Module 9- Urinary Elimination

Urinary system function

Elimination of toxins and waste products
Regulation of fluid balance
Control of acid-base levelsrenal
Blood pressure managementrenal
Specific Nursing Measures Include:
Monitoring Fluid Intake and output- >30
mL/hr to ensure normal Kidney function.
Cardiac, renal, and liver pts. Are more
closely monitored.
Assessing urine characteristics- 9.6% water, faint aromatic smell, no microorganisms, and
clear, straw, or amber color. Specific gravity 1.010-1.025. Abnormal: blood, pus, glucose,
ketones. Pus in urine can come from any part of the urinary system. The closer to the
kidneys, the worse the situation. A spike in temperature may indicate infection.
Collecting Urine Specimens- Never let a specimen sit for more than an hour. May collect
fresh specimen from a just placed Foley. Do not collect anything that has set in the Foley
for 12-24 hours.
Testing Urine
MicturitionAct of emptying the bladder
Urinary Incontinence- Unable to hold urine. Uncontrolled.
Causes of Infrequent Urination- Being scared, loss of muscle tone, weak pelvic floor
Urinary Retention- Holding urine in. Retaining. Prostate medications cause urine
retention. Narcotics also cause retention by slowing the process down. Scar tissue will
also cause retention. A failing kidney will not cause retention because there is no urine
being produced.
Factors Affecting Micturition
Developmental
Food & Fluid Intake
Psychological Variables
Activity & Muscle Tone-Kegels
Pathological Conditions
Medications
Medications
Can cause kidney damagenephrotoxic
Effects of diuretics- Whoever takes Lasix should have a healthy set of kidneys.
Investigate any pt. who is taking Lasix and is on dialysis.
Change color of urine- Perform more assessment. When did it start?

Nursing History
Usual patterns
Recent changes
Aids/Artificial Devices
Present/past problems
Physical Assessment
Bladder
Urethral opening
Skin integrity
Urine
Urine
Color- A whiter color urine needs to be monitored more due to over diluted urine. Severe
loss of electrolytes may lead to heart attack.
Odor- Pt. with diabetes will smell sweet
Clarity
Presence of sediment or mucus
Measure output Min. 30 mL/hour
Collecting Urine
Routine U/A
Clean-catch/midstream
Children/Infants
Indwelling catheter
24 hour specimen- Can be done at home or hospital. Must be kept cold. First urine catch
should be thrown away. This test is performed to check how well the kidneys are
functioning. Should contain no less than 500 mLs.
Promoting Normal Urination
Schedule
Privacy
Promoting fluid intake
Strengthening Muscle Tone
Types of Incontinence
Transient Incontinence
Stress Incontinence
Urge Incontinence
Mixed Incontinence
Overflow Incontinence
Functional Incontinence

Reflex Incontinence
Total Incontinence

Post void Residual (PVR)

The amount of urine remaining in the bladder after voiding
<50 mL- considered adequately emptying bladder
>150 mL incomplete emptying of bladder
Collected via catheter after voiding
Complications
Sepsis
Trauma
Bacteriuria
Urinary Tract Infections (UTI)
Risk Factors
- Sexually active women
- Elderly
- Diabetes
- Individuals with indwelling catheters- 4-6 hours after removal of Foley a patient
should be urinating on their own.
Treatment

Learning Objectives
1.

Describe the anatomy and physiology of the urinary system.

2. Identify variables that influence urination.

3. Assess urinary elimination, using appropriate interview questions and physical assessment
skills.
4. Perform the following assessment techniques: measure urine output, collect urine specimens,
determine the presence of select abnormal urine constituents, determine urine specific
gravity, and assist with diagnostic tests and procedures.
5. Develop nursing diagnoses that correctly identify urinary problems amenable to nursing
therapy.
6. Demonstrate how to promote normal urination; facilitate use of the toilet, bedpan, urinal,
and commode; perform catheterizations; and assist with urinary diversions.
7. Describe nursing interventions that can be used to manage urinary incontinence effectively.
8. Describe nursing interventions that can prevent the development of urinary tract infections.

9. Plan, implement, and evaluate nursing care related to select nursing diagnoses associated
with urinary problems.

Pt.s output is 50 MLs of urine in 4 hours, what do you do?

A.
B.
C.
D.
E.

Monitor
Call the doctor
More assessment
Ambulate the patient
Give more fluids

Post-surgical or dialysis patients will not have a great amount of output.