Urinary Health: Adult Hydration, Assessment, and Aging Effects

How much should most adults drink to prevent urinary issues?

2-3 L/day (unless fluid-restricted).

What is a healthy voiding schedule?

Void every 2-4 hours, before/after meals, and before bed.

Which fluids should be limited to prevent bladder irritation?

Caffeine, alcohol, acidic drinks, artificial sweeteners.

Why avoid holding urine?

Prevents retention and infections.

How does bowel regularity affect urination?

Constipation increases bladder pressure → urinary problems.

What are key perineal hygiene practices?

Front-to-back cleansing, cotton underwear, no bubble baths/douches, void after intercourse.

What exercise helps prevent urinary problems?

Kegel exercises to strengthen pelvic floor.

How does smoking affect urinary health?

Increases bladder irritation & incontinence risk—stop smoking.

What history should you obtain for urinary assessment?

Frequency, urgency, nocturia, color, odor, pain, incontinence, fluid I&O.

What is the minimum acceptable urine output?

≥ 30 mL/hr; I&O should be nearly equal over 24 hours.

What meds/conditions should you ask about in urinary assessment?

BPH, diabetes, MS, and meds affecting output/retention.

What skin findings suggest urinary issues?

Pink, warm, intact is normal; note breakdown from incontinence.

How to assess kidneys for tenderness?

Gentle posterior flank palpation.

What does a distended bladder indicate and how confirm?

Palpable above symphysis pubis → retention; confirm with bladder scan.

What to assess at urethral meatus?

Redness, discharge, lesions.

Why track both intake and output?

Detects imbalance, retention, dehydration, overload.

What urine characteristics are routinely assessed?

Color, clarity, odor, and amount.

What symptoms signal lower UTI?

Dysuria, urgency, frequency (plus suprapubic discomfort).

How does growth & development affect urination?

Control at 18-24 months; older adults: ↓capacity, ↑urgency/nocturia/incontinence.

How do sociocultural/psychological factors affect urination?

Need privacy, same-gender caregivers; anxiety/stress alter patterns.

Which personal habits affect urination?

Hygiene, position, adequate time.

How does fluid type affect urination?

Caffeine ↑frequency; alcohol ↓ADH → ↑output.

How do surgery/anesthesia affect urination?

↓bladder contractility → retention.

Which meds affect urination?

Diuretics ↑output; anticholinergics ↑retention; sedatives ↓awareness.

Which diseases alter urination?

Diabetes, MS (neuropathy); BPH (obstruction); Alzheimer's; immobility → functional incontinence.

How does renal function change with age?

Decreased renal perfusion/function.

How does bladder elasticity/capacity change with age?

Decreases, causing urgency & nocturia.

How do sphincter/pelvic muscles change with age?

Weakened → ↑incontinence risk.

Why are older adults at higher UTI risk?

Incomplete emptying, ↓immune response.

What does diminished thirst perception cause?

Dehydration risk.

Aging effects on urinary health

↑urgency, nocturia, incontinence, infection.

Renin

Activates RAAS → vasoconstriction, BP regulation.

Erythropoietin

Stimulates RBC production in bone marrow.

Renal prostaglandins (E₂, prostacyclin)

Cause vasodilation.

Kidney's role with vitamin D

Activates vitamin D for Ca/PO₄ balance (with PTH).

Anemia in CKD

↓Erythropoietin → ↓RBCs.

Hypertension in CKD

RAAS activation → vasoconstriction & Na/H₂O retention.

Fluid/electrolyte issues in CKD

Fluid overload and electrolyte imbalance (e.g., ↑K⁺, ↑PO₄³⁻).

Uremia

Waste accumulation → nausea, confusion, coma.

Nephrostomy tube

Catheter directly from kidney; keep patent, sterile care.

Suprapubic catheter

Surgical tract to bladder; hygiene, fluids, empty at ½ full, prevent infection.

WOCN nurse

Key resource for pouching/education.

Psychosocial support with diversions

Body image support, privacy, teaching.

General pouch emptying rule

Empty when ½ full to prevent leaks/weight strain.

Frequency

Voiding > 4-6 times/day.

Nocturia

Nighttime voiding.

Urgency

Sudden strong need to void.

Dysuria

Painful/difficult urination.

Hesitancy

Delay starting urine flow.

Dribbling

Leakage after voiding.

Polyuria

Excessive urination.

Oliguria

< 30 mL/hr for > 2 hours.

Anuria

No urine output.

Hematuria

Blood in urine.

Neurogenic bladder

Nerve damage → impaired bladder control.

Stress incontinence

Leakage with cough/laugh; Kegels, weight loss, bladder training.

Urge incontinence

Sudden strong urge; bladder training, anticholinergics.

Overflow incontinence

Overfilled bladder → dribbling; Crede method, intermittent cath.

Functional incontinence

Physical/cognitive barriers; scheduled toileting, easy access.

Reflex incontinence

No awareness due to nerve damage; self-cath, bladder retraining.

Back

Warm sterile solution in peritoneum; wastes via osmosis/diffusion; infection risk—sterile technique; monitor weight, I&O, electrolytes.

Describe hemodialysis and nursing concerns.

Blood filtered via fistula/graft; risks: infection, hypotension, bleeding; assess bruit/thrill, restrict fluids/electrolytes.

What technique is used for catheter insertion?

Sterile technique.

What hand hygiene is required with catheters?

Before and after contact.

How should a catheter be secured?

Inner thigh (female); abdomen/thigh (male).

Where should the drainage bag be kept?

Below bladder, never on floor.

How often should the bag be emptied?

Every 4-8 hours or when ½ full.

How often is perineal care done with catheters?

Every 8 hours (or per policy).

What catheter size principle should be followed?

Use the smallest size possible.

Key tip for male catheter insertion?

Insert at 90° angle to avoid urethral trauma.

What are common UTI symptoms?

Dysuria, frequency, urgency, hematuria, foul odor, fever, chills, flank pain, delirium in elderly.

How much fluid prevents UTIs?

2-3 L/day, unless restricted.

What hygiene helps prevent UTIs?

Front-to-back wiping; cotton underwear.

What post-intercourse habit prevents UTIs?

Void after intercourse.

Which personal care items should be avoided?

Bubble baths and tight clothing.

How do you prevent CAUTIs with drainage systems?

Maintain closed system and unobstructed flow.

What is the best catheter-related prevention?

Remove indwelling catheters ASAP.

What is a key sign of UTI in older adults?

Acute confusion/delirium.

What teaching reduces UTI recurrence?

Hydration, regular voiding, hygiene, avoid irritants.

What does a urinalysis include?

pH, protein, glucose, ketones, blood, WBC/bacteria, specific gravity 1.005-1.025.

How is a urine culture & sensitivity collected?

Midstream clean-catch to identify organism & antibiotic sensitivity.

What is a 24-hour urine used for and key handling?

Creatinine clearance; keep cold, discard first specimen then collect all.

What is bladder ultrasound used for?

Residual volume; often requires full bladder for volume assessment.

What is a KUB X-ray?

X-ray of kidneys/ureters/bladder.

What is an IV pyelogram (IVP) and nursing considerations?

Iodine contrast; check allergy (iodine/shellfish), NPO, encourage fluids after.

What are CT/MRI considerations for urinary diagnostics?

NPO × ~4-6 hours if contrast; remove all metal for MRI.

What is cystoscopy and what is expected after?

Endoscopic bladder exam; pink urine 1-2 days post-procedure is common.

What toileting schedule supports continence?

Every 2-3 hours.

What is bladder retraining?

Gradually increase voiding intervals to reduce frequency/urgency.

What is habit training?

Routine toileting for cognitive impairment.

What is the Crede method?

Manual pressure over bladder to assist emptying.

What skin care prevents breakdown from incontinence?

Barrier creams, gentle cleansing, keep skin dry.

What metrics evaluate urinary interventions?

I&O, urine characteristics, fluid intake, continence status.