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Urinary Elimination

By

Dr. Amer Hasanien

Dr. Ali Saleh

Dr. Ibrahim Salami2/6/2019 1

Factors Affecting Voiding

Developmental factors Enuresis: involuntary passing of urine in children

after bladder control is achieved.

Nocturnal Enuresis: involuntary passing of urine during sleep.

Psychosocial factors Conditions stimulate urination: privacy, normal

position, sufficient time, and running water.

Time pressure ↓ urination

Fluid and food intake: e.g alcohol and fluids containing caffeine ↑ urine output. Food and fluids containing sodium ↓ urine output

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Factors Affecting Voiding

Medications: e.g. diuretics e.g. furosemide

(lasix).

Muscle tone

Pathologic conditions: e.g. kidney

diseases, heart and circulatory diseases.

Surgical and diagnostic procedures: e.g.

urinary tract surgeries, cystoscopy (endoscopy of

the urinary bladder via the urethra)..

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Altered Urine Production

Polyuria (Diuresis): the production of abnormally large amounts of urine by the kidneys. It can follow polydipsia (excessive thirst)

Oliguria: production of abnormally small amounts of urine by the kidney. less urine output than 500 ml/day or 30 ml/hr

Anuria: the failure of the kidneys to produce urine, resulting in a total lack of urination or output of less than 100 mL per day in an adult

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Altered Urinary Elimination

Frequency or Nocturia

Urinary frequency: is voiding at frequent

intervals, that is, more than 4 to 6

times/day. Causes such as ↑ fluid intake,

UTI, stress, and pregnancy.

Nocturia: voiding two or more times at

night

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Altered Urinary Elimination

Urgency: is the sudden strong desire to void. There may or may not be a great deal of urine in the bladder.

Dysuria: painful or difficult urination such as burning sensation- accompanied with stricture of urethra or UTI’s. Urinary hesitancy: a delay and difficulty in initiating

voiding, and often associated with dysuria.

Enuresis: involuntary passing of urine in children after bladder control is achieved. Nocturnal

Diurnal

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Altered Urinary Elimination

Urinary incontinence (involuntary

urination): is a symptom, not a disease.

Different causes such as UTI, urethritis,

restricted mobility, volume overload.

Acute

chronic

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Altered Urinary Elimination

Urinary retention: urine accumulates in

bladder and the bladder become

distended (when emptying the bladder is

impaired). Common causes include:

prostatic enlargement, surgery, and some

medications.

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Altered Urinary Elimination

Neurogenic Bladder: patient does not

perceive bladder fullness and is unable to

control of the urinary sphincters. Caused

by impaired neurologic function.

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Nursing Assessment of Urinary

Function

Nursing history

Physical assessment of urinary system,

Hydration status, and Examination of urine

Data from diagnostic tests and procedures

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Nursing History

Normal voiding patterns

Appearance of urine

Recent changes

Past or current problems

Presence of ostomy

Factors influencing the elimination pattern

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Physical Assessment

Percussion of kidneys and bladder to

detect tenderness

Inspect urethral meatus for swelling,

discharge, inflammation

Skin color, texture, turgor, signs of

irritation

Edema

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Assessing Urine

96% water and 4% solutes

Organic solutes include urea, ammonia,

creatinine, and uric acid

Inorganic solutes include sodium, chloride,

potassium sulfate, magnesium, and

phosphorus

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Assessing Urine

Volume

Color, clarity

Odor

Sterility

pH

Specific gravity

Glucose

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Assessing Urine (cont'd)

Ketone bodies

Blood

Measuring urinary output

Measuring residual urine (normally is 50-100 ml)

Diagnostic Tests

Blood urea nitrogen

Creatinine

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Normal urine (Table 16-4 / Page: 450)

1.200-1.500 ml/day- 60ml/hr

Straw, amber yellow transparent. (Hematuria)

Faint aromatic odor

No microorganism growth

4.5-8 pH

No glucose

No ketone (acetone) bodies

No blood present

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NANDA Nursing Diagnosis

Impaired Urinary Elimination

Urinary Retention

Risk for infection

Risk for impaired skin integrity

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NANDA Nursing Diagnosis(Box 16-1 / page. 451)

Impaired Urinary Elimination

Functional Urinary Incontinence (inability to reach

toilet in time)

Reflex Urinary Incontinence (occur when a specific

bladder volume is reached)

Stress Urinary Incontinence (occur with activities that

increase abdominal pressure)

Total urinary incontinence (continuous & unpredictable

passage of urine)

Urge Urinary Incontinence (occur after a strong sense of

urgency to void)

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General Nursing Interventions Promoting fluid intake

Maintaining normal voiding patterns

Assisting with toileting

Preventing urinary tract infections Drink adequate amount of water per day (eight glasses)

Practice frequent voiding (every 2 to 4 hours)

Avoid use of harsh soaps, bubble bath, powder, or sprays in the perineal area

Avoid tight-fitting clothing

Wear cotton rather than nylon underclothes

Always wipe the perineal area from front to back following urination or defecation (girls and women)

Take showers rather than baths in recurrent urinary infections

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General Nursing Interventions

Managing urinary incontinence

Continence training program: bladder training,

habit training, prompted voiding, pelvic muscle exercises, and positive reinforcement.

Maintaining skin integrity and care

Applying external urinary drainage devices (for male)

Performing urinary catheterizations

Performing bladder irrigations2/6/2019 25

Bladder training is an important form of behavior therapy that can be effective in

treating urinary incontinence. The goals are to increase the amount of time betw een

emptying your bladder and the amount of f luids your bladder can hold.

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external urinary drainage devices

General Nursing Interventions

Providing care for clients with indwelling

urinary catheters and urinary diversions

Fluids

High proteins dietary measures to increase urine acidity e.g. cheese, eggs, meat.

Perineal care

Changing catheter

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Applying an External Urinary Device Urinary drainage leg bags.

(Courtesy of Bard Medical Division.)

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Performing Urinary Catheterization Catheter insertion kits: A, indw elling; B, straight.

(Courtesy of Bard Medical Division.)

A

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Performing Urinary Catheterization Catheter insertion kits: A, indw elling; B, straight.

(Courtesy of Bard Medical Division.)

B

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Performing Urinary Catheterization A catheter securement device.

(Courtesy of Dale Medical Products, Inc.)

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Performing Urinary Catheterization Correct position for urine drainage bag and

tubing.

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Performing Bladder Irrigation A continuous bladder irrigation (CBI) setup.

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Performing Bladder Irrigation An irrigation set.

(Courtesy of Bard Medical Division.)

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