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Function of the kidney
- filter metabolic wastes, toxins, excess ions, water from the bloodstream and excrete them as urine.
- Help regulate blood volume, blood pressure, electrolyte levels, and acid-base balance by selectivly reabosorbing water and other substances.
- Produce erythropoietin, secrete the enzyme renin, activate vitamin D3
- Nephron from urine
- ADH and aldosterone maintane normal blood volume and therefore blood pressure.
- Help maintain the normal pH of blood by secreting hydrogen ions.
most commonly prescribed laboratory tests. Used as an overal screening test as well as an aid to diagnosing renal, hepatic, and other diseases. Can by done by dipstick or microscopic examination.
Urine dip stick
it can determine pH and specific gravity and the presence of protein, glucose, ketones, and occult blood in the urine.
Urine specific gravity
- measure of dissolved solutes in a soulution (urine concentration). As the consentration of the urine solutes increases, specific gravitiy increases.
- Distilled water s.g. is 1.000 because tehre is no disolved solutes.
- Normal s.g for urine is 1.002 - 1.028
- During ddyhidration s.g. rises.
Factors that affect urinary elimination patterns
- Developmental factors: Older adults, 2/3 of the functionit nephrones remain. Potential volume of the blooder decreases becuase of a loss of elasticity in teh bladder wall - urinate more frequently during the night. Loss of elasicity and muslce tone also decreases the ability of the bladder to empty compltely - inreases of bladder infection.
- Personal, Sociocultural and environmental: delyaing urination promotes urinary stasis and can lead to bladder infections. Following things can inhibit voiding - anxiety, lack of time, lack of privacy, loss of dignity, cultural influences.
- Nutrition, hydration and Acivity level: caffeine and alcohol are diuretics. High salt diet causes water retention.
- Medication: some are diuretics, water renetion and nephrotoxic
- Suregery and anasthesia: anasthetic agents decrease blood pressure and glomerular filtration,
- Pathological conditions: infection or inflammation of the bladder, ureters, or kidneys and diseases involving other systems can indirectly affect urinary function.
- I&O is measured to monitor fluid status.
- To measure fluid INTAKE, record all fluids the pt drinks or recieves intravenously (oral fluids, semiliquids, ice, iv, tube feeding, irrigations instilled and not withdrawn immediately.
- OUTPUT, urine output, gastrointenstinal fluid loss, liquid feces, and drainage.
- Total I&O at the end of each shift, and 24hr period.
Clean catch specimen
clean genitalia before voiding and collect the sample in midstream.
- occurs when E.coli, which normally lves harmlessly in the colon, enter theurethra and begin to multiply.
- Urethrities - infection in urethra
- Cystitis - infection in bladder
- pyelonephrities - infection in kidneys
inability to empty the bladder completely. Etiologies include obstruction, inflammation and swelling, neurological prblems, medications and anxiety
- is a lack of voluntary control over urination.
- Associted with skin impairment, obesity, UTIs, self-rated poor health, reduced mobility,depression, and increased caregiver burden.
Types of Urinary Incontinence
- Continence occurs when presure in the uretrha is greater thatn pressure in the bladder.
- Stress incontinence: most common. The involuntary loss of urine during activities that increase abdominal and detrusor pressure. Loss small amoumt.
- Urge incontinence: the preceptionof an urgent need to urinate as a result of bladder contractions regardless of the volume of urine in the bladder. Leak large amount of urine.
- Mixed incontinence: presence of more than one type of incontinence. Related to both stress and urge incontinence.
- Overflow (reflex) intontinence: occures when the detrusor muscle fials to contract and the detrouser muscle becomes overdistended. Bladder has riched max copacity and urine must leak out to prevent rapture.
- Functonal incontenence: results of factors other than bladder and urethra abnormal functions. Ex. loss of congitive funtion.
Treatment for dif types of incontinence
- Stress intontinence: Pelvic floor Kegel exerciese therapy, nutritional therapy (weight reduction), drug therapy (improve urethral resistance), vaginal cone therapy, behavioral modifications, electrical stimulation devices, surgical management.
- Urge urinary intontinence: drug therapy(relax the smoothmuscle and inrease the bladder's capacity), nutritional therapy (spacing fluid intervansl and avoinding foods that are duiretics), Behavioral internvetntions (bladder training, habit tarining, exercise therapy, and electrical stimulation)
Nursing measures to prevent UTI
- Drink 8-10 8oz glasses of water per day
- Urinate when you first feel the urge
- wipe front to back
- Wear cotton
- Urinate after having intercourse
- Avoid bubble baths
- Promptly report any symptoms of UTI
- Use aseptic routine when handling catheter devices
- Select a small size catheter
- Strict sterile technique to insert the catheter
- Do not injecet more than 10ml in to baloon
- Avoid routine catheter irrigation
- Keep urine collection bags below the level of the bladder at all times
- Secure catheter to the pt's thigh(women) or lower abdomen(men)
- Daily catheter care by washing the perineum and proximal portion of the catheter with soap and water and rying
- Cosinder using coated ccatheters for longer use.
Types and purposes of urinary catheterizatin
- Silver-alloy: coated catheters reduce infection rates when catheter remained in place for less than 7 days
- Teflon-bonded latex: for short to medium term use (>28 days), the coating reduces friction and tissue irretation during inserction and while it ramins in place
- Polyvinyl chloride (PVC): designed for long term (up to 6 wks) because they soften and conform to the urethra
- Silicone or hydrogel-caoted: 3 months use, helps prevent encrustaion around the urinary meatus and reduce friction.
- Some have a lubricant and/or antimicrobial coating to help prevent infection
- Always check for latex or Teflon and iodine allergies
- Straight catheter: a single lumen tube tha is inserted for immediate drainage of the bladder (to obtain a sterile urine specimen)
- Indwelling catheter: also known as Foley or retention catheter, is used for continuous bladder drainage. A double-lumen tube. Inflated baloon holds the catheter in place.
- Suprapubic catheter: used for continues urine drainage when urethra must be bypassed
Normal and abnormla appearance of the urine
- Normal: light yellow
- Abnormal: Cloudy, foul smelling, or blood tinged.