王克芳 [email protected] 0531-88382201 山东大学护理学院 Elimination.
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Transcript of 王克芳 [email protected] 0531-88382201 山东大学护理学院 Elimination.
2 WKF SON SDU护理学基础
能正确陈述尿液、粪便观察的主要内容。 能举例说明影响排尿、排便的因素。 能识别常见的排尿异常与排便异常。 能正确解释导致排尿异常和排便异常的原因。 能针对患者的情况制定改善排尿异常与排便异常的
护理措施。 能运用所学知识对患者进行排泄护理健康教育。 能规范完成导尿术与灌肠术的操作。
学习目标
3 WKF SON SDU护理学基础
Anatomy and Physiology
Assessment of Urination
Nursing Interventions for Urination
Nursing Skills for Urination
Urinary EliminationUrinary EliminationSection 1Section 1
Anatomy and Physiology
Kidneys
Diameter: 1.25 cm Length: 20 to 30 cm
--Hollow, distensible, muscular organ Organ of excretion Reservoir of urine
Urine formation Hormone production
Internal sphincter External sphincter :voluntary
M:18-20cm3个狭窄2个弯曲
M:18-20cm3个狭窄2个弯曲
F : 4-5cm,短、直、粗
F : 4-5cm,短、直、粗
Ureters
Bladder
Urethra
5 WKF SON SDU护理学基础
Act of Urination
Act of Urinationvolume 400-500ml
bladder stretch sensor micturition center( S2-S4)
spinal cord
detrusor muscle contract
internal urethral sphincter relaxing
Voding--Emptying bladder
micturition center( brain stem, cerebral cortex)
external urethral sphincter relaxing
Pelvic nerve
Desire to void
Pelvic nerveparasympathetic impulses
7 WKF SON SDU护理学基础
Urinary EliminationUrinary EliminationSection 1Section 1
你经历过或听别人说过所谓的排尿方面的问题吗
案例
8 WKF SON SDU护理学基础
Problems
Ignore the urge External sphincter remains contracted
Eventually, bladder capacity is maximum Pressure on sphincter makes voluntary control impossible
Neurogenic bladder Spinal cord injury above sacral region
Loss of voluntary control of urination: incontinence
Sacral region injury Retention
Blockage Retention
9 WKF SON SDU护理学基础
Assessment of Urination
Normal Patterns
Altered Urinary Elimination
Factors Affecting Urination
10 WKF SON SDU护理学基础
Normal Patterns
Times
Amounts
Color
Clarity
Specific gravity
pH
Odor
11 WKF SON SDU护理学基础
Times: 3-5 at daytime 0-1 at night
Amounts: 200-400 ml/time 1000-2000 ml/24hr
Normal Patterns
12 WKF SON SDU护理学基础
Color Pale, straw to deep yellow – normal
More concentrated in morning
Dark red Bleeding from kidneys or ureters
Bright red Bleeding from bladder or urethra
Dark amber High levels bilirubin
Liver dysfunction
Normal Patterns
13 WKF SON SDU护理学基础
Clarity Transparent when fresh – normal Foamy--Kidney disease Thick and cloudy--Bacteria
Specific gravity 1.015-1.025
Higher Concentrated urine: Dehydration, reduced renal blood flow, increased ADH
Lower Dilute urine: Overhydration, early renal disease, inadequate ADH
Normal Patterns
14 WKF SON SDU护理学基础
pH 4.5-7.5 average: 6.0 Indicates acid base balance
Odor Slightly aromatic (fresh) – normal
Ammonia --Stagnant Sweet or fruity
Diabetes Starvation
Normal Patterns
15 WKF SON SDU护理学基础
Altered Urinary Elimination
Oliguria (少尿) , Anuria (无尿) , Polyuria (多尿)
Frequency (尿频) , Urgency (尿急) , Dysuria (尿痛)
Urinary Incontinence (尿失禁)
Retention of urine (尿潴留)
Oliguria Anuria Polyuria
<400ml/24 hr
Dehydration
Renal failure
Increased ADH
>2500ml/24 hr
Excess fluid intake
Diabetes
Diuretics
<100ml/24 hr
Severe shock
Acute renal failure
Frequency--Urination at more frequent intervals Increased fluid intake Bladder inflammation Increased pressure on bladder
Urgent micturition --A sudden strong desire to urinate Full bladder Urinary tract inflection Psychological stress
Dysuria--Difficult or painful urination Bladder inflammation Trauma Inflammation of urethra
膀胱刺激征 (Bladder Irritation Syndrome)
18 WKF SON SDU护理学基础
Urinary Retention( 尿潴留 )
Definition: Holding urine in the bladder and can’t excrete voluntary 尿液大量存留于膀胱内而不能自行排出
Causes Urethral obstruction Trauma Altered motor and sensory innervation of bladder Medication side effects anxiety
19 WKF SON SDU护理学基础
Urinary Incontinence
Definition International Continence Society (ICS) :
Condition where involuntary loss of urine is a social or hygienic problem and is objectively demonstrable
客观存在的不自主性尿液排出,并对社会活动和个人卫生造成不良影响。
20 WKF SON SDU护理学基础
Categories of Incontinence
压力性尿失禁( Stress Incontinence )
充溢性尿失禁( Overflow Incontinence )
急迫性尿失禁( Urge Incontinence )
功能性尿失禁( Functional Incontinence )
21 WKF SON SDU护理学基础
Stress Incontinence
Occurs with increase in abdominal pressure coughing, straining, sneezing, lifting heavy objects, etc.
The most common type in women, mid-aged, elderly A result of weakened pelvic muscles A malfunction of the urethral sphincter
Childbirth Lack of estrogen Pelvic surgery Obesity
22 WKF SON SDU护理学基础
Urge Incontinence
Abrupt desire to void which cannot be suppressed
Common in women and the elderly
Causes:
The majority of cases are idiopathic
Infection, tumor, stones, urethritis, stroke, Parkinson’s Disease, dementia
厕所-- 那么近
-- 却那么远
厕所-- 那么近
-- 却那么远
23 WKF SON SDU护理学基础
Overflow Incontinence
The uncontrollable leakage of small amount of urine from a overfilled and enlarged bladder
Bladder outlet obstruction BPH, fecal impaction
Non-contractile bladder diabetes, spinal injury, medications
24 WKF SON SDU护理学基础
Functional Incontinence
mental or physical disabilities to control urinating, the urinary system itself is normal.
Conditions that can lead to functional incontinence : Parkinson's disease
dementia
Mental confusion may prevent both recognition of the need to void and locating a bathroom.
Severe depression
25 WKF SON SDU护理学基础
Fluid Intake
Age
Health Status and treatment
Emotional Status
Others
Factors Affecting Urination
26 WKF SON SDU护理学基础
Fluid Intake
Fluid Homeostasis
Input = output Caffeine promotes urine formation Alcohol inhibits ADH Fever causes diaphoresis
27 WKF SON SDU护理学基础
Age
Young Control of urination begins between 2 to 3 years of
age Nighttime : cannot control till age 4 or 5
Elderly Mobility problems Chronic neurological problems Changes in kidney and bladder function
28 WKF SON SDU护理学基础
Health Status
Diseases
Peripheral nerve lesions Loss of bladder tone
Reduced sensation
Difficulty in control
Physical disability Difficult to reach/use toilet
29 WKF SON SDU护理学基础
Surgery Stress of surgery
Triggers General Adaptation Syndrome Increased ADH Elevated aldosterone
Anesthetic analgesics Slows glomerular filtration rate Impairs sensory and motor impulses
Lower abdominal and pelvic area surgery Edema and inflammation
Health Status
30 WKF SON SDU护理学基础
Medications Prevent reabsorption
Diuretics
Urinary retention Anticholinergics Antihistamines Antihypertensives
Color change
Toxic to kidneys
Health Status
31 WKF SON SDU护理学基础
Emotional Status
AnxietyStress
Urgency Frequency Muscle tension
Difficult to relax abdominal and perineal muscles
32 WKF SON SDU护理学基础
Other factors
Social cultural norms Privacy environment Facilities
Habits Proper positioning
Climate
33 WKF SON SDU护理学基础
Nursing interventions for urination
Urinary Retention
Urinary Incontinence
34 WKF SON SDU护理学基础
Interventions for Urinary Retention patient
Privacy environment
Normal position
Sensory stimuli
Muscle relaxing
Health education
habits : time voiding
Medications
灌肠 / 排便诱导排尿Catheterization
Squatting for female
Standing for male
Running waterHand in waterWarm the bedpan
耻骨上膀胱区热敷或针灸
35 WKF SON SDU护理学基础
Maintain skin integrity, promote comfort
External drain the urine
Restore normal micturition
Interventions for Urinary incontinence patient
Offer fluid: 2000-3000 ml/day
Bladder Retraining: Take to bathroom q1-
2H
Pelvic floor muscle training, PFMT(Kegel's
)
CatheterizationPsychological support
收缩与放松盆底肌群开始各持续 2 秒,重复 15次, Tid每周增加 1 秒收缩与放松时间,至10 秒维持 10 秒,重复 10 次, Qd
36 WKF SON SDU护理学基础
Catheterization
Plastic, rubber or silica gel tube through urethra into bladder
Continuous flow of urine Assess hourly urine output Medication therapy
Nursing skills for urination
37 WKF SON SDU护理学基础
Catheterization
Types
Intermittent Catheterization Insert long enough to drain bladder
Repeat PRN
Indwelling Catheterization Stays in place Change periodically
38 WKF SON SDU护理学基础
Indications
Intermittent urinary retention--
Relieve bladder distention
Obtain urinary specimen
Assess residual
Long term management of spinal cord injury
Indwelling Obstruction
Surgery ( pelvic area 、 Urinary system )
Measure I&O in critically ill
Urinary incontinence and Severe retention
Terminally ill with trouble moving
39 WKF SON SDU护理学基础
Care and Removal
Care---Maintain flow and prevent infection
Sterile Maintain closed system Hang lower than bladder Clean with soap and water at least Qd
Area and tube After each BM (bowel movement)
Maintain fluid intake
Removal of indwelling catheter Promote normal bladder function Prevent trauma Need order--Explain, empty, remove
40 WKF SON SDU护理学基础
Nursing Implications to Urine Tests
All specimens must be labeled with name, date and time of collection
Transported in time If unable, refrigerate
Wear gloves
Nursing skills for urination
41 WKF SON SDU护理学基础
Common Urine Tests
Random
Midstream
Timed
Clean, not sterile
Don’t contaminate with stool
Specific gravity; pH;
Glucose
Test renal function and urine composition
12 or 24 hours
Creatinine clearance,
protein
Catheterized
Culture and sensitivity
42 WKF SON SDU护理学基础
Words
Urinary Elimination Kidney Ureter Bladder Urethra Oliguria Anuria Polyuria Frequency urination Urge urination
Dysuria Stress Incontinence Overflow Incontinence Urge Incontinence Functional Incontinence Retention of urine Intermittent Catheterization Indwelling Catheterization Bladder Irrigation
43 WKF SON SDU护理学基础
了解:与排尿有关的解剖与生理。熟悉:影响排尿的因素。掌握:掌握对排尿活动的评估及护理。
教学目标