Urine, Urination, and Urine Output (Nursing)

00:01 Well, I bet you didn't expect to see this.

00:03 But we're going to talk about your brain and urination.

00:07 So what goes on when you have that panic feeling when you really really have to pee? Let's break it down.

00:13 So you have these nerve endings in the bladder wall that are sensitive to the bladder stretching.

00:19 I know when I'm proctoring exams for students, when it takes that full length of time and I've been sipping a drink through the whole proctoring time, my bladder is screaming at me by the time I'm done.

00:31 Well, here's what's going on in my brain.

00:33 Those nerve endings in the bladder are stretched way beyond what they should be.

00:39 Now they start shooting a message right up to my brain.

00:42 This is nerve impulse, it goes straight to the cerebral cortex, it says, "Hello, I'm not going to be able to hold much more." Now what the brain shoots back down is it stimulates the detrusor muscle to contract and it stimulates relaxation of the internal urethral sphincter.

00:59 Okay...

01:01 That sounds super fancy.

01:03 But let's talk about what's going on here.

01:05 That's a very intense message sent to your brain.

01:09 That's why you can't really think very well, if you have to go to the bathroom really bad because there's screaming at your brain to do something about it.

01:16 Now, a result of that detrusor muscle contracting and the internal urethral sphincter opening up and relaxing, is that those bladder walls will contract and the sphincter muscle releases and when it relaxes, that opens a chute to let the urine leave your body.

01:33 That's why when you're really really panicking, and you're dancing around, is because your brain is screaming to your bladder to let this happen.

01:42 And that's also why potty training can be a little difficult for children.

01:45 But the next time you over drink and can't get to a bathroom quick enough, just say, "Hey, this is no problem. It's just my brain screaming." But make sure you get to the bathroom.

01:56 So what's in all this stuff that's filling up my bladder? Well, it's mostly...

02:00 Water.

02:01 Yep, that's it.

02:03 What's in your urine is 95% even a little more than that water.

02:08 Now most of you are really good about drinking water.

02:11 So you know, when you first wake up in the morning, it's more concentrated.

02:14 In fact, we use the first urine of the morning for some specialized urine testing.

02:19 But as you go through the rest of the day, and you're drinking adequately, you notice that your urine should be getting lighter and lighter in color.

02:28 But urine is predominantly greater than 95% water.

02:31 So you do the math.

02:34 What's in the other 5%? Well, urea, chloride, sodium, potassium, creatinine, and we've got some other...

02:43 let's just call them dissolved ions.

02:45 Inorganic and Organic compounds like proteins, hormones, and metabolites.

02:51 Okay, so if you're not impressed, you really should be because in from a urine analysis, it's like a poor man's CBC.

02:59 We can tell a lot of things that are going on in the body just from analyzing someone's urine.

03:05 So be impressed.

03:07 Well, it's 95% water.

03:09 All this other stuff that's located in the urine can tell us a lot about the health of a patient.

03:15 Now you can learn how to see what's going on with your patient just by looking at their urine.

03:20 Okay, this is usually much easier to do if they have a Foley.

03:23 Or if they hand you their specimen cup.

03:26 Did you have to do that awkward lab where they made you pee in a cup and then bring it back in front of your peers? I hate that lab when you're walking down the hallways at school with your cup of urine, but we've all been there.

03:37 So let's look when urine looks all funny, right? Protienuria Well, that's the medical terminology.

03:44 Uria means urine.

03:46 So what's in front of that is what's in their.

03:48 Proteinuria.

03:50 And when the protein content in urine is extra high, that tells us your kidneys are having a problem, because the glomeruli is been damaged and protein is leaking into the urine that shouldn't be there.

04:04 Now, you'll see that it kind of has a foam on top.

04:07 That's a real characteristic of a lot of protein in the urine.

04:11 Now, there might be less you have microalbuminuria you can have small amounts of protein.

04:16 You can see them a dipstick test, where you take a strip with chemicals on it and you dip it in the urine.

04:21 Not as accurate as we do.

04:23 A urine analysis can tell us exactly how much protein is in the urine.

04:28 Why do we care? Again, it's a sign of kidneys that are struggling.

04:32 So particularly if a patient is diabetic, they're at extremely high risk for kidney disease.

04:38 So we want to watch their albumin levels when it's not obvious like giant foamy on the top of their urine.

04:44 We want to catch it when it's micro when it's just a little bit of it, so that we can make sure we're taking care of those kidneys as much as possible.

04:51 Alright, so that's the first one.

04:52 We started out with foamy urine in the cup.

04:55 Now let's look at what it looks like when it's oliguria.

04:58 Now again, uria means urine.

05:00 olig means scant.

05:03 So that's an abnormally small amount of urine.

05:05 Often because the patient is super dehydrated, they've had kidney damage or even shock.

05:12 Now remember, shock is you don't have enough oxygen moving around the body to meet the body's metabolic cellular needs.

05:20 Somebody in shock, their kidneys are not being perfused because nothing's getting perfused adequately, and that's why they put out only a small amount of urine.

05:30 Now when there's only a scant amount of urine, it's generally pretty dark.

05:34 So look at the difference in the picture there between proteinuria with his white foamy and oliguria.

05:40 See how it's much more dark and concentrated.

05:43 That's the sign there's not very much water in there because there's not very much able to be filtered by the kidney.

05:48 Now polyuria is the exact opposite of oliguria.

05:52 Olig means scant.

05:53 Poly means mucho, it means a lot.

05:56 So, if abnormally large amounts of urine, it's often caused by diabetes.

06:02 So that's a key sign to someone if they've lost weight, and they weren't really trying.

06:07 And they're putting out lots and lots and lots of urine.

06:10 That is a key cardinal symptom of diabetes.

06:13 So the patient does sometimes this is how we find out that they're diabetic through one of these symptoms.

06:18 So we've talked about protein in your urine, not very much urine and probably kind of dark.

06:23 and polyuria they'll be lots of it and it'll be lighter colored.

06:27 These are three examples by observing someone's urine.

06:31 You can learn a lot about what's going on in their body.

06:35 Now, dysuria.

06:36 Dys means difficulty urine.

06:38 This means...

06:39 "Oh, man...

06:40 it is painful or uncomfortable when I pee." I mean, often, he's got some type of urinary tract infection so you feel like you have to urinate a lot.

06:47 And when you do it burns like fire.

06:51 So this is one of the main symptoms people report when they have a UTI.

06:57 Hematuria is blood in the urine.

07:00 So red blood cells in the urine could be from infection.

07:04 That's one of the signs of infection, or there could be some injury to the kidneys.

07:09 So watch, if you see red color urine, is it just dark because it's concentrated? Or does it have blood in it? That's when we can do a further urinalysis.

07:17 Now you always want to compare that to what's going on in your patient.

07:21 Was the patient in a trauma? Have we done some type of procedure to their urinary tract? If you have a patient, who like a male patient who has benign prostatic hypertrophy, they'll do surgery to help kind of whittle down that prostate.

07:36 Now we will keep regulating with fluid.

07:38 We'll keep draining fluid in and draining fluid out of that bladder.

07:42 We expect that urine to be blood blood tinged.

07:45 That's acceptable.

07:46 But if your patient is putting out bloody urine, and we don't know why that's an example of when you use your skills to assess and figure out what's the source of that blood in their urine.

07:56 Now lastly, you see that we've got some strips next to that urine.

08:00 This is glycosuria.

08:02 That's too much sugar, or glucose in your urine.

08:07 Now those strips are examples, they're chemicals that are put on a little strip.

08:11 You can dip it into the water, pull it out, and we can read lots of things about it.

08:16 But the example here is when you have too much glucose in your urine, you've got so much glucose in your bloodstream for diabetics, it's beyond the amount that can be reabsorbed by the kidneys in the proximal convoluted tubules.

08:28 So it just gets dumped out into the urine.

08:32 So we've talked about two types of diabetic urine, even a third one.

08:37 So if I look at your urine and there's protein on it, it will look...? Right.

08:41 It will look foamy.

08:43 That's a pretty severe case.

08:45 That could be a sign of diabetes because their kidneys have been damaged, and we're dumping too much protein into the urine.

08:51 We've got glycosuria.

08:54 Correct.

08:54 We've got too much glucose in the urine.

08:57 We can see that on a dipstick test.

08:59 Because there's just so much in the bloodstream.

09:00 It can't be reabsorbed by the kidneys.

09:03 And so it dumps out in the urine.

09:05 And what was the third option? Right.

09:08 A diabetic client might be putting out lots and lots of urine known as polyuria.