Urinary

• Urinary Elimination


  is the process of removing waste products and excess water from the body through the urinary system. Adequate urinary elimination depends on normal functioning of the upper urinary tract: kidneys and ureters and lower urinary tract: urinary bladder and urethra
• upper urinary tract: kidneys and ureters
• lower urinary tract: urinary bladder and urethra
• KIDNEYS – are two bean- shaped organs, located just below the rib cage, one on each side of the spine Right kidney - slightly lower than the left due to the position of the liver -are vital organs responsible for: *filtering blood(remove waste products in the body) * maintaining fluid and electrolyte balance(major electrolytes are sodium, potassium, chloride, calcium, phosphate, and magnesium)
• Urinary Bladder - It is a hollow, muscular organ that serves as a reservoir for urine.
• • ADULT

  • The normal bladder capacity in healthy adults is around 400-500 ml.

  • The urge to urinate is triggered when the bladder is about 25% full, at around 100-125 ml.
• CHILDREN

  • Bladder capacity in children can be estimated using the formula: (Age in years + 2) × 30 ml. • For example, a 5-year-old child's bladder capacity would be: (5 + 2) × 30 = 210 ml. • Anatomically, functional bladder capacity increases with age from childhood to adulthood
• • URETHRA – extends from the bladder to the urinary meatus ( opening) • Serve as a passageway for the elimination of urine into the external environment.
• The normal urinary elimination process:

  1. Kidneys filter blood, removing waste, excess water, and substances, forming urine.
  2. Urine flows through the ureters into the bladder.
  3. The bladder stores urine until full, triggering stretch receptors and the urge to urinate.
  4. The brain signals the external urinary sphincter to relax.
  5. The bladder contracts, expelling urine through the urethra and out of the body.
• MICTURITION/ VOIDING / URINATION

  – process of emptying the urinary bladder or the act of expelling urine from the bladder.
• - normal urinary frequency per day is between 6-7 times a day
• Urinalysis - a screening test use for early disease detection, monitoring treatment progress and identifying serious conditions in their early stage.
• Clean-catch (midstream) urine collection: The patient cleans the area around the urethra and then collects a midstream sample of urine in a sterile container. This is a non-invasive method but has a higher contamination rate compared to other methods.
• Urine culture - identify the causative microorganism for UT
• Sterile urine bag: A plastic bag with adhesive is attached to the patient's genital area to collect the urine sample. This is an easy method but has the highest contamination rate of up to 43.9%.
• Suprapubic aspiration (SPA): A needle is inserted through the abdomen into the bladder to collect urine. This method provides a sterile sample with the lowest contamination rate of 9.1%. However, it is an invasive procedure.
• Urethral catheterization: A hollow tube is inserted through the urethra into the bladder to collect urine. This provides a sterile sample but is invasive and has a contamination rate similar to clean-catch at 14.3%.
• 24-hour urine collection: The patient collects all urine over a 24-hour period, usually starting with the first morning void. This is used identify kidney function abnormalities.
• Color

  Straw color / Amber. - normal

  Dark red - bleeding from kidneys.

  Bright red - bleeding from urethra or bladder.

  Red - beets, rhubarb, and blackberries.

  Dark amber - increased bilirubin.
• Transparencyy:

  Clear - normal

  Cloudy - may be protein.

  Thick, Cloudy -may be bacteria.
• Odor: Normal ammonia odor. Get stronger the longer it stands.
• pH: Slightly acidic (range: 4.6-8; average of 6)
• Specific Gravity: 1.010-1.025 (as measured by urinometer)
• • Protein: Small amounts are normal. Larger amounts may indicate kidney disease.
• Ketones: Normally absent. Presence may indicate diabetic ketoacidosis
• Bilirubin: Normally absent. Presence may indicate liver disease
• Glucose: Normally absent. Presence may indicate diabetes
• • Blood: Normally absent. Presence may indicate kidney stones, infection, or cancer.
• Nitrites: Indicate presence of bacterial infection
• Leukocyte esterase: Indicates presence of white blood cells
• Red blood cells (RBCs): Normal is 0-1 per high-power field (HPF). Presence indicates damage to urinary tract.
• •White blood cells (WBCs): Normal is 0-5 per HPF in women, 0-2 per HPF in men. Presence indicates inflammation or infection.
• Oliguria – Production of decrease amount of urine, such as < 30ml/hr or < 500ml/24 hrs.
• Urinary Tract Infection (UTI)

  •Most common infections involve the lower urinary tract

  •Women are more likely to have UTI because urethra is very short and close to the anus.

  •40% of nosocomial infections, due to catheterization.
• Anuria – Absence of production of urine by the kidneys such as 0-10 ml/hr (also urinary suppression).
• Frequency – Voiding of frequent intervals.
• Polyuria – Production of excessive amount of urine, such as more than 100 ml/hr or 2500 ml/day
• Nocturia – Increased frequency at night.
• Urgency – The strong feeling that the person wants to void
• Dysuria – Difficult or painful urination