Urinary

• Urinary elimination


  The last step in the removal and elimination of excess water and by-products of metabolism
• Kidneys


  • Filter waste products of metabolism from the blood
• Ureters


  • Transport urine from the kidneys to the bladder
• Bladder


  • Holds urine until the volume in the bladder triggers a sensation of urge indicating the need to pass urine
• Micturition


  Occurs when the brain gives the bladder permission to empty; the bladder contracts, the urinary sphincter relaxes, and urine leaves the body through the urethra
• Nephrons


  • The functional unit of kidneys; removes waste products from the blood and plays a major role in the regulation of fluid and electrolyte balance
• Normal range of urine production: 1 to 2 L/day
• Erythropoietin


  Produced by the kidneys; stimulates RBC production and maturation in the bone marrow
• Renin-angiotensin system (RAS)


  The kidneys play a major role in BP control via the release of angiotensin and prostacyclin
• Factors influencing urination

  • Growth and development
  • Sociocultural factors
  • Psychological factors
  • Personal habits
  • Fluid intake
  • Pathological conditions
  • Surgical procedures
  • Medications
  • Diagnostic examinations
• Urinary retention


  An accumulation of urine due to the inability of the bladder to empty
• Urinary incontinence


  Involuntary leakage of urine
• Urinary diversion


  Diversion of urine to an external source
• Nephrostomy tubes


  • Small tubes tunneled through the skin into the renal pelvis
  • Placed to drain the renal pelvis when the ureter is obstructed
• Urinary tract infection (UTI)


  Results from catheterization or procedure
• Symptoms of UTI

  • Dysuria
  • Fever
  • Chills
  • Nausea
  • Vomiting and malaise
  • Cystitis
  • Hematuria
  • WBCs or bacteria in urine
• Common symptoms of urinary alterations

  • Urgency
  • Dysuria
  • Frequency
  • Hesitancy
  • Polyuria
  • Oliguria
  • Nocturia
  • Dribbling
  • Hematuria
  • Retention
• Nursing knowledge base includes infection control and hygiene, growth and development, and psychosocial considerations
• Nursing process for urinary elimination

  1. Assessment

  2. Physical assessment

  3. Assessment of urine

  4. Laboratory and diagnostic testing
• Nursing diagnoses for urinary elimination problems

  • Functional urinary incontinence
  • Stress urinary incontinence
  • Urge urinary incontinence
  • Risk for infection
  • Toileting self-care deficit
  • Impaired skin integrity
  • Impaired urinary elimination
  • Urinary retention
• Implementation: Health promotion

  1. Patient education

  2. Promoting normal micturition

  3. Maintaining elimination habits

  4. Maintaining adequate fluid intake

  5. Promoting complete bladder emptying

  6. Preventing infection
• Implementation: Acute care

  1. Catheterization

  2. Catheter drainage systems

  3. Preventing catheter-associated infection

  4. Catheter irrigations and installations

  5. Removal of indwelling catheters

  6. Suprapubic catheters

  7. External catheters
• Implementation: Continuing and restorative care

  1. Lifestyle changes

  2. Pelvic muscle floor training

  3. Bladder retraining

  4. Toileting schedules

  5. Intermittent catheterization

  6. Skincare
• Evaluation involves assessing the patient's self-image, social interactions, sexuality, and emotional status, as well as evaluating patient/caregiver compliance with the plan
• Safety guidelines for nursing skills include following principles of surgical and medical asepsis, identifying patients at risk for latex allergies, and identifying patients with allergies to povidone-iodine (BETADINE)