Maintaining Normal Urination

Maintaining Normal Urination

A. pt education focus on pt's specific clinical problem

1. teach about proper hygiene to prevent infections when giving bath

2. teach pt early symptoms of urinary alterations

3. incorporate teaching when giving meds or administering fluids (talk about increasing

fluid intake)

B. promoting normal micturition maintain normal elimination

1. nurse can teach pt to relax to void. sit or squat, raise head of bed, assume normal position

2.sound of running water can help

3. stroke inner aspect of thigh stimulates sensory nerve & promotes urination

4. pouring water over perineum can create sensation to urinate

C. maintain elimination habits

1. post childbirth should urinate within 4 hrs.

2. prevent urinary stasis, incontinence

D. maintain adequate fluid intake a pt with normal renal function without heart, kidney

problems 2000-2500mL /day is good

1. an average of 1200-1500 mL is usually sufficient unless history of UTI

2. when fluid intake is increased, excreted urine flushes out solutes or particles that may

collect in urinary system

E. Preventing infection good perineal hygiene & adequate fluid intake, wipe front to back,

F. Acidifying urine inhibit microbial growth

1. meats, eggs, whole grain breads, prunes

2. cranberry juice & ascorbic acid lower pH

VIX. Medications

A. meds that are given for incontinence caused by bladder irritation: anticholinergics

1. the drugs depress the neurotransmitter acetylcholine which stimulates bladder ie.

Opropantheline, Oxybutenine chloride, Digipan

2. these meds can cause cardiac dysrhythmias not use on cardiac pts. anticholinergics can

cause constipation & dry mouth

B. When the bladder empties, detrusor muscle contracts in response to parasympathetic

stimulation

1. incomplete bladder emptying results from impaired enervation or weakness of detrusor

2. pt. experiences retention & overflow incontinence

3. cholinergic drugs increase contraction of the bladder

4. Bethanechol (Urecholine)

C. the dribbling or overflow incontinence seen in men with prostatic enlargement

1. Terazosin is given daily

2. It can also cause

X. Many falls in older adult make sure pathways clear

some meds cause transient hypotension

Identify all of pt's prescription drugs

Identify all of pt's prescription drugs

1. how long taking? any changes?

2. drugs for diabetes mellitus, hypertension, cardiac disorders, hormonal disorders, cancer,

arthritis, psychiatric disorders, potential causes of renal dysfunction

D. Any over the counter drugs or herbal supplements laxatives, analgesics, NSAID's,

St. John's Wort

E. Ask the pt about chemical exposures at the work place, exposure to hydrocarbons, heavy

metals, Pb, mercury, Cl gas.

F. Ask the pt about any protein / albumen in urine, any BP meds, any high BP readings

VI. Physical Assessment

A. skin & mucosal membranes turgor (hydration), urinary incontinence skin breakdown

B. kidneys infected / inflamed flank or back pain nurse assesses for tenderness

costo-vertebral angle (spine & 12^th rib) LeMone

C. bladder -on inspection the nurse may note swelling or convex curviture of lower abdomen -

using light palpation, partially filled bladder is smooth rounded when apply pressure pt can

feel pain, tenderness, urge to urinate.

D. Urethra meatus inspect for discharge, inflammation & lesions

VII. Common types of Urinary alterations

A. Urgency feel need to void full bladder, irritation, inflammation from infection,

noncompliant urethra, sphincter, or psychological stress

B. dysuria difficult / painful urination (trauma inflammation of urethral sphincter

C. frequency interval 2hrs. - increased fluid intake, bladder inflammation, bladder

pressure, pregnancy, psychological stress

D. Hesitancy difficulty in initiating urination prostate enlargement, anxiety, urethral edema

E. Polyuria void large amounts urine or frequent excess fluid intake, diabetes mellitus, diabetes

insipidus (low ADH or reduced sensitivity to ADH.

F. Oliguria diminished urinary output relative to intake, kidney function (30 mL/hr) need at least

240 mL/day. factors dehydration, renal failure, UTI, increased ADH, CHF

G. nocturia frequent night urination excessive fluid intake before bedtime. esp. caffeine,

alcohol, renal disease, aging, prostate enlargement

H. dribbling leakage of urine despite voluntary control of urination stress, incontinence,

overflow from urinary retention

I. Incontinence involuntary loss of urine multiple factors unstable urethra, loss of pelvic

muscle tone, estrogen depletion, fecal impaction, neurological impairment

J. hematuria blood in urine neoplasms of kidney or bladder, glomerular disease, infection of

kidney, bladder, trauma, calculi, stones, bleeding disorder (hemophilia)

K. retention accumulation of urine in bladder (100mL) inability to empty fully obstruction,

bladder inflammation, decreased sensory activity, necrogenic bladder, prostate enlargement,

post-anesthesia effect, side effect of meds, (anticholinergic, antidepressants)

Review diagnostic test in LeMone

Identify all of pt's prescription drugs

Identify all of pt's prescription drugs

1. how long taking? any changes?

2. drugs for diabetes mellitus, hypertension, cardiac disorders, hormonal disorders, cancer,

arthritis, psychiatric disorders, potential causes of renal dysfunction

D. Any over the counter drugs or herbal supplements laxatives, analgesics, NSAID's,

St. John's Wort

E. Ask the pt about chemical exposures at the work place, exposure to hydrocarbons, heavy

metals, Pb, mercury, Cl gas.

F. Ask the pt about any protein / albumen in urine, any BP meds, any high BP readings

VI. Physical Assessment

A. skin & mucosal membranes turgor (hydration), urinary incontinence skin breakdown

B. kidneys infected / inflamed flank or back pain nurse assesses for tenderness

costo-vertebral angle (spine & 12^th rib) LeMone

C. bladder -on inspection the nurse may note swelling or convex curviture of lower abdomen -

using light palpation, partially filled bladder is smooth rounded when apply pressure pt can

feel pain, tenderness, urge to urinate.

D. Urethra meatus inspect for discharge, inflammation & lesions

VII. Common types of Urinary alterations

A. Urgency feel need to void full bladder, irritation, inflammation from infection,

noncompliant urethra, sphincter, or psychological stress

B. dysuria difficult / painful urination (trauma inflammation of urethral sphincter

C. frequency interval 2hrs. - increased fluid intake, bladder inflammation, bladder

pressure, pregnancy, psychological stress

D. Hesitancy difficulty in initiating urination prostate enlargement, anxiety, urethral edema

E. Polyuria void large amounts urine or frequent excess fluid intake, diabetes mellitus, diabetes

insipidus (low ADH or reduced sensitivity to ADH.

F. Oliguria diminished urinary output relative to intake, kidney function (30 mL/hr) need at least

240 mL/day. factors dehydration, renal failure, UTI, increased ADH, CHF

G. nocturia frequent night urination excessive fluid intake before bedtime. esp. caffeine,

alcohol, renal disease, aging, prostate enlargement

H. dribbling leakage of urine despite voluntary control of urination stress, incontinence,

overflow from urinary retention

I. Incontinence involuntary loss of urine multiple factors unstable urethra, loss of pelvic

muscle tone, estrogen depletion, fecal impaction, neurological impairment

J. hematuria blood in urine neoplasms of kidney or bladder, glomerular disease, infection of

kidney, bladder, trauma, calculi, stones, bleeding disorder (hemophilia)

K. retention accumulation of urine in bladder (100mL) inability to empty fully obstruction,

bladder inflammation, decreased sensory activity, necrogenic bladder, prostate enlargement,

post-anesthesia effect, side effect of meds, (anticholinergic, antidepressants)

Review diagnostic test in LeMone