Chapter 22 Urinary Elimination

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Introduction
Urinary problems are often not easily discussed with the older adult May result in delayed diagnosis and treatment Potentially life-threatening complications can develop Nurses can develop the relationships necessary to discuss these often embarrassing problems
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Effects of Aging on Urinary Elimination

Hypertrophy of the bladder muscle Urinary frequency Nocturia Inefficient neurological control of bladder emptying and weaker bladder muscles Urinary retention
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Effects of Aging on Urinary Elimination (contd)

Reduced renal function Potential for adverse drug reactions Reduction in the ability to concentrate and dilute urine Increase in renal threshold for glucose False negative results for glucose in the urine
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Question
Is the following statement true or false?

Urinary frequency is caused by the normal agerelated changes of hypertrophy of the bladder muscle and thickening of the bladder.

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Answer
True.

One of the elimination problems that faces older adults is urinary frequency, caused by hypertrophy of the bladder muscle and thickening of the bladder, which decreases the bladders ability to expand and reduces storage capacity.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Urinary System Health Promotion

Good fluid intake Maintenance of acidic urine Avoidance of catheterization Activity Frequent toileting Efforts to enhance voiding and prevent retention Nursing assessment
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Urinary Incontinence
Common and bothersome problem of older adults Incidence Not a normal part of aging Age-related changes increase the risk

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Types of Urinary Incontinence

Stress Urgency Overflow Neurogenic Functional Mixed
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Question
Which of the following types of incontinence is caused by bladder neck obstructions and medications? a. Stress incontinence b. Urgency incontinence c. Overflow incontinence d. Neurogenic (reflex) incontinence
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
c. Overflow incontinence

Overflow incontinence is associated with bladder neck obstructions and medications (adrenergics, anticholinergics, calcium channel blockers). Bladder muscles fail to contract or periurethral muscles do not relax, leading to excessive accumulation of urine in the bladder.
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Factors to Assess for Incontinence

Medical history Medications Functional status Cognition Neuromuscular function in lower extremities Urinary control and retention Bladder fullness and pain
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Factors to Assess for Incontinence (contd)

Elimination pattern Presence of fecal impaction Symptoms Diet Reactions to incontinence
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Urinary Incontinence
Initial goal is to identify the cause Treatment goals are then developed based on the underlying cause and type of incontinence Nursing interventions Comprehensive evaluation Positive reinforcement and encouragement
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Question
Is the following statement true or false?

Half of all patients who have received an indwelling Foley catheter will develop bacteriuria within the first 24 hours of being catheterized.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer

True. Indwelling catheters should be used only in special circumstances and never for the convenience of staff. Half of all patients will develop bacteriuria within the first 24 hours of being catheterized, and 35%-40% of all nosocomial infections are catheter-associated UTIs.
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Bladder Cancer
Incidence Signs and symptoms Diagnosis Treatment Observation for signs of metastasis
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Renal Calculi
Causes of the formation of stones Signs and symptoms Diagnosis Treatment Nursing interventions

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Glomerulonephritis
Acute and chronic Signs and symptoms Diagnosis Treatment Nursing interventions
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General Nursing Considerations for Urinary Conditions

Need for sensitivity while discussing urinary problems with the older adult Consider fear and anxiety of incontinence Provide education Involve all members of the health care team Use discretion and maintain dignity
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