MALE URIGENITAL SYSTEM

FEMALE URIGENITAL SYSTEM

The Urinary Bladder

Physiology of Urinary Elimination

• Urinary Elimination (voiding, urination)

– The kidneys form the urine.

– The ureters carry urine to the bladder.

– The bladder acts as a reservoir for the urine.

– The urethra is the passageway for the urine to exit the body.

• Both the renal pelvis and ureters consist primarily of smooth muscle.

• Peristalsis(muscular contraction)moves urine from the upper to the lower urinary tract.

• Occurs during the prolonged phases of bladder filling and storage.

Factors Affecting Micturition

• Developmental considerations

• Food and fluid intake

• Psychological variables

• Activity and muscle tone

• Pathologic conditions

• Medication

Medications Affecting Color of Urine

• Anticoagulants — red urine

• Diuretics — pale yellow urine

• Pyridium — orange to orange-red urine

• Elavil — green or blue-green urine

• Levodopa — brown or black urine

Nursing Diagnoses
• Impaired Urinary Elimination
• Stress Urinary Incontinence
• Reflex Urinary Incontinence
• Urge Urinary Incontinence
• Functional Urinary Incontinence
• Urinary Retention

Other Nursing Diagnoses

• Low Self-Esteem
• Deficient Knowledge
• Risk for Infection
• Risk for Impaired Skin Integrity
• Toileting Self-Care Deficit

Outcome Identification and Planning

• Target outcomes center around restoring and maintaining regular elimination habits and preventing
complications.

Planned Patient Goals

• Urine output about equal to fluid intake
• Maintain fluid and electrolyte balance
• Empty bladder completely at regular intervals
• Report ease of voiding
• Maintain skin integrity

Promoting Normal Urination

• Maintaining normal voiding habits

• Promoting fluid intake
• Strengthening muscle tone
• Stimulating urination and resolving urinary retention

Maintaining Normal Voiding Habits

• Schedule
• Privacy
• Position
• Hygiene
Implementation

• Maintain Elimination Health

– Fluid intake
– Diet
– Lifestyle and Prevention

• Lifestyle and Prevention

– Initiate pelvic muscle exercise regimen
– Bladder training for urge incontinence
– Management of urinary retention
– Management of functional urinary incontinence
– Suggest environmental modifications
– Implementation
• Perform Catheterization
• Intermittent Catheterization
• Complementary Therapies
– Holistic approach to effective elimination of waste products and toxins
• Diuretics
• Antimicrobials
• Antiseptics
• Stimulants and Cathartics

Evaluation
• Client’s level of maintenance or restoration of elimination patterns and return to an appropriate level of
independence
• Prevention of skin breakdown and infection
• Client understanding of procedures and self-care
• Evaluating Effectiveness of Plan
• Maintain fluid, electrolyte, and acid–base balance
• Empty bladder completely at regular intervals with no discomfort
• Provide care for urinary diversion and note when to notify physician
• Develop a plan to modify factors contributing to problem
• Correct unhealthy urinary habits

Bowel Elimination

Factors Affecting Elimination

• Age
• Diet
• Exercise
• Medications
Alterations in Bowel Elimination
• Constipation
• Diarrhea
• Fecal Incontinence
• Fecal Impaction

Bowel Retention
• Constipation is infrequent and difficult passage of hardened stool.
– Dietary factors, dehydration
– Inadequate dietary bulk
– Diverticular disease
– Neuropathic conditions
– Functional limitations
 • Fecal Impaction
– Bolus of hardened stool
– Further slows colonic transit time and passage of further fecal contents
• Perceived constipation is influenced by psychological and emotional stress.

Alterations in Bowel Elimination

• Diarrhea is the passage of liquefied stool with increased frequency and consistency.
• Bowel (fecal) Incontinence
– Dysfunction of the anal sphincter
– Disorders of the delivery of stool to the rectum
– disorders of rectal storage
– Anatomic defects

Nursing Diagnoses
• Constipation
• Perceived Constipation
• Diarrhea
• Bowel Incontinence

Implementation
• Lifestyle and Prevention
– Alcohol and tobacco use
– Stress management
– Weight reduction
– Elimination habits
– Positioning
• Administer Medications
– Over the Counter (OTC)
– Prescription
• Administer Enemas
– Cleanse the lower bowel
– Assist in evacuation
– Instill medication
• Initiate Rectal Stimulation
• Monitor Elimination Diversions
– Urinary Diversions
• Ileal conduit
• Continent urinary diversion
– Bowel Diversions
• Ileostomy
• Colostomy
• Ileoanal reservoir

Evaluation
• Client’s level of maintenance or restoration of elimination patterns and return to an appropriate level of
independence
• Prevention of skin breakdown and infection
• Client understanding of procedures and self-care