Chapter 34: Urinary Elimination Study Guide.

Characteristics of normal urine:

v Volume:
o Average amount per void 250 to 400 mL in adults
o Number can vary greatly depending on intake and fluid losses, all but 5-10mL of
urine is typically emptied from the bladder.
o Catheterized patients should drain a minimum of 30mL of urine per hr.
o Urine output of less than 30mL/h may indicate inadequate blood flow to the kidneys.
v Color:
o Light yellow (straw) to amber
o Colorless if it is very dilute secondary to a high fluid intake.
v Clarity:
o Freshly voided urine is clear and without sediment.
v Odor:
o “Aromatic”
o The more dilute the urine, the fainter the odor
o Medications and certain food can alter urine’s odor.

Factors Affecting Urinary Elimination:

v Fluid intake- the amount of fluid that a person ingest is the most influential factor in
determining urine output.
v Loss of body fluid- when a person loses a great deal of body fluid, the kidneys increase
reabsorption of water from glomerular filtrate to maintain the proper osmolarity of the
ECF.
v Nutrition- diet may affect urinary elimination. (Food with high water content soup,
gelatin, fruits, vegetables).
v Body position- the typical body position for urinary elimination in men standing up.
v Cognition- cognitive impairment interferes with a person’s ability to maintain urinary
incontinence.
Neurologic conditions such as Alzheimer disease, brain tumor, or a stoke can reduce the
person’s ability to perceive bladder fullness or to delay voiding until he or she reaches the
toilet.
v Psychological factors (hypotension)- Hearing another person talk about need to void,
reading a chapter about the need to void, reading running water may all produce the need
for bathroom break.
v Surgery- postoperative patient should be able to void within 8 hrs after surgery. The
stress of surgery triggers. The release of ADH, which decreases urinary output. Many
medications used to control postoperative pain have urinary retention as a side effect.
v Medications- medications classified diuretics are administered to increase urinary output.
Some of these medications are chlorothiazide, hydrochlorothiazide, furosemide,
spironolactone and triamterene and some medications change the color of urine for
example Pyridium who changes the color to bright orange and amitriptyline turns urine
blue green.
v Infections of the urinary tract- some of the species commonly responsible for uti’s are
the Enterobacteriaceae group and include Escheria coli, Klebsiella and Proteus
 v Catheter-associated urinary tract infection (CAUTI)
v Neurologic injury- spinal cord injury, stroke, brain tumor
v Decreased muscle tone- aging, multiple pregnancies, obesity.
v Pregnancy- compression of the bladder by the uterus may also lead to obstruction of
urinary flow and incomplete emptying of the bladder.
v Factors obstructing urine flow-
o Structural abnormalities of urinary tract, urinary tumors, renal stones, prostatic
enlargement, kinked or blocked catheters.

Altered urinary function:

v Dysuria- pain (UTI)
v Polyuria- excessive, more than 2500 to 3000 in 24 hrs (diuretics, caffeine)
v Oliguria- less than 500mL in 24 hrs (excessive vomiting)
v Urgency- cannot delay voiding voluntarily. Urge is not usually felt at 250 to 400 mL and
most adults can postpone.
v Frequency- voiding @ frequent intervals.
v Nocturia- voiding @ night, kidneys better able to be perfused.
v Hematuria- renal calculi, UTI, blood in urine
v Pyuria- pus, UTI
v Urinary retention- inability to emptying the bladder, more than 600mL can be palpated
@ symphysis pubis.

Risk:
Neuro impairments
Post appts
Who have spinal anesthesia

symphyses [growing together] A line of fusion between two bones that are separate in early
development, as symphysis of the mandible. A joint in which two bones are connected only by a
fibrocartilaginous pad, as the pubic symphysis and the intervertebral disks.

Urinary diversion-
Is a surgical procedure in which the normal pathway of urine elimination is altered. Muscle
invasive bladder cancer is the most common reason for a urinary diversion procedure in which
the bladder is surgically removed. This procedure is called Cystectomy.

Causes and treatments for incontinence-

v Urinary incontinence
o Stress incontinence- increased abdominal pressure causes involuntary loss of
small amounts of urine.
 Causes: high abdominal pressure from coughing, sneezing, jumping, or
weak pelvic support from obesity, pregnancy, prostate surgery.
 Treatment: Kegel exercises, weight loss if obese, vaginal pessary,
estrogen vaginal creams, male external catheters, surgery.
 o Urge incontinence- random involuntary passage of urine after a strong urge to
void.
 Causes: irritation of the bladder, bladder infection, overdistention of the
bladder, intake of diuretics, caffeine, or alcohol.
 Treatment: timed voiding schedule, anticholinergic drugs.
o Reflex incontinence- involuntary loss of urine
 Causes: spinal cord impairment above the sacral reflex arc (spinal cord
injury, stroke, brain tumor). Or radical pelvic surgery.
 Treatment: In and out catheterization; alpha-adrenergic drugs to relax
internal sphincter, baclofen to relax external sphincter.
o Functional incontinence- inability of a person to reach the bathroom in time to
avoid unintentional loss of urine.
 Causes: Altered environment treat. And sensory, cognitive, psychological,
neurovascular, or mobility deficits.
 Treatment: Toileting routine, verbal reminders with assistance to the
bathroom, alteration of environment for easy access to the bathroom,
clothing that is easy to remove.
o Total incontinence- a person that experiences continuous, unpredictable loss of
urine.
 Causes: Neurologic lesion, trauma to or congenital malformation in the
spine cord or brain, severe cognitive deficits.
 Treatment: Toileting routine and verbal reminders, external catheters for
men, absorbent products, excellent skin care and hygiene.

Assessment: Pattern Identification-

v How many times per day urination occurs.
v How much is usually voided each time.
v How many times the patient wakes at night to void.

Physical Assessment-
v Inspection
o Obvious bladder distention.
v Palpation
o Begin at umbilicus and move in a downward direction toward the symphysis
pubis to detect bladder distention.

Collection of urine specimens-

v Random specimen- sterile not required.
v Clean catch or midstream specimen- free of microorganism.
v 24-hour specimen- measures kidney’s excretion of substance
v Specimen from a catheter- collect using sterile procedure.
Urine tests
o Reagent strips- urine dipstick, detects UTI, can also check for glucose, protein,
and ketones.
o Urinalysis- most common screening test, and this provides data about the color,
turbidity, pH, specific gravity of the urine and detects proteins, glucose, ketones,
red blood cells, white blood cells, bacteria, or casts. Specimen of 20 to 30mL of
urine.
o Urine culture and sensitivity- This can be performed on urine to identify any
microorganism causing UTI (if suspected) and to determine which antibiotic can
kill the organism.

Diagnostic Test-
v Blood tests-
o Bun- when kidneys are diseased, they are enabled to excrete urea adequately and
urea begins to accumulate in the blood, causing BUN to rise.
o Creatinine- Is a more sensitive indicator of renal function, an elevated serum
creatinine concentration is indicative of impaired renal function.
o GFR- is the amount of plasma filtered through glomeruli per unit of time and is
the best indicator for kidney function. GFR less than 60mL/min, indicating
significant kidney disease that requires dosage adjustment for many medications.
v Cystoscopy- insertion of a tube into the bladder for the purpose of direct visualization.
o Stones
o Tumors
o Structural problems

Health Promotion
v Promoting voiding
o Provide a private setting; allow adequate and uninterrupted time for voiding.
o Offer assistance to Bathroom when needed during times patient usually voids.
o Encourage voiding every 4 hours.
o Provide medications for pain and other comfort measures prior to voiding.
o Aid patients in assuming a comfortable and physiologic position for voiding.
o Promoting adequate fluid intake
o Preventing urinary tract infections
o Promoting optimal muscle tone

Urinary Catheterization: Involves inserting a small tube, called a catheter, though the urethra
into the bladder to allow urine to drain.

Intermittent catheterization and leg bags: involve the introduction and removal of a catheter
into the bladder to permit drainage of urine at routine intervals, usually every 6 to 8 hrs. this is
commonly use in patients with spinal cord injuries and those who are neurologically impaired
and not able to void.
Leg bag: smaller drainage units that can be attached to the leg. This is helpful from when a
patient goes home with a catheter or urinary drainage system.