Chapter 44

Urinary Elimination

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Urinary System
 Kidneys:filtration;RBC volume; BP regulation; bone
mineralization

 Ureters: transport

 Bladder: storage; middle layer part AKA detrusor

contracts; base @ the trigone

 Urethra: internal sphincter =voluntary control except

during voiding- relaxed then

 Act of urination: micturitiuon

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Se nsory reflex a rc part
I bladder Stretches

 sensory impulses to Sacrum

 Stimulus back to bladder

 bladder contracts

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Re fle x Ar c part I I

 Bladder contracts

 sensory impulses to Brain

 midbrain & cerebral cortex

 Be quick to urinate

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 Factors Influencing Urination
 Disease conditions: ESRD causes

UremicSyndrome

 Sociocultural factors:privacy;culture

 Psychological factors: psych problem

 Muscle tone: longevity of catheter

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Factors Influencing Urination
(cont'd)
 Fluid balance

 Surgical procedures

 Medications

 Diagnostic examinations
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Alterations

 Urinary retention
 Urinary tract infections
 Urinary incontinence
 Urinary diversions

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Urinary Incontinence p.1349
 Overflow: voluntary or involuntary; sm. amt.

 Reflex: Involuntary; large./small amt.; ARC

 Stress: Involuntary; increased abd. pressure-

Sneeze

 Urge Functional: Involuntary Uh oh; small loss

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Infection Control and Hygiene

 Asepsis

 Client education

 Catheterization and other procedures

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 Growth and Development
 Infants: large U.O./ size; skin care*
 Toddlers and young children sensation @ 2-
3 y.o./be patient; new sibling-may revert
continence
 Adults: nocturia not normal; PMEs*
 Older adults:urethral mucosal thinning
 makes suseptable to infection; do not
concentrate their urine well
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Psychosocial Considerations

 Self-concept: body image/identity/self

esteem/roles

 Culture: some squat

 Gender: males prefer upright

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Assessment of Urinary
Elimination
 Nursing history
 Pattern of urination: 5x/day usual
AM/PC/@HS

 Symptoms of alterations: nocturia in renal

disease/prostate enlargement

 Factors affecting urination: Constipation;

fluid intake; physical conditions; meds
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Assessment of Urinary
Elimination (cont'd)
 Physical assessment
 Skin and mucous membranes: irritation

 Kidneys: flank pain: U.O. present

 Bladder: palpable?; UTI S/S; PVR

 Urethral meatus: vaginal discharge

present; soreness present
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Assessment of Urinary
Elimination (cont'd)

 Assessment of urine
 Intake and output

 Characteristics: color, clarity, odor

 Urine testing: specimen collection

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Assessment of Urinary
Elimination (cont'd)
 Common urine tests
 Urinalysis
 Specific gravity
 Culture
 Diagnostic examinations
 Consents
 Allergies
 Pre- and postprocedure interventions

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Nursing Diagnoses

 Incontinence
 Risk for infection
 Toileting self-care deficit
 Impaired urinary elimination
 Urinary retention

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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
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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

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Implementation: Acute Care

 Maintaining elimination habits

 Medications
 Urethral catheterization
 Alternatives to urethral catheterization:
supra-pubic catheters, condom
catheters

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Urethral Catheterization

 Types
 Insertion
 Drainage systems
 Routine care: hygiene, fluids
 Prevention of infection
 Irrigations and instillations
 Removal
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Implementation: Restorative
Care
 Strengthening pelvic floor muscles
 Bladder retraining
 Habit training
 Self-catheterization
 Maintenance of skin integrity
 Promotion of comfort

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Evaluation

 Client care
 Client expectations

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