Urinary
Foundations of Nursing
Topic 6: Urinary Elimination
Chapter 46: Focus on urinary elimination processes and nursing care
Page 2: Scientific Knowledge Base
Anatomy of Urinary System
Kidneys – produce urine and regulate fluid balance
Ureters – transport urine from kidneys to bladder
Bladder – stores urine
Urethra – conduit for urine exit
Adrenal glands – located atop each kidney, involved in hormone production
Page 3: Urinary Elimination Components
Act of Urination – voluntary process influenced by various factors
Factors Influencing Urination
Common Urinary Problems
Urinary Retention – inability to empty bladder
UTIs – infections in urinary system, common and preventable
Urinary Incontinence – involuntary loss of urine
Urinary Diversions – alternative routes for urine excretion
Page 4: Urinary Diversions
Internal Pouch – a reservoir created surgically
Stoma – opening created for urine to exit the body
Page 5: Nursing Knowledge Base
Infection Control and Hygiene – crucial to prevent UTIs
Growth and Development – impact on urinary function across lifespan
Psychosocial Implications – effects of urinary issues on well-being
Page 6: Case Study of Mrs. Vallero
65-year-old woman hospitalized with:
Heart failure
Fluid Retention
Diabetes
History of urinary retention due to diabetic neuropathy
Issues post indwelling catheter removal:
Can only urinate up to 100 mL
Experiences small amounts of incontinence, urgency, and pain
Page 7: Critical Thinking in Nursing
Successful Critical Thinking
Requires synthesis of knowledge, experience, patient information
Critical Thinking Attitudes – includes intellectual and professional standards
Use Knowledge – apply clinical knowledge to patient assessments
Page 8: Knowledge Base Elements
Physiology of fluid balance and normal urine production
Pathophysiology of urinary alterations, affecting urination
Communication Principles – addressing self-concept and sexuality issues
Recognizing Impact of Illness on urinary patterns
Attitudes required for assessment: humility, trust, respect
Page 9: Nursing Process - Assessment
Through Client’s Eyes – understanding from patient perspective
Self-care Ability – assess their capacity to manage urinary health
Cultural Considerations – respect patient's background and habits
Nursing History and Pattern of Urination
Page 10: Physical Assessment
Assessment focus on:
Kidneys
Bladder
External Genitalia and Urethral Meatus
Perineal Skin for signs of irritation
Page 11: Assessment of Urine
Intake and Output – measure fluid balance
Urine Characteristics – assess color, clarity, odor
Lab Testing for infection or disease analysis
Page 12: Nursing Diagnosis
Examples of nursing diagnoses related to urinary issues:
Incontinence Types – Functional, Overflow, Reflex, Stress, Urge
Urinary Tract Infection
Impaired Self Toileting
Impaired Skin Integrity
Urinary Retention
Page 13: Evaluating Urinary Output
Mrs. Vallero: catheter removed, no urine output recorded
Intermittent Catheterization ordered – 600 mL returned after nursing intervention
Page 14: Nursing Process - Planning
Goals and Outcomes Identification – set clear priorities
Teamwork and Collaboration as key components
Page 15: Knowledge Base - Patient Care
Importance of caring for self-esteem in patients
Role of Other Health Professionals in urinary care
Attitudes for creative care approaches
Page 16: Case Study Insights
Recognizing urinary issues common in diabetes and elderly
Misdiagnosing urinary retention as incontinence
Normal voiding pattern: every 6-8 hours; aim for normality
Page 17: Implementation - Health Promotion
Educate on healthy urination practices
Maintain Elimination Habits and fluid intake
Page 18: Implementation - Acute Care
Catheterization techniques and types
Page 19: Continuing Care Measures
Focus on preventing catheter-associated infections, maintenance of hygiene
Page 20: Types of Catheters
Explore cross-section anatomy for different catheter types:
Indwelling retention catheter – with balloon for prolonged use
Triple-lumen catheter – for irrigation and drainage
Page 21: Alternative Catheter Options
Suprapubic Catheterization – when urethral access is challenging
Use of External Catheters for specific patients
Page 22: Assessing Patient Urge
Assessing Mrs. Vallero's urges and mobility restrictions
Palpation of distended bladder can indicate retention issues
Page 23: Continuing Care and Restorative Measures
Lifestyle Changes for better urinary health
Introduce pelvic floor exercises and bladder retraining
Page 24: Findings from Patient Assessment
Bladder distention noted during assessment
Patient experiences frequent dribbling and inability to urinate
Page 25: Evaluation in Nursing Process
Assessment through the client’s experiences
Focus on patient outcomes and satisfaction
Page 26: Characteristics of Normal Micturition
Signs of typical urine characteristics and patterns of elimination
Accountability in assessing care complications
Page 27: Case Study Nursing Diagnosis
Identify Urinary Retention causes and establish a normalization goal within a month
Page 28: Nursing Interventions
Employ scheduled toileting and fluid management
Use Credé’s Method to aid urinary output
Page 29: Techniques in Urinary Retention Care
Record keeping for urine output accuracy
Strategies for patient comfort during urination, including warm baths
Page 30: Evaluation of Patient Outcomes
Monitor urinary urges and sensations
Set measurable goals for bladder control and output
Page 31: Safety Guidelines
Adhere to medical asepsis principles
Identify allergies to latex or iodine for tailored patient care
Page 32: Learning Outcomes for Patients
Plan outcome to describe methods of promoting urinary function
Page 33: Evaluation Strategies for Teaching
Build rapport, ensure understanding of urinary health practices
Provide practical examples and emphasize hygiene measures
Page 34: Reference
Potter, P. A., et al. (2023). Fundamentals of Nursing (11th ed.). Elsevier.
Page 35: Questions
For any clarification, contact the course instructor for assistance.