Chapter 37

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 Filter and excrete Excrete waste

composition and blood constituents product (urine)
volume of body not needed; retain
fluids those that are
needed

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 Reservoir/or
gan of • Bladder wall adapts to
excretion the volume of urine
and expands

Sphincter • adult stores 150-

guards 250ml before desire
opening to void, which is a
between result of stimulation
Bladder urinary of stretch receptors in
bladder and bladder wall
urethra
Urethra
transports
urine from
bladder to
exterior of
body

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The Urinary
Bladder

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  Process of emptying the bladder
 Detrusor muscle contracts,
internal sphincter relaxes, urine
enters posterior urethra
Act of
Urination  Muscles of perineum and external
(Micturition sphincter relax
, Voiding)  Muscle of abdominal wall
contracts slightly
 Diaphragm lowers, micturition
occurs

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 Which term describes a
condition in which 24-hour
urine output is less than 50 mL?

A. Dysuria

Question #1 B. Glycosuria

C. Pyuria

D. Anuria

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 Answer: D. Anuria

Rationale: Anuria is synonymous

Answer
to with kidney shutdown or renal
Question failure. Dysuria is painful or difficult
#1 urination. Glycosuria is the presence
of sugar in the urine. Pyuria is pus in
the urine.

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 Minimal expected adult
output==30ml/hr;
720ml/day; avg is about
1200cc/day

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 Factors Affecting Micturition

FOOD AND FLUID PSYCHOLOGICAL ACTIVITY AND PATHOLOGIC

INTAKE VARIABLES MUSCLE TONE CONDITIONS

MEDICATIONS

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  Effects of aging
 Nocturia
Developmental  Increased frequency
Considerations  Urine retention and stasis
 Voluntary control affected by
physical problems
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 Tell whether the following statement
is true or false.
Diuretics cause increased urine
production, resulting in the need for
Question
#2 increased urination and possibly urge
incontinence.
A. True
B. False

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 Answer: A. True
Answer to
Question Rationale: Diuretics cause
#2 increased urine production,
resulting in the need for increased
urination and possibly urge
incontinence.

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 Diseases Associated With Renal Problems

Congenital Polycystic Urinary tract Urinary calculi

urinary tract kidney disease infection
abnormalities

Hypertension Diabetes Gout Connective

mellitus 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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 Anticoagulants: red urine

Diuretics: pale yellow urine

Medications
Affecting Pyridium: orange to orange-red urine
Color of
Urine The antidepressant amitriptyline or B-
complex vitamins: green or blue-green
urine

Levodopa: brown or black urine

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 Assessing data about voiding
patterns, habits, past history
of problems

Using the Physical examination of the

bladder, if indicated, and

Nursing urethral meatus; assessment of

skin integrity and hydration;
and examination of the urine
Process

Correlation of these findings

with results of procedures and
diagnostic tests

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 Urine production
 Polyuria (diuresis): abnormally
large amounts Oliguria: scant
amounts (less than 400ml/day)
Assessing a
 Anuria: less than 50ml/day
Problem With
Voiding  Explore its duration, severity,
and precipitating factors.
 Note the patient’s perception
of the problem.
 Check the adequacy of the
patient’s self-care behaviors.
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 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

Physical the bladder or use a bedside scanner.
Assessment of
Urethral orifice: Inspect for signs of
infection, discharge, or odor.
Urinary
Functioning Skin: Assess for color, texture, turgor,
and excretion of wastes.

Urine: Assess for color, odor, clarity,

and sediment.

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 Tell whether the following
statement is true or false.
Normal fresh urine has an
Question #3 ammonia odor.
A. True
B. False

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 Answer: B. False

Answer to Rationale: Normal fresh urine has an aromatic odor. As

Question urine stands, it often develops an ammonia odor
#3 because of bacterial action.

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 Measuring  Procedure:

Urine  1. wash hands put on gloves

Output:  2. have a graduated cylinder

 3. ID patient let them know whats goin on
REVIEW,  4. hat on toilet
YOU TELL  5. measure at eye level

ME  document

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Devices for Collecting and Measuring Urine

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 Urine Specimens: Create a Pamphlet

Clean-catch or Sterile specimens

Routine urinalysis midstream from indwelling
specimens catheter

Urine specimen Specimens from

24-hour urine
from a urinary infants and
specimen
diversion children

Point-or-care urine
testing

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 Tell whether the following statement
is true or false.
A urine specimen from a patient with
an indwelling catheter should be
Question
#4 obtained from the collection
receptacle.
A. True
B. False

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 Answer: B. False

Rationale: A urine specimen

Answer to from a patient with an
Question #4 indwelling catheter should be
obtained from the catheter
itself.

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 Nursing Diagnoses

Urinary functioning as the problem

• Incontinence
• Pattern alteration
• Urinary retention

Urinary functioning as the etiology

• Anxiety
• Caregiver role strain
• Risk for infection

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 Planned Patient Goals

Produce Empty Provide care Develop plan Correct

sufficient bladder for urinary to modify unhealthy
quantity of completely at diversion and factors urinary
urine to regular know when contributing habits.
maintain intervals to notify to current or
fluid, without physician. future urinary
electrolyte, discomfort. problems.
and acid–base
balance.

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 Promoting Normal Urination

MAINTAINING PROMOTING STRENGTHEN ASSISTING

NORMAL FLUID INTAKE ING MUSCLE WITH
VOIDING TONE TOILETING
HABITS

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 Schedule

Urge to void
Maintaining
Normal Privacy
Voiding
Habits
Position

Hygiene
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 Mixed: urine loss
Transient: appears
with features of two
suddenly and lasts 6
or more types of
months or less
incontinence

Overflow: Functional: caused

overdistention and by factors outside
overflow of bladder the urinary tract
Types of
Urinary Reflex: emptying of
Total: continuous,
Incontinence the bladder without
sensation of need to
unpredictable loss of
urine
void

Stress: involuntary
loss of urine related
to an increase in
intra-abdominal
pressure

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 Factors to Consider With
Use of Absorbent Products

Functional disability Type and severity of

of the patient incontinence

Availability of
Gender
caregivers

Failure with previous

Patient preference
treatment programs

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 Patients at Risk for UTIs

Sexually active women

Women who use diaphragms for contraception

Postmenopausal women

Individuals with indwelling urinary catheter

Individuals with diabetes mellitus

Older adults

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 Prolonged patient
Relieving urinary retention
immobilization

Obtaining a sterile urine Accurate measurement of

specimen when patient is urinary output in critically
unable to void voluntarily ill patients

Assisting in healing open
sacral or perineal wounds
in incontinent patients
Reasons for
Emptying the bladder
before, during, or after
Catheterization
select surgical procedures
and before certain
diagnostic examinations.

Providing improved
comfort for end-of-life care

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Scan Bladder for
Post-Void
Residual

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 A Suprapubic
Catheter
Positioned in the
Bladder

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Location of an
Ileal Conduit

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 Explain reason for diversion and
rationale for treatment

Demonstrate effective self-care

behaviors

Patient Describe follow-up care and

support resources
Education for
Urinary Report where supplies may be
obtained in the community
Diversion
Verbalize related fears and
concerns

Demonstrate a positive body

image

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