Urination elimination

Definition: A precise system involving filtration, reabsorption, and excretion to maintain fluid and electrolyte balance while filtering/excreting water-soluble waste.
Primary Organs: Kidneys are the main organs, with nephrons performing filtration and elimination tasks.
Urine Production: Adults typically produce between 1,000 to 2,000 ml of urine daily.

Filtration to Excretion: After filtration, urine travels from the kidneys through the ureters to the bladder (storage).
Bladder Capacity: An average of 250 to 450 ml triggers stretch receptors to notify the brain to urinate.
Urinary Sphincters: The internal and external sphincters must relax to allow urine to pass through the urethra.

Interventions: Surgery, medications, immobility, and therapeutic diets can significantly impact urinary function.
Urinary Diversions: Created to reroute urine flow; can be temporary or permanent, often necessary in cases of bladder cancer or severe injury.

Continent Diversions: Allow controlled elimination of urine (e.g., Koch pouch).
Incontinent Diversions: Continuous drainage with no control (e.g., ureterostomy, nephrostomy).

Consulting with Specialists: Engage with wound ostomy continence nurses for clients with incontinent diversions.
Stoma Care: Regularly monitor the stoma and surrounding skin for breakdown or irritation.

Children: Most achieve full bladder control by ages 4-5.
Older Adults: Changes include reduced nephron numbers, loss of bladder muscle tone, increased nocturia, and risk of incontinence leading to urinary tract infections (UTIs).
Postmenopausal Women: Decreased estrogen causes loss of perineal tone, contributing to urgency and incontinence.

Sodium & Hydration: Increased sodium reduces urination; adequate hydration (2,000 - 3,000 ml/day) is essential unless contraindicated.
Substances Affecting Urination: Caffeine and alcohol increase urination.

Psychological Stress: Can restrict urination need, while lack of privacy in public settings or hospitals can amplify anxiety.
Physical Constraints: Issues like arthritis may delay urination due to pain or mobility challenges.

Risk Factors: Women are at greater risk due to anatomical proximity of urethra to the anus.
Symptoms: Can include urgency, frequency, painful urination, and flank pain.

Hydration: Encourage fluid intake (2,000 to 3,000 ml/day).
Proper Hygiene: Females should clean from front to back; avoid bubble baths.

Sonography: Using ultrasound to measure bladder volume and residual urine.
X-Rays & Intravenous Pyelogram: To assess kidney, ureters, and bladder structures.
Cystoscopy & Urodynamic Testing: For visualizing and testing bladder function.

Output Measurement: Use clear containers for urine collection.
Routine Care for Catheters: Ensure patency, hygiene, and monitor for signs of infection.

Types of Incontinence:
- Stress Incontinence: Leakage from increased abdominal pressure.
- Urge Incontinence: Sudden urge to urinate due to overactive bladder.
- Overflow Incontinence: Frequent loss of small amounts of urine due to retention.
- Functional Incontinence: Inability to reach the toilet due to cognitive or mobility issues.

Scheduled Toileting: Establish a routine to encourage regular voiding.
Fluid Management: Increase intake during the day, limit before bedtime.
Use of Garments: Incontinence products can support those with leakage issues.

Bladder Retraining: Gradually increasing time between voiding.
Kegel Exercises: To strengthen pelvic floor muscles and support urinary control.

Alteration in Health (Diagnosis)

Stress: The loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting
Urge: The inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle with increased bladder pressure
Overflow: Urinary retention from bladder overdistention and frequent loss of small amounts of urine due to obstruction of the urinary outlet or an impaired detrusor muscle
Reflex: The involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction
Functional: The loss of urine due to factors that interfere with responding to the need to urinate (cognitive, mobility, and environmental barriers)
Transient: Reversible incontinence due to inflammation or irritation (UTI), temporary cognitive impairment, disease process (hyperglycemia), medications (diuretics, anticholinergics, sedatives)

Risk Factors

Female anatomy
History of multiple pregnancies and vaginal births, chronic urinary retention, urinary bladder spasm, renal disease, chronic bladder infection
Neurologic disorders: Parkinson’s disease, cerebrovascular accident, spinal cord injury, multiple sclerosis
Medications: diuretics, opioids, anticholinergics, calcium channel blockers, sedative/hypnotics, adrenergic antagonists
Obesity
Confusion, dementia, immobility, depression
Physiological changes of aging
Decreased estrogen levels, decreased pelvic-muscle tone
Immobility, chronic degenerative diseases, dementia, diabetes mellitus, cerebrovascular accident
Urinary incontinence increasing the risk for falls, fractures, pressure injuries, and depression