urinary and bowel elimination

• Urinary elimination is the removal of waste products from the body thru urinary system
• when urine is collected in the bladder, desirre to void is experienced due to the stimulation of the stretch receptors
• stimulation of stretch receptors occurs when bladder is filled with 250-450ml urine(adults) and 50-200ml urine(children)
• stretch receptors transmits the message to the voiding reflex center in the spinal cord (2nd and 4th sacral vertebrae)
• if time is appropriate, the brain sends message thru the spinal cord causing stimulation so that urine can be released from the bladder
• if time and place are appropriate, the external sphincter relaxes and the urination process takes place
• Composition of urine:

  • urine = 96% water, 4% solids
  • solids and inorganic substances
• organic substances in urine:

  • urea
  • uric acid
  • creatinine
  • ureates
  • chlorides, phosphates, sulfates, and oxalates
• inorganic substances in urine:

  • sodium
  • potassium
  • calcium
  • chlorides, phosphates, sulfate, oxalates
• Characteristics of normal urine:

  • Volume = 1000-2000ml/24hours
  • color = pale yellow or amber
  • appearance = clear with no deposit
  • odor = aromatic
  • reaction = slightly acidic
  • specific gravity = 1.016-1.025
• micturation is a process where urine is expelled from the body
• FACTORS AFFECTING URINARY ELIMINATION

  • Foods and Fluids

  • Muscle tone

  • Diabetes Insipidus

  • Sociocultural factors

  • Body Position

  • Medications

  • Aging
• ASSESSMENT

  • Nursing history: client's normal voiding pattern, frequency, appearance of urine, any recent changes, any past or current problems with urination, presence of ostomy, factors influencing the elimination pattern.

  • Physical assessment: Palpation of kidneys to detect areas of tenderness, palpation and percussion of the bladder, urethral meatus inspected for swelling, discharge, inflammation.

  • Skin of perineum should be inspected for irritation

  • Assessing urine
• urgency - strong desire to void
• dysuria - painful or difficulty voiding
• frequency - voiding that occurs more usual; norm of voiding - once every 3-6 hours
• hesitancy - undue delay and difficulty in initiating voiding
• polyuria - large volume of urine
• oliguria - small volume of urine between 100-500ml/24hours
• nocturia - excessive urination at night
• hematuria - rbc in the urine
• Nursing dx - Impaired urinary elimination
• PLANNING

  • Restore a normal voiding pattern

  • Regain normal urine output

  • Prevent associated risks

  • Perform toileting activates independently with or without assistive devices
• Promoting fluid intake


  1. Increasing fluid intake

  2. Increases urine production

  3. Stimulates the micturition reflex
• Normal daily fluid intake

  Averaging 1500 ml of measurable fluids is adequate for most adult clients
• Maintaining normal voiding habits

  Bladder training
• Preventing urinary tract infection

  1. Drinking plenty of water

  2. Frequent voiding

  3. Avoiding use of irritating soaps, powder, sprays

  4. Avoiding tight fitting pants

  5. Wearing cotton undercloths
• Managing urinary incontinence


  1. Bladder training

  2. Pelvic muscle exercises (kegel exercise)

  3. Maintaining skin integrity

  4. Applying external urinary draining device
• implementation in urinary elimination

  • promoting fluid intake
  • maintaining normal voiding habits
  • preventing UTI
  • managing urinary incontinence
• Collection of urine

  • 24 hour timed specimen
  • catheterized specimen
  • midstream clean catch specimen
  • U-bag for infants
• Urinary catherization - introduction of a catheter thru the urethra into the bladder fro the purpose of withdrawing urine
• purpose of catherization

  • to relieve urinary retention
  • to measure the amount of residual urine in the bladder
  • to obtain a urine specimen when a specimen cannot secure satisfactory by other means
  • to empty bladder before and during surgery and before certain diaagnostic examinations
• catheters - graded on the french scale according to the size of lumen
• female adult - #14 and #16 french catheters are usually used
• Male adults - #18 or #20 french catheters are commonly used

  Children catheter - #8 and #10 french catheters
• Foley catheter is most common type of indwelling catheter
• small catheters are generally not necessary and the size of lumen is also so small that increases the length of time necessary for emptying the bladder
• larger catheters distends the urethra and tends to increase the increase the discomfort of the procedure
• preparation of the patient in the urinary elimination

  • adeqaute exploration
  • position
  • provision of privacy
• position:

  Female - dorsal recumbent or sim's lateral position

  Male - supine