URINARY

ELIMINATION
DISORDERS
KRISTINE MAJELENE F. ERCILLO, RN, MSN
Urinary Tract Infection

 Acute or Chronic bacterial infection of the bladder (cystitis), renal pelvis

(pyelonephritis), usually caused by E. Coli, common in women
 S/sx:
 Suprapubic pain
 Flank pain
 Dysuria
 Urinary Frequency and Urgency
 Fever and Chills
 Leukocytosis
 Positive Urine Culture
 Ascending Infection

WBC Pain Burning Sensation

low grade fever flank pain increased frequency to void

chills costovertebral angle pain

Dysuria

Hematuria

Drug of Choice: Anti-infectives: Methenamine, Nalidixic Acid, Nitrofurantoin,

Sulfisoxazole, TMP-SMZ; Analgesic: Phenazopyridine
Management:

 increased oral fluid intake

 Do warm sitz bath
 DIET: acid ash diet – C –cranberry, corn, cheese; P – prunes and plums
 Avoid bladder irritants
 C – cola, coffee
 A - alcohol
 S - spicy
 H - hot
Neurogenic Disorders

 Types of Urinary Incontinence:

 Stress
 Urge
 Mixed
 Overflow
 Functional
Interventions:

 Anticholinergics e.g Ditropan, Oxybutinin

 Bladder Retraining
 Pelvic Floor Exercises
Kidney Disorders

 Renal Failure:

ACUTE CHRONIC

>Suddenly, Abruptly >Gradually yet progressive

>Good Prognosis >Poor Prognosis

>Reversible >Irreversible

>Recovery – within 2 years >ESRD

Causes of Renal Failure:

Pre-Renal Intra-Renal Post-Renal

Poor Perfusion Within the Kidneys Obstruction
Hypovolemia Nephrotic Syndrome Benign Prostatic Hyperplasia
(Infection: Pyelonephritis,
Dehydration Glomerulonephritis) Renal Calculi or Stones

Burns Nephrotoxic Drugs Hydronephrosis

Aminoglycosides
***Cardiac Dysrhytmias, N – Neomycin Neurogenic Bladder
Shock A - Amikacin
G - Gentamycin
S - Streptomycin
 Oliguric Phase (>400cc/day)
Fluid Retention ____ GFR

___ BP Edema ____ BUN _____ K+ ____ Na+

_____ Creatinine
Headache “Pitting” Edema ECG: tall, peaked T
Nausea Weight Gain Pleural wave
Vomiting Effusion Azotemia Increased H2O
Pruritis (early signs)
Diuretic Phase (>500 L/day)

 Monitor:

 Weight loss
 Dehydration
 Input and Output
 Vital Signs: Blood pressure, Heart Rate
Recovery Phase (up to 2 years)

 improvement in Renal Function

 Normal BUN and Creatinine
 Normal Urine Output/hr: 30 cc
 Normal Urine Specific Gravity
Chronic Renal Failure
Reduced Renal Reserve
Damage: >75%
Compensation: <25%
S/Sx: Asymptomatic
Renal Insufficiency End Stage Renal Disease
Damage: 75-90% Damage: 90-100%
Compensation: 10-25% Compensation: 0-10%

Manifestations Management

Blood Pressure Fluid retention –high BP Restrict fluids, Diuretics,

Bones Brittle bones
Erythropoietin Decreased RBC – anemia Epogen SQ
Electrolytes Increased K Kayexalate
Acid Base H2 retention – metabolic acidosis - Supplement O2
hyperventilate
Nitrogenous Increased BUN/Crea
Waste
Dialysis:
Nephrotic Syndrome
Autoimmune – Antibodies
Diffuse Damage to Glomerular lining

Widened pores of Glomerulus

Leakage of Plasma Protein

Massive Proteinuria

Synthesize lipoprotein by Liver Decreased Albumin

Hypoalbuminemia
Binds with Fats
Decreased Oncotic pressure
Hyperlipidemia
Edema
Management:

 high Protein (lean protein like soya, bean, chicken, fish)

 low Fat
 Restrict Sodium Intake
 Restrict Fluid Intake

 Medications:
 Atorvastatin
 Captopril
 Diuretics
 Corticosteroids
 Albumin IV
Nephritic Syndrome
Acute Glomerulonephritis
GABHS (Group A Beta-Hemolytic Streptococcus)
Inflammation of Glomeruli due to an antigen-antibody reaction

URTI (Sore Throat)

Antigen-Antibody Complex Reaction

Inflammation of Glomerular Capillaries

Increased Epithelial Cells Decreased GFR

Increased Increased K+ Increased Na+

Scarring/Thickening BUN/Crea
Fluid Retention

Injury to blood vessels Azotemia Increased BP Oliguria

Cola-colored urine Increased Urine Specific Gravity

N – no urine/Oliguria
E – Edema
P – Pallor
H – Hypervolemia
R – Reddish Brown Urine
I – Increased BUN/Crea
T – Tenderness (Flank Area)
I – Increased Specific Gravity
S – Sore Throat
Management:

 decreased Protein
 low K+
 Restrict Sodium Intake
 Restrict Fluid Intake

 Medications:
 Antibiotics - Penicillin
 Anti-Hypertensives (ACE Inhibitors)
 Diuretics
 Corticosteroids
 Kayexalate, IV Glucose and Insulin
Types of Kidney Stones:

Calcium Oxalate Stones Uric Acid Stones Struvite Stones Cystine Stones

Spinach, rhubarb, rice Anchovies, lentils, beer, “Infection Stones”, UTI’s Rare, due to excessively
bran, wheat berries, corn organ meats, yeast, high protein diet
grits, cocoa powder, sardines, salmon,
chocolates, dairy products anchovies

Management Management Management Management

ACID ASH Diet Alkaline Ash Diet Decreased Protein Diet Decreased protein diet
Restrict Na+ Diet Resrtrict Na+ diet
Nephrolithiasis
Location: Kidney or Renal Pelvis
Urolithiasis
Location: Ureters
Obstruction of the Urinary Passageway

Acute Pain

Pain on urination
Excruciating pain at the flank area, Nausea/Vomiting
back, below the ribs (radiates to the
lower abdomen and groin) Injury to blood
vessels Drug of Choice: Meperidine HCL
(Demerol)

WOF:
Gross Hematuria
Oliguria
UTI
Hydronephrosis