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Urinary Elimination

The document describes the process of urination and factors that influence urinary problems. It covers urinary system anatomy, normal and abnormal urine production and elimination, nursing assessment of urinary function, and nursing management including maintaining normal elimination and preventing issues like urinary tract infections.

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17 views20 pages

Urinary Elimination

The document describes the process of urination and factors that influence urinary problems. It covers urinary system anatomy, normal and abnormal urine production and elimination, nursing assessment of urinary function, and nursing management including maintaining normal elimination and preventing issues like urinary tract infections.

Uploaded by

Stream Golden
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Urinary Elimination

Prepared by: Romeo T. Papa, DMD RN


Learning Outcomes

After completing this chapter, you will be able to:


1. Describe process of urination.
2. Identify factors that influence urinary problems.
3. Describe nursing assessment of urinary function.
4. Identify normal and abnormal constituents of urine.
5. Develop nursing diagnosis and desired outcomes and interventions to maintain
normal urinary elimination, prevent UTI, and manage urinary incontinence.
6. Explain the care of clients with urinary diversions.
7. Understand the steps and rationale for catheterization.
8. Demonstrate appropriate documentation concerning urinary elimination and
catheterization.
Review of Anatomy and Physiology

● Upper urinary tract


○ Kidney
○ Ureters
● Lower urinary tract
○ Bladder
○ Urethra
○ Pelvic floor
Kidneys

● Pair of kidneys situated in either side of the spinal column


behind the peritoneal cavity.
● Primary regulators of fluid and acid-base balance
● Functional unit - Nephrons
● Nephrons filter the blood and remove metabolic waste
● Urine formation
Ureters

● Carries formed urine from kidneys to bladder


● 25 - 30 cm long and 1.25cm in diameter (adult)
Bladder

● Reservoir for urine


● Wall of bladder is made up of smooth muscles called -
detrusor muscles
● Trigone - marks the opening of the ureters and the opening
of urethra
● Normal bladder capacity = between 300 and 600 mL of urine
Urethra

● Extends from the bladder to urinary meatus(opening)


● Serves as passageway for elimination of urine
● Male = approximately 20 cm (8inches) long
● Female = 3 to 4 cm (1.5 inches) long
Pelvic Floor

● Pelvic floor muscles (PFM) - are under


voluntary control and are important in
controlling urination
● Internal sphincter - involuntary
● External sphincter - voluntary
Urination

● AKA micturation/Voiding
● Refers to the process of emptying the bladder
● Stimulated by stretch receptors
● Occurs when bladder contains 250 - 450 ml (adult) and 50 to 200 ml (child) of urine
Factors affecting Voiding

1. Developmental factors
2. Psychosocial factors
3. Food and fluid intake
4. Medication
5. Muscle tone
6. Pathologic condition
7. Surgical and diagnostic procedure
Normal Urine Production

Normal urine output:

● 5 to 1ml/kg/hour
● 30 to 60 ml/hour
● Average daily urine output = 1500 ml (adult)
Altered Urine Production

● Polyuria (diuresis)
○ More than 60 ml/hour
● Oliguria
○ Less than 30 ml/hour
● Anuria
○ Less than 10 ml of urine/hour
Altered Urinary Elimination

● Urinary frequency
○ Voiding at frequent interval more than 4 to 6 times per day
● Nocturia
○ Voiding 2 or more times at night
● Urgency
○ Is sudden strong desire to void may or may not be a great deal of urine in bladder
● Dysuria
○ Painful or difficulty in urination
Altered Urinary Elimination

● Enuresis
○ Involuntary urination in children when bladder control is acquired
○ Nocturnal enuresis/Diurnal enuresis
● Incontinence
○ Involuntary urine leakage
● Urinary retention
○ Overdistension of bladder due to urinary stasis
Nursing Management: ASSESSMENT

● History taking
● Physical assessment
● Assessing urine
○ Urine output
○ Measuring residual urine
○ Color - normal: straw/amber/transparent(clear)
○ Odor - normal:faint aromatic
● Diagnostic testing
○ Urinalysis
○ BUN/Creatinine
Characteristics of Urine
Characteristics Normal Abnormal

Amount 1200 - 1500ml Less than 1200 or large amount

Color Straw, amber, clear Dark amber, cloudy, dark orange, red/dark brown, mucus plugs

Odor Faint aromatic Offensive

Sterility No microorganism Microorganism present

pH 4.5 to 8 Over 8 or under 4.5

Specific gravity 1.010 to 1.025 Under 1.010 and over 1.025

Glucose Not present present

Ketone bodies Not present present

Blood Not present Present


Nursing Management: PLANNING

● Maintain or restore voiding pattern


● Regain normal UO
● Prevent associated risk for infection
● Perform toileting activities independently
● Contain urine with appropriate device catheter
Nursing Management: IMPLEMENTATION

1. Promoting fluid intake


2. Maintaining normal voiding habits
3. Assisting with toileting
4. Prevent UTI
5. Manage urinary incontinence
a. Pelvic floor muscle exercises - Kegel’s Exercises
Nursing Management: IMPLEMENTATION

6. Maintain skin integrity


7. Applying External Urinary device
a. External penile sheath

8. Managing Urinary Retention

a. Promote normal voiding pattern


b. Crede’s maneuver for flaccid bladder
c. Urinary Catheterization
Reference

Kozier & Erb’s (2022) Urinary Elimination Fundamentals of Nursing 11th ed 2022 pp1250-1259

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