Urinary System and Elimination

As nursing assistants, your responsibility of taking care of your patients/residents will incorporate many body systems. This part of learning is just to understand the basics and be observant to any changes in your patient or residents’ health. Reporting any changes to your team leaders so that your patients will get the proper care to maintain health and well-being.

The genitourinary system includes the kidneys, ureters, bladder, urethra and the associated organ, the prostate gland.

Your kidneys are vital organs that perform essential functions by filtering waste and excess fluid from the blood where urine is produced as a byproduct. They regulate blood pressure, maintain electrolyte balance. Produce hormones like erythropoietin which stimulates red blood cell production. They also activate vitamin D for bone health. Kidneys filter approximately 200 quarts of blood daily separating waste products and excess fluid. The waste products and extra fluid is then excreted as urine. This also helps to prevent the buildup of toxins in our body. The erythropoietin hormone stimulates red blood cell production in the bone marrow. It also activates Vitamin D which is essential for calcium absorption and maintaining healthy bones and muscles. Very important as your patients get older, they should be tested for calcium levels and bone density exams should be done. The kidneys also maintain the acid- base balance and regulate electrolytes like Sodium (NA), Potassium (K*), and Calcium (CA).

Sodium (NA) 135-145meq/L normal levels. This ion maintains extracellular fluid balance. The balance is controlled by the Central Nervous System and the endocrine system. If there is any shift to the balance of sodium it can result in edema or dehydration. Hyponatremia or low sodium signs and symptoms can be confusion, headaches, nausea and vomiting, muscle cramps, weakness, increased pulse and decreased blood pressure. Hypernatremia or high sodium signs and symptoms could be thirst, dehydration, hallucinations, confusion, coma, seizures, pulmonary edema an increased blood pressure, pulse and temperature.

Potassium (K*) 3.5-5.5meq/L normal levels. This electrolyte is acquired in one’s diet and excreted in the urine and must be replaced daily. This electrolyte maintains osmotic pressure inside the cells. Maintains acid/base balance and participates in metabolism. Hypokalemia or low potassium, if you become dehydrated and are lacking this electrolyte you may get leg cramping. Muscle weakness, fatigue, cardiac arrest or fibrillation. Hypoactive reflexes. So, you must watch that your patients and or residents are not falling or dropping items that cause harm to themselves. Decreased blood pressure. Hyperkalemia or high potassium rapid heart rates occur but slows to a bradycardia below 60. Muscular weakness, paralysis or a paresthesia (an abnormal sensation of tingling, numbness or prickling) occur. Intestinal cramping. Irritability and anxiety.

Calcium (CA) 8.4-10.2meq/dl normal levels. The function of calcium is neuromuscular activity. The integrity of cell membranes. Cardiac activity and blood coagulation. Hypocalcemia or low calcium. Tingling of hands, feet and around the lips. Spasms of leg and arm muscles and face. Hyperactive reflexes. Hypercalcemia or high calcium levels signs and symptoms muscle weakness, loss of coordination, anorexia which is loss of appetite, nausea and vomiting even cardiac arrest.

Your ureter’s primary function is to transport urine from the kidneys to the urinary bladder. They are narrow tubes that use a peristalsis which is a wavelike flow where the muscle contracts to move the urine downward. They act as an outlet carrying urine from the renal pelvis to the bladder. Each kidney has its own ureter one leading to the left and the other leading to the right. They are a key part in the elimination of urine from the body. If someone is having trouble peeing it could be caused by a condition with the ureter like a blockage or a kink. If your patient does not urinate in a 24-hour period the team leader must be notified so they can get orders to follow up.

The urinary bladder primary function is the storage and emptying organ for urine. It receives urine from the kidneys via the ureters as this occurs the bladder expands as it fills and then contracts to push out the urine through the urethra during urination. It can hold between 300-500 milliliters in an adult before the urge to urinate. A full bladder is not fun especially when you are dependent on someone else to help you to the bathroom. That is why it is very important no matter where you work to round on your patients and take them to the bathroom. For patients who are in need of assistance it is very embarrassing if they need to urinate and have no control and then become incontinent. Effects their pride.

The urethra is a muscular tube that serves as an outlet for urine and semen in the body. Transports urine from the bladder to outside the body. In men it carries semen from the reproductive organs to the penis during ejaculation. The urethra has sphincters which are muscles that help regulate the flow of the urine. There are two- the internal urethral sphincter is involuntary and the external urethral sphincter is voluntary. In males the urethra is longer than the females.

The prostate gland is an organ the size of a walnut located below the bladder in men. Plays important role in male reproductive system. Regulates urine flow by surrounding the upper part of the urethra carrying urine out of the body. It produces a hormone called dihydrotestosterone (DHT) which plays a very important role in male sexual development and function. It is very important for male patients to have this examined by a physician because if it is not functioning correctly can lead to infections or cancers.

Some definitions for the urinary system

Urination is the process of emptying urine from the bladder by voiding.

Anuria-failure of kidney function. Urine output of less than 100ml/day or no urine output at all.

Oliguria– diminished amounts of urine. The urine output is less than 500ml/day or less than 30cc/hour. Sometimes seen in patients who are severely dehydrated, have profuse sweating or diarrhea.

Polyuria– abnormally large amounts of urine output.

Dysuria– painful or burning on urination. Can be a sign of infection.

Micturation – another word for urination/voiding.

Nocturia – frequent urination at night time.

Urinary Incontinence– involuntary loss or leakage of urine.

Stress incontinence– leakage of urine when certain exercises are done, sneezing, coughing where pressure is applied to the bladder.

Urinary retention– inability to void.

Hematuria -blood in the urine.

Pyuria– pus in the urine.

So, the importance of your skills is to help maintain one’s health and well-being for this body system and to maintain their life balance. You would be responsible to monitor your patient’s intake and output. Help to maintain their skin integrity related to any issues of incontinence and prevent breakdowns. While observing and recording as well as reporting any changes to the team leader. You will also be adding fall risk protocols as well. Your advocacy of your patient/resident can help their health maintenance more than you realize.