Elimin urinary Winter 2018pdf [Compatibility Mode] (3).pdf

Elimin urinary Winter 2018pdf [Compatibility Mode] (3).pdf...

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1/5/2018 1 Barbara Pieper, Ph.D., RN Objectives Summarize components of voiding/urine assessment Examine categories of urine containment and skin care Define types of urinary incontinence and its treatment Voiding Complex neurophysiologic action controlled locally but under CNS inhibition Neurologic Central Nervous System Autonomic Nervous System Sympathetic – urine storage Parasympathetic – urine release (pee) Normal Adult Voiding Frequency 4 6 voids/24 hrs. (every 4 6 hrs.) Must void within 8 hrs. of surgery, birth of child, or catheter removal Daytime bladder control – 2 – 3 yrs. of age Nighttime voids Most seldom get up; some always get up once Nighttime bladder control – 4 – 5 yrs. of age Urgency (having to rush to the toilet) Should be rare Pain free Dysuria is painful urination
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1/5/2018 2 Normal Adult Voiding Sensation Usually none until 150 250 ml Maximum comfort capacity = 300 500 ml Urge returns at increasingly frequent intervals and intensity as capacity increases Normal Adult Voiding Emptying Most can empty at any time even with small volumes: “anticipatory” voiding Post void residual Urine left in bladder after voiding NL < 50 ml Volume > 150 ml is considered inadequate emptying Leakage should not occur Check for Urine Residual Have patient void Within 15 minutes Straight catheterization for residual Bladder scan for residual Non invasive Important to know – residual urine increases the risk of UTI Aging and Voiding Decreased elastin leads to decreased bladder capacity NL = 300 600 ml to age 65 years NL = 250 300 ml for age 65 – 90 years NL = 180 ml for age > 90 years Decreased urinary flow rate Decreased bladder muscle tone resulting in increased frequency of urination Decreased bladder contractility Increase in post void residual From 50 ml to 100 200 ml Increase in involuntary bladder contractions Increase in nocturia – diminished ability of kidneys to concentrate urine Neuromuscular problems, joint problems, altered mental status may interfere with voluntary control and ability to reach the toilet
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1/5/2018 3 Characteristics of Urine ‐ Amount Amount 30 – 100 ml/hr or 600 – 2,400 ml/d Anuria – failure of the kidneys; 50 to <100 ml/d Oliguria – 100 to 400 ml/d Polyuria –excessive amounts of urine; some references > 2,500 ml/d Characteristics of Urine: Color & Specific Gravity Clear yellow, no blood, no protein, no acetone Specific gravity 1.010 1.025 Urine Tests Random Any time of day Does not need sterile container Specific component analysis Abnormal constituents – blood, pus, albumin, glucose, ketones, gross bacteria, casts, bile Urine Tests 24 hour collection Steps Note time – void & discard that urine Collect all urine after the discarded urine Last void at time of start Each type has requirements for collection, i.e., chemicals
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  • Winter '17
  • Barbara Pieper

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