varies according to the fluid intake but gradually this increases to 250 to 500 ml a day during the first year remember always that the urine of the neonate is colorless and other less why is this so do you have something in mind students well it is because newborns have immature kidneys they are unable to concentrate urine very effectively. Infants are born without control, so most infants will develop this between ages 2 to 5 years old, wherein control during the daytime normally precedes nighttime control. Next are preschoolers. This is the stage that we develop or encourage independent toileting. At this stage, the child is actually taught to wipe from front to back to prevent infection so up until now students you are being taught about this so parents need to realize that accidents do occur and the child should never be punished for this children often forget to wash their hands and flush the toilet and needs instructions in wiping themselves just remember to always allow the child to do this on her or his own and be patient so as parents it is encouraged to not do this or to not um do it for the child instead to allow the child to do it for himself so the key there as parents in the near future students is to just be patient so this is a crucial stage next are school-aged children.

At this stage, the child's elimination system reaches maturity. The kidney doubles in size between 5 and 10 years old. So the child urinates 6 to 8 times a day. We have here a term called enuresis or the involuntary passing of urine. And one example is nocturnal enuresis which is Also known to us as bedwetting.

It is the involuntary passing of urine during sleep. So since control should have been established at age 5, and some problems occur for some, for some only school-aged children. So they cannot control.

Sometimes, mostly actually, sorry, this happens during the night. But of course, course there are instances that and uresis also happens in the morning I'm not sure if somebody here experienced this when they were where five to ten years old so about 10% of all six year old experience difficulty of controlling bladder so the key to this is constant practice and patience to the parents and bladder timing. At certain point, inform the parents to allow the child to urinate before going to bed, wake the child in the middle of the night and upon waking up so to establish bladder control and timing. It is as many causes but basically because the client fails to awaken when the bladder empties.

So that's it. Last are older adults. respiratory function decreases of course you are well aware older adults arise during the night to void which is what we call nocturnal frequency and retention of residual urine predisposing to bladder infections so second factor that affects voiding are psychosocial factors so set conditions like privacy normal conditions sufficient time in running water helps stimulate the micturition reflex voluntary suppression of urination due to time pressure may also increase urinary tract infection so one example would be nurses so i can say that it's a normal habit for nurses to actually suppress urination because of factors like um trying to complete the tasks or responsibilities that we need to do throughout the day and of course pressure and maybe the thought that we are busy so we tend to forget to actually take care of ourselves Second factor are fluid and food intake. So healthy body maintains a balance between the amount of fluid ingested and the amount of fluid eliminated.

So bear in mind students that when the amount of fluid intake increases, the output normally increases. So the problem would arise if you have Increased oral fluid intake but you have decreased output or the other way around. You have decreased fluid intake but the output is more than your fluid intake.

So maybe there's leakage in the cells if that happens. So fluids such as alcohol and caffeine increases urine production while sodium-rich foods and fluids cause Retention, of course, because of sodium reabsorption. Fourth factor are medications.

So those affecting the autonomic nervous system interfere with normal urination process and causes retention. Medication such as diuretics increases urine formation by preventing reabsorption of water and electrolytes fifth factor are is muscle tone so remember children that good muscle tone maintains the stretch and contractility of the trusor muscle so bladder can fill and empty completely so if you have a loss of muscle tone this is where urinary incontinence comes or happens. The sixth factor is pathologic condition. So we have four.

We identified four here. First are diseases of the kidneys. So this affects the ability of the nephrons, which is the functional unit of the kidney, to produce urine.

Second, we have heart and circulatory disorders. So this affects blood flow, of course, interfering with urine production. We also have urine stones. Of course, this obstructs the ureter. And last, we have the hypertrophy of the prostate gland, which obstructs the urethra.

Last, we have surgical and diagnostic procedures. So we have identified three. One is cystoscopy, or this results to the swelling of the urethra.

Another is surgery, so post-operative bleeding, turning the urine pink or red. Actually, there are also medications that can turn the urine pink or red. And I... It's rifampicin, a medication that is given for anti-TB.

It's an anti-TB drug. It's given for tuberculosis. And last, we have spinal anesthetics.

This decreases awareness of need to void. That's why for mothers who underwent cesarean section, of course, they were given spinal anesthetics. So um it is sorry um foley catheter is actually used when you undergo cesarean section because of this of this rationale that it decreases awareness of the need to void. Next, we will be discussing about alterations in urine production. So there are many actually, but we will be discussing three.

So first is polyuria or diuresis. It's the production of abnormally large amounts of urine by the kidneys. So in relation to this is polydipsia or the excessive fluid intake that results to polyuria another is oliguria oliguria is the low urine output which is less than 500 ml a day and anuria is the lack of urine production so when you say students poly it simply means many if it's only it's low if and it means it lacks So those are just some of the terms you need to understand because aside from urine, you will also encounter a lot of poly, a lot of oly, and a lot of an.

So we have discussed about alterations in urine production. So now we will discuss about alterations in urinary elimination. So first we have frequency. It is the voiding at frequent intervals more than four to six times per day. So what I have been mentioning to you students that increase in oral fluid intake means increase in elimination.

Doctoria, it is the voiding of two or more times at night. So this happens to our older adults. Urgency, it is the sudden strong desire to void.

Dysphoria. From the word die, meaning difficulty. So it is the voiding that is either painful or difficult. So difficulty in urination.

Enuresis. We've discussed this earlier as one of the factors under development. Developmental factors, I mean. It is the involuntary urination in children when voluntary bladder control is normally acquired.

Usually 4 to 5 years of age. Second to the last, we have urinary retention. It is the accumulation of urine and over-distension of the bladder caused by impairment in the emptying capacity of the bladder. In other terms, a full bladder. Lastly, we have urinary incontinence.

It is the involuntary leakage of urine or loss of bladder. So we have four. We have stress urinary incontinence.

This occurs due to the weak pelvic floor muscles causing urine leakage when laughing, coughing, sneezing, etc. We also have urge urinary incontinence or the sudden if you can remember it. in the previous slide it is the urgent need to void and the inability to stop micturition so one factor here is of course um full bladder already you you already have a full bladder so mixed urinary incontinence of course it is a mixture of stress urinary incontinence and urgency urinary incontinence Lastly, we have overflow incontinence. It is a continuous involuntary leakage or dribbling of urine resulting to incomplete bladder and team.

So in this slide, we will be discussing an overview about the characteristics of normal and abnormal urine. Actually, we have two slides for this. And in this slide, we will be discussing four. First character.

is the amount in 24 hours. So for normal individuals, it is expected to have 1,200 to 1,500 ml of urine, while abnormal individuals will have under 1,200 ml. But also let's put to consideration against students, as what I've mentioned, that increased oral fluid intake results in increased elimination.

So a nursing consideration for this is of course to increase again oral fluid intake. For color and clarity. Normal, straw, and amber, and transparent.

For abnormal, we have dark amber, cloudy, dark orange, red, or dark brown, buccal splugs. So for cloudy-colored urine, of course, this is an indication of infection. For red or dark brown, so actually this is an indication of hematuria or blood, sorry. blood in the urine but of course for women it is expected that monthly we have menstruation so please do not confuse yourself with this so it's different for odor normal is faint aromatic while abnormal is of course offensive but take note students that there are also food that may affect the order of urine for example asparagus may cause a musty odor and urine high in glucose so those of you who likes to eat sweets it is expected that your urine output will have a sweet odor for sterility normally it is expected that no microorganisms will be present for abnormal Of course, there is presence of microorganisms.

So you will see this abnormal finding for urinary tract infections. So always remember, students, that urine in the bladder is always sterile. That's why it is expected that there are no microorganisms.

So sometimes when we collect urine or when we teach our patients to collect urine, We ask them to urinate first midstream and then in the middle of the urination that is the time that they should collect their urine for laboratory testing further characteristics involves pH normal pH is 4.5 to 8 while abnormal pH is over 8 and under 4.5 For specific gravity, normal is 1.010 to 1.025 while abnormal will be over 1.025 and under 1.010. Glucose. Glucose should not be present in urine. So if it is present, it is an abnormal finding and actually it is an indication of diabetes mellitus.

Ketones, bodies, or acetone, it should not be present also in urine because if it is present, it is an indication of one of the complications of diabetes mellitus or mellitus. Ketones in the urine could be an indication of diabetic ketoacidosis. for blood It is not normal that blood is present in urine except for women who has menstruation. And that's why it is abnormal if it is present.

So in this slide, you will see normal urine and abnormal urine. For normal urine here, as you can see, it is here. While abnormal urine, of course, this one indicates kidney failure. This indicates hematuria. And this is cloudy urine, which indicates infection in the urine.

Furthermore, let's discuss urine color chart. So we have six here. For brown urine, it is indicative actually that The client is taking antibiotics such as metronidazole.

So a brown urine is a side effect of this antibiotic. And also those who are taking over-the-counter laxatives, which specifically Sena. For light brown urine, this may be indicative of kidney failure, students.

And also muscle breakdown from extreme exercise also can cause a light brown urine. for orange urine as what i've said one of the factors will be medication so if you are taking vitamin c um this your urine can turn orange and also for antibiotics as what i've mentioned rifampicin it could turn your urine into orange or red actually and mind you for those orange urine it it may be also an indication of liver disease so it it may be normal it may be normal so it would really depend fourth is a red or pink urine so this could be indicative of blood so hematuria or It may be possible that your client or your patient just took beads or berries that turned his or her urine into paint. We have blue-green urine. It could be also a side effect of medications such as propofol or indomethacin, which are antibiotics also.

And lastly, of course, cloudy urine, as what we've mentioned. indicative of urinary tract infection. So what are the possible nursing diagnosis for urinary elimination? So we have impaired urinary elimination, readiness for enhanced urinary elimination, functional urinary incontinence, overflow urinary incontinence, reflex urinary incontinence.

So there are also nursing diagnoses for problems indicative of urinary elimination. We have disturbed body image, deficient knowledge, risk for caregiver role strain, and risk for social isolation. So I encourage you students to read more on possible nursing diagnoses.

So what are the nursing interventions? So first, maintain normal urinary elimination. So promoting fluid intake.

So increase oral fluid intake, one liter to two liters per day. Maintaining normal voiding habits. Assisting with toileting.

Number two, preventing urinary tract infection. So you drink eight eight ounce glasses of water per day Practice frequent voiding every two to four hours. Avoid harsh soaps, bubble baths, powder or sprays in the perennial area. Avoid tight-fitting clothing and wear cotton, not nylon, under clothes. And so, dear students, I want to leave this quote to you.

Healthy is an outfit that looks different on everybody. So remember that your perception of healthy may not be actually a healthy person. And your perception of a not healthy person may actually be a healthy person.

So it really depends. So we do not judge a healthy person based from our own perceptions. So that's the end of this audio video lecture. If you have honestly reached this end of the video, I have a bonus question for you.

If you get the answer correctly, you will have the chance to get one bonus point to be credited in your quiz under urinary elimination. Are you ready? The question is, what is the content in the urine that is found to whiten teeth?

Again, what is the content in the urine that is found to whiten teeth. So please send me your answers in my Hangout. I have indicated it in the message before this audio-video presentation.

And indicate your section and wait for the lucky student upon selection using Snowball method. So thank you students for listening and actually reaching this end of the slide. Thank you again and good luck everybody.

Transcript for:Urinary Elimination Overview

Transcript for:
Urinary Elimination Overview