1. Chapter 21
Urinary Elimination

2. Eliminating waste is a physical need. The urinary system:
Removes waste products from the blood
Maintains the body’s water balance
Review the contents of Box 21-1 on p. 355 in the textbook.

3. NORMAL URINATION
The healthy adult produces about 1500 mL, or 3 pints, of urine a day.
Many factors affect urine production.
Age
Disease
The amount and kinds of fluid ingested
Dietary salt
Body temperature
Perspiration
Drugs
A diet high in salt causes the body to retain water. Less urine is produced.
Urination, micturition, and voiding mean the process of emptying urine from the bladder.

4. Frequency of urination is affected by:
The amount of fluid intake, habits, and available toilet facilities
Activity, work, and illness
Observations
Normal urine:
Is pale yellow, straw-colored, or amber
Is clear with no particles
Has a faint odor
Observe urine for color, clarity, odor, amount, and particles.
Report complaints of urgency, burning on urination, or painful or difficult urination.
People usually void at bedtime, after sleep, and before meals.
Some persons need help getting to the bathroom. Others use bedpans, urinals, or commodes.
Follow the rules in Box 21-2 on p. 356 in the textbook and the person’s care plan.
Review the Focus on Children and Older Persons: Normal Urination Box on p. 355 in the textbook.
Review the Focus on Communication: Normal Urination Box on p. 356 in the textbook.
Review the Teamwork and Time Management: Normal Urination Box on p. 356 in the textbook.
Some foods and certain drugs affect urine color and odor. Ask the nurse to observe urine that looks or smells abnormal.
Report the problems in Table 21-1 on p. 357 in the textbook.

5. Bedpans are used by persons who cannot be out of bed.
Women use bedpans for voiding and bowel movements.
Men use them for bowel movements.
Standard bedpans and fracture pans are used.
Fracture pans are used:
By persons with casts
By persons in traction
By persons with limited back motion
After spinal cord injury or surgery
After a hip fracture
After hip replacement surgery
A fracture pan has a thin rim. The smaller end is placed under the buttocks.
Review the Focus on Children and Older Persons: Bedpans Box on p. 357 in the textbook.
Review the Delegation Guidelines: Bedpans Box on p. 357 in the textbook.
Review the Promoting Safety and Comfort: Bedpans Box on p. 358 in the textbook.
Review the Focus on Ethics and Laws: Bedpans Box on p. 358 in the textbook.

6. Men use urinals to void. To use the urinal: Remind men:
The man stands if possible.
Some sit on the side of the bed or lie in bed.
Some men need support when standing.
You may have to place and hold the urinal for some men.
Remind men:
To signal after using the urinal
Not to place urinals on overbed tables and bedside stands
Plastic urinals have caps and hook-type handles.
The urinal hooks to the bed rail within the man’s reach. Some beds may not have bed rails. Follow agency policy.
After voiding, the urinal cap is closed. This prevents urine spills.
Review the Delegation Guidelines: Urinals Box on p. 361 in the textbook.
Review the Promoting Safety and Comfort: Urinals Box on p. 361 in the textbook.

7. Persons unable to walk to the bathroom often use commodes.
The commode :
Allows a normal position for elimination
Provides support and helps prevent falls
Some commodes are wheeled into bathrooms and placed over toilets.
The container is removed if the commode is used with the toilet.
Wheels are locked after the commode is positioned over the toilet.
A commode is a chair or a wheelchair with an opening for a bedpan or container.
Review the Delegation Guidelines: Commodes Box on p. 362 in the textbook.
Review the Promoting Safety and Comfort: Commodes Box on p. 362 in the textbook.
Review the Focus on Ethics and Laws: Commodes Box on p. 362 in the textbook.

8. URINARY INCONTINENCE
Urinary incontinence is the loss of bladder control.
It may be temporary or permanent.
The basic types of incontinence are:
Stress incontinence (dribbling)
Urge incontinence
Overflow incontinence
Functional incontinence
Reflex incontinence
Mixed incontinence
If incontinence is a new problem, tell the nurse at once.
With stress incontinence, urine leaks during exercise and certain movements that cause pressure on the bladder.
With urge incontinence, urine is lost in response to a sudden, urgent need to void. The person cannot get to a toilet in time.
With overflow incontinence, small amounts of urine leak from a bladder that is always full.
The person with functional incontinence has bladder control but cannot use the toilet in time.
With reflex incontinence, urine is lost at predictable intervals when the bladder is full.
A person can have more than one type of incontinence. This is called mixed incontinence.
Sometimes incontinence results from intestinal, rectal, and reproductive system surgeries or from physical illness.

9. Incontinence is embarrassing. The person is uncomfortable.
Skin irritation, infection, and pressure ulcers are risks.
Falling is a risk.
The person’s pride, dignity, and self-esteem are affected.
Good skin care and dry garments and linens are essential.
Social isolation, loss of independence, and depression are common. Quality of life suffers.
The person’s care plan may include some of the measures listed in Box 21-3 on p. 364 in the textbook.

10. Incontinence products help keep the person dry.
Promoting normal urinary elimination prevents incontinence in some people.
Others need bladder training.
Sometimes catheters are needed.
Incontinence products help keep the person dry.
Incontinence is linked to abuse, mistreatment, and neglect.
Caring for persons with incontinence is stressful.
If you find yourself becoming short-tempered and impatient, talk to the nurse at once.
The person has the right to be free from abuse, mistreatment, and neglect.
Review the contents of Box 21-2 on p. 356 in the textbook.
The nurse selects incontinence products that best meet the person’s needs. Follow the manufacturer’s instructions and agency procedures when using them.
Remember, incontinence is beyond the person’s control. Kindness, empathy, understanding, and patience are needed.
Review the Focus on Children and Older Persons: Urinary Incontinence Box on p. 365 in the textbook.
Review the Focus on Long-Term Care and Home Care: Urinary Incontinence Box on p. 365 in the textbook.

11. CATHETERS
Inserted through the urethra into the bladder, a urinary catheter drains urine.
A straight catheter drains the bladder and then is removed.
An indwelling catheter (retention or Foley catheter) is left in the bladder.
A balloon near the tip is inflated with sterile water after the catheter is inserted. It prevents the catheter from slipping out of the bladder.
Tubing connects the catheter to the drainage bag.
Catheterization is the process of inserting a catheter.
Catheterization is done by a doctor or a nurse. With the proper education and supervision, some states and agencies let nursing assistants insert and remove catheters.

12. Catheters often are used:
Before, during, and after surgery
For persons who are too weak or disabled to use the bedpan, urinal, commode, or toilet
To protect wounds and pressure ulcers from contact with urine
To allow hourly urinary output measurements
As a last resort for incontinence
Catheters do not treat the cause of incontinence.
For certain diagnostic purposes
When caring for persons with indwelling catheters, the risk of infection is high.
Follow the rules in Box 21-4 on p. 366 in the textbook to promote safety and comfort.
Review the Delegation Guidelines: Catheters Box on p. 367 in the textbook.
Review the Promoting Safety and Comfort: Catheters Box on p. 367 in the textbook.

13. Drainage systems
A closed drainage system is used for indwelling catheters.
Nothing can enter the system from the catheter to the drainage bag.
The drainage bag must not touch the floor.
The drainage bag is always kept lower than the person’s bladder.
Some people wear leg bags when up.
The urinary system is sterile. Infection can occur if microbes enter the drainage system. A urinary tract infection can threaten health and life.
If the drainage bag is higher than the bladder, urine can flow back into the bladder.
Do not hang the drainage bag on a bed rail.
When the person walks, the bag is held lower than the bladder.

14. If the drainage system is disconnected accidentally, tell the nurse at once.
Do not touch the ends of the catheter or tubing.
Practice hand hygiene and put on gloves.
Wipe the end of the tube with an antiseptic wipe.
Wipe the end of the catheter with another antiseptic wipe.
Do not put the ends down.
Do not touch the ends after you clean them.
Connect the tubing to the catheter.
Discard the wipes into a biohazard bag.
Remove the gloves and practice hand hygiene.

15. Leg bags are changed to drainage bags when the person is in bed.
Drainage bags are emptied and urine is measured:
At the end of every shift
When changing from a leg bag to a drainage bag
When changing from a drainage bag to a leg bag
When the bag is becoming full
You must prevent microbes from entering the system.
Review the Delegation Guidelines: Drainage Systems Box on p. 369 in the textbook.
Review the Promoting Safety and Comfort: Drainage Systems Box on p. 369 in the textbook.

16. Removing indwelling catheters
An indwelling catheter has two lumens (passage-ways).
Sterile water is injected through one lumen to inflate the balloon.
Urine drains from the bladder through the other lumen.
A doctor’s order is needed to remove a catheter.
Most people need bladder training first.
Dysuria and frequency are common after removing catheters.
To remove the catheter, the balloon is deflated. You need a syringe large enough to hold all of the water in the balloon. Balloon size is marked at the end of the catheter.
Review the Delegation Guidelines: Removing Indwelling Catheters Box on p. 372 in the textbook.
Review the Promoting Safety and Comfort: Removing Indwelling Catheters Box on p. 372 in the textbook.

17. Condom catheters (external catheters, Texas catheters, urinary sheaths) are often used for incontinent men.
A condom catheter is a soft sheath that slides over the penis.
To apply a condom catheter:
Follow the manufacturer’s instructions.
Thoroughly wash the penis with soap and water.
Dry the penis before applying the catheter.
Condom catheters are self-adhering or applied with elastic tape.
Never use adhesive tape to secure catheters.
Condom catheters are changed daily after perineal care
Adhesive tape does not expand. Blood flow to the penis is cut off, injuring the penis.
Review the Delegation Guidelines: Condom Catheters Box on p. 374 in the textbook.
Review the Promoting Safety and Comfort: Condom Catheters Box on p. 374 in the textbook.

18. BLADDER TRAINING
Bladder training helps some persons with urinary incontinence.
Some persons need bladder training after indwelling catheter removal.
Control of urination is the goal of bladder training.
You assist with bladder training as directed by the nurse and the care plan.
There are two basic methods for bladder training:
The person uses the toilet, commode, bedpan, or urinal at certain times.
The person has a catheter. The catheter is clamped and unclamped on a schedule. Urine drains when the catheter is unclamped. When the catheter is removed, voiding is encouraged every 3 to 4 hours, or as directed by the nurse and the care plan.