Lesson 5e

Urinary
Elimination
Anatomy of Kidney
Nephron-Functional
unit of kidney, forms
urine
Each kidney has 1
million nephrons
Nephron composed of
glomerulus, Bowman’s
capsule, proximal
convoluted tubule, loop
of Henle, distal tubule,
& collecting tubule
Physiology of Urine
Formation
 Normalglomerular function- Urine formation starts at
glomerulus where blood is filtered
 GFR-(Glomerular filtration rate)- amt of blood filtered by
glomeruli in a given time
 NormalGFR- 125ml/minute, however only 1 ml per minute
becomes urine, most is reabsorbed
 Normal 24 hr urine output is 1500-1600ml
Urethra
Urine travels from the
bladder through the urethra
& passes outside the body
through the urethral meatus
Lined by mucus membranes,
bacteriostatic, forms mucus
plug
Women-1.5-2.5 inches long,
external sphincter allows
voluntary flow of urine,
prone to infection
Urethra
Men-Urethra is both a urinary canal and a
passageway for secretions form
reproductive organs
20cm in length
Selected Urinary Problems
• Polyuria
Production of abnormally large amounts of urine by the kidneys,
often several liters more than the client’s usual daily output.

• Oliguria
 low urine output usually less than 500 ml a day or 30 ml per hour
for an adult

• Anuria
 lack of urine output

• Urinary Frequency
 is voiding at frequent intervals, that is more than 4 to 6 times per
day.

• Nocturia
 voiding 2 or more times at night.
Selected Urinary Problems

• Urgency
 the sudden strong desire to void.

• Dysuria
 voiding that is either painful or difficult

• Urinary hesitancy
associated with dysuria, a delay & difficulty in initiating
voiding

• Enuresis
Involuntary urination in children beyond the age when
voluntary bladder control is normally acquired, usually 4 or 5
years of age
Act of Urination
 Controlled by brain
 Coordination
of cerebral cortex,
thalamus, hypothalamus, & brain stem
 Suppress contraction of bladder’s
detrusor until person is ready to void
 Bladder normally holds as much as 600
ml of urine
 Desireto void is felt(sensed) when
bladder contains a smaller amount
(150-200ml in adult)
 Asbladder volume increases, bladder
walls stretch, sending sensory impulses
to micturition center in sacral spinal
cord
Act of Urination
Parasympathetic impulses
from the micturition
center stimulate detrusor
muscle to contract
Internal sphincter relaxes
so urine can enter urethra
As bladder contracts,
nerve impulses travel up
spinal cord to the cerebral
cortex, now you are aware
of the urge to void
Factors Influencing
Urination
Disease

Growth & Development

Socio-cultural factors
Psychological Factors
Muscle Tone
Fluid Balance
Surgery

Medications
Dialysis
 Peritoneal-Indirect
method of cleansing
blood of waste
products using the
process of osmosis
and diffusion
 Hemodialysis-
machine process
utilizes osmosis,
diffusion, &
ultrafiltration
through a vascular
graft (Udall,
TESIO, Permcath,
Shiley)
UTI Symptoms
 Pain or burning on urination (dysuria)
 Fever, chills, n/v, malaise (later signs)
 Hematuria-irritation of bladder & urethral mucosa
resulting in blood-tinged urine
 Pyelonephritis-infection spreads up to kidney-
flank pain, fever
Nursing Process
Alterations in Urinary Function
Assessment: Nursing history
Physical Assessment-inspection,
percussion, palpation
Assessment of Urine- color, clarity,
odor
Urine testing & specimen collection
Diagnostic tests: KUB, IVP, renal
ultrasound, renal CT scan
Urine Specimen Collection
 Random

 Clean-voided or midstream
 Sterile

 Timed specimens (24 hour collection)

Urine Testing

 Uninalysis

 Specific Gravity

 Urine Culture
Characteristics of Urine
Characteristic Normal Abnormal
Amt in 24 hrs 1,200-1,500 ml > Or <

Color, Clarity Straw, amber Dark amber, Cloudy,

Transparent Dark orange, Red or
dark brown

Odor Faint aromatic Offensive

Sterility No mcroorganisms Microorganisms present

present

pH 4.5-8 Over 8, under 4.5

Specific gravity 1.010-1.025 Over 1.025

Under 1.010
Characteristics of Urine
Characteristic Normal Abnormal
Glucose Not present Present
Ketone Bodies Not present Present
(acetone)
Blood Not present Occult
(microscopic)
Bright red
Nursing Diagnosis
 Incontinence

 Self-Care deficit
 Skin Integrity
 Altered Urinary Elimination
 Pain

 Body Image Disturbance

Implementation
Promoting Normal Micturition
Medications

Catheterization (Indwelling vs. straight)

Routine Catheter Care/Perineal Care
External Urinary Cathethers (Condom
caths)
Female Urinals
Maintaining Skin Integrity
Preventing Infection
Last Updated: April 1, 2005

Foley catheter

Illustration copyright 2004 Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.com
An indwelling Foley catheter remains in place continuously. To keep the catheter from slipping out, there is a balloon on one end that is inflated with sterile water once that end is inside
the bladder.

Medical Review: Adam Husney, MD - Family Medicine

Nancy Greenwald, MD - Physical Medicine and Rehabilitation

Last Updated: April 1, 2005

Clicker Question
A young girl is having problems urinating
postoperatively. You remember that children may
have trouble voiding:
 A. In bathrooms other than their own
 B. In a urinal
 C. While lying in bed
 D. In the presence of person other than their
parents

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Clicker Question
 1. A client with long-standing history of
diabetes mellitus is voicing concerns about
kidney disease. The client asks the nurse where
urine is formed in the kidney. The nurse’s
response is the:
 A. Glomerulus
 B. Kidney
 C. Nephron
 D. Ureter

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Clicker Question
A health care provider may suspect that a client
is experiencing urinary retention when the client
has:
 A. Large amounts of voided cloudy urine
 B. Pain in the lower abdomen
 C. Small amounts of urine voided 2 to 3 times
per hour
 D. Pain during urination

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