URINARY ELIMINATION

Process of urination

Depends on effective functioning of

Upper urinary tract (kidneys, ureters)

Lower urinary tract (bladder, urethra, pelvic floor)

CV system

Nervous system

Urine formation

Nephron

Functional unit of the kidney

Urine is formed here

Glomerulus

Tuft of capillaries surrounded by Bowmans capsule

Fluids and solutes move across endothelium of the capillaries into the
capsule

Bowmans Capsule

Proximal convoluted tubule

Most of water and electrolytes are reabsorbed

Loop of Henle

Solutes such as glucose reabsorbed here

Other substances secreted

Distal convoluted tubule

Filtrate move from here into the tubule of the nephron

Additional water and sodium reabsorbed here under control of

hormones

Formed urine then moves to:

Calyces of the renal pelvis

Ureters

Bladder

Process of Micturition

Urine collects in the bladder

Pressure stimulates special stretch receptors in the bladder wall

Stretch receptors transmit impulses to the spinal cord voiding reflex center

Internal sphincter relaxes stimulating the urge to void

If appropriate, the conscious portion of the brain relaxes the external urethral
sphincter muscle

Urine eliminated through the urethra

Factors Influencing Urinary Elimination

Developmental factors

Psychosocial factors

Fluid and food intake

Medications

Muscle tone

Pathologic conditions

Surgical and diagnostic procedures

Selected urinary problems

Polyuria

Oliguria, Anuria

Frequency or Nocturia

Urgency

Dysuria

Enuresis

Incontinence

Retention

Neurogenic Bladder

Nursing Assessment of Urinary Function

Nursing history

Physical assessment of urinary system

Hydration status

Examination of urine

Data from diagnostic tests and procedures

Nursing History

Normal voiding patterns

Appearance of urine

Recent changes

Past or current problems

Physical Assessment

Percussion of kidneys and bladder to detect tenderness

Inspect urethral meatus for swelling, discharge, inflammation

Skin color, texture, turgor, signs of irritation

Edema

Assessing Urine

Measuring urinary output

Measuring residual urine

Diagnostic Tests

Blood urea nitrogen

Creatinine

Characteristics of Normal Urine

96% water and 4% solutes

Organic solutes include urea, ammonia, creatinine, and uric acid

Inorganic solutes include sodium, chloride, potassium sulfate, magnesium,

and phosphorus

Characteristics of Urine

Volume

Color, clarity: amber yellow

Odor: aromatic

Sterility

pH: 4.5-8

Specific gravity:

Glucose

Ketone bodies

Blood

NANDA Nursing Diagnosis

Impaired Urinary Elimination

Functional Urinary Incontinence

Reflex Urinary Incontinence

Stress Urinary Incontinence

Total Urinary Incontinence

Urge Urinary Incontinence

Urinary Retention

Risk for Infection

Low Self-esteem

Risk for Impaired Skin Integrity

Self-care Deficit

Risk for Deficient Fluid Volume or Excess Fluid Volume

Disturbed Body Image

Deficient Knowledge

Risk for Caregiver Role Strain

Risk for Social Isolation

Desire Outcomes

Maintain or restore a normal voiding pattern

Regain normal urine output

Prevent associated risks such as infection, skin breakdown, fluid and

electrolyte imbalance, and lowered self-esteem

Perform toilet activities independently with or without assistive devices

Contain urine with the appropriate device, catheter, ostomy appliance, or

absorbent product

General Nursing Interventions

Promoting fluid intake

Maintaining normal voiding patterns

Assisting with toileting

Preventing urinary tract infections

Managing urinary incontinence

Continence (bladder) training

General Nursing Interventions

Pelvic muscle exercises

Maintaining skin integrity

Applying external urinary drainage devices

Performing urinary catheterizations

Performing bladder irrigations

Providing care for clients with indwelling urinary catheters and urinary
diversions

Preventing Urinary Tract Infections

Drink eight oz of water per day

Practice frequent voiding (every 2 to 4 hours)

Avoid use of harsh soaps, bubble bath, powder, or sprays in the perineal area

Avoid tight-fitting clothing

Wear cotton rather than nylon underclothes

Always wipe the perineal area from front to back following urination or
defecation (girls and women)

Take showers rather than baths if recurrent urinary infections are a problem

Nursing Care of Client with an Indwelling Catheter

Encourage large amounts of fluid intake

Intake of foods that create acidic urine

Perineal care

Change catheter and drainage system only when necessary

Catheterize only when necessary

Maintain sterile closed-drainage system

Remove catheter as soon as possible

Follow good hand hygiene

Prevent fecal contamination

Interventions to Maintain Urinary Flow Through Drainage System

Ensure tubing free of obstructions

Ensure tubing not clogged

Ensure there is no tension on catheter or tubing

Ensure gravity drainage maintained

Ensure no loops in tubing below entry

Keep drainage receptacle below level of clients bladder

Ensure closed drainage system

Observe flow of urine q. 2 to 3 hours

Note color, odor, abnormal constituents

If sediment present, check more frequently

Nursing Care of Client with Urinary Diversion

Assess intake and output

Note any changes in urine color, odor, or clarity (mucous shreds are
commonly seen in the urine of clients with an ileal diversion)

Frequently assess the condition of the stoma and surrounding skin

Consult with the wound ostomy continence nurse (WOCN)