Chapter 38
Urinary Elimination
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Urinary System
❖ Kidneys and ureters
❖ Bladder
❖ Urethra
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Female and Male Urinary Tracts
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Kidneys and Ureters
❖ Maintain composition and volume of body fluids
❖ Filter and excrete blood constituents not needed;
retain those that are needed
❖ Excrete waste product (urine)
o The nephrons maintain and regulate fluid
balance through the mechanisms of selective
reabsorption and secretion of water, electrolytes,
and other substances
o Urine from the nephrons empties into the
kidneys
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Bladder
❖ Smooth muscle sac innervated by ANS
❖ Serves as a temporary reservoir for urine
❖ Composed of three layers of muscle tissue called
detrusor muscle
o The inner longitudinal layer, the middle circular
layer, and the outer longitudinal layer
❖ Sphincter guards opening between urinary bladder
and urethra
❖ Urethra conveys urine from bladder to exterior of
body
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The Urinary Bladder
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Urethra
❖ Conveys urine from the bladder to the exterior
❖ Male urethra functions in excretory and reproductive
systems
❖ No portion of female urethra is external to the body
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Act of Urination (Micturition, Voiding)
❖ Process of emptying the bladder
o Detrusor muscle contracts, internal sphincter
relaxes, urine enters posterior urethra
o Muscles of perineum and external sphincter relax
o Muscle of abdominal wall contracts slightly
o Diaphragm lowers, micturition occurs
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Question #1
Which term describes a condition in which 24-hour
urine output is less than 50 mL?
A. Dysuria
B. Glycosuria
C. Pyuria
D. Anuria
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Answer to Question #1
Answer: D. Anuria
Rationale: Anuria is synonymous with kidney
shutdown or renal failure. Dysuria is painful or
difficult urination. Glycosuria is the presence of
sugar in the urine. Pyuria is pus in the urine.
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Factors Affecting Micturition
❖ Developmental considerations
o Toilet training
o Effects of aging
❖ Food and fluid intake
❖ Psychological variables
❖ Activity and muscle tone
❖ Pathologic conditions
❖ Medications
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Developmental Considerations
❖ Children
o Toilet training 2 to 3 years old, enuresis
❖ Effects of aging
o Nocturia
o Increased frequency
o Urine retention and stasis
o Voluntary control affected by physical problems
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Question #2
Tell whether the following statement is true or false.
Diuretics cause increased urine production, resulting
in the need for increased urination and possibly urge
incontinence.
A. True
B. False
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Answer to Question #2
Answer: A. True
Rationale: Diuretics cause increased urine
production, resulting in the need for increased
urination and possibly urge incontinence.
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Diseases Associated With Renal Problems
❖ Congenital urinary tract abnormalities
❖ Polycystic kidney disease
❖ Urinary tract infection
❖ Urinary calculi
❖ Hypertension
❖ Diabetes mellitus
❖ Gout
❖ Connective tissue disorders
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Effects of Medications on Urine
Production and Elimination
❖ Diuretics: prevent reabsorption of water and certain
electrolytes in tubules
❖ Cholinergic medications: stimulate contraction of
detrusor muscle, producing urination
❖ Analgesics and tranquilizers: suppress CNS, diminish
effectiveness of neural reflex
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Medications Affecting Color of Urine
❖ Anticoagulants: red urine
❖ Diuretics: pale yellow urine
❖ Pyridium: orange to orange-red urine
❖ The antidepressant amitriptyline or B-complex
vitamins: green or blue-green urine
❖ Levodopa: brown or black urine
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Nursing History
❖ Usual patterns of urinary elimination
❖ Recent changes in urinary elimination
❖ Aids to elimination
❖ Present or past occurrence of voiding difficulties
❖ Presence of urinary diversion
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Physical Assessment of
Urinary Functioning
❖ Kidneys: Palpation of the kidneys is usually
performed by an advanced health care practitioner
as part of a more detailed assessment
❖ Urinary bladder: Palpate and percuss the bladder or
use a bedside scanner
❖ Urethral orifice: Inspect for signs of infection,
discharge, or odor
❖ Skin: Assess for color, texture, turgor, and excretion
of wastes
❖ Urine: Assess for color, odor, clarity, and sediment
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Additional Assessment Techniques
❖ Measuring urinary output
o Continent patients
o Incontinent patients
o Indwelling catheter
❖ Routine urinalysis
o Clean-catch or midstream specimen
o Sterile specimen
o Urinary diversion specimen
o 24-hour specimens
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Question #3
Tell whether the following statement is true or false.
Normal fresh urine has an ammonia odor.
A. True
B. False
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Answer to Question #3
Answer: B. False
Rationale: Normal fresh urine has an aromatic odor.
As urine stands, it often develops an ammonia odor
because of bacterial action.
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Measuring Urine Output
❖ Ask the patient to void into a bedpan, urinal, or
specimen container in bed or bathroom
❖ Put on gloves. Pour urine into the appropriate
measuring device
❖ Place the calibrated container on a flat surface and
read at eye level
❖ Note amount of urine voided and record on the
appropriate form
❖ Discard urine in the toilet unless specimen is
needed. If a specimen is required, pour the urine
into an appropriate specimen container
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Question #4
Tell whether the following statement is true or false.
A urine specimen from a patient with an indwelling
catheter should be obtained from the collection
receptacle.
A. True
B. False
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Answer to Question #4
Answer: B. False
Rationale: A urine specimen from a patient with an
indwelling catheter should be obtained from the
catheter itself.
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Patient Health Problems
❖ Urinary functioning as the problem
o Incontinence
o Pattern alteration
o Urinary retention
❖ Urinary functioning as the etiology
o Anxiety
o Caregiver role strain
o Risk for infection
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Promoting Urinary Elimination
❖ Maintaining regular voiding habits
❖ Promoting fluid intake
❖ Strengthening muscle tone
❖ Assisting with toileting
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Planned Patient Goals
❖ Produce urine output about equal to fluid intake
❖ Maintain fluid and electrolyte balance
❖ Empty bladder completely at regular intervals
❖ Report ease of voiding
❖ Maintain skin integrity
❖ Demonstrate appropriate self-care behaviors
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Promoting Normal Urination
❖ Maintaining normal voiding habits
❖ Promoting fluid intake
❖ Strengthening muscle tone
❖ Assisting with toileting
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Patients at Risk for UTIs
❖ Sexually active people with female genitalia
❖ People who use diaphragms for contraception
❖ Postmenopausal people
❖ People with indwelling urinary catheter in place
❖ People with diabetes mellitus
❖ Older adults
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Types of Urinary Incontinence
❖ Transient: appears suddenly and lasts 6 months or less
❖ Mixed: urine loss with features of two or more types of
incontinence
❖ Overflow: overdistention and overflow of bladder
❖ Functional: caused by factors outside the urinary tract
❖ Reflex: emptying of the bladder without sensation of need to
void
❖ Total: continuous, unpredictable loss of urine
❖ Stress: involuntary loss of urine related to an increase in
intra-abdominal pressure
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External Urine Collection Devices
❖ Urinary sheath
❖ Urine collection system
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Reasons for Catheterization
❖ Relieving acute urinary retention
❖ Obtaining a sterile urine specimen when patient is unable to
void voluntarily
❖ Accurate measurement of urinary output in critically ill patients
❖ Assisting in healing open sacral or perineal wounds in
incontinent patients
❖ Emptying the bladder before, during, or after select surgical
procedures and before certain diagnostic examinations
❖ Providing improved comfort for end-of-life care
❖ Prolonged patient immobilization
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Types of Catheters
❖ Intermittent urethral catheters
❖ Indwelling urethral catheter
❖ Suprapubic catheter
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Nursing Interventions
❖ Urethral catheter insertion and care for patients with
an indwelling catheter
❖ Caring for a patient with a urologic stent
❖ Caring for a patient with a urinary diversion
❖ Caring for a patient receiving dialysis
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Question #5
Tell whether the following statement is true or false.
There are no interventions effective for preventing
urinary incontinence.
A. True
B. False
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Answer to Question #5
Answer: B. False
Rationale: There are appropriate interventions
effective for preventing urinary incontinence.
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Factors to Consider With
Use of Absorbent Products
❖ Functional disability of the patient
❖ Type and severity of incontinence
❖ Gender
❖ Availability of caregivers
❖ Failure with previous treatment programs
❖ Patient preference
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