Urine Elimination

• Anuria

  24 hour urine output is less than 50 mL. BIG CONCERN. [ kindly failure patient / obstruction ]
• Dysuria

  painful/ difficult urination
• Frequency

  increased incidence of voiding, 3-4+ times a day, how often do they urinate
• Glycoguria

  presence of glucose in urine
• Oliguria

  24 hour urine output is less than 400 mL - [chronic renal failure / lack of fluid intake ]
• Polyuria

  excessive output of urine (diuresis)- avoid caffeine/ alcohol / chocolate
• Hesitancy

  delay/ can’t initiate urinary stream, can’t control sphincter [ due to enlarged prostate / kidney stone / first void is most difficult ]
• Voiding or Micturition


  Urination: emptying bladder
• Kidneys help maintain the composition and volume of body fluids


  [ filter and excrete blood constituents]
• UAP can measure intake and output, BUT nurse must validate the accuracy of the measurements

  CANNOT palpate empty bladder
• Person feels desire to void

  when bladder fills to about 150-250 mL in adults
• Incontinence

  involuntary loss of urine- NOT AGE RELATED
• Intervention for Incontinence

  pelvic floor training helps/ kegal exercises/ can result in risk for pressure injury/ avoid caffeine / alcohol, increase fluids
• Urge incontinence


  when you really really need to go” the involuntary loss of urine that occurs soon after feeling an urgent need to void. inability to suppress the need to urinate[ ex. urine before getting to the toilet
• Urge incontinence caused by

  immobility, decrease bladder/sphincter tone = poor urine control/ urinary stasis, UTI
• Interventions of Urge incontinence

  provide skin care immediately after soiling, assess for disturbed self esteem
• Stress Incontinence

  involuntary loss of urine related to an increase in intra-abdominal pressure[ ex. coughing, sneezing, laughing, and physical activities ] patients at risk? menopause, obesity, multiple vaginal births
• Retention

  when urine is produced normally but its not excreted completely from bladder

  Can be acute: from removal of catheter
• Retention caused by

  meds, enlarged prostate, vaginal prolapse (chronic)
• How do you assess for Retention

  BLADDER SCAN
• Protein in urine is NO GOOD

  • *  Urine should be CLEAR
  • *  Sweet odor- from diuretics pt
  • *  Anticoagulation: pink/red
  • *  Vitamins: bright yellow/ green
  • *  Diuretics: pale yellow
  • *  Pyretium (anti-infection painmed) helps with pain and frequency for UTI - orange
  • *  Dark amber: dehydration/ or side effect of medications
  • Skin turgor = hydration
• Urinary Tract Infection “UTI”

  urine appears cloudy, amber, foul smell having to urinate, as soon as getting urge
• Urinary Tract Infection “UTI”

  Women are at higher risk for infection

  In older adult; COMMON - first sign is confusion “acute delirium”
• Urinary Tract Infection “UTI” causes

  urgency,frequency
• Interventions of UTI


  encourage lots of fluids
• Enuresis

  continued incontinence of urine, past the age of toilet training
• Nocturnal enuresis

  night time bed wetting; typically subsides by 6 years old
• Nocturia

  urination during the night - can become safer hazard

  [ avoid alcohol before bed, ensure easy access to bathroom or commode ]
• Nephrotoxicity

  kidney damage
• Nephrotoxicity caused by

  abuse of analgesics (aspirin/ ibuprofen), antibiotics
• Hematuria

  blood in urine (pink-red tinge/ reddish brown)

  definitely big concern *
• Lower back pain = flank pain = kidney problems Lower abdominal pain = bladder infection

  Pain in groin = pain in ureter (kidney stones)
• suprapubic

  surgical stoma because cannot get through the ureter due to obstruction
• Routine Urinalysis

  requires 10 mL . Not a sterile specimenpatient voids in container / must send to lab RIGHT AWAY within an hour. if patient on period must write on slip
• Clean catch or Midstream

  requires sterile gloves . Sterile specimenwant to clean meatus, for females front to back, start voiding discard, stop, collect urine mid stream (first urine is to flush bacteria )
• Sterile Specimen from Indwelling Catheter

  Sterile specimen

  from catheterizing patients bladder or taking specimen from indwelling catheter thats already in place

  Use antiseptic swab to clean access port [OBTAINED FROM PORT . buttt it fresh bag may get urine from the bag ] / attach syringe and aspirate urine into the syringe/ specimen, should get from catheter itself / use sterile technique
• 24 Hour Urine Specimen


  START & END EMPTY!! [how much kidney is being excreted in 24 hours ]Post sign on patients door because EVERYONE needs to be involved/ initiate collection at specific time (which is recorded) by asking the patient to empty the bladder and discard this urine/ collect all urine voided for the next 24 hrs/ at the end of 24 hours ask patient to void / add this urine to previously collected urine / sent entire specimen to lab
• Culture and sensitivity

  get specimen first for culture, then start antibiotic (empiric therapy)
• Fluid intake should be 2,000-3,000 mL (8-10 of 8oz glasses)
• Kegal exercises

  target inner muscle that lie under and support the bladder - can be toned/ strengthened