URINARY ELIMINATION in Midwifery Practice.pptx

Urinary Elimination

1. URINARY ELIMINATION EDGAR A. ULEP, RM, LPT, MSPH Midwifery department

2. LEARNING OBJECTIVES Review of anatomy and physiology Composition and characteristics of urine Factors influencing urination Alteration in urinary elimination Types and collection of urine specimen, observation, urine testing Facilitating urine elimination: (Assessment, Types, Equipment, Procedures, and special considerations) Providing urinal/bed pan, condom drainage Catheterization, Care of urinary drainage, and perineal care

3. INTRODUCTION Urinary elimination is defined as expulsion of waste products from the body through the urinary system. It is essential to maintain homeostasis of the body It helps in removal of metabolic waste products from the body

4. REVIEW OF ANATOMY AND PHYSIOLOGY ORGANS OF URINE ELIMINATION KIDNEY URETERS URINARY BLADDER URETHRA

5. KIDNEY There are two kidneys present retroperitoneal in each side It consists of two parts i.e Medulla and Cortex Nephron is the structural and functional unit of urinary system Blood supply is by renal artery and venous blood is drained to renal vein Renal pelvis is the point where renal artery enters the kidney, and renal vein and ureters leave the kidney.

6. FUNCTIONS OF KIDNEY EXCRATORY FUNCTION Excretion of metabolites Drugs and toxins from the body HOMEOSTATIC FUNCTION Maintenance of water balance Maintenance of electrolyte balance Maintenance of acid-base balance ENDOCRINE (HORMONAL) FUNCTION Renin secretion by JG cells Secretion of Erythropoietin Hormone Secretion of Prostaglandins THE KIDNEY converts VITAMIN D3 – active 1,25-dihydroxycholecalciferol

7. URETERS There are two ureters descends from each kidney They are made-up of smooth muscles and inner lining is by transitional epithelium These ureters carriers the urine from kidney to urinary bladder Each ureters are around 10 to 12 (20 to 30cm) inch longer Upper half of the ureter located in abdominal cavity and lower half is present in pelvic cavity CLINICAL SIGNIFICANCE Ureteral stones Reflux of urine - Vesicoureteral reflux (VUR) Congenital malformation CA ureters ( Ureteral cancer)

8. URINARY BLADDER it is a hallow muscular organ present in pelvic cavity which store the urine produced by kidney before eliminating Superiorly connected to ureters and inferiorly to urethra. CA bladder, cystitis, incontinence, retention and spastic bladder are the main clinical significance.

9. MECHANISM OF URINE FORMATION

10. NEPHRON STRUCTURE

11. COMPOSITION OF URINE 95% of volume of normal urine is due to water Organic components Urea –end product of protein metabolism Uric acid – end product of purines Creatinine Amino acids Metabolites of hormones - insulin In organics Cations : Na 2+ , K + , Ca 2+ , etc Anions: CI - , SO 4 2- , HCO 3 - etc

12. CHARACTERISTICS OF URINE PHYSICAL CHARACTERS Color-pale yellow to deep amber Odor-odorless Volumme-1 to 2 liters per 24hours Specific gravity-1.032 (1.010) OTHER CHARACTERS pH-4.5 to 8.0 (6.8) Blood cells – nil Protein- nil Glucose-nil Ketone bodies-nil

13. FACTORS INFLUENCING URINATION Lifestyle Fluid and food intake Environment Psychological factor – emotional stress may cause urgency in urination Medications – cholinergics & diuretis cause urinary elimination Muscle tone and activity – regular exercise Pathological condition – some diseases can affect formation of urine Surgical and diagnostic procedures

14. ALTERATION IN URINE ELIMINATION Polyuria-urine volume in excess of 3L/day Oliguria-urine volume less than 500ml/day Anuria-urine volume less than 100ml/day Nocturia -frequent night time urination Dysuria-difficulty in urination/burning maturation Enuresis-bed wetting Urinary incontinence and involuntary dribbling of urine Urinary retention- inability to void the urine / empty the bladder completely Hematuria-blood in the urine Proteinuria(Albuminuria)-presence of protein in the urine Glycosuria-presence of glucose in urine

15. URINE SPECIMEN COLLECTION Proper collection of specimen is important to maximize the outcome of laboratory test for the diagnosis of infectious diseases. A variety of laboratory test can be performed to make a presumptive or definitive diagnosis so that therapy can begin.

16. TYPES OF URINE SPECIMEN COLLECTION Random specimen collection First morning specimen Clean catch or midstream urine Urine sample collection from catheter Supra pubic aspiration

17. DIAGNOSTIC TESTS Routine urine analysis Blood test (BUN and Creatinine Clearance) Cystoscopy Intravenous pyelogram IVP Urine culture and sensitivity Computed Tomography (CT) Scan

18. FACILITATING URINE ELIMINATION Providing urinal/bed pan Condom drainage Catheterization Care of urinary drainage and perineal care

19. CATHETERIZATION Urinary catheterization is the insertion of a hollow tube through the urethra into the bladder for removing urine It is a aseptic procedure for which sterile equipment’s required SIZES 8-10 are used for children 12-14 are used for female adults 14, 16 & 18 used for male adults

20. PURPOSE OF URINARY CATHETER To relieve from urinary retention To obtain a sterile urine specimen To measure residual urine To empty the bladder before, during and the surgery To measure the urine output accurately

21. TYPES OF CATHETERIZATION INTERMITTENT CATHETER – is used to drain the bladder for short period or at once. It will have only single lumen INDWELLING/RETENTION CATHETER – a type of catheter placed in to bladder and secured there for a period of time SUPRA PUBIC CATHETERIZATION – is used to bladder by making a small incision above the pubic area

22. PROCEDURE OF CATHETERIZATION Preparation Insertion of catheter After are and removal of urinary catheter

23. PREPARATION PREPARATION OF PATIENT Prepare the patient mentally by explaining the procedure to gain cooperation Prepare the part (urethral opening) Provide privacy and position the patient PREPARE THE ARTICLES: Catheter Bladder wash set 10cc/20cc syringe Sterile water Cotton balls with betadine Lubricant Sterile gloves urine bag micropore

24. PROCEDURE IN INSERTING CATHETER Explain the procedure to the patient Provide privacy and adequate lightening and collect all articles Position the male patient in supine position and female patient in dorsal recumbent position Wash the hands Drape the perineal area Open the sterile catheter kit, using sterile technique Put on the sterile gloves Lubricate the catheter with sterile lubricant Retract the foreskin of the penis in male and open the labia folds in female

25. Cleaned the urethra in a circular motion from inside to outer Hold the penis in 90 degrees angle, insert the catheter and allow urinary sphincter to relax Lower the catheter and continue to advance the catheter NOTE: Never force the catheter to advance and discontinue the procedure if there is resistance When the catheter reaches bladder urine starts to flow, gently insert until 1-2 inches beyond where urine is noted Inflate the balloon, using correct amount of sterile liquid

26. Gently pull the catheter until inflation balloon is sung against bladder neck, and connect the catheter to drainage system Fix the tube with micropore and keep bag below the bladder level AFTER CARE OF PROCEDURE AND ARTICLES Discard the waste, remove gloves and replace the articles Wash hands and document the procedure

27. CATHETER CARE Fix the catheter to high or abdominal wall of the patient Always keep urine bag below the bladder level Everyday morning catheter care should be given with aseptic techniques Maintain close drainage system Irrigate bladder with antimicrobials Routinely examine for any signs of infection Don’t collect urine sample from urine bag or catheter directly Provide perineal care Don’t allow the fecal to contaminate the catheter

28. REMOVAL OF URINARY CATHETER Once patient got relieved from the condition physician can plan to remove the catheter Take a sterile 10/20cc syringe Deflate the catheter Pull the catheter gently until catheter come out Discard the catheter, wash hands and document the procedure

29. END

30. BOWEL ELIMINATION

31. BOWEL ELIMINATION OR DEFECATION Defecation, also called bowel movement, the act of eliminating solid or semisolid waste materials/feces from digestive tract In human beings, wastes are usually removed once or twice daily, but the frequency can vary from several times daily to three times weekly and remain within normal limits Muscular contractions – move fecal material to the rectum The rectum – temporary reservoir for the waste As the rectal walls expand with filling, stretch receptors from the nervous system, located in the rectal walls, stimulate the desire to defecate

32. The urges passes within one to two minutes if not relieved, and the material in the rectum is then often returned to the colon where more water is absorbed If defecation is continuously delayed, constipation and hardened fees result When the rectum is filled, pressure within it is increased This increased rectal initially forces the walls of the anal canal part and allows the fecal material to enter the canal In the anus there are two mascular constrictors, the internal and external sphincters, that allows the feces to be passed or retained

33. While defecation is occurring, the excretion of urine is usually stimulated The chest muscles, diaphragm, abdominal-wall muscles, and pelvic diaphragm all exert pressure on the digestive tract Respiration temporarily ceases as the filled lungs push the diaphragm down to exert pressure Blood pressure rises in the body, and the amount of blood pumped by the heart decreases

34. COMPOSITION OF FECES 1. WATER 65-85% of stools are water All the water drank by an individual is completely absorbed in the small and large intestine In case of diarrhea, the water content of stool is more than 85% 2. PROTEIN Protein from food is digested completely in the small intestine and is converted into amino acids before being absorbed in blood 3. FAT 95% of all fat consumed is absorbed in the small intestine Traces of fat can definitely be found in stools Fats in excess of 6% in stools are abnormal ( Steatorrhea )

35. 4. CARBOHYDRATE Simple and complex carbohydrates – sugar and starches in diet They are completely absorbed in the small intestine and assimilated in blood as glucose, fructose or g alactose Undigested carbohydrates in normal stools should be below 0.5% 5. FIBER Fiber is completely indigestible and gives volume and bulk to stools The more fiber one eats the more of undigested food wastes can be discharged from the body Fiber diet – undigested food would account for 5-7% of the total stool volume High fiber diet, 10-15% of the undigested wastes could be discharged from the body

36. 5 MAJOR COMPONENTS Mineral salts which are insoluble They too cannot be digested by the body This indigestible component of feces is known as Ash. 0.2 to 1.2% of normal stool is ash The stools also contain mucous shed from the inner lining of digestive tract The mucus helps to bind together undigested food, intestinal bacteria and metabolic debris like dead cells or bile secreted by the liver etc.

37. CHARACTERISTICS OF FECES NORMAL COLOR Adult – Brown Infant - Yellow

38. ABNORMAL COLOR CLAY OR WHITE –absence of bile pigment( bile obstruction) or diagnostic study using barium BLACK OR TARRY – drug ( e.i. Iron), bleeding from upper gastrointestinal tract ( e.i. Stomach, small intestine), diet high in red meat and dark green vegetables ( e.i. Spinach) RED –bleeding from lower gastrointestinal tract ( e.i. rectum), some foods ( e.i. Sugar beets) PALE – malabsorption of fats, diet high in milk and milk products and low in meat

39. CONSISTENCY NORMAL CONSISTENCY : Formed, soft, semisolid, moist ABNORMAL CONSISTENCY: hard, dry, constipated stool Dehydration, decreased intestinal motility resulting from lack of fiber in diet, lack of exercise, emotional upset, laxative abuse Diarrhea – increased intestinal motility

40. SHAPE NORMAL SHAPE: Cylindrical, about 2.5 cm (1inch) in diameter in adults ABNORMAL SHAPE: Narrow, pencil-shaped, or string likestool Obstructive conditional of rectum

41. FACTORS AFFECTING BOWEL ELIMINATION Age Diet Fluid intake Medications Physical activity Psychological activity Personal habits Position Pain Pregnancy Surgery & Anesthesia Diagnostic tests

42. DIET There are different ways that diet can affect bowel elimination ex,. High fiber diets & fruits promote regularity, while cheeses causes constipation AGE Must be of a certain age or physical maturity to be able to control your bowels Humans also can lose control of their bowels after a certain age

43. PHYSICAL ACTIVITY Higher activity rate lessens the chances of constipation FLUID INTAKE The more fluid you take in the less likely you are to become constipated The less fluid you take in the more likely you are to become constipated

44. PSYCHOLOGICAL FACTOR Usually the source of ulcerative colitis or Crohn’s disease Depression causes peristalsis to decrease

45. PERSONAL HABITS A person not wanting to go for an extended period of time can cause harm to their body and can make it harder to go later They may not want to use those facilities

46. PAIN Person may be hesitant about going if they think it will cause them pain Usually due to hemorrhoids, rectal surgery or abdominal surgery POSITIONS Normal positioning for bowel elimination is sitting or squatting

47. PREGNANCY The way the baby is lying on the mothers GI tract affects peristalsis by slowing it Force the mother to go in between

48. SURGERY & ANESTHESIA Affects defecation by the slowing of peristalsis or complete stop

49. MEDICATION Different medicines affect bowel elimination differently Some medications increase the process others may inhibit it or stop it completely

50. DIAGNOSTIC TESTS These affect patient because they usually require them to be NPO prior to it which in turn will limit their food intake which limits bowel elimination or stops them completely

51. ALTERATION IN BOWEL ELIMINATION

52. CONSTIPATION