URINARY ELIMINATION
Course Outline This allows fine regulation of fluid and
ANATOMY & PHYSIOLOGY OF URINARY
ELIMINATION FACTORS AFFECT
VOIDING
ALTERED URINE PRODUCTION
ALTERED URINARY ELIMINATION
NURSING MANAGEMENT
 Urinary elimination is important to health
 Elimination from the urinary tract is
usually taken for granted.
 A person’s urinary habits depend on
social culture, personal habits, and
physical abilities.
ANATOMY & PHYSIOLOGY OF URINARY
ELIMINATION
KIDNEYS
 Adult: 12 cm long, 6cm wide and 3cm thick
 Lie against the dorsal body wall in a
retroperitoneal position (behind the
parietal peritoneum) in the superior lumbar
region
 Extends from the T12 to L3 vertebra thus
receive protection from the ribcage.
 Right kidney is slightly lower than the left
because it is crowded by the liver.
 Primary regulators of fluid and acid-base
balance.
 NEPHRONS: functional unit of kidney that
filters the blood and remove metabolic
wastes.
 BOWMAN’S CAPSULE: the filtrate
moves into the tubule of the nephron
 PROXIMAL CONVOLUTED TUBULE:
water and electrolytes are reabsorbed.
Solutes [glucose], are reabsorbed in the
loop of Henle. Other subs are secreted in
the same area resulting into urine
concentration.
 DISTAL CONVOLUTED TUBULE:
additional water and sodium are
reabsorbed under ADH and aldosterone.
electrolyte balance in the body.
 When fluid intake is low/ solute
concentration in the blood is high, ADH
in the posterior pituitary is
released, more water is reabsorbed in the
distal tubule so less urine is excreted.
No ADH or less ADH = distal tubule is
impermeable = more excreted urine
Aldosterone: Na & H2O are reabsorbed in
greater quantities, increase blood volume and
decreasing urinary output.
URETERS
 Moves through the collecting ducts into the
calyces of the renal pelvis and from there into
the ureters.
 Adult: 25 to 30cm [10 to 12 inches] long and
1.25cm [0.5inches] in diameter.
 Upper end: funnel shape as it enters the
kidney.
 the junction between the ureter and the
bladder, a flaplike fold of mucous
membrane acts as a valve to prevent reflux
(backflow) of urine up the ureters.
BLADDER
 Serves as the reservoir of urine and organ of
excretion
 Empty: lies between the symphysis pubis
 Men: lies in front of the rectum and above
the prostate gland.
 Women: lies in front of the uterus and vagina.
 Detrusor Muscle [smooth muscle layers]
allows the bladder to expand when it is filled
by urine and contract to release urine to the
outside of the body during voiding.
 Full bladder: may extend above the symphysis
pubis and in extreme situations, it may extend
to the umbilicus
 Normal Capacity: 300mL to 600mL
URETHRA
  Extends from the bladder to the urinary meatus
 Male: 20cm and passageway of urine and semen
 Female: 3 to 4cm and located behind symphysis
pubis, anterior to the vagina and serves only as
passageway of urine.
 Women are particularly prone to urinary tract
infections (UTIs) because of their short urethra
and the proximity of the urinary meatus to the
vagina and anus.
PELVIC FLOOR
 Vagina, urethra, and rectum pass through the
pelvic floor that consists of sheets of muscle
and ligaments that provide support to the
viscera of the pelvis.
 Specific sphincter muscles contribute to the
continence mechanism: (1) internal sphincter
muscle (2) external sphincter muscle
 Internal sphincter muscle: located in the
proximal urethra and bladder neck that is
composed of smooth
muscle under involuntary control. It
provides active tension to closed the
urethral lumen.
▪ External sphincter muscle: composed of
skeletal muscle under voluntary control
that allow us to
choose when to urinate.
URINATION
 Micturition/voiding/urination refers to
emptying the bladder.
 Stretch receptors are special sensory nerves
that transmit impulses to the spinal cord,
specifically to the voiding reflex center
located at the level of the second to fourth
sacral vertebrae, causing the internal
sphincter to relax and stimulating the urge
to void.
 Stimulates when the adult bladder contains
250mL to 450mL of urine and in children,
50 to 200mL of urine.
 Voluntary control of urination is possible
only if the nerves supplying the bladder and
urethra, the neural tracts of the cord and
brain, and the motor area of the cerebrum
are all intact
 Injury to any parts of these nervous system
results in intermittent involuntary
micturition.
 Cognition impaired may not be aware of the
need to urinate or able to respond to urge of
seeking toilet facilities.
FACTORS AFFECT VOIDING
1. DEVELOPMENTAL FACTORS
(a) Infants
- Gradually increases to 250 to 500mL a day
during first year.
- May urinate as often as 20 times a day.
- Colorless and odorless and has a specific
gravity of 1.008.
- Unable to concentrate urine very effectively.
- Born without urinary control and will
develop this between the ages of 2 to 5 years
old.
(b) Preschoolers
- Able to take responsibility for independent
toileting
- Parents or guardians need to realize that
accidents do occur and they should not be
punished.
- Need to instruct them to wash their hands,
flush the toilet and wipe themselves.
- From front to back to avoid contamination.
- Teach not to hold urine and go to
bathroom as soon as possible.
(c) School-Age Children
- Urinates 6 to 8 times a day
- Enuresis: the involuntary passing of urine
when control should be stablished [about 5
years of
age]
- Nocturnal Enuresis: bedwetting;
involuntary passing of urine during
sleep.
- Nocturnal enuresis may refer to as
“primary” when the child hasn’t achieved
 night-time urinary control.
- Secondary enuresis appears after the child
achieve dryness for a period of 6 consecutive
months. Related to problem such as
constipation, stress, or illness and may
resolve when the cause is eliminated.
- Both primary and secondary nocturnal
enuresis may both be related to poor
daytime voiding
habits.
(d) Older Adults
- Excretory function diminishes with age.
- Blood flow can be reduced by
arteriosclerosis that impairs renal
function.
- With age, nephrons decrease to some
degree that leads to impairing kidney’s
filtering abilities. - Having influenza or
surgery can alter the I&O of normal fluid
that can compromise kidney’s ability to
filter, maintain acid-base balance, and
maintain electrolyte balance.
- Decrease in kidney function places
them at higher risk for toxicity
from medications if
excretion rates are longer.
- Complaints of urinary urgency and urinary
frequency are common.
- Men: enlarged prostate gland can inhibit
complete emptying bladder resulting into
urinary incontinence.
- Women: weakened muscles supporting
the bladder or weakness of the
urethral sphincter
due to low levels of estrogen that leads to
urgency, UTI and stress incontinence.
- Stiffness & joint pain, previous joint
injury and neuromuscular problems
impair mobility that
makes difficult to get in the bathroom.
- Dementia, prevents the person from
understanding of urinating because of
cognitive impairment.
2. PSYCHOSOCIAL FACTORS
- Privacy, normal position, sufficient time,
and, occasionally, running water helps
to stimulate
micturition reflex.
- Time pressure can suppress the urination
- Nurses often ignore the urge to void until
they are able to break and this behavior
can increase risk of UTIs.
3. FLUID INTAKE & OUTPUT
- When amount of fluid intake increases,
the output normally increases.
- Alcohol increases fluid output by inhibiting
production of ADH.
- Caffeine also increases urine output.
- Foods and fluids high in sodium can cause
fluid retention because water is retained to
maintain the normal concentration of
electrolytes,
- Foods containing carotene can cause
urine to appear yellower than usual.
4. MEDICATIONS
- Diuretics can increase urine formations by
preventing the reabsorption of water and
electrolytes from the tubules of the kidney into
the bloodstream.
- Medications that cause urinary retention:
o Anticholinergic
o Antidepressant and antipsychotic drugs
o Antihistamine
o Antihypertensive
o Antiparkinsonism drugs
o Beta-adrenergic drugs
o Opioids
5. MUSCLE TONE
- Good muscle tone maintains the
elasticity & contractility of detrusor
muscle so that the
bladder can fill adequately and empty
completely.
- Catherization for a long period of time will
lead to poor bladder muscle tone
- Pelvic muscle tone also contributes to the
ability to store and empty urine.
6. PATHOLOGIC CONDITION
- Diseases of the kidney may affect the
ability of nephrons to produce urine.
 - Proteinuria or blood cells may be present
in the urine, or the kidneys stop producing
urine
altogether, a condition known as renal failure.
- Heart failure, shock, or hypertension can
affect blood flow to the kidneys,
interfering with urine production.
- Abnormal amounts of fluid are lost through
another route [vomiting/hyperthermia],
water is retained and urine output falls
- Calculus [urinary stone], obstruct ureter
that blocks the urine flow from kidney to the
bladder. - Hypertrophy of prostate gland may
obstruct the urethra that impairs micturition.
7. SURGICAL & DIAGNOSTIC
PROCEDURES - After cystoscopy
the urethra may swell.
- Surgical procedures on any part of the
urinary tract may result in to postop
bleeding; as a result, the urine may be red through a catheter.
or pink tinge.
- Spinal anesthetics can affect the passage of
urine because they decrease the client’s
awareness of the need to void.
ALTERED URINE PRODUCTION
POLYURIA/DIURESIS
- Abnormally large amounts of urine by the
kidneys. - Can follow excessively fluid intake
[polydipsia] - Associated with diseases such as
diabetes mellitus, diabetes insipidus, and
chronic nephritis,
- Can cause excessive fluid loss that leads to intense
thirst, dehydration, and weight loss.
OLIGURIA
- Low urine output
- Less than 500mL a day or 30mL an hour
- May occur due to abnormal fluid loss, lack of
fluid intake that often indicates impaired blood
flow to the kidneys or impending renal failure. URGENCY
ANURIA
- Lack of urine production
The kidneys become unable to adequately function,
some mechanism of filtering the blood is necessary
to prevent illness and death. Dialysis, a technique by
which fluids and molecules pass through a
semipermeable membrane according to the rules of
osmosis.
(I) Hemodialysis
▪ The client’s blood flows through a
vascular catheter
▪ Passes by the dialysis solution in an
external machine then returns to the
client.
(II) Peritoneal Dialysis
▪ Dialysis solution is instilled into the
abdominal cavity through a catheter
▪ Allowed to rest there while the fluid and
molecules exchange and then removed
ALTERED URINARY ELIMINATION
Frequency, nocturia, urgency, and dysuria often are
manifestations of underlying conditions such as a
UTI. Enuresis, incontinence, retention, and
neurogenic bladder may be either
a manifestation or the primary problem
affecting urinary elimination.
FREQUENCY AND NOCTURIA
Urinary Frequency
- Voiding at frequent intervals, that is more than
4 to 6 times per day.
- UTI, stress, and pregnancy can cause frequent
voiding of small quantities of urine. [50 to
100mL]
Nocturia
- Voiding two or more times at night.
- Sudden, strong desire to void.
- Accompanies psychological stress and irritation
 of the trigone and urethra.
- Common in people who have poor external
sphincter control and unstable bladder
contractions.
DYSURIA
- Painful or difficult voiding
- Accompany a stricture of the urethra, urinary
infections, and injury to the bladder and
urethra,
- Feeling of they have to push to void or
there’s a presence of burning sensation.
- Urinary hesitancy [delay and difficult in
initiating voiding] is associated with
dysuria.
ENURESIS
- Involuntary urination in children beyond the age
when voluntary bladder control is normally
acquired.
URINARY INCONTINENCE
- involuntary leakage of urine or loss of bladder
control. - Health symptom not a disease.
- Facts that make women more likely to
experience UI include shorter urethras, the
trauma to the pelvic floor associated with
childbirth, and changes related to menopause.
- Common causes: UTIs, urethritis, pregnancy,
hypercalcemia, volume overload, delirium,
restricted mobility, stool impaction, and
psychological causes. - Can be transient or
established.
URINARY RETENTION
- Bladder is impaired, urine accumulates and the
bladder becomes overdistended.
- Overdistention of bladder causes poor
contractility of detrusor muscle that impairs
urination.
- Common causes: prostatic hypertrophy,
surgery, and some medications.
- Overflow voiding or incontinence, eliminating
25 to 50 mL of urine at frequent intervals.
- Firm bladder and distended on palpation;
may be displaced to one side of the
midline.
NEUROGENIC BLADDER
- Does not perceive bladder fullness therefore
unable to control urinary sphincters.
- Bladder become flaccid and distended or
spastic, with frequent involuntary urination.
NURSING MANAGEMENT
ASSESSING
Complete assessment of patient’s urinary function:
▪ Nursing history
▪ Physical assessment of genitourinary
system ▪ Hydration status
▪ Urine examination
▪ Relating data obtained to results of diagnostic
tests & procedures
NURSING HISTORY
€ Normal voiding pattern
€ Frequency
€ Appearance of urine or any recent changes
€ Past or current problems with urination
€ Presence of ostomy
€ Factors influencing elimination pattern
PHYSICAL ASSESSMENT
€ Percussion of kidneys to detect
tenderness. € Palpation & percussion of
bladder.
€ Urethral meatus is inspected as indicated for
swelling, discharge, and inflammation.
€ Assess skin for color, texture, and tissue turgor
as well as the presence of edema.
€ If continence, dribbling, or dysuria is noted in
the history, skin of perineum should be
inspected for irritation because contact with
urine can excoriate the skin.
 ASSESSING URINE
€ Normal urine: 96% water 4% solutes
€ Organic Solutes: urea, ammonia, creatinine,
and uric acid
€ Inorganic solutes: sodium, chloride, potassium,
sulfate, magnesium, and phosphorus
€ Urea is the chief organic solute
€ Sodium chloride is the most abundant inorganic
salt.
MEASURING URINARY OUTPUT
€ Normal: 60mL per hour or 1500mL per day
€ Urine is affected by fluid intake, body fluid
losses through other routes, cardio/renal
status of the
patient.
€ Below 30mL per hour may indicate low blood
volume or kidney malfunction.
To measure fluid output:
✓ Wear gloves to avoid contact with
microorganisms ✓ Ask patient to void in clean
urinal, bed pan, commode or toilet collection
device.
✓ Instruct to keep urine separated from feces and
toilet paper in the urine container,
✓ Pour voided urine into calibrated container
✓ Hold the container, eye level, then read the
amount in the container.
✓ Record the amount on the fluid intake & output
sheet ✓ Rinse the urine collection & measuring
with cool water & store appropriately
✓ Remove gloves & perform hand hygiene
✓ Calculate & document the total output at the
end of each shift & at the end of 24hr on the
client’s chart
Measuring urine from a client who has urinary catheter:
✓ Apply clean gloves
✓ Take calibrated container to the bedside
✓ Place container under urine collection so
that the spout is above the container but not
touching it.
✓ Open the spout & permit the urine to flow
into the container
✓ Close the spout, then proceed as described
in the previous list.
MEASURING RESIDUAL URINE
€ Residual urine is normally 50 to 100mL
€ Bladder outlet obstruction or loss of bladder
muscle tone may interfere with complete
emptying the
bladder during urination.
€ Residual urine is measured to assess the
amount of retained urine after voiding &
determine the need for interventions.
€ Nurse catheterizes or scan the bladder after
voiding and then document.
€ An indwelling catheter may be inserted if
residual urine exceeds a specific amount.
DIAGNOSTIC TESTS
€ Urea & creatinine are routinely used to evaluate
renal function
€ Urea: end product or protein metabolism &
measured as BUN
€ Creatinine: produced in relatively constant
quantities by the muscles.
€ Creatinine clearance test uses 24-hour urine &
serum creatinine levels to determine the
GFR, a sensitive indicator of renal function.
DIAGNOSING
❖ Impaired Urinary Elimination
❖ Readiness for Enhanced Urinary Elimination
❖ Functional Urinary Incontinence
❖ Overflow Urinary Incontinence
❖ Reflex Urinary Incontinence
❖ Stress Urinary Incontinence
❖ Urge Urinary Incontinence
❖ Risk for Urge Urinary Incontinence
❖ Urinary Retention
❖ Risk for infection
 ❖ Situational Low Self-Esteem
❖ Risk for Impaired Skin Integrity
❖ Toileting Self-Care Deficit
❖ Risk for Deficient Fluid Volume
❖ Excess Fluid Volume
❖ Disturbed body Image
❖ Deficient Knowledge
❖ Risk for Caregiver Role Strain
❖ Risk for Social Isolation
PLANNING
PLANNING FOR HOME CARE
▪ Provide continuity of care
▪ Nurse needs to consider the patient’s
needs for teaching & assistance with care
in the home.
▪ Home Care Assessment outlines an assessment
of home care capabilities related to urinary
elimination problems.
▪ Many patients have increased fluid
requirements, necessitating higher daily fluid
intake.
▪ Clients who are at risk for UTI/ urinary calculi
should consume 2000 to 3000mL of fluid
daily.
▪ Increased fluid intake may be
contraindicated for patient with renal or
heart failure.
MAINTAINING NORMAL VOIDING HABITS
▪ Prescribed medications interfere with client’s
normal voiding
▪ Nurse helps the client adhere to normal voiding
habits as much as possible.
ASSISTING WITH TOILETING
▪ Physically impaired should require assistance
when toileting.
▪ Clients need to be encouraged to use handrails
placed near the toilet.
▪ Nurse can provide urinary equipment close to
the bedside & provide necessary assistance
to use them.
PREVENTING URINARY TRACT INFECTIONS
▪ UTI is the most common type of nosocomial
infection found in long-term care facilities.
▪ Most UTIs are caused by bacteria common in
the GI tract.
Guidelines to prevent UTI:
(i) Drink 8-glasses of water a day.
(ii) Practice frequent voiding. Void after
intercourse. (iii) Avoid use of harsh soaps, bubble
bath, or sprays in the perineal area.
(iv) Avoid tight-fitting pants or clothes that can
irritate urethra & prevents ventilation of perineal
area.
(v) Wear cotton rather than nylon underclothes.
(vi) Always wipe the perineal area from front to
back. (vii) Take showers rather than baths.
MANAGING URINARY INCONTINENCE
▪ UI is not normal part of aging & often
treatable. ▪ Independent nursing
interventions with UI:
(a) a behavior-oriented continence training
program that may consist of bladder
training, habit
training, prompted voiding, pelvic muscle
exercises, and positive reinforcement.
(b) Meticulous skin care
(c) Application of external drainage device
Stress incontinence in women may be successfully
treated by insertion (under local anesthesia) of a
transvaginal tape (TVT) sling to support the
urethra.
CONTINENCE (BLADDER) TRAINING
▪ Requires involvement of nurse, client, and
support people.
▪ The client postpones voiding, resist or
inhibit the sensation of urgency, and void
according to a
 timetable rather than according to the urge
to void. ▪ Goal: lengthen the intervals between
urination to correct the client’s frequent
urination, stabilize the bladder, and diminish
urgency.
▪ Instruct the client to practice deep, slow
breathing until diminish or disappears.
▪ Habit training also known as timed
voiding or scheduled toileting.
▪ Can be effective in children who are
experiencing urinary dysfunction.
▪ Prompted voiding supplements habit training
by encouraging to try to use toilet &
reminding when to void.
PELVIC MUSCLE EXERCISE
▪ Kegel exercises
▪ Help to strengthen the pelvic floor.
▪ Reduce or eliminate episodes of
incontinence ▪ Tightening the anal sphincter
as if to hold bowel movement.
▪ Contraction of the buttocks & thigh
muscles are avoided.
MAINTAINING SKIN INTEGRITY
▪ Moist skin is risk for maceration.
▪ Accumulation of urine in the skin is
converted into ammonia.
▪ Skin irritation & maceration predispose the
client to skin breakdown & ulceration.
▪ Nurse washes the perineal area with mild soap
& water or commercially no-rinse cleanser
after episodes of incontinence.
▪ Clean, dry clothing or bed linen should be
provided. ▪ Apply barrier ointments or creams to
URINARY CATHETERIZATION
protect the skin from contact with urine.
▪ Nurse should use products that absorb water &
leave dry surface in contact with skin.
▪ Incontinence drawsheets are used to provide
significant advantages over standard
drawsheets for incontinent patients
confined to bed.
▪ It is like drawsheet but double layered.
▪ Quilted upper layer nylon or polyester
surface. ▪ Absorbent viscose rayon layer
below.
▪ This absorbent sheet helps to maintain skin
integrity; does not stick to skin when wet,
decreases risk of bedsores & reduces odor.
EXTERNAL URINARY DEVICE
The application of condom catheter connected to
urinary drainage system used for incontinent males.
It is preferable to insertion of retention catheter due
to minimal risk for UTI. The nurse should
determine when the client experiences incontinence.
Purpose:
€ To collect urine & control UI
€ To permit the patient physical activity while
controlling UI
€ To prevent from skin irritation as a result of UI
MANAGING URINARY RETENTION
▪ If interventions that maintains normal voiding
pattern are unsuccessful, primary health care
provider will prescribe cholinergic drug
[bethanechol chloride] to stimulate bladder
contraction & facilitate voiding.
▪ Flaccid bladder: manual pressure or Crede’s
Maneuver to promote bladder emptying.
▪ Used only for clients who lost or not
expected to regain their voluntary bladder
control,
▪ Fail to initiate voiding, urinary catheterization
may be necessary to empty the bladder.
▪ Foley catheter may be inserted until the
underlying cause is treated.
▪ Introduction of catheter into the urinary
bladder, ▪ Clients who have lowered immune
resistance are at the greatest risk.
▪ Strict sterile technique is used for
catheterization. ▪ Urinary catheters are one of the
most common causes of nosocomial infections.
▪ Trauma is also common particularly in male
client, whose urethra is longer & more
tortuous.
▪ The size of diameter of the lumen using the
French (Fr) scale
▪ The larger the number, the larger the
lumen. ▪ Straight catheters: inserted to
drain bladder & immediately removed.
▪ Retention catheters: remain in the drain urine.
▪ Coudé catheter is a variation of straight
catheter and has a tapered, curved tip. This
catheter used for men with prostatic
hypertrophy because it is easily
controlled and less traumatic on insertion.
▪ Foley catheter is a double lumen catheter. The
larger lumen drains the urine while the small
one is used to inflate the balloon to hold the
catheter in place within the bladder.
▪ Clients who require continuous or intermittent
bladder irrigation may have a three-way Foley
catheter.
▪ Pretesting silicone balloons is not
recommended because the silicone can
form a cuff or crease at the balloon area
that can cause trauma to the urethra during
catheter insertion
Purposes:
€ To relieve discomfort due to bladder distention
or to provide gradual decompression of a
distended bladder € To assess the amount of
residual urine if the bladder empties
incompletely
€ To obtain a sterile urine specimen
€ To empty the bladder completely prior to
surgery € To facilitate accurate measurement of
urinary output for critically ill clients whose
output needs to be monitored hour
€ To provide for intermittent or continuous
bladder drainage and/or irrigation
€ To prevent urine from contacting an
incision after perineal surgery
€ To manage incontinence when other measures
have failed
NURSING INTERVENTIONS
Encouraging large amounts of fluid intake, accurately
recording the fluid intake and output, changing the
retention catheter and tubing, maintaining the
patency of the drainage system, preventing
contamination of the drainage system, and teaching
these measures to the client.
FLUIDS
▪ Should drink up to 3000mL per day if
permitted ▪ Large amount fluid keeps the bladder
flushed out and decreases the risk for infection
and urinary stasis. ▪ Also minimizes the
sediment or other particles obstructing the
drainage tubing.
DIETARY MEASURES
▪ Acidifying the urine with retention
catheter may reduce the risk for UTI &
calculus formation.
▪ Eggs, cheese, meat & poultry, whole grains,
cranberries, plums and prunes, and
tomatoes can increase the acidity of
urine.
PERINEAL CARE
▪ Routine hygienic care is necessary for
clients with retention catheters.
CHANGING THE CATHETER & TUBING
▪ Routine changing of catheter & tubing
is not recommended.
▪ Collection of sediment in the catheter/tubing
or impaired urine drainage are indicators
for changing the catheter & drainage
system.
REMOVING INDWELLING CATHETERS
▪ Indwelling catheters are removed after their
purpose has been achieved,
▪ Clients who have had a retention catheter for
a prolonged period may require bladder
retraining to regain bladder muscle tone.
▪ A few days before removal, the catheter may
be clamped for specified periods of time (e.g.,
 2 to 4 hours), then released to allow the bladder
to empty.
▪ This allows the bladder to distend and
stimulates its musculature.
CLEAN INTERMITTENT SELF-CATHETERIZATION
▪ Mostly performed by patients who have
some neurogenic bladder dysfunction,
▪ Clean or medical aseptic technique is used.
▪ Similar to that used by the nurse to
catheterize a client.
▪ The procedure requires physical and
mental preparation, client
assessment is important.
▪ Prior teaching CISC, establish client’s voiding
pattern, volume voided, fluid intake, residual
amounts.
▪ CISC is easier for males to learn due to
visibility of urinary meatus.
URINARY IRRIGATION
▪ Flushing with specified solution.
▪ To wash out the bladder & sometimes
apply medication to the bladder lining,
▪ It also performs to maintain or restore the
patency of the catheter.
▪ Closed method: preferred technique due to low
risk for acquiring UTI. Often used for clients
who have had genitourinary surgery. The
continuous irrigation helps prevent blood clots
from occluding the catheter
▪ Open method: necessary to restore the catheter
patency. Strict precautions must be taken to
maintain the sterility of both the drainage
tubing connector and the interior of the
indwelling catheter. Necessary for clients
who develop blood clots & mucous fragments
that occlude the catheter or undesirable to
change the catheter.
Purpose:
€ Maintain the patency or urinary catheter &
tubing € To free a blockage in a urinary
catheter or tubing,
SUPRAPUBIC CATHETER
▪ Inserted surgically through abdominal wall
above the symphysis pubis into the urinary
bladder,
▪ Can be temporary or permanent device.
▪ It is secured in place with sutures if retention
balloon isn’t used & then attached to closed
drainage system. ▪ Regular assessment of client’s
urine, fluid intake, comfort, patency of drainage
system, skin care around insertion site, and
clamping of catheter preparatory to removing it.
▪ Dressings around the newly placed suprapubic
catheter are changed whenever they are
soiled with drainage to prevent bacterial
growth around the insertion site and reduce
the potential for infection.
▪ For catheters that have been in place for an
extended period, no dressing may be needed
and the healed insertion tract enables
removal and replacement of the catheter as
needed.
▪ Nurse assesses the insertion area at regular
intervals. If pubic hair invades the insertion site,
it may be carefully trimmed with scissors. Any
redness or
discharge at the skin around the insertion site
must be reported.
URINARY DIVERSIONS
It is a surgical rerouting of urine from the kidneys to
a site other than the bladder.
INCONTINENT
▪ Incontinent diversions clients have no control
over the passage of urine and require the use
of an external ostomy appliance to contain
the urine.
▪ The stomas provide direct access for
microorganisms from the skin to the kidneys,
the small stomas are difficult to fit with an
appliance to collect the urine, and they may
narrow, impairing urine drainage.
 CONTINENT reservoir [Kock Pouch] or by strained
▪ Entails creation of a mechanism that allows the voiding [neobladder].
client to control the passage of urine either
EVALUATING
by intermittent catheterization of the internal
Nurse collects data to evaluate the effectiveness
of nursing activities. If desired outcomes are not
achieved, formulate questions that need to be
considered.

✓ What is the client’s perception of the problem?

✓ Does the client understand and comply with the
health care instructions provided?
✓ Is access to toilet facilities a problem?
✓ Can the client manipulate clothing for
toileting? ✓ Are there adjustments that can
be made to allow easier disrobing?
✓ Are scheduled toileting times appropriate?
✓ Is there adequate transition lighting for
night-time toileting?
✓ Are mobility aids such as a walker, elevated
toilet seat, or grab bar needed? If currently used,
are they
appropriate or adequate?
✓ Is the client performing pelvic floor muscle
exercises appropriately as scheduled?
✓ Is the client’s fluid intake adequate? Does the
timing of fluid intake need to be adjusted
(e.g., restricted after dinner)?
✓ Is the client restricting caffeine, citrus juice,
carbonated beverages, and artificial sweetener
intake? ✓ Is the client taking a diuretic? If so,
when is the medication taken? Do the times need
to be adjusted (e.g., taking second dose no later
than 4 PM)? Should continence aids such as a
condom catheter or ab sorbent pads be used?