_Elimination - Urine

URINE ELIMINATION & FLUID BALANCE

Overview

  • Topic: Urine elimination and maintaining fluid balance.

  • Source: Eastern Mennonite University, Foundations of Professional Nursing.

WATER IN THE HUMAN BODY

Water Content

  • Human body composition:

    • Infants: 75%

    • Adults: 60%

    • Elderly: 50%

  • Water is the primary constituent of cells, tissues, and organs.

Sources of Water Intake

  • Major Sources:

    • Oral hydration in older adults

    • Nutritional sources (e.g., food)

    • Beverages

DAILY FLUID BALANCE

Fluid Intake and Output

  • Typical Daily Output: 2500 ml

    • 1500 ml from beverages

    • 750 ml from foods

    • Rest through other losses (sweat, insensible loss)

Average Daily Output Breakdown

  • Urine: 1500 ml (60% of total daily output)

  • Feces: 100 ml (4%)

  • Sweat: 250 ml (8%)

  • Insensible loss: 200 ml (8%)

    • Skin and lungs: 700 ml (28%)

Composition of Urine

  • 95% water, 5% solutes including:

    • Urea, sodium, potassium, phosphate, sulfate ions, creatinine, uric acid.

URINE OUTPUT TERMINOLOGY

  • Normal Output: 1500 ml/day (60 ml/h)

  • Terms Related to Output:

    • Anuria: complete stoppage of urine flow

    • Oliguria: less than normal urine output

    • Polyuria: greater than normal urine output

INTAKE SOURCES

Types of Intake

  • Oral fluids (water, juice, etc.)

  • Ice chips, Jell-O, tube feeding

  • IV fluids and medications

  • Catheter irrigations

OUTPUT MEASUREMENT

Types of Outputs

  • Urine (void or catheter bag)

  • Emesis (vomiting)

  • Nasogastric suctioning

  • Diarrhea and wound drainage

  • Unmeasurable losses due to diaphoresis, rapid/deep respiration, fever

I & O PRACTICE

Practice Problems

  1. Calculation of total intake for a given day based on fluid types.

  2. Understanding shifts of intake vs. output over specified hours.

FLUID VOLUME DEFICIT MANAGEMENT

Nursing Management strategies

  • Measure all fluids entering and leaving the body (I&Os).

  • Assess electrolytes, CBC, urine-specific gravity.

  • Monitor for hypotension and weak pulses.

  • Daily weights to check for fluid changes.

  • Assess respiratory status and tissue perfusion.

  • Ensure good oral care.

FLUID VOLUME EXCESS MANAGEMENT

Nursing Management strategies

  • Monitor for edema and assess breath sounds.

  • Conduct daily weight checks.

  • Restrict fluids as necessary.

  • Maintain careful observation to prevent life-threatening conditions.

URINE ASSESSMENT

Elements of Assessment

  • Assess urine color, clarity, odor, amount, and frequency.

Urine Color Indication

  • Ranges from yellow to brown indicating hydration levels.

URINARY TRACT INFECTION (UTI) SYMPTOMS

Associated Symptoms

  • Frequency, urgency, suprapubic pain, hematuria, burning upon urination, fever, nausea, vomiting, flank pain.

Nursing Goals

  • Provide symptomatic relief and educate on prevention (e.g., proper wiping technique, perineal hygiene).

URINE DIAGNOSTICS

Testing for Conditions

  • Importance of clean catch urine specimen for accurate diagnosis and culture.

URINARY ELIMINATION CASE STUDY

Case Study Overview

  • 32-year-old female with symptoms of dysuria and frequent urination.

  • Urinalysis results indicating possible UTI from E. Coli.

DEVELOPMENTAL CHANGES IN ELIMINATION

Age Factors

  • Infants: Higher risk for dehydration, immature kidney function.

  • School-age: Need for education on hygiene to reduce UTI risk.

  • Elderly: Reduced bladder tone, nocturia associated with decreased kidney function.

URINARY INCONTINENCE TYPES

Classification of Incontinence

  1. Overflow: Inability to empty bladder

  2. Stress: Pressure from the bladder (e.g., coughing)

  3. Urge: Overactive bladder sensitivity

  4. Functional: Physical or mental inability to reach the toilet in time

CATHETERIZATION

Considerations

  • Differences in catheter insertion for males vs. females.

  • Correct usage of lubricant and handling of catheter mistakes.

  • Proper documentation of urine output is critical.

CAUTI PREVENTION

Strategies to Avoid Infection

  • Use sterile technique, limit duration of catheter placement, remove as soon as not needed.

NURSING DIAGNOSES

Common Diagnoses Related to Urinary Issues

  • Impaired urinary elimination, risk for infection, urinary retention, fluid volume deficits/overload conditions.