1. Urinary Elimination
Chapter 48

4. Urination
Micturition, voiding, urinating

5. Factors
Developmental
Psychosocial
Fluid/Food intake
Medications

6. Factors (cont.) Muscle tone Pathological conditions
Surgery & diagnostic procedures

7. Altered Urine Production
Polyuria
Oliguria
Anuria

8. Altered Urinary Elimination
Urinary frequency
Nocturia
Urgency
Dysuria, associated with urinary hesitancy
Enuresis

9. Altered Urinary Elimination (cont’d)
Urinary incontinence
Transient (acute)
Established (chronic)
Psychosocial aspects

10. Altered Urinary Elimination (cont’d)
Urinary retention
Neurogenic bladder

11. Assessing Nursing history Physical assessment and hydration status
Assessment of urine
Diagnostic tests and procedures
Urine specimens in lab

12. Assessing Urine Tab 48-4 pg. 1183
Volume
Color, clarity
Odor
Sterility pH
Specific gravity

13. Assessing Urine (cont’d)
Glucose
Ketones
Blood
Measure residual urine
Diagnostic tests
Blood urea nitrogen (BUN)
Creatinine clearance

14. Nursing Diagnoses (Pg. 1184)
Impaired Urinary Elimination
Functional Urinary Incontinence
Overflow Urinary Incontinence
Reflex Urinary Incontinence
Stress Urinary Incontinence
Urge Urinary Incontinence

15. Nursing Process (Pg. 1186)
Goals
Interventions

16. Implementing
In small groups discuss how you would help your client maintain normal urinary elimination. What teaching would be performed to prevent UTIs?
Interventions focus on:
Maintaining normal urinary elimination
Practice guidelines pg. 1187
Preventing urinary tract infections (UTI)

17. Managing Urinary Incontinence
Continence training
Bladder training
Habit training
Prompted voiding
Pelvic muscle exercises
Maintaining skin integrity
Use of external draining devices

18. Managing Urinary Retention
Interventions to promote normal urinary elimination as discussed
Catheters
Cause of healthcare associated infection

19. Catherization Indications Types Complications Indwelling or foley
Straight (intermittent)
Suprapubic
Complications

20. Catheter insertion & removal as discussed in learning lab
Straight catheter
Foley catheter

21. Nursing Care for Clients with Indwelling Catheters
Fluids
Dietary measures
Perineal care
Change catheter and tubing when necessary
Maintain sterile closed-drainage system

22. Nursing Care for Clients with Indwelling Catheters (cont’d)
Remove catheter as soon as possible
Bladder retraining if needed
Follow good handwashing techniques
Preventing catheter associated urinary infections pg. 1192

23. Clean Intermittent Self-Catheterization
Performed by clients with neurogenic bladder dysfunction
Clean or medical aseptic technique

24. Suprapubic catheter

25. Urostomy

26. QUESTIONS????