Nursing Foundation

Unit –5
Elimination needs
Objectives …
• Urine elimination needs ….
• Review of physiology of urine elimination .
• Composition and characteristics of urine .
• Alteration is urinary elimination .
• Facilitating urine elimination :-
-assessment
-types
-equipment
- procedures and considerations
•Review of physiology of urine elimination :-

• The function of urinary system – filter

blood and create urine .

• Urination : it’s the process by which urinary

bladder is emptied .
•Process of Urinary elimination :-

• 3 basic process :-

•-Glomerular filtration

•-Tubular reabsorption

•-Tubular secretion and bladder emptying

•Glomerular filtration :-
•-First step of urine formation .

•-Process is marked by water , more

solutes from blood plasma moving through
walls of glomerular capillaries .

•-These capillaries filter the substances and

then these substance are moved into renal
tubule through glomerular capsule
•Tubular reabsorption ​:-

•-About 99% are filtered .

•-some useful solutes are reabsorbed by the

tubule cells .
•Tubular secretion :-

•-Other materials such as wastes , drugs , ions

•Which are excess are secreted by duct cells
and renal tubules .

•Bladder emptying :- The process of

Micturition
•Composition of urine :-

• Urine :-
• liquid waste of human body
• Major content is water
• Water constitutes about 96% of the urine in
a healthy human being
• 1-2 liters of water is excreted as urine
everyday
Characteristics of urine :-​

1 – color ...
2– odor ...
• Fresh urine is slightly aromatic
• Standing urine develops an ammonia odor
• Some drugs and vegetables (asparagus) alter
the usual odor
• Elevated ketones smells fruity or acetone-like
smell
• Consumption of alcohol, saffron ,coffee, and
onion can result in teltate scents...
3– quantity ...​

 Around 1.4 liters of urine is produced in a

day in a normal human being

 The whole quantity of urine is released in 6-

8 micturition

 The frequency the urine depends upon

ANURIA : COMPLETE STOPPAGE OF URINE​

OLIGURIA :REDUCED AMOUNT OF URINE​

POLYURIA :INCREASED AMOUNT OF URINE​

NOCTURIA :INCREASED AMOUNT OF URINE

AT NIGHT​

HEMATURIA : BLOOD IN URINE .

4- PH -5.5-6.8...

Acidic :meat food, diabetes - mellitus,

starvation, fever ETC

Alkaline: plant food, cystitis, pyelitis ETC

Factors effecting / influencing urination :-

1 .Developmental factors :-
 output depends majorly on the age of a person.
 The amount of urine excreted is different for age
groups.
 For instance, infants and adults have different
urine output.
2. psychological factors :-
 Certain factors stimulate urination for some
people.
 For instance, some people cannot void anywhere
their home.
 privacy is the utmost requirement for voiding.
 The sound of running water may also stimulate
urination. If such conditions are not fulfilled, the
process of urination is suppressed.
 This can result into increased chances of UTIs.
3 –food and fluid intake :-
 The food balance is maintained by the body
in which the ingested food or fluid is
balanced with the eliminated products.

 If the fluid intake is high, the eliminated

urine will be more.

 There are fluids which can increase or inhibit

the urine output.
 For instance, alcohol can suppress the ADH and
can increase the output , on other hand sodium
rich fluid can retain water inside body decreasing
the output. ​

 Caffeine rich fluids can also increase urine output ​

4- medications :-
 Many medications such as antidiuretics or
diuretics can interfere with the process of
voiding •

 Furosemide can increase urine formation. Other

medications such as atropine, Robinul increase
urinary retention in the body
5-Muscle tone :-
 The good muscle tone is required for the ability to
store and empty the urine.
 Muscle tone plays an important role in filling the
bladder and completely emptying.
6-Pathological conditions:-

 There are disease conditions, which affect the

formation and elimination of urine.
 These conditions can be the diseases of kidney,
which affect the nephrons.
 This way, kidneys stop producing urine altogether.
Conditions such as a urinary stone can cause
obstruction blocking the urine to pass from kidney
to bladder.
 Other situations can include the loss of fluids
through other means, such as bleeding,
vomiting, etc.​

 A condition in man called hypertrophy of

prostate gland can also result in obstruction. ​
Alteration in urine : -

 Urinary elimination is altered when an

individual is not able to pass urine or control
the urine urge .

 There are two conditions I . e

1. Urinary retention
2. Urinary incontinence
1. Urinary retention ​:-

 The process of bladder emptying is impaired

 accumulation of urine inside the

bladder leading to over-distention of the
urinary bladder

 As the condition worsens – the detrusor muscles

Becomes very poorly contractible worsening the
Factors effecting urination / causes of urinary
Retention :-

1. Obstruction
2. Reduced muscle bladder stimulation
3. Decreased muscle tone
4. Pressure imposed
5. Fluid volume deficit
6. Lifestyle
7. Medication
2. Urinary incontinence :-

 It’s a symptom – not a disease...

 Defined as – the leakage of urine from the

urinary bladder involuntarily.

 Urinary sphincters are unable to control the

urine passage leading to leakage from
the bladder
Causes of urinary incontinence :-
1. old age

2. Unconsciousness

3. Neurological condition

4. Perineal muscle weakness

5. Effects of drugs
Types of incontinence :-

1. Uncontrollable urge to pass

2. Stress incontinence

3. Mixed incontinence

4. Overflow incontinence
Facilitating urine elimination :-

Bedpan:
​
Bladder irrigation :- ​
 Process carried out in order to wash the urinary
bladder out.
 It reduces the inflammation and risk for
infection

Procedure – in lab
Procedures of urinary elimination :-
 Proving bedpan
 Care of patient with
-condom drainage
-intermittent / indwelling
catheterization
 Bladder irrigation .
Urinary diversions :-
 Process by which the urine flow is diverted

 It’s a surgical procedure in which the urine is

diverted and re-routed from kidneys and is
directed to the body part other than bladder .

 Through diversions - a new pathway will be

built for the urine to pass
 Thus , urine exits from a new site.
​ Procedure is done when the urinary tract or
some other part of urinary tract is diseased .

 Indications :- tumor, cyst ET C

Types of urinary diversions :-
1. Incontinent
2. Continent

(Presentation)
Bowel
eliminati
on
needs ….​
Facilitating bowel elimination :-​
​