urinary

• Urination


  Micturition, voiding, and urination all refer to the process of emptying the urinary bladder
• Factors affecting urination


  • Developmental
  • Psychosocial
  • Fluid and Food Intake
  • Medication
  • Muscle Tone
  • Pathologic Condition
  • Surgical and Diagnostic Procedure
• Newborn and Infants


  • Have immature kidneys, they are unable to concentrate urine very effectively, urine appears light yellow
  • Born without urinary control
• Pre-schoolers


  • Reaches maturity of kidney between the first and second year of life; urine is concentrated effectively and appears a normal amber color
  • Between 18 and 24 months of age, the child starts to recognize bladder fullness and is able to hold urine beyond the urge to void
  • At approximately 2 1/2 to 3 years of age, the child can perceive bladder fullness, hold urine after the urge to void, and communicate the need to urinate
  • Full urinary control usually occurs at age 4 or 5 years; daytime control is usually achieved by age 3 years
  • Hygiene should also be thought to children because they often forget to wash their hands or flush the toilet and need instruction in wiping themselves
• School-age children


  • Elimination system reaches maturity during this period
  • The kidneys double in size between ages 5 and 10 years
  • The child urinates six to eight times a day
• Enuresis


  The involuntary passing of urine when control should be established (about 5 years of age)
• Nocturnal enuresis or bed-wetting


  Involuntary passing of urine during sleep
• Adults


  • The kidneys reach maximum size between 35 and 40 years of age
  • After 50 years, the kidneys begin to diminish in size and function. Most shrinkage occurs in the cortex of the kidney as individual nephrons are lost
• Older Adults


  • An estimated 30% of nephrons are lost by age 80
  • Renal blood flow decreases because of vascular changes and a decrease in cardiac output
  • The ability to concentrate urine declines
  • Bladder muscle tone diminishes, causing increased frequency of urination and nocturia
  • Diminished bladder muscle tone and contractibility may lead to residual urine in the bladder after voiding, increasing the risk of bacterial growth and infection
  • Urinary incontinence may occur due to mobility problems or neurologic impairments
• Psychosocial factors


  • Helps stimulate the micturition reflex
  • Privacy
  • Normal position
  • Sufficient time
  • Running water
• Anxiety and muscle tension results to the inability to relax abdominal and perineal muscles and the external urethral sphincter; thus, voiding is inhibited
• People also may voluntarily suppress urination because of perceived time pressures
• Fluid and food intake

  • Fluid Ingested = Fluid Eliminated
  • Alcohol increases fluid output by inhibiting the production of antidiuretic hormone
  • Fluids that contain caffeine (e.g., coffee, tea, and cola drinks) also increase urine production
  • Food and fluids high in sodium can cause fluid retention because water is retained to maintain the normal concentration of electrolytes
  • Some foods and fluids can change the color of urine
• Medications


  • Particularly those affecting the autonomic nervous system, interfere with the normal urination process and may cause retention
  • Diuretics (e.g., chlorothiazide and furosemide)
  • Some medications may alter the color of the urine (rifampicin)
• Muscle tone


  • Good muscle tone is important to maintain the stretch and contractility of the detrusor muscle so the bladder can fill adequately and empty completely
  • Use of retention catheter for a long period have poor bladder muscle tone because continuous drainage of urine prevents the bladder from filling and emptying normally
  • Pelvic muscle tone also contributes to the ability to store and empty urine
• Pathologic conditions


  • Diseases of the kidneys may affect the ability of the nephrons to produce urine
  • Renal failure
  • Heart and circulatory disorders such as heart failure, shock, or hypertension affect blood flow to the kidneys interfering with urine production
  • Urinary stone (calculus) may obstruct a ureter, blocking urine flow from the kidney to the bladder
• Surgical and diagnostic procedures

  • Some surgical and diagnostic procedures affect the passage of urine and the urine itself
  • The urethra may swell following a cystoscopy
  • Surgical procedures on any part of the urinary tract may result in some postoperative bleeding
  • Spinal anesthetics can affect the passage of urine because they decrease the client's awareness of the need to void
  • Surgery on structures adjacent to the urinary tract (e.g., the uterus) can also affect voiding because of swelling in the lower abdomen

  
• Polyuria/diuresis


  • Refers to the production of abnormally large amounts of urine by the kidneys, often several liters more than the client's usual daily output
  • Polyuria can cause excessive fluid loss, leading to intense thirst, dehydration, and weight loss
• Causes of polyuria/diuresis


  • Ingestion of fluids containing caffeine or alcohol
  • Prescribed diuretic
  • Presence of thirst, dehydration, and weight loss
  • History of diabetes mellitus, diabetes insipidus, or kidney disease
• Oliguria


  • Low urine output, usually less than 500 mL a day or 30 mL an hour for an adult
  • It indicates impaired blood flow to the kidneys or impending renal failure and should be promptly reported to the primary care provider
• Causes of oliguria


  • Decrease in fluid intake
  • Signs of dehydration
  • Presence of hypotension, shock, or heart failure
  • History of kidney disease
  • Signs of renal failure such as elevated blood urea nitrogen (BUN) and serum creatinine
  • Edema
  • Hypertension
• Anuria


  Refers to a lack of urine production
• Causes of anuria


  • Decrease in fluid intake
  • Signs of dehydration
  • Presence of hypotension, shock, or heart failure
  • History of kidney disease
  • Signs of renal failure such as elevated blood urea nitrogen (BUN) and serum creatinine
  • Edema
  • Hypertension
• Urinary frequency


  Voiding at frequent intervals, that is, more than four to six times per day
• Causes of urinary frequency

  • Pregnancy
  • Increase in fluid intake
  • UTI
• Nocturia


  Voiding two or more times at night
• Causes of nocturia


  • Pregnancy
  • Increase in fluid intake
  • UTI
• Urgency


  The sudden, strong desire to void. Accompanies psychological stress and irritation of the trigone and urethra. It is also common in people who have poor external sphincter control and unstable bladder contractions. It is not a normal finding.
• Causes of urgency


  • Presence of psychological stress
  • UTI
• Dysuria


  Voiding that is either painful or difficult
• Causes of dysuria


  • Urinary tract inflammation
  • Infection
  • Injury
  • Hesitancy
  • Hematuria
  • Pyuria (pus in the urine)
  • Frequency
• Enuresis


  Involuntary urination in children beyond the age when voluntary bladder control is normally acquired, usually 4 or 5 years of age
• Causes of enuresis


  • Family history of enuresis
  • Difficult access to toilet facilities
  • Home stresses

  
• Urinary incontinence


  Involuntary leakage of urine or loss of bladder control, is a health symptom, not a disease
• Causes of urinary incontinence

  • Bladder inflammation
  • Cerebrovascular accident (CVA)/stroke
  • Spinal cord injury, or other disease
  • Difficulties in independent toileting (mobility impairment)
  • Leakage when coughing, laughing, sneezing
  • Cognitive impairment
• Transient (acute) urinary incontinence


  Usually arrives suddenly, lasts 6 months or less, and has reversible causes
• Causes of transient (acute) urinary incontinence

  • Polyuria
  • Exposure to irritants
  • Infection
  • Urinary retention
  • Use of pharmaceuticals
  • Stool impaction or constipation
  • Atrophic urethritis or vaginitis
  • Restricted mobility or dexterity
  • Psychological conditions
  • Delirium or acute confused state
• Established (chronic) urinary incontinence

  When emptying of the bladder is impaired, urine accumulates and the bladder becomes overdistended
• Signs of established (chronic) urinary incontinence

  • Distended bladder on palpation and percussion
  • Associated signs, such as pubic discomfort, restlessness, frequency, and small urine volume
  • Recent anesthesia
  • Recent perineal surgery
  • Presence of perineal swelling
  • Medications prescribed
  • Lack of privacy or other factors inhibiting micturition

  
• Neurogenic bladder

  Results from impaired neurologic function can interfere with the normal mechanisms of urine elimination due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes.