ANATOMY & PHYSIOLOGY OF URINARY

SYSTEM

 COMPONENTS:
1. Kidneys
2. Ureters
3. Urinary bladder
4. Urethra

FUNCTIONS & CHARACTERISTICS

KIDNEYS
1. functions filtration
✓ enzyme & hormone production  Polyuria – increased volume of urine
✓ excretion voided.
✓ maintain blood PH  Oliguria – total urine output less than
2. characteristics 400ml in 24 hours.
-bean shaped, retroperitoneal,12th TV  Dysuria – painful urination
to the 3rd TV,10-12 cm  Pyuria – pus in the urine; WBC in urine
 Hematuria – blood in the urine; RBC in
 URETERS- transport urine from renal urine
pelvis to urinary bladder, primarily by
peristalsis.

 BLADDER- stores urine temporarily

 URETHRA- discharges urine from the

body, 3-4 cm (Females), 20 cm (Males)

RELATED TERMS
 Micturition- act of emptying thebladder.
 Retention - the bladder is unable to expel
its contained urine.
 Incontinence- inability to control Computation of urine output:
micturition.
 Hesitancy- delay, difficulty initiating
voiding.
 Anuria - total urine output less than 50 ml
in 24 hours.

MECHANISM of URINATION:

FORMULA:
Urine output = Total Volume in drained – amount
of solution irrigated

Example: Mr. Estacion, 56 y.o., is a 1-day

postTURP client and is on continuous bladder
irrigation with Normal Saline Solution. The
urologist ordered that the rate be set at “fast drip
(about 120 gtts/min)”. The delivery set is
20gtt/mL. The intake and output record for the
irrigation shows the entries above during the 7-3
shift.
1. How much solution was used to irrigate
between 7-3pm?
2. How much is Mr. Estacion’s total urine output
during the 7- 3 shift?
Answer:
1. Total volume of solution irrigated: 2,900 mL
2. Urine output 7-3 shift: 840 mL
_________________
Assisting in BLADDER IRRIGATION
-
triangle -shaped,
- hollow organ with distensible walls - located in
the lower abdomen.
- held in place by ligaments that are attached to
other organs and the pelvic bones.
- lined by layers of muscle tissue that stretch to
hold urine
- The musculature of the bladder contracts during
micturition, with concomitant relaxation of the
sphincters.
• Urine is made in the kidneys and travels down
two tubes called ureters to the bladder.
• The bladder stores urine, allowing urination to
be infrequent and controlled.
• The bladder's walls relax and expand to store
urine, and contract and flatten to empty urine
through the urethra.
• Temporary storage of urine
• Assists in the expulsion of urine
BLADDER IRRIGATION
• is the introduction of a large amount of sterile
solution into the urinary bladder through a sterile
catheter with provision for the return flow
• An irrigation is a flushing or washing out with a
specified solution
• carried out on a primary care provider’s order,
usually to wash out the bladder and sometimes
to apply a medication to the bladder lining
• Catheter irrigations may also be performed to
maintain or restore the patency of a catheter, for
example, to remove pus or blood clots blocking
the catheter
Conditions that necessitate BI
1. Post TURP
2. Prostatectomy
3. Prostatic hematuria
4. Post-genitourinary surgery
5. Hemorrhagic cystitis
SIGNS of a BLOCKED CATHETER
• No urine flow from the catheter
• Patient complaining of suprapubic pain,
becoming more pronounced as the bladder fills
• If unrelieved vaso-vagal symptoms may develop
• Bypassing around the catheter
PURPOSES OF BLADDER IRRIGATION
1. To clean the urinary bladder of irritating
products of inflammation and blood clots.
2. To relieve congestion, inflammation, and pain.
3. To instill medications to treat infection.
4. To prepare the urinary bladder for surgery
• the type of sterile solution, the amount and
strength to be used, and the rate (if continuous);
and
• the type of catheter in place

*What is the difference between an open and a

closed irrigation? When is one used over the
other?

Do open and closed irrigations use the same type

of urinary catheter in the system?
INTERMITTENT BLADDER IRRIGATION
BLADDER IRRIGATION
-Occasionally an open irrigation may be necessary
to restore catheter patency. The closed method is
the preferred technique for catheter or bladder
irrigation because it is associated with a lower
risk of UTI

Urinary catheter types

• Instill the prescribed amount of irrigant solution

• If specific amount is not ordered, fill up to 150
ml of irrigant solution
• Clamp the irrigating tubing
• Wait for the prescribed length of time
• Open the clamp, monitor the drainage as it
flows into the drainage tube.

PLANNING
TYPES of IRRIGATING SOLUTION
• Before irrigating a catheter or bladder, check
• Sterile Water
for the following:
• Normal Saline
• the reason for the irrigation;
• Glucose solution 5%
• the order authorizing the continuous or
• Sodium nitrate (1:8000)
intermittent irrigation (in most agencies, a
• Boric Acid 2%
primary care provider’s order is required);
• Acriflavin 1:10,000
• Silver Nitrate 1:5000
• Acetic acid 1:400 to treat pseudomonas
infection

NURSE’S RESPONSIBILITIES (BEFORE)

• Check for order
• Inform the patient
• Arrange the articles
• Comfortable position
• Privacy
• Hand washing
• Expose only the area

NURSE’S RESPONSIBILITIES (DURING)

• Maintain aseptic technique
• Follow all the necessary steps
• Use only recommended solutions
• Follow the flow rate for CBI as ordered
• Make sure that the fluid is draining properly

NURSE’S RESPONSIBILITIES (AFTER)

• Clean the area
• Regular catheter care should be given
• Watch for any signs of complications
• Record and report the procedure