HEAL 5026 Introduction to Professional Nursing practice
Elimination
Part 1: Urinary
Learning Outcomes
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Define key terms
Describe the structure and function of the urinary system
Outline the process of micturition
Describe the characteristics of normal urine
List and describe alterations in normal voiding patterns
Describe factors that can alter urinary elimination
Recognise age-related differences in urinary elimination
Discuss assessment and care of altered urinary elimination
Terminology
 anuria
 oliguria
 polyuria
 diuresis
 dysuria
 haematuria
 nocturia
 bacteriuria
 catheterisation
 proteinuria
 pyelonephritis
 renal calculus
 residual urine
 urgency
 frequency
 pyuria
 urinary retention
 urinary incontinence
-stress incontinence
-urge incontinence
-reflex incontinence
 functional incontinence
 total incontinence
 enuresis
 Kegel exercises
Structure of the Urinary System
The NEPHRON
-functional unit of the kidney
-forms the urine
Function of the Urinary System
Elimination of fluid waste
-Urine formation
-Urine excretion
Urine formation
-filtration
-reabsorption
-secretion
Urine excretion
-urination
-micturition
-voiding
Characteristics of normal urine
-Volume
-Colour
-Clarity
-Odour
Maintenance of normal urinary elimination
Characteristics
-4-6 times/day
-pass approx. 200-500 ml per void
-1200 to 1500mls / 24hrs
-Empty bladder at normal intervals
-Respond to the urge to void
-Drink 8 – 10 glasses of water per day
Factors affecting urination
-developmental
-aging
-fluid intake
-nutrition
-sociocultural
-psychological
-muscle tone
-surgical procedures
-disease
-medications
-urinary tract infections
-neurologic injury
-diagnostic examination
-pregnancy
-urinary diversion
Manifestations of altered urinary function
-dysuria
-polyuria
-anuria
-oliguria
-urgency
-frequency
-nocturia
-eneuresis
-haematuria
-pyuria
-urinary retention
Urinary incontinence
(involuntary loss of urine from the bladder)
may be:
- temporary or permanent
- continuous or intermittent
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stress incontinence
urge incontinence
reflex incontinence
functional incontinence
total incontinence
Assessment of urinary elimination
Nursing history
Subjective data
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normal urinary pattern
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symptoms – dysfunction identification
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factors affecting urination – risk identification
Objective data
- assessment of urine – intake and output
- urine characteristics
- urine testing – random specimen
- midstream specimen
- sterile specimen
- timed urine specimens
- urinalysis
- specific gravity
Physical assessment
- inspection
- percussion
- palpation
- skin and mucosal membranes
- kidneys
- bladder
- urethral meatus
Urinalysis
- Bilirubin - Glucose - Ketones - Leucocytes - PH - Protein -
+ in obstructive jaundice and hepatitis
In diabetics where high levels of sugar cannot be reabsorbed
Fatty acids in urine
White blood cells in urine UTI
5.0 to 6.0
not normally present in urine in renal disease or pregnancy
Nursing care plan -example
Mrs Sim, 75 years of age, is admitted to the hospital with her 4th urinary tract infection.
Her temperature is measured and documented as 39.9°C. During your
assessment of her normal urinary pattern she tells you “I wet myself all the time
and it doesn’t smell very good”. You note that she is incontinent of urine and has
dysuria.
Problem (Actual)
Urinary incontinence related to pain caused by the urinary tract infection.
Goal
Mrs Sim’s episodes of urinary incontinence will reduce within two weeks.
Interventions and Rationale
1. Encourage fluid intake of 2 litres every 24 hours
Regular fluid intake increases urine output which strengthens the bladder muscles and
facilitates bladder re-training.
2. Toilet Mrs Sim every 2 hours during the day.
Regular toileting retrains the bladder and decreases the episodes of incontinence.
3. Ensure loose fitting clothing that is easily removed when the need to void arises.
Loose clothing facilitates easy removal and thus avoids incontinence.
References
Crisp, J., & Taylor, C., Douglas, C., & Rebeiro, G. (4th. ed.). (2013). Potter and Perry’s
Fundamentals of nursing. Chatswood: Elsevier.
Mosby’s Nursing Consult
Mosby’s Nursing Skills