Urinary Elimination
Teresa V. Hurley, MSN, RN
Urinary System
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Kidneys filter nitrogen, metabolic wastes, excess
ions and water
Urine produced at a rate of 60 mL/hour
Bladder stores average 500 mL or more
Void: detrusor muscle contracts and urine is
pushed through internal urethral sphincter into
urethra
Urinalysis
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Urine: clear, yellow, aromatic, without pathogens
or parasites
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Specific Gravity: 1.025 (concentrate urine)
Increases with dehydration
 Decreases with increased fluid intake
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Urinalysis
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Abnormal
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Protein: renal disease, 2nd to exercise and stress
Glucose: elevated BS; diabetes
Ketones: CHO metabolism
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Diabetes, fever, fasting, starvation, high protein intake, vomiting,
post-op
Hemoglobin: UTI, nephritis, trauma, lithiasis, hemolytic rx
Bilirubin: liver disease
Urobilinogem: cirrhosis, heart failure, pernicious anemia,
mono
Nitrates: bacteria
Leukocyte esterase: bacteria, fungal, parasitic, tumor,
nephritis
Hematological
Hematological
BUN 8-16 mg/dL (end product protein
metabolism)
Creatinine 0.6-1.2mg/dL (muscle metabolism of
creatin)
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Increased: renal failure, infection, obstruction,
dehydration, increase protein intake, TPN
Decreased: liver disease, decrease protein intake
Factors Affecting Micturition
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Developmental considerations
Food and fluid intake
Psychological variables
Activity and muscle tone
Pathologic conditions
Medication
Developmental Considerations
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Children
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Toilet training 18 to 24 months, enuresis
Effects of aging
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Nocturia, increased frequency, urine retention and
stasis, voluntary control affected by physical
problems
Effects of Medications on Urine
Production and Elimination
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Diuretics — prevent
reabsorption of water
and certain electrolytes in
tubules
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Cholingeric medications
— stimulate contraction
of detrusor muscle,
producing urination
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Analgesics and
tranquilizers — suppress
CNS diminish
effectiveness of neural
reflex
Medications Affecting Color of
Urine
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Anticoagulants — red color
Diuretics — lighten urine to pale yellow
Pyridium — orange to orange-red urine
Elavil — green or blue-green
Levodopa — brown or black
Using the Nursing Process
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Assessing data about voiding patterns, habits,
past history of problems
Physical examination of urinary system, skin
hydration, urine
Correlation of these findings with results of
procedures and diagnostic tests
Assessing a Problem With Voiding
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Explore its duration, severity, and precipitating
factors.
Note client’s perception of the problem.
Check adequacy of client’s self-care behaviors.
Physical Assessment of
Urinary Functioning
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Kidneys — check for
costovertebral tenderness
Urinary bladder —
palpate and percuss the
bladder or use bedside
scanner
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Urethral meatus —
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
Measuring Urine Output
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Ask client to void into
bedpan, urinal, or
specimen container in
bed or bathroom.
Pour urine into
appropriate measuring
device.
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Place calibrated container
on flat surface and read
at eye level.
Note amount of urine
voided and record on
appropriate form.
Discard urine in toilet
unless specimen is
needed.
Urine Specimens
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Routine urinalysis
Specimens from infants and children
Clean-catch or midstream specimens
Sterile specimens from indwelling catheter
24-hour urine specimen
Promoting Urination
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Maintaining voiding habits
Promoting fluid intake
Strengthening muscle tone
Kegel Exercises (PFME) to Tx stress, urge mixed
 Imagine voiding, stop flow, tighten rectal muscles
 Hold 5-10sec and rest 5-10sec
 Daily 40-60 PFME doing 2-4 sets of 15 each time
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Client’s at Risk for UTIs
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Sexually active women
Postmenopausal women
Individuals with indwelling urinary catheter
Individual with diabetes mellitus
Elderly people
Four Types of Urinary Incontinence
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Stress — increase in intraabdominal pressure
Urge — urine lost during abrupt and strong
desire to void
Mixed — symptoms of urge and stress
incontinence present
Overflow — overdistention and overflow of
bladder
Functional — caused by factors outside the
urinary tract
Client Education for Urinary
Diversion
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Explain reason for diversion and rationale for
treatment
Demonstrate effective self-care behaviors
Describe follow-up care and support resources
Report where supplies may be obtained in
community
Verbalize related fears and concerns
Demonstrate a positive body image
Evaluating Effectiveness of Plan
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Maintain fluid, electrolyte, and acid-base balance
Empty bladder completely at regular intervals
with no discomfort
Provide care for urinary diversion and when to
notify physician
Develop a plan to modify factors contributing to
problem
Correct unhealthy urinary habits
Hazards of Catheterization
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UTI.
Sepsis.
Trauma- specially in
men.
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DO NOT USE FORCE!
USE STERILE
ASEPTIC
TECHNIQUE!
Research
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clean technique can be
used for self
catheterization at home.
Reasons for Catheterization
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Relieving urinary retention.
Obtaining a sterile urine specimen..
Emptying the bladder
before,
 during,
 after surgery or diagnostic procedures.
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Monitoring of critically ill patients.
Types of Catheters
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Indwelling catheter
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Intermittent catheter
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remains in place for
continuous drainage.
used to drain bladder for
short periods of time.
Suprapubic catheter
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inserted surgically above
the pubic bone for
continuous drainage.
Urinary Diversions
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Ureterostomy
Bladder is removed
 One or both ureters redirected from kidney through
the abdominal wall
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Ileal Conduit
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Bladder removed and small intestine (ileum)
used as conduit between ureters and skin
surface. Urine collects continuously
Client Care Goals:
Interventions Indwelling Catheter
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Prevent UTI (meatus burning, cloudy, foul, chills, fever)
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Maintain closed system
Cleanse catheter soap/H2O; pat dry
Alcohol swab for contamination
Empty bag q 8 h or more
Bag below bladder level
Maintain urine acidity: cranberry juice, prunes, plums, tomatoes, eggs,meat,
cheese, citrus fruits
Change only sediment collects, sandy particles, trouble draining
Maintain Urine Flow ( prevent urinary stasis and backflow)
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Gravity drainage
Check for kinks, coils, lying on tube
Clamp if higher than bladder
Do not allow on floor
Client Goals
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Prevent Infection Transmission
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Wash hands before and after
Wear gloves
Promote Urine Production (pathogen flushing; tube
irrigation; prevents stasis)
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Oral intake 8-10 glasses (3000 mL/day) unless contraindicated
Parenteral or Enteral feedings
Monitor I & O q 8 h
Check for blood, sediments, color, odor
Client Goals
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Maintain Skin and Mucosal Integrity
Prevent fecal and encrustation to catheter and
perineal area
 Cleasnse: soap/H2O
 Sandy particle encrustation at the meatus (catheter
change)
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