Urinary Elimination

By Kishore Singh
Characteristics of Urine
• Color
▫ Amber/ straw
• Odor
▫ Aromatic upon voiding
• Transparency
▫ Clear
• pH
▫ Slightly acidic (4.6-8; average
6)
Characteristics of Urine
• Specific gravity
▫ 1.010-1.025
 High – concentrated urine
 Low – diluted urine
• Amount
▫ 30-60 cc./hour = 1500
cc./day
Problems in Urinary Elimination
• Altered Urine Composition
▫ RBC – hematuria
▫ WBC
▫ Pus – pyuria
▫ Bacteria – bacterunia
▫ Albunin – albuminuria
▫ Protein – proteinuria
▫ Casis – cylindruria
▫ Glucose – glycosuria
▫ Ketoes – ketonuria
Problems in Urinary Elimination
• Altered urine production
▫ Polyuria – excessive urination
 More than 100 cc/hour
 Above 2500 cc/day (diuresis)
▫ Oliguria – decreased urination
 Less than 30 cc/hour
 100-500 cc/day
▫ Anuria – absence of urine
 0-10 cc/hour = less than 100 cc/day
 Urinary suppression
Altered Urinary Elimination
• Frequency
• Nocturia – frequent during the night
• Urgency – strong feeling that a person wants to
void
• Dysuria
• Hesitancy – difficulty in initiating voiding
• Enuresis – repeated involuntary voiding beyond
4-5 yr old
Altered Urinary Elimination
• Pollakuria – frequent daytime urination
• Urinary incontinence
▫ Total incontinence
 A continuous and unpredictable loss of urine
 Ex: injury to external urinary sphincter in males
▫ Functional incontinence
 The involuntary unpredictable passage of urine
 With intact urinary and nervous system
 Cause – change in environment, sensory , in
cognitive, or mental defects
Altered Urinary Elimination
▫ Stress incontinence
 Leakage less than 50 cc as a result of sudden increase in
intra-abdominal pressure
 Ex: when one coughs, sneezes, laughs or exerts physically
▫ Urge incontinence
 Follows a sudden strong desire to urinate
 Unable to stop urine flow one it start as in the elderly
▫ Reflex incontinence
 Is an involuntary loss of urine occurring at somewhat
predictable intervals when a specific bladder volume is
reacted
Altered Urinary Elimination
• Urinary retention
▫ Accumulation of urine in bladder with associated
inability of bladder to empty itself -> 250-400
cc. urine in bladder triggers urination
For Urinary Incontinence
• Bladder retraining program – establishes regular
voiding time
• Avoid large amounts of fruit juices and
carbonated drinks
• Schedule diuretics in AM
• Adequate fluid intake
• Avoid stimulants at night
• Kegel’s exercise
Clinical Signs of Urinary Retention
• Discomfort in the pubic area
• Bladder distention
• Inability to void or frequent voiding of small
volumes
• A disproportionately small amount of fluid output
in relation to intake
• Increasing restlessness and need to void
Nursing Measures to Induce Voiding
• Provide privacy
• Provide fluids to drink
• Assist in proper positioning for voiding
• Serve clean, warm, and dry bedpan
• Allow to listen to sound of running water etc.
• Alternate warm and cold water over perineum
• Promote relaxation
• Provide adequate time for voiding