Macam-Macam Topologi Jaringan Komputer

URINARY ELIMINATION

Created by :

Lisa Novia Safitri        J210174051
Wulan Syafitry            J210174134
Andi Nur Hidayah      J210154003

BACHELOR OF NURSING

HEALTH FACULTY

MUHAMMADIYAH SURAKARTA UNIVERSITY

2017

Table of contens

	Cover……………………………………………………………………………………..	1
	Table of contens………………………………………………………………………….	2
A.	Definition…………………………………………………………………………….......	3
B.	Anatomy and Physiology………………………………………………………………...	3
C.	Factor affecting urinary elimination……………………………………………………...	7
D.	Common problem in urinary elimination………………………………………………...	9
E.	Assessing…………………………………………………………………………………	11
	1. Nursing History………………………………………………………………………..	11
	2. Physical Assessment…………………………………………………………………..	11
F.	Diagnostic test……………………………………………………………………………	13
G.	Common nursing diagnosis………………………………………………………………	18
H.	Nursing treatment………………………………………………………………………...	21
I.	Kidney Stone……………………………………………………………………………..	22
J.	Picture…………………………………………………………………………………….	24
K.	References………………………………………………………………………………..	26

URINARY ELIMINATION

A.    Definition

Elimination from the urinary tract is usually taken for granted.Only when a problem arises do most people become aware of their urinary habits and any associated symptoms.Urinary elimination is ensential to health, and voiding can be postponed for only so long before the urge normally too great to control. (Berman, Snyder, Kozier, & Erb, 2008) Urine is the residual fluid excreted by the kidneys which will then be removed from the body through the urinary process. The urine system is an organ system that produces, stores, and drains urine.

B.     Anatomy and Physiology Of Urinary Elimination

Urinary elimination depends on affective functions of the upper urinary tract : Kidsneys and Ureters ; and the lower urinary tract ; Urinary baldder,urethra,and pelvic floor (Hidayat & Uliyah, 2015)

1.      Kidneys

The paired kidneys are situated on the either side of the spinal column,behind the peritoneal cavity.The right kidney is slightly lower than the left due to the position of the liver.they are the primary regulators of fluid and acid-base balance in the body.

a.       Structure

The kidneys are wrapped by a thin capsule membrane of fibrous tissue. The color is dark purple, consisting of the cortex on the outside and the medulla on the inside.

The medulla section is composed of 15 to 16 pyramid-shaped masses, which are called renal pyramids. The peak leads to the hilum and ends in the calyces. This calyces connects it with the renal pelvis. (Pearce, 2017)

b.      Functions

    The functional units of the kidneys,the nephrons : Filter the blood and remove metabolic wastes.In average adults 1.200 ml of blood,or about 21% of the cardiac output,passes through the kidneys every minute. Each nephrons has a Glomerulus, a tuft of cappilaries surrounded by bowman’s capsule. Golmerulus filtrate is similar in compostion to plasma, made up of water, electrolytes, glucose, amino acids, and metabolic wastes.

From bowman’s capsule that filtrate moves into the tubule of the nephrons. In the proximal convolutes tubule, most of the water and electrolytes are reabsorbed. Solutes such as glucoce are reabsorbed in the loopof henle, but in the same area, other substances are secreted into the filtrate, concentrating the urine. In the distal convoluted tubule, additional water and sodium are reabsorbed under the control of hormones such as antidiuretic hormonene (ADH) and aldosterone. This controlelled reabsoptions allows fine regulation of fluid and electrolyte balance in the body .

When fluid intake is low or the concentrations of solutes in blood is high, ADH is released from the anterior piyutary ,more water is reabsorbed in the dista tubule,and less urine is excreted . by contrast,when fluid intakes is high or the blood solute concentration is low ADH is suppressed . Without ADH, the distal tubules become impermeable to water, and more urine is excreted .Aldosterone also effect the tubule. When aldosterone is released from adrenal cortext,sodium and water are reabsorbed in greather quantities ,increasing the bllod volume and decreasing urinary output.

2.      Ureters

a.       Structure

Once urine is formed in the kidneys, it moves throuhr the collecting ducts into the calyces of the renal pelvis and from there into the ureters. The ureters are from 25 to 30 cm (10 to 12 in) . Long in the adult and about 1,25 cm (0,5 in) in diameters. The uppers emd of each ureter is funnel shaped as it nters the kidney . The lower ends of the ureters enter the bladder at the posterior corners of the floor of the bladder . At the junction between the ureter and the bladder,a flaplike fold of mucous membrane acts as a valve to prevent refluk (blackflow) of urine up the ureters.

3.      Bladder

a.       Structure

The urinary baldder (vesicle) is a hollow, Muscolar organ that servesas a reservoir for urine and the organ of excreation . When empty , it lies behind the symphysis pubis . IT men ,the baladder lies in front of the rectum and above the prostage gland.

In womb it lies in front of the uterus and vagina.The wall of the bladder is made up four layers :

1)      An inner mucous layer

2)      A connective tissue layer

3)      Three layers of smooth muscle fibers,some of which extend lengthwise, some obliquely,and some more of less circculary.

4)      An outer serous layer.

b.      Functions

The smooth muscle layers are collectively called the destrusor muscle. The detrusor muscle allows the bledder to expand as it fills with urine , and to contract to release urine to the outside of the body during voiding . The trigone at the base of the bladder is a triangular area marked by the ureter openings at the posteriors corners and the opening of the uretra at the anterior inferior corner.

c.       System

The bladder is capable of considered distention because of rugae (folds) in the mucous membrane lining and because of the elasticity of its walls .When full ,the dome of the bladder may extend above the symphysis pubis. In extreme situation,it may extend as high as the umbilicius .Normal bladder capacity is between 300 and 600 ml of urine. (Kozier, Erb, Berman, & Snyder, 2010)

4.      Urethra

a.       Structure

The urethra extend from the bladder to the urinary meatus (opening).in adult woman,the urethra lies directly behind the symphysis pubis,anterior to the vagina,and is between 3 and 4 cm (1.5 in).long (see figure 48-4).The urethra serve only as passage way for the elimination of urine.the urinary meatus is located between the labia minora,in front of the vagina and bellows the clitoris.The male urethra is approximately 20 cm (8 in) .long and serves as a passageway for semen as well urine .The meatus is located at the dista end of the penis.

In both men and woman ,the urethra has a mucous membrane lining that is continuous with the bladder and the ureters. Thus an infection of the urethra can extend through the urinary to the kidneys. Woman are particularly proneto urinary tract infections because of their short uretha and proximity of the urinary meatus to the vagina and anus.

5.      Pelvic floor

The vagina and the urethra and the rectum pass through the pelvic floor wich consict of sheet of muscle and ligament that provide support to the viserra of the pelvis .They extend froms the symphysis pubis to the coccyx forming a sling . Specific sphinter muscle contributed to the continence mechanism.It process active tension designed to closed the urethral lumen. The external sphinters muscle is compossed of skeletal muscle under voluntary control.,allowing the individual to choose when urine is eliminated

6.      Urination

Mictrurition,voiding, and urination all prefer to the procces of empthing the urinary bledder. Urine collect in the bledder until pressure stimulates special sensory nerve endings in the bladders wall called stretch receptors.This occur whn adult bladder contains smaller volume,50 to 200 ml,stimulates these nerves. the urinary mechanism occurs when urinary vesica contains urine which can cause stimulation, through the spinal cord is delivered to the urinary control center located in the cerebral cortex, then the brain impulses through the spinal cord into the neurotransisis in the sacral region, and conneks and relaxes the internal sphincter muscle

C.    Factor Affecting Urinary Elimination

1.      Developmental factor

a.       Infants

Urine output varies according to fluid intake but gradually increase to 250 to 500 ml a day during the first year. An infant may urinate as often as 20 times a day . The urine of the neonate is colorless and ordoless and has a specific gravity of 1.008 ,because new born and infant have immature kidneys,they are unable to concentrate urine every effectively. most babies can control urine at the age of 2 to 5 years.

b.      Preschoolers

School children usually do self-elimination. parents are often negligent, children sometimes forget to wash or flush toilets. Women should be taught to wipe from front to back to avoid bacterial contamination

c.       School-Age children

At this age the size of the kidney becomes larger at the age of 5 to 10 tahun.selama this child urinate 6 to 8 times a day.Enuresis Involuntary urine excretion control can be a problem for preschoolers. About 10% of 6-year-olds find it difficult to control their bladder. Enuresis nocturnal or bedwetting, involuntary urine removal during sleep. Eesuresis considered primary if the child has not been able to control urine in the night

d.      Elderly

The function of renal excretion often diminish with age. blood flow can be reduced due to anterioclerosis factors that interfere with kidney function, the number of decreased nephron function that causes decreased ability of kidney filtering

2.      Physical Factors

Some people's reflections can stimulate urinary reflexes. including privacy, normal position, adequacy of time, running water.consequently one can not relax the abdominal muscles and the perineum and external urethral sphincter and urination are inhibited. a person can also withstand his or her urine if the condition is pressed

a.       Fluid and Food Intake

A healthy body maintains a balance between the amount of fluid and the amount of fluid removed. by kareana it if the intake increases then the hormone increases also.dan also vice versa.

b.      Medications

Many drugs affect the autonomous syaraf system, disrupting normal urinary processes and can lead to retention. Diuretics (eg, corotiazide, furosemide) increase urine formation by preventing water reabsion and electrolytes from the renal tubules into the bloodstream.

c.       Muscle Tone

Good muscle tone is important to maintain the stretch and contractility of the detrusor muscle so baldder can fill adequately and empty completely. Client who require a retention catheter for a long period may have poor bladder muscle tone because continousdrainage of urine prevent the bladder from filling and emptying normally. Pelvic muscle tone also contributed to the ability to store and empty urine.

d.      Pathologic Condition

Several diseases affect the formation and excretion of urine. for example kidney disease affects the amount of nephron's ability to produce urine.

1)      Altered Urine Production

Some surgical and diagnostic procedures affect urinary expenditure. the urethra may swell after cystoscopy and surgical procedures in a urinary tract can cause postoperative bleeding. consequently urine red.Spinal anesthesia causes a decreased awareness of the client to urinate.

D.    Common Problem in Urinary Elimination

Despite normal urine production, a number of factors of conditions can affect urinary elimination. (Berman, Snyder, Kozier, & Erb, 2008)

1.      Frequency and nocturia

Urinary ferquency is voiding at frequent intervals, more than 4 or 6 times per day. An increased intake of fluid causes some increase in the frequency of voiding. Conditions such as urinary tract infection, stress, and pregnancy can cause frequent voiding of small quantities ( 50 to 100 mL ) of urine. Total fluid intake and output may be normal. Nocturia is voiding two or more times at night. It is usually expressed in terms of the number of times the person gets out of bed to void.

2.      Urgency

Urgency is the sudden strong desire to void. Not be a great deal of urine in the bladder, the person feels a need to void immediately. Urgency accompanies psychologic stress and irritation of the trigone and urethra. It is also common in people who have poor external sphineter control and unstable bladder contractions.

3.      Dysuria

Dysuria means voiding that is either paitful or dificult. It can accompany a structur ( descrease in caliber ) of the urethra, urinary infection, and injury to the bladder and urethra.

4.      Enuresis

Enurasis is involutary urination in children beyend the age when voluntary bladder control is normally acquired, usually 4 or 5 years of the age, often is irregular in occurrence and affects boys more often than girls. Daytime enuresis may be persistent and pathologic in origin.

5.      Urinary incontinence

Urinary incontinence, or involuntary urination, is a symptom, not a disease. It can have a significant impact on the client’s life, creating physical problems such as skin breakdown and possibly leading to psycosocial problems such as embarrassment, isolation, and social withdrawal.

6.      Acute

Many factors can contribute to acute or reversible incontinence, including polyuria. Expose to irritans, infection, urinary retention, use of pharmaceuticals, stool impaction or constipation, atropic urethritis or vaginitis, restricted mobility or dexterity, psychologic, conditions, and delirium or acute confused state. Some of these factors are readily reversible with a lessening of syptoms if not complete rsolution of urinary incontinence.

7.      Chronic

There are different types of chronic incontinence, each having a different etiology, including stress, urge, reflex, retetion with overflow. And function incontinence. Treatment may include surgery, medication, or behavioral therapies. Nursing management of incontinence includes implementing individualized bladder programs. Containment of urine, and meticulous skin care.

8.      Urinary retention

When emptying of the bladder is impaired, urine accumulates and the bladder becomes overdistended, a condition known as urinary retention. Overdistation of the bladder causes poor contractility of the detrustor muscle, further impairing urination. Common causes of urinary retention includemprostatic hypertrophy ( enlargement), surgery, and some medications. Clients with urinary retention may experience overflow voiding or incontinence, eliminating 25 to 50 mL of urine at frequent intervals. The bladder is firm and distended on palpation and may be displaced to one side of midline.

9.      Neurogenetic bladder

Impaired neurologic function can interfere with the normal mechanisms of urine elimination, resulting in a neurogenic bladder. The elient with a neurogenic bladder does not perceive bladder fullness and is unable to control the urinary sphineters. The bladder may become flaccid and distended or spastic, with frequent involuntary urination

E.     Assesing

The nursing assessment of elimination is based on a clientinterview and history, evaluation of an objective log or record of urinary or patterns, focused physical examination, and review of diagnostic laboratory data. When altered patterns of elimination indicate a significant health problem, additional diagnostic information is used to formulate a plan of care. (Delaune & Ladner, 2011)

1.      Health History

Because issues of urinary elimination may produce feelings of anxiety,guilt, or shame among clients, the interview must be instigated by the nurse and conducted in a setting that provides adequate privacy. Clients are asked to describe their usual urinary elimination habits.

When screening questions concerning altered patterns of elimination reveal significant findings, the interview should be expanded to include specific questions about the nature of the elimination disorder. These questions explore the type of incontinence, complicating factors, and bladder management strategies currently used by the client.Nurses need to speak freely with clients regarding continence problems since they may have a negative effect on a client’s

2.      Physical Examination

The physical examination for urinary elimination patterns focuses on functional issues. Functional evaluation begins with the interview and continues throughout the physical examination. Mental status can be evaluated by listening to the client’s responses to questions and by observing interactions with others. When mental assessment reveals changes from normal or expected function, such as the Mini–Mental Status Examination, may be administered.

Mobility and dexterity are evaluated by observation or by asking the client to perform simple tasks. Mobility may be evaluated by observing the client undress or move onto a table, chair, or bed. Dexterity is assessed by observing the client remove clothing; particular attention is paid to the manipulation of zippers, buttons, shoestrings, and snaps.

Inspect all four abdominal quadrants for symmetry, contour, shape, and skin color, noting masses, peristaltic waves, scars, venous patterns, stomas, and lesions. If the client is experiencing abdominal pain, the client may guard (tighten the abdominal muscles) on palpation; if this occurs, have the client flex the knees to relax the abdomen to provide for a complete palpation of the abdomen.

The perineum is initially inspected for skin integrity. Among clients with severe urinary leakage, the characteristic odor of urine may be present, and the skin may show signs of a monilial rash (maculopapular, red rash with satellite lesions) or an ammonia contact dermatitis (papular rash with saturated, macerated skin). This monilial rash may involve the inner aspect of the thighs, and it frequently extends throughout the skin surface covered by a containment device.

The vaginal vault of the woman is inspected for signs of atrophic vaginitis and for bladder and urethral support. The atrophic vagina has a dry, thin, friable mucosa with a loss of rugae (regular folds of tissue observed in the normal vagina). It is tender to touch, pale, and cracks or bleeds easily. The vaginal introitus and vault may be quite small, and the client may be intolerant of even gentle efforts to distend the vagina for examination. Atrophic vaginal changes are important to assess because they are associated with SUI, irritative voiding symptoms, and urge incontinence.

Pelvic support is assessed in the woman because it is associated with pelvic muscle weakness. Loss of pelvic muscle tone is associated with pelvic descent, increasing the risk of urethral hypermobility or intrinsic sphincter deficiency. Paravaginal support is assessed using a gloved hand or speculum. The posterior vaginal wall is supported using either a Sims speculum or a gloved finger gently inserted into the vagina. The woman is asked to cough or strain down, and movement of the posterior vaginal wall is evaluated. Bulging of the anterior wall indicates a cystocele or loss of support of the bladder base. This maneuver is repeated, and the posterior vaginal wall is evaluated for the presence of a rectocele. Uterine prolapse is noted when the uterus or cervix migrates toward the vaginal introitus in response to physical exertion.

The sensations of the perineal area are assessed, using a small needle to evaluate sharp versus dull stimuli and using two probes to determine one- versus two-point discrimination. The bulbocavernosus reflex (BCR) is evaluated by gently tapping on the clitoris while observing the anal sphincter. A positive reflex will produce an anal ‘‘wink’’ or contraction of the perianal muscle. A weaker response is assessed by placing a gloved finger at the anus or by pelvic muscle electromyogram using patch or needle electrodes. Loss of sensations or absence of the BCR indicates neurologic damage associated with urinary incontinence or retention.

The prostate is examined for size, consistency, and induration when urinary retention is suspected. Benign prostatic hyperplasia, a common cause of urinary retention in older men, produces a uniform enlargement of the prostate. In contrast, prostate cancer causes asymmetric enlargement or discrete, hard nodules.

When altered patterns of urinary elimination suspected from the health history, a log or diary should be completed. The simple bladder log is kept over a long period of time to determine patterns of urinary elimination and patterns of incontinence. A more detailed log allows the nurse to evaluate fluid intake, client responses to prompted toileting, functional bladder capacity, and the estimated volume of an incontinent episode.

F.     Diagnostic Test

When significant urinary problems is observed, further testing is needed to evaluate the underlying cause of the condition and to determine treatment options. When urinary incontinence exists, a dipstick urinalysis is obtained and evaluated for nitrites, leukocytes, hemoglobin, glucose, and specific gravity. When nitrites or leukocytes are present, a microscopic analysis is completed to determine the presence of white blood cells in the urine (pyuria) and bacteria in the urine (bacteriuria). (Delaune & Ladner, 2011)

1.      Cystoscopy

Examintation of the bladder using a rigid or flexible cystoscope

2.      Kidney Biopsy (Bx)

Renal biopsy removal of kidney tissue for pathologic examination

3.      Radiography

X-ray studies commonly used in urology

4.      Intravenous Pyelogram (IVP), Intravenous Urogram

X-rays of the urinary tract taken after an iodine contrast medium is injected into the bloodstream; the contrast passes through the kidney and may reveal an obstruction, evidence of trauma, and so on

5.      Kidney, Ureter, Bladder (KUB)

Abdominal x-ray of kidney, ureter, and bladder typically used as a scout film before doing an IVP

6.      Scout Film

Plain x-ray take to detect any obvious pathology before further imaging (e.g., a KUB before an IVP)

7.      Renal Angiogram (arteriogram)

X-ray of the renal artery made after injecting contrast material into a catheter in the artery

8.      Retrograde Pyelogram (RP)

X-ray of the ureters, bladder, and kidney taken after contrast medium is administered backward through a small catheter through a cystoscope to detect the presence of stones, obstruction, and so on

9.      Voiding (Urinating) Cystourethrogram (VCU) or (VCUG)

X-ray of the bladder and urethra taken during urination

10.  Abdominal Sonogram

Ultrasound image of the urinary tract, including the kidney and bladder

11.  Urinalysis (UA)

Physical, chemical, and microscopic examination of urine

12.  Specific gravity (SpGr)

Measure of the concentration or dilution of urine

13.  Ph

Measure of the acidity or alkalinity of urine

14.  Glucose (sugar)

Chemical test used to detect sugar in the urine; used most oftern to screen for diabetes

15.  Albumin (alb) protein

Chemical test used to detect the presence of albumin in the urine

16.  Ketones

Chemical test used to detect the presence of ketone bodies in the urine; positive test indicates fats are being used by the body instead of carbohydrates, which occurs in starvation or in an uncontrolled diabetic state

17.  Occult Blood, Urine

Chemical test for the presence of hidden blood in the urine resulting from red blood cell hemolysis; indicates bleeding in the kidneys (occult = hidden)

18.  Bilirubin

Chemical test used to detect bilirubin in the urine; seen in gallbladder and liver disease

19.  Urobilinogen

Chemical test used to detect bile pigment in the urine - increased amounts seen in gallbladder and liver disease

20.  Nitrite

Chemical test to determine the presence of bacteria in the urine

21.  Microscopic Findings

Microscopic identification of abnormal constituents present in the urine (e.g., red blood cells, white blood cells, and casts); reported per high or low power field (hpf or lpf)

22.  Urine Culture And Sensitivity (C&S)

Isolation of a urine specimen in a culture medium to propagate the growth of microorganisms; organisms that grow in the culture are identtified along with drugs to which they are sensitive

23.  Blood Ures Nitrogen (BUN)

Blood test to determine the level of urea in the blood; a high BUN indicates the kidney's inability to excrete urea

24.  Creatinine, Serum

Test to determine the level of creatinine in the blood, useful in assessing kidney function

25.  Creatinine, Urine

Test to determine the level of creatinine in the urine

26.  Creatinine Disease Testing

Measurement of the level of creatinine in the blood and a 24-hour urine specimen to determine the rate that creatinine is "cleared" from the blood by the kidneys

Urine culture and sensitivity testing are completed and the client is treated for a urinary tract infection. If glucose is noted in the urine, the client may undergo further evaluation for diabetes mellitus, or methods of glucose control may be reviewed and adjusted in the client with known diabetes. If the specific gravity (the weight of urine compared with the weight of distilled water) of the urine is abnormally low (below 1.010), the volume of fluid consumed by the client over a 24-hour period is evaluated further. Hematuria (blood in the urine) may be noted.

More detailed diagnostic testing of lower urinary tract function may be obtained in cases of complex urinary retention or incontinence. Urodynamics is a set of tests that measure bladder and surrounding abdominal pressures. Pressure data are combined with electromyography of the pelvic muscles and urinary flow rate to determine lower urinary tract function during bladder filling and micturition.

G.    Nursing Diagnosis

Domain 3: Elimination and Exchange 181

Class 1. Urinary function 183

·         Impaired urinary elimination – 00016 183

·         Readiness for enhanced urinary elimination – 00166 184

·         Functional urinary incontinence – 00020 185

·         Overflow urinary incontinence – 00176 186

·         Reflex urinary incontinence – 00018 187

·         Stress urinary incontinence – 00017 188

·         Urge urinary incontinence – 00019 189

·         Risk for urge urinary incontinence – 00022 190

·         Impaired Urinary Elimination

·         Urinary retention – 00023 191 (Blackwell, 2014)

Impaired urinary elimination is the state in which the individual experiences a disturbance in urine elimination. Defining characteristics include dysuria (painful urination), frequency, hesitancy, incontinence, nocturia, retention, and urgency. Altered urinary elimination patterns can result from multiple causes, including anatomic obstruction, sensory motor impairment, and urinary tract infection. (Delaune & Ladner, 2011)

1.      Stress Urinary Incontinence

Stress urinary incontinence is the state in which an individual experiences a loss of urine less than 50 mL occurring with increased abdominal pressure. Major characteristics include reported or observed dribbling with increased abdominal pressure. Minor characteristics may include urinary urgency and urinary frequency (more often than every 2 hours). The client may also be experiencing related factors such as degenerative changes in pelvic muscles and structural supports associated with increased age, high intra-abdominal pressure (e.g., obesity, gravid uterus), incompetent bladder outlet, overdistension between voidings, or weak pelvic muscles and structural supports.

2.      Reflex Urinary Incontienece

The state in which an individual experiences an involuntary loss of urine, occurring at somewhat predictable intervals when a specific bladder volume is reached, is known as Reflex urinary incontinence. Major characteristics include no awareness of bladder filling, no urge to void or feelings of bladder fullness, and uninhibited bladder contraction or spasm at regular intervals. Related factors include a neurologic impairment (e.g., spinal cord lesion that interferes with conduction of cerebral messages above the level of the reflex arc).

3.      Urge Urinary Incontinence

Urge urinary incontinence is the state in which an individual experiences involuntary passage of urine occurring soon after a strong sense of urgency to void. Major characteristics include urinary urgency, frequency (voiding more often than every 2 hours), and bladder contracture or spasm. Minor characteristics include nocturia (more than two times per night), voiding small amounts (less than 100 mL) or large amounts (more than 550 mL), and inability to reach the toilet in time. Urge incontinence may be related to decreased bladder capacity (e.g., history of pelvic inflammatory disease, abdominal surgeries, indwelling urinary catheter), irritation of bladder stretch receptors causing spasm (e.g., bladder infection)

4.      Functional Urinary Incontinence

The state in which an individual experiences an involuntary, unpredictable passage of urine is called Functional urinary incontinence. Major characteristics include the urge to void or bladder contractions sufficiently strong to result in loss of urine before reaching an appropriate receptacle. Altered environment and sensory, cognitive, or mobility deficits may contribute to functional incontinence.

5.      Total Urinary Incontinece

Total urinary incontinence is the state in which an individual experiences a continuous and unpredictable loss of urine. Major characteristics include constant flow of urine occurring at unpredictable times without distension, uninhibited bladder contractions or spasms, unsuccessful incontinence refractory treatments, and nocturia. Related factors include neuropathy that prevents transmission of the reflex that indicates bladder fullness; neurologic dysfunction causing triggering of micturition at unpredictable times; independent contraction of the detrusor reflex owing to surgery, trauma, or disease that affects spinal cord nerves; or anatomy (fistula).

6.      Urinary Retention

The state in which the individual experiences incomplete emptying of the bladder is known as Urinary retention. Major characteristics for urinary retention include bladder distension and small, frequent voiding or absence of urine output. Minor characteristics include sensation of bladder fullness, dribbling, residual urine, dysuria, and overflow incontinence. High urethral pressure caused by a weak detrusor, inhibition of the reflex arc, a strong sphincter, and blockage are related factors for urinary retention.

H.    Nursing Treatment/ Nursing Intervention

1.      Major goals for the patient may include

a.       Relief of pain and discomfort

b.      Increased knowledge of preventive measures and treatment modalities.

c.       Absence of complications. (Delaune & Ladner, 2011)

2.      Nurses care for patients

a.       Relief pain

3.      Antispasmodic agents may relieve bladder irritability and analgesics and application of heat help relieve pain and spasm.

a.       Maintaining fluids

The nurse should encourage the patient to drink liberal amounts of fluids to promote renal blood flow and to flush bacteria from the urinary tract.

1.      Giving education

Encourage frequent voiding every 2 to 3 hours to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection.

2.      Irritants

Avoid urinary irritants such as coffee, tea, colas, and alcohol.

3.      Personal hygiene

The nurse should instruct the female patient to wash the perineal area from front to back and wear only cotton underwear.

4.      Medicine therapy

Strictly adhere to the antibiotic regimen prescribed by the physician.

I.       Urinary Elimination Disorder

1.      Kidneys stone

Kidney stone disease is endemic. Extracorporeal shockwave lithotripsy was the first major technological breakthrough where focused shockwaves were used to fragment stones in the kidney or ureter.The purpose of this study to bind microbubble binding enough to kidney stones.

Microbubbles has played an increasingly important role in medical and diagnostic therapy as a contrast agent for ultrasound imaging .Biofuel targeted as a contrast material requires small doses and exhibits excellent detection sensitivity [27-29]. CT is the 'gold standard' in the diagnosis of renal stone radiography which gives the highest sensitivity, but some stones (ie stone of the drug) are not seen even in CT. Targeted biofuels can bind to specific drug targets, pointing them to radiography. Plain X-rays do not have visualization of radiolucent stones (ie uric acid, cystine), but these stones can be specifically targeted to allow detection using simple plain radiographs. The stones in the renal parenchyma can be distinguished from those in the collecting system, thus proving more accurate stone measurements. Traditionally MRI is poor on rock visualization. Most calcium-based urine, and most consist of hydroxyapatite. Many think that most biomineralization begins with hydroxyapatite crystals. In addition, these stones contain an unevenly distributed number of cavities throughout the interior that enlarge a small area of ​​hydroxyapatite in a crystal sheet lattice [58-61]. Theoretically with microbubbles characterized by bisphosphonates, urinary stones can be specifically targeted; and can be used as an alternative minimally invasive treatment for rock fragmentation. A microbubble can have specific targeting parts (such as biphosphonate ligands) made ex vivo, which will have an affinity for hydroxyapatite in the urethra after being injected into the urinary system.

This new technology differs from such procedures by using application-specific microbubbles containing ex vivo-produced gases. The produced mikrobubbles contain targeting tags (such as bisphosphonates) that allow them to concentrate on or near targeted networks (eg urinary stones). They are then typically sent to the surface or around the desired target.

The novel application of targeted microbubble technology represents the next frontier in minimally invasive stone surgery, and our team envisions this as a platform technology in medicine. Traditional ESWL uses an extracorporeal energy source that creates microbubbles at the targeted stone, and subsequent cavitation leads to stone fragmentation. Targeted, tagged microbubbles eliminate the need for a large, bulky machine, and these unique microbubbles can be delivered directly to the offending stones. An energy source applied from either an extracorporeal or intracorporeal source can initiate the cavitation process, leading to stone fragmentation. This is the extension of minimally invasive stone treatment. We envision the principles of this technology to be applied to other commonly appreciated pathological conditions in medicine. (Mark, Kennie, & Lasser, 2015)

 

References

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Blackwell, W. (2014). NURSING DIAGNOSES definition and classification. Oxford: SPi Publisher Services.

Delaune, S., & Ladner, P. (2011). Fundamental Of Nursing Standart and Practices. New York: Cengange Learning.

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