URINARY ELIMINATION

• Urinary system


  Responsible for absorption of nutrients and fluids, controlling composition of blood by removing waste products, regulating blood pressure, and maintaining acid-base balance
• Kidneys


  • Major excretory organs that filter liquid waste from the blood, balance salts and electrolytes, regulate blood volume and pressure, produce erythropoietin, synthesize vitamin D, and maintain acid-base balance
• Urine formation


  1. Filtration in glomerulus

  2. Reabsorption in renal tubule

  3. Secretion of waste products, excess solutes, and water to form urine
• Ureters


  • Carry urine from kidneys to bladder
  • Urine is forced downward by contraction and relaxation of ureter wall muscles
• Bladder


  • Stores urine
  • Bladder walls relax and expand to store urine, and contract and flatten to empty urine through urethra
  • Sphincter muscles at base help keep urine from leaking
• Urethra


  • Transports urine from bladder to outside the body for elimination
• Urine is sterile and contains fluids, salts, and waste products, but is free of bacteria, viruses, and fungi
• Average adult passes 1-2 quarts (960-1920 mL) of urine per day
• Altered elimination


  • Urinary retention
  • Loss of voluntary control of voiding
• Factors affecting urinary system structure or function

  • Psychosocial factors
  • Food and fluid intake
  • Surgical and diagnostic procedures
  • Pathologic conditions (HTN, arteriosclerosis)
  • Urinary tract infections
• Abnormal urination patterns


  • Anuria
  • Oliguria
  • Polyuria
  • Nocturia
  • Dysuria
  • Hematuria
  • Urinary incontinence
  • Urinary retention
• Anuria


  Failure of kidneys to excrete urine, resulting from any process that limits effective blood flow through the kidneys
• Dialysis


  Technique where fluids and molecules pass through an artificial semipermeable membrane and are filtered via osmosis
• Oliguria


  Reduced urine volume: less than 1mL/kg/h in infants, less than 0.5 mL/kg/h in children, less than 400 mL/day in adults
• Polyuria


  Excessive volume of urine formed and excreted each day, over 2500 mL in adults
• Nocturia


  Excessive urination at night or waking several times to urinate
• Dysuria


  Painful urination
• Hematuria


  Abnormal presence of red blood cells in urine
• Types of urinary incontinence

  • Stress incontinence
  • Urge incontinence
  • Mixed incontinence
  • Functional incontinence
  • Overflow incontinence
• Urinary retention


  Inability of the bladder to empty, caused by obstruction or neurologic disorder
• Factors affecting urinary elimination

  • Pathologic and surgical conditions
  • Privacy issues and embarrassment
  • Medications
  • Food and fluid intake
  • Ambulatory ability
  • Muscle tone
• Enuresis, the involuntary passing of urine, may be structural, pathologic, or related to non-urinary problems like constipation, stress, and illness
• Diversity considerations affecting urinary elimination

  • Age
  • Pregnancy
  • Gender
  • Culture
  • Disability
  • Morphology
• Urinary tract infections are the single most common hospital-acquired infection, with females more vulnerable than males
• Urinary diversion is a surgical procedure performed when bladder function is impaired due to trauma or disease
• During initial assessment, the nurse should consider the patient's physical and mental abilities, prioritize immediate problems, address relief of symptoms, and note signs of distress and patient orientation
• Health assessment questions


  • History of kidney/bladder disease, urinary tract/kidney infections, family history
  • Physical problems affecting urinary tract (HTN, diabetes, kidney stones, neurological conditions)
  • Changes in urination pattern, ability to control urination, nocturia, difficulty initiating/stopping urine flow
  • Changes in urine characteristics (quality, quantity, color, odor)
  • Medications, diet, chemical exposures
  • Pain/discomfort associated with urination
  • Cleansing practices (for female patients)
• Abdominal examination


  • Inspection
  • Auscultation
  • Percussion
  • Palpation
• Vomitus


  50 mL
• 1. hour Intake Total


  1950 mL
• 1. hour Output Total


  990 mL
• I&O Balance


  +960 (= 1950 - 990)
• Oral fluid


  100 mL
• Tube feeding


  480 mL
• 1. hour Intake Total


  580 mL
• 1. hour output total


  1040 mL
• I&O Balance


  • 460 (= 580 - 1040)
• Kegel exercises


  • Help keep the female pelvic floor toned, which reduces the risk of incontinence
  • If performed correctly and regularly, Kegel exercises have been shown to strengthen the pelvic floor muscles which support the uterus, bladder, and bowel
  • Improvement is normally seen in approximately 8 to 10 weeks
• Kegel exercises are also known as pelvic floor exercises
• Kegel exercises improve muscle tone in the pelvic floor, which helps to prevent stress incontinence