Chapter 46 Urinary Elimination Copyright © 2017,

Transcript:Chapter 46 Urinary Elimination Copyright © 2017,:
Chapter 46 Urinary Elimination Copyright © 2017, Elsevier Inc. All Rights Reserved. Scientific Knowledge Base Kidneys Ureters Bladder Urethra Copyright © 2017, Elsevier Inc. All Rights Reserved. 2 1. A patient with a long-standing history of diabetes mellitus is voicing concerns about kidney disease. The patient asks the nurse where urine is formed in the kidney. The nurse’s response is the: A. bladder. B. kidney. C. nephron. D. ureter. Quick Quiz! Copyright © 2017, Elsevier Inc. All Rights Reserved. 3 Mrs. Vallero is a 65-year-old woman who has been in the hospital for 4 days with problems related to heart failure, fluid retention, and diabetes. She has a history of urinary retention secondary to neuropathy caused by her diabetes. Mrs. Vallero’s indwelling urinary catheter was removed 2 days ago and subsequently was replaced yesterday at 6 a.m. because of her inability to urinate more than 100 mL at a time, being incontinent of small amounts of urine, complaints of urinary urgency, and lower abdominal pain. Case Study Copyright © 2017, Elsevier Inc. All Rights Reserved. 4 Brain structures influence bladder function. Voiding: Bladder contraction + urethral sphincter and pelvic floor muscle relaxation 1. Bladder wall stretching signals micturition center. 2. Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control. 3. When a person is ready to void, the central nervous system sends a message to the micturition centers, the external sphincter relaxes and the bladder empties. Act of Urination Copyright © 2017, Elsevier Inc. All Rights Reserved. 5 Growth and development Sociocultural factors Psychological factors Personal habits Fluid intake Pathological conditions Surgical procedures Medications Diagnostic Examinations Factors Influencing Urination Copyright © 2017, Elsevier Inc. All Rights Reserved. 6 Sandy notes that the urinary catheter was removed at 7 a.m. this morning, and the patient has no recorded urine output for the day. Mrs. Vallero verifies that she has only “dribbled” urine. While making rounds, Sandy talks with Mrs. Vallero, who says she is worried because “I thought this was all under control.” The health care provider is notified, and an order is obtained for an intermittent catheterization. The registered nurse on the day shift catheterizes Mrs. Vallero at 3 p.m. with a return of 600 mL of pale, clear yellow urine. Case Study (Cont.) Copyright © 2017, Elsevier Inc. All Rights Reserved. 7 As Sandy prepares to assess Mrs.