Mosby items and derived items © 2005 by Mosby, Inc. Chapter 44 Urinary Elimination

Mosby items and derived items © 2005 by Mosby, Inc. Urinary System Kidneys Ureters Bladder Urethra Act of urination

Mosby items and derived items © 2005 by Mosby, Inc. Factors Influencing Urination Disease conditions Sociocultural factors Psychological factors Muscle tone

Mosby items and derived items © 2005 by Mosby, Inc. Factors Influencing Urination (cont'd) Fluid balance Surgical procedures Medications Diagnostic examinations

Mosby items and derived items © 2005 by Mosby, Inc. Alterations Urinary retention Urinary tract infections Urinary incontinence Urinary diversions

Mosby items and derived items © 2005 by Mosby, Inc. Urinary Incontinence Functional Overflow Reflex Stress Urge

Mosby items and derived items © 2005 by Mosby, Inc. Infection Control and Hygiene Asepsis Client education Catheterization and other procedures

Mosby items and derived items © 2005 by Mosby, Inc. Growth and Development Infants Toddlers and young children Adults Older adults

Mosby items and derived items © 2005 by Mosby, Inc. Psychosocial Considerations Self-concept Culture Gender

Mosby items and derived items © 2005 by Mosby, Inc. Assessment of Urinary Elimination Nursing history –Pattern of urination –Symptoms of alterations –Factors affecting urination

Mosby items and derived items © 2005 by Mosby, Inc. Assessment of Urinary Elimination (cont'd) Physical assessment –Skin and mucous membranes –Kidneys –Bladder –Urethral meatus

Mosby items and derived items © 2005 by Mosby, Inc. Assessment of Urinary Elimination (cont'd) Assessment of urine –Intake and output –Characteristics: color, clarity, odor –Urine testing: specimen collection

Mosby items and derived items © 2005 by Mosby, Inc. Assessment of Urinary Elimination (cont'd) Common urine tests –Urinalysis –Specific gravity –Culture Diagnostic examinations –Consents –Allergies –Pre- and postprocedure interventions

Mosby items and derived items © 2005 by Mosby, Inc. Nursing Diagnoses Incontinence Risk for infection Toileting self-care deficit Impaired urinary elimination Urinary retention

Mosby items and derived items © 2005 by Mosby, Inc. Planning Goals and outcomes –Client will void within 8 hours after catheter removal –Client’s bladder is not distended on palpation Setting priorities Continuity of care

Mosby items and derived items © 2005 by Mosby, Inc. Implementation: Health Promotion Client education Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake Promoting complete bladder emptying Preventing infection: hygiene and acidifying urine

Mosby items and derived items © 2005 by Mosby, Inc. Implementation: Acute Care Maintaining elimination habits Medications Urethral catheterization Alternatives to urethral catheterization: suprapubic catheters, condom catheters

Mosby items and derived items © 2005 by Mosby, Inc. Urethral Catheterization Types Insertion Drainage systems Routine care: hygiene, fluids Prevention of infection Irrigations and instillations Removal

Mosby items and derived items © 2005 by Mosby, Inc. Implementation: Restorative Care Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort

Mosby items and derived items © 2005 by Mosby, Inc. Evaluation Client care Client expectations