1. URINARY ELIMINATION
Pamela Llana, MSN, RN

2. Urinary System

3. Factors Affecting Urinary Elimination
Fluid balance
Body position
Cognition
Psychological factors
Sociocultural conditions
Surgical/diagnostic procedures
Medications
Medical conditions

4. Factors Affecting Urinary Elimination, continued
Urinary Tract Infections
Most often is a lower UTI
Bladder inflammation characterized by dysuria, urgency, and frequency; also referred to as cystitis
Females are more at risk anatomically due to shorter urethra

5. Altered Urinary Function
Dysuria
Urgency
Frequency
Polyuria
Oliguria

6. Altered Urinary Function
Anuria
Nocturia
Hematuria
Pyuria

7. Altered Urinary Function
Urinary Retention
Inability to empty the bladder of urine
Can either be inability to empty, to void at all, or overflow voiding
Can be caused by obstruction, inflammation/swelling, meds, anxiety, neuro problems
Usually involves inability to void or adequately void within hours of last voiding.
Urine that remains in the bladder after urination is called residual urine. It is normal for <50 mL to remain in the bladder.
When assessing, be aware of volume and frequency of voiding.

8. Altered Urinary Function
Urinary Incontinence
Involuntary loss of urine from the bladder
Not a normal consequence of aging
Can be acute/reversible or chronic
Can lead to depressive symptoms/social isolation
Contributory factor in seeking institutional care

9. Altered Urinary Function
Types of Urinary Incontinence
Stress
Urge
Functional
Reflex
Total

10. Altered Urinary Function
Enuresis
Involuntary voiding after age of voluntary control
Usually nocturnal
Urinary Diversion
Most common cause- cancer
Removal of bladder- cystectomy
Diversion= ileal conduit; section of ileum dissected out and refashioned for urine drainage

11. Ileal Conduit

12. Assessment: Nursing History
Normal pattern of urination
Symptoms of urinary alteration
Factors affecting urinary alteration

13. Assessment: Physical Assessment
Inspection
Mucous membranes
Urethral meatus
As students you will not normally inspect the meatus unless there is a problem. If inspected, pink color with no drainage and smegma are WDL.
Palpation
Bladder – bulge with 500 mL urine
Kidneys

14. Assessment: Assessment of Urine
Intake and output (I & O)
Every 8 hrs with 24 hr total
I & O should be approx. equal over 24 hrs
Characteristics of Urine
Volume
Color
Clarity
Odor

15. Assessment: Specimen Collection
Random
Timed
Sterile
Clean voided or midstream
Specimen from a catheter

16. Assessment: Diagnostic Tests
Urine Tests
Reagent strips pH, glucose, protein, ketones, nitrites, occult blood
Urinalysis mL min; 1st morning voided spec preferred; detects all above plus bacteria, casts, cells, Specific Gravity = – 1.030
Urine for culture and sensitivity sterile spec required; 24 hr minimum time required for culture to grow; another 24 hrs for sensitivity report
Blood Tests how well kidneys are working to clean the blood; high levels indicate kidney malfunction or kidney failure; Creat. imp.
BUN mg/dL = normal
Creatinine mg/dL (serum creatinine)
BUN = normal
Creatinine (serum Cr.)

17. Assessment: Diagnostic Procedures
Imaging Studies are used to visualize urinary system to see
calculi, cysts, and tumors
Ultrasound can be done at bedside
MRI
CT scan
Radiographic x-ray such as KUB
Cystoscopy look into bladder with scope

18. Nursing Diagnoses Urinary Retention Stress Incontinence
Functional incontinence
Urge Incontinence
Reflex Incontinence
Total incontinence
Social Isolation

19. Implementation Promote Normal Voiding Assist with normal position
Provide sensory stimuli to aid in elimination
Provide for privacy
Maintain intake of at least mL/24 hrs unless contraindicated

20. Implementation Promote Complete Bladder Emptying
Kegel exercises and sit-ups
Pelvic floor exercises
Tightening perineal and anal muscles
Staggering/starting urination
Weight reduction relieves pressure on bladder
Medications
Anticholinergics (Detrol, etc.)
Catheterization
Necessary if patient is unable to urinate

21. Implementation Behavioral Interventions Lifestyle modifications
Daily fluid intake of mL
Scheduled voiding regimens
External catheter
Condom catheter
Absorbent products
Pads, briefs; change frequently to avoid odor and skin breakdown

22. Implementation Prevent Infection
Decrease pH or increase acidity of urine
Drink cranberry juice
Increase fluids
6-8 glasses/day -OR mL/day
Void at regular intervals
Void at regular intervals; Stagnant urine can increase infections
Encourage/promote good hygiene
Wipe front to back; Avoid bubble baths, powders, sprays
Shower vs. tub bath
Voiding before and after intercourse

23. Implementation Care of Indwelling Catheter
Utilize standard precautions
Maintain closed system
Empty drainage collection bag
Positioning of drainage collection bag below insertion/bladder
Monitor I & O
Cath care after peri-care
While holding catheter in place, clean 6-8 inches, wiping away from the body.

24. Implementation Maintenance of Skin Integrity
Keep client as clean and dry as possible
Wash with mild soap and water after incontinent episodes. Be sure to rinse soap completely.

25. I & O sheet INTAKE OUTPUT DATE Oral (po) Tube Fdg IV Totals Urine
Oral (po)
Tube Fdg IV
Totals
Urine
Emesis
Other
9/10/14
7-3
480
600
1080
500
3-11
320
920
750
200
950
11-7
100
700
300
24 HR Total
24 Hr
2700
1750
24 HR Fluid Balance
+950
24 Hr Total
24 HR
Total