Urinary Elimination

Factors affecting urination

1. age/ developmental factors
2. psychosocial factors
3. food and fluid intake
4. bladder capacity/ muscle tone
5. pathologic/ medical conditions
6. surgical and diagnostic procedures
7. medications

Normal urine color

pale yellow to deep amber

the pigment responsible for the color of urine

urochrome

what contributes to the color of urine?

urochrome and how diluted/ concentrated the urine is

Example of foods that can most likely affect the color of urine

1. berries
2. beans

Common Causes of Urine Color:
Clear; colorless (dilute)

1.Large amount of liquids
2. Conditions (e.g., diabetes insipidus - impaired tubular
reabsorption), diabetes mellitus)
3. Diuretics (particularly if overused)
4. Liver disorders (e.g., acute viral hepatitis, cirrhosis)

Common Causes of Urine Color:
Bright, neon yellow

Vitamin supplements

Common Causes of Urine Color:
Cloudy

1. Urine left standing, causing phosphates to precipitate out
2. Pyuria (pus in the urine)
3. Urinary tract infection, bacteriuria (bacteria in the urine)
4. Epithelial cells
5. Blood
6. Leukocytes (white blood cells)
7. Kidney stones

Common Causes of Urine Color:
Green

1. Pseudomonas infection
2. Bile pigments

Common Causes of Urine Color:
Dark yellow, gold

1. Low fluid intake
2. Dehydration (concentrated urine)
3. Inability of kidneys to dilute urine
4. Bile

Common Causes of Urine Color:
Pink, red

1. Hematuria - blood in urine (kidney or bladder infection,
cancer)
2. Some laxatives
3. Some foods (red berries, food dye, beets, red gelatin,
some red juices)

Common Causes of Urine Color:
Orange, red brown

1. Some medications, )e.g., rifampin, phenazopyridine,
warfarin, doxorubicin)
2. Some foods
3. Some food coloring
4. Dehydration

Common Causes of Urine Color:
Blue, green

1. Some medications (e.g., amitriptyline, indomethacin)
2. Some foods (e.g., asparagus)
3. Some food dyes

Common Causes of Urine Color:
Smoky, hazy

1. Hemoglobin (remnants of red blood cells)
2. Chyle (product of digestion normally emptied into venous
system)
3. Prostatic fluid
4. Yeast infection

Common Causes of Urine Color:
Yellow, brown

Bile

Common Causes of Urine Color:
Dark brown, black

1. Methylene blue
2. Typhus infection
3. Some medications (e.g., iron)
4. Some foods and food dyes
5. Hematuria (blood in urine)
6. Liver disorders (especially with light stools and jaundice

Complications that may be prevented by the management of urinary elimination problems

1. impaired kidney functions
2. changes in fluid volume and electrolytes
3. skin breakdown
4. changes in quality of life

What are included in the Urinary Elimination (UE) assessment?

1. NHH
2. PHEX of the genitourinary system, hydration status, and examination of the urine
3. relating data obtained to the results of any diagnostic tests and procedures

Diagnostic tests related to urinary elimination

1. Urinalysis
2. Blood urea nitrogen (BUN)
3. Creatinine clearance

Nursing interventions in managing urinary elimination problems may be grouped into the following:

A. Maintaining and Promoting urinary Elimination
B. Preventing Urinary Tract Infections
C. Managing Urinary Incontinence
D. Managing urinary Retention
E. Urinary Catheterization

- Facilitates the rerouting of urine from the kidneys to
another site other than the bladder

- Clients with these contraptions require additional care to
prevent complications

Urinary diversions

Basic Nursing Skills in Caring for Clients with Urinary Elimination Problems

1. Inserting urinary catheter
2. Performing bladder irrigation

Seen to be the one of the major causes of healthcare acquired
infections

Use of indwelling catheters

way your body rids itself of solid wastes

Bowel Elimination

Factors that influence Bowel Elimination (BE)

1. Age/Developmental Factors
2. Diet
3. Fluid Intake and Output
4. Activity and Exercise
5. Psychological Factors
6. Defecation Habits
7. Medications
8. Diagnostic Procedures
9. Anesthesia and Surgery
10. Pathologic Conditions
11. Pain

Common Bowel Elimination Problems

1. Constipation
2. Bowel Incontinence
3. Flatulence
4. Diarrhea

Assessment of bowel elimination includes

1. NHH
2. Physical Examination of the abdomen, rectum, and anus
3. Inspection of feces

Samples of Bowel Elimination Problems

1. Bowel Incontinence
2. Constipation
3. Risk for Constipation
4. Perceived Constipation
5. Diarrhea
4. Dysfunctional Gastrointestinal Motility

Basic Nursing Skills in Caring for Clients with Bowel Elimination Problems

1. Giving and removing bedpan
2. Administering Enema

method of clearing out your colon using an injection of fluid — basically, loosening up impacted bowels to help make yourself poop

enema

A person's urinary habits depend on what?

1. social culture
2. personal habits
3. physical abilities

T/F: The left kidney is slightly lower than the left due to the position of the liver

False; the right kidney is slightly lower

organ that is the primary regulator of fluid and acid-base balance in the body

kidneys

functional units of kidneys that filter blood and remove metabolic wastes

nephrons

How many mL of blood passes through the kidneys every minute?

1,200 mL or 21% of cardiac output

tuft of capillaries surrounded by Bowman's capsule that filters the blood passing through it and initiate urine formation

glomerulus

This is where most of the water and electrolytes are reabsorbed

proximal convoluted tubule

what happens when fluid intake is low or the concentration of solutes in the blood is high?

ADH is released from the posterior pituitary, more water is reabsorbed in the distal tubule, and less urine is excreted

What happens when fluid intake is high or the blood solute concentration is low?

ADH is suppressed, distal tubule becomes impermeable to water, and more urine is excreted

What happens when aldosterone is released from the adrenal cortex?

sodium and water are reabsorbed in greater quantities, increasing the blood volume, and decreasing urinary output

hollow, muscular organ that serves as a reservoir for urine and as the organ of excretion

urinary bladder

smooth muscle layers that allows the bladder to expand as it fills with urine, and to contract to release urine to the outside of the body during voiding

detrusor muscle

What is the size of ureters?

25-30 cm (10-12 in) long and 1.25 cm (0.5 in) in diameter

Normal bladder capacity

300-600 mL of urine

consists of sheets of muscles and ligaments that provide support to the viscera of the pelvis

pelvic floor

emptying the urinary bladder

urination/ micturition

How many mL of urine that can stimulate the special sensory nerve ending in the bladder wall in ADULTS?

250-450 mL

How many mL of urine that can stimulate the special sensory nerve ending in the bladder wall in CHILDREN?

50-200 mL

How many times does an infant urinate

20x a day

Characteristics of neonate urine

colorless
odorless
specific gravity of 1.008

When will children develop urinary control?

between 2 and 5 years old

How must girls wipe?

front to back (to prevent contamination of urinary tract by feces)

involuntary passing of urine when control should be established

enuresis

involuntary passing of urine during sleep

nocturnal enuresis

appears after the child has achieved dryness for a period of 6 consecutive months

secondary enuresis

nocturnal enuresis when the child has never achieved nighttime urinary control

primary enuresis

need to arise during the night to void

nocturnal enuresis

When does the fetal kidney begin to excrete urine?

11-12th week of development

T/F: Infants have minimal ability to concentrate urine, so their urine is light yellow

True

What is the color of urine of children?

normal amber color

At what age do the kidneys reach their maximum size?

between 35 and 40 years old

How many % of nephrons lost by the age of 80?

30%

What fluids increase urine production?

Alcohol and caffeinated drinks (ex. coffee, tea, and cola)

What foods can cause fluid retention?

food and fluids high in sodium

increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidney into the bloodstream.

diuretics

condition where the kidneys stop producing urine

renal failure

obstruct the ureter, blocking urine flow from the kidney to the bladder

urinary stone

How many times do most people void in a day?

5-6

refers to the production of abnormally large amounts of urine by the kidneys, often several liters more than the client’s usual daily output

polyuria/ diuresis

feeling of extreme thirstiness

polydipsia

low urine output, usually 500 mL a day or 30mL an hour

Oliguria

Average daily urine output of 14 years through adulthood?

1,500 mL

lack of urine production

anuria

a technique by which fluids and molecules pass through a semi-permeable membrane according to the rules of osmosis

renal dialysis

the client’s blood flows through vascular catheters, passes by the dialysis solution in an external machine, and then returns to the client

hemodialysis

the dialysis solution is instilled into the abdominal cavity through a catheter, allowed to rest there while the fluid and molecules exchange, and then removed through the catheter

peritoneal dialysis

voiding at frequent intervals, that is, more
than four to six times per day

urinary frequency

voiding two or more times at night

nocturia

- sudden, strong desire to void

- may or may not be a great deal of urine in the bladder, but the person feels a need to void immediately

urgency

voiding that is either painful or difficult

dysuria

delay and difficulty in initiating voiding

urinary hesitancy

involuntary urination in children beyond the age when voluntary bladder control is normally acquired, usually 4 or 5 years of age

enuresis

BOYS OR GIRLS: Who does nocturnal

boys

BOYS OR GIRLS: Who does diurnal (daytime) enuresis affects more?

girls

involuntary leakage of urine or loss of bladder control

urinary incontinence

T/F: Urinary incontinence is a disease.

False; it is a symptom

4 types of Urinary Incontinence (UI)

Stress UI
Urge UI
Mixed UI
Overflow Incontinence

occurs because of weak pelvic floor muscles and/or urethral hypermobility, causing urine leakage with such activities as laughing, coughing, sneezing, or any body movement that puts pressure on the bladder

Stress Urine Incontinence

T/F: Stress Urinary Incontinence is related to emotional stress

False; it is “caused by increased pressure or ‘stress’ on the bladder as well as anatomical changes to the urethra, and pelvic floor muscle weakness”

urgent need to void and the inability to stop micturition (passage of urine)

Urge UI

What is the major symptom of overactive bladder?

Urge UI

diagnosed when symptoms of both stress UI and urgency UI are present

Mixed UI

continuous involuntary leakage or dribbling of urine that occurs with incomplete bladder emptying

Overflow incontinence

what does an individual have if they cannot perceive bladder fullness and is therefore unable to control the urinary
sphincters

neurogenic bladder

condition wherein the urine accumulates and the bladder becomes overdistended

urinary retention

What is the most common complication in the first 2 to 4 hours posoperatively

urinary retention

GUESS THE ALTERED UE PATTERN:
Ingestion of fluids containing caffeine or alcohol
Prescribed diuretic
Presence of thirst, dehydration, and weight loss
History of diabetes mellitus, diabetes insipidus, or kidney disease

Polyuria

GUESS THE ALTERED UE PATTERN:
Decrease in fluid intake
Signs of dehydration
Presence of hypotension, shock, or heart failure
History of kidney disease
Signs of renal failure such as elevated blood urea nitrogen (BUN) and serum creatinine, edema, hypertension

Oliguria, anuria

GUESS THE ALTERED UE PATTERN:
Pregnancy
Increase in fluid intake
UTI

Frequency or nocturia

GUESS THE ALTERED UE PATTERN:
Presence of psychological stress
UTI

Urgency