Unit X Urinary Elimination
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| Nephron | Functional unit of the kidney; forms urine
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| Glomerulous | Tuft of capillaries that allows certain fluid and solutes to move across the porous membrane into Bowman's capsule
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| Bowman's capsule | Filtrate moves from here into the tubule of the nephron
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| Action that occurs in the proximal convoluted tubule | Most absorption of water and electrolytes
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| glucose is absorbed here | Loop of Henle (other substances are secreted into the filtrate here, resulting in concentrated urine)
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| Action that occurs in the distal convoluted tubule | Additional water and soduim are reabsorbed under hormonal control (Antidiuretic (ADH) and aldosterone)
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| Calyces | Where formed urine goes when it leaves the distal convoluted tubule
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| Micturation (voiding, urination) | The process of emptying the urinary bladder
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| Stretch receptors | Special sensory nerve endings in the bladder wall that are stimulated with pressure. About 250 - 450 mL for adults and 50 - 200 mL for children
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| Normal urine elimination per day | Varies, but approximately 5 - 6 times per day while awake
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| Reasons for less urine production while sleeping | Decreased renal flow, kidney's ability to concentrate urine, decreased fluid intake after dinner.
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| Visual/color of urine | Light yellow, straw colored due to pigment urochrome. Should be clear, not cloudy. Medications, disease, decrease or increase fluid intake may alter color.
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| Odor of urine | Slightly aromatic when fresh. Stale when it has been sitting for a long time and smells of ammonia. Drugs, infection, or food may result in foul odor.
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| Variables of urine output | Age, fluid intake, and health status
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| Normal urine output for an adult | 1500 mL per day. About 150 - 600 mL at a time.
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| Effect of alcohol and caffeine for urine output | Inhibits production of ADH and thus. increases urine output
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| How Development/Age effects urinary output | Renal function and micturation at full capacity through age 50. Older adults over 65 have decreased concentration and have decreased bladder capacity.
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| Importance of muscle tone | To maintain the stretch and contractility of the detrusor muscle so the bladder can fill adequately and empty completely.
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| Kidney diseases effect on urine output | Nephrons unable to produce urine. Abnormal amounts of protein or blood cells present in the urine. No urine production.
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| Heart and circulatory disorders effect on urine output | Affect blood flow to the kidneys (eg. heart failure, shock, hypertension)
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| Surgical effects on urine output | Swollen urethra from invasion. Decreased awareness of the need to void due to spinal anesthetics. Swelling in lower abdomen from other structures adjacent to urethra.
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| Medication effects on urine output | Particularly those affecting the autonomic nervous system.
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| Diuretics | Increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidneys into the bloodstream.
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| Signs and symptoms of kidney problems | Increased BUN and Creatinine, decreased output, edema, weight gain, hematuria, albuninuria.
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| Stress's effect on urine elimination | Increases frequency and urgency related to sympathetic relaxation of the internal sphincter.
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| Reasons hospitalization may affect micturation | Privacy, time, anxiety, position.
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| Polyuria | Production of large amounts of urine unrelated to fluid intake.
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| Oliguria | Less than 30 mL per hour or less than 500 mL per day
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| Anuria | Less than 100 mL of urine produced in 24 hours
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| Functional Incontinence | Person is usually aware of the need to urinate, but for physical or mental reasons they are unable to get to a bathroom. Varies from small leakage to full emptying of bladder.
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| Stress Incontinence | Loss of less than 50 mL of urine that occurs with a sudden increase of pressure (laughing, coughing, sneezing)
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| Reflex Incontinence | Involuntary loss of urine at somewhat predictable intervals when a certain bladder volume is reached. No urge to void, no awareness of bladder fullness. Usually caused by a CNS defect (spinal cord leision).
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| Urge Incontinence | Urgent need to void and the inability to stop micturation.
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| Overflow Incontinence | Continuous, involuntary leakage or dribbling of urine that occurs with incomplete bladder emptying. Seen in men with enlarged prostate and clients with neurological disorders.
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| Enuresis | Involuntary passing of urine when control should be established (children >5 yr.)
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| Nocturnal Enuresis | Involuntary passing of urine during sleep.
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| Primary Enuresis | Child has never achieved control / has never been dry.
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| Secondary Enuresis | Appears after the child has achieved dryness for a 6 month period. Often related to another problem (stress, constipation, illness) and will resolve when the cause is eliminated.
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| Nocturia | Awakening from sleep to urinate.
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| Frequency | Increased times of urination in small amounts
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| Urgancy | Sudden, strong desire to urinate, may lead to incontinence
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| Dysuria | Painful or difficulty voiding
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| Retention | Client cannot initiate or completely empty bladder
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| Neurogenic Bladder | Impaired neurological function; Patient does not perceive bladder fullness and is unable to control sphincters
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| Ureterostomy | One or both ureters brought directly to the side of the abdomen to form a small stoma. (Disadvantages: microorganisms from skin, narrowing of stoma, and too small to properly fit appliance to catch urine)
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| Nephrostomy | Diverts urine from the kidney via a catheter inserted into the renal pelvis into a nephrostomy tube and bag.
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| Vesicostomy | Used when urination through urethra is not possible. Ureters are left connected to the bladder and the bladder wall is surgically attached to an opening in the skin below the naval.
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| Ileal Conduit / Ileal Loop | Segment of ilium is removed. One end is sutured to form a pouch and the other end creates a stoma on abdominal wall. Ureters are surgically connected to the pouch for continuous drainage of urine.
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