ELIMINATION NOTES

• Genitourinary system


  Kidney - Paired bean-shaped organs located in the upper abdominal cavity, one on each side of the spine
• Kidney function


  • Filtration: Remove waste products, excess ions, and water from the blood to form urine
  • Regulation: Maintain electrolyte balance, regulate blood pressure (RAAS), and produce hormones like erythropoietin and renin (EPO)
• Ureters


  Pair of narrow tubes that connect each kidney to the bladder
• Ureters function


  • Transport urine from the kidneys to the bladder through peristaltic contractions of smooth muscle
  • Prevent backflow of urine using one-way valves and smooth muscle contractions
• Bladder


  Hollow muscular organ located in the pelvis, capable of expanding to store urine
• Bladder function


  • Temporary storage of urine until it is expelled from the body
  • Sensation of fullness triggers the urge to urinate, controlled by the nervous system
• Urethra


  Tube that carries urine from the bladder to the outside of the body
• Urethra function


  • Elimination: Allows urine to exit the body during urination
  • Micturition: Controlled by the internal and external urethral sphincters, allowing voluntary control over urination
• Common signs of aging in kidney include decrease in kidney tissue, decrease in number of nephrons, hardening of kidney vessels, atrophy of kidney, and increased risk of kidney disease
• Related blood work, diagnostics or nursing care for kidneys

  • Urinalysis
  • Specific gravity
  • Urine culture
• "Normal" urine terminology


  • Little or no blood and protein present
  • Little urochrome present
  • Yellow/amber color
  • pH of 6.5-9
• Normal urine output is 30 mL/hour or 1-2L/day, about 6-7 times per hour
• Post-void residual volume (PVR)


  • The amount of urine retained in the bladder after a voluntary void, functions as a diagnostic tool
  • Normal PVR is 50 mL
• Urination process


  1. Bladder fills with urine, sensory nerves detect increased pressure and send signals to brainstem

  2. Forebrain activity controls voluntary micturition, afferent signals result in simultaneous contraction of bladder and relaxation of sphincter

  3. Ureters work with peristalsis and prevent reflux of urine back into kidneys
• Common signs of aging in GU function/bladder

  • Decreased peristalsis
  • Bladder muscle weakness
  • Bladder capacity is decreased
  • Less stretch or increased rigidity
  • Increased PVR
  • Difficulties of emptying bladder, leaving a PVR of over 50 (normal)
• Changes with aging in GU function or bladder

  Increases the risk of UTI, incontinence, leakage, and chronic kidney disease
• The urinary tract is shorter in females (3-4 inches) compared to male (18-20 inches) which increases the risk of UTI
• Kidney damage


  • Pain in back, radiates to abdomen, under the ribs, groin
  • Fluid retention leading to edema (legs, arms, and lungs)
  • Decreased urine output (oliguria)
  • Absence of urine output (anuria)
• In kidney damage, there are changes in urine composition (smell, odor, chemical composition)
• In kidney damage, calcium is increased in the blood, renin is increased, and RBC is reduced (anemia)
• URIA - urine


  • POLY - many
  • OLIG - few or little
  • HEME - BLOOD
  • DYS - abnormal
• Factors that influence urination

  • Age
  • Food and fluid intake
  • Medication
  • Culture / environmental concerns
  • Stress / anxiety
  • Activity level
• Common alterations in GU function

  • UTI
  • Urinary incontinence - involuntary leakage of urine
  • Nocturia - walking at night to urinate
  • Urinary retention - accumulation of urine caused by the inability of the bladder to empty
  • Urinary diversion - diversion of urine to source
  • Renal failure
• Urinary Tract Infection (UTI)


  • Most common hospital acquired infection (HAI), typically caused by bacteria
  • Cystitis - lower UTI, most common UTI in women, inflammation of the bladder
  • Pyelonephritis - upper UTI that affects the kidneys
  • Bacteremia - presence of bacteria in the blood, occurs as a result of severe infections, including UTI
• UTI risk factors


  • Pregnancy
  • Less estrogen
  • Diabetes
  • Urine retention or weakening of bladder and pelvic floor muscles
• Signs and symptoms of UTI

  • Dysuria - pain or burning sensation when voiding
  • Nocturia
  • Urgency (cystitis)
  • Frequency
  • Hematuria
  • Fever, chills
  • Back/side/groin pain - pyelonephritis
  • Costovertebral angle tenderness - pain with pressure to the kidney area - pyelonephritis
• Signs and symptoms of UTI in older adults

  • Sometimes may be asymptomatic
  • Change in LOC
  • Confusion
  • Delirium
  • Agitation
  • Behavior change
  • Falls
• UTI treatment and prevention

  • Treatment: Fluids, Antibiotic
  • Prevention: Adequate hydration, Movement, Incontinent care, Caution with indwelling catheter
• Urine testing methods


  • Non-invasive: Urinalysis, Bladder scan, CT scan, Urine culture
  • Invasive: Endoscopy, Angiography, Cystoscopy
• Lab values important for assessing GU function

  • Urinalysis values - physical components, chemical, sediments
  • eGFR
  • Electrolytes
• The kidney filters 180L per day and only 1% turns into urine
• Gastrointestinal (GI) system


  • Mouth - mechanical and chemical digestion
  • Esophagus - peristalsis, connecting the mouth and stomach, cardiac sphincter prevents backflow
  • Stomach - chemical digestion (pepsin) and mechanical digestion, HCl
  • Small Intestine - organ where absorption primarily occurs, breakdown of chyme also occurs here
  • Large Intestine - water reabsorption, makes and stores feces
• Common aging changes in GI

  • Decreased saliva production
  • Decreased nutrient absorption
  • Muscle atrophy
  • Increased constipation
  • Sphincters weakened
• Process of defecation


  1. Distension causes relaxation of the internal anal sphincter and signals an awareness of the need to defecate

  2. At the time of defecation, the external sphincter relaxes and the abdominal muscles contract to force the stool out
• The proper position during defecation is to squat, as this straightens the anorectal angle
• Normal expectations for GI output

  • 3-4 bowel movements per day, some people have 1 every 2-4 days
  • Color should be brown, no presence of blood (little green is okay)
• Meaning of different fecal colors

  • Super green - sign of infection, eating lots of vegetables, or passing too fast
  • Black - bleeding in upper intestinal tract OR eating licorice, iron supplements or bismuth medication
  • Pale, white, clay colored - blocked bile duct
  • Red - hemorrhoids OR bleeding in lower intestine OR eating red things
  • Yellow - too much fat, malabsorption, celiac disease
• Factors influencing defecation


  • Stress
  • Diet
  • Medication
  • Viruses (C-diff)
  • Amount of Bile
  • Liver Failure or other diseases
  • Food intake
• Common GI alterations


  • Age-related changes
  • Infectious diseases - norwalk, C-diff, rotavirus
  • Medical conditions - inflammatory bowel disease, irritable bowel syndrome, diabetes
  • Acute Medical Concerns and Interventions - pain, pelvic floor trauma, acute illness, surgery, anesthesia, medications, enteral feeding
• Causes of constipation


  • Lack of fiber (insoluble fiber)
  • Lack of water intake
  • IBS (irritable bowel syndrome)
  • Medications (opioids) or polypharmacy
  • Immobility