S

Urinary Elimination

Objectives

  • Identify factors impacting urinary elimination.
  • Compare and contrast common alterations in urinary elimination.
  • Interpret features of normal vs abnormal urine.
  • Select nursing diagnoses for urinary elimination alterations.
  • Discuss nursing interventions promoting normal urinary elimination.
  • Discuss nursing interventions to reduce urinary tract infection risk.

Background

  • Urinary elimination is a basic human need, also known as voiding or micturition.
  • The process involves coordination between the CNS and the urinary system.
  • Filling of the bladder occurs with 200-450 mL of urine.
    • Activation of stretch receptors in the bladder wall signals the voiding reflex center.
    • Results in the contraction of the detrusor muscle and conscious relaxation of the external urethral sphincter.

Factors Affecting Urinary Elimination

  1. Growth & Development
  2. Sociocultural Factors
  3. Psychological Factors
  4. Personal Habits
  5. Fluid Intake
  6. Pathological Conditions
  7. Surgical Procedures
  8. Medications
  9. Diagnostics

Lifespan Considerations for Urination

  • Older Adults:
    • Decreased kidney function.
    • Increased urgency and frequency of urination.
    • Loss of bladder elasticity and muscle tone leads to:
    • Nocturia
    • Incomplete emptying.

Common Urinary Problems

  • Urinary Retention
  • Urinary Tract Infections (UTI)
  • Urinary Incontinence
  • Urinary Diversions

Urinary Diversions

  • Ureterostomy (ileal conduit)
  • Continent Urinary Reservoir
    • Orthotopic neobladder: catheter drainage used by the patient.
  • Suprapubic Catheter
  • Nephrostomy: drains renal pelvis when ureter is obstructed.

Common Urine Studies

  • Urinalysis includes:
    • Dipstick testing, specific gravity, pH, protein, glucose, ketones, blood, RBCs, WBCs, bacteria, casts, and crystals.
  • Specimens can be:
    • Freshly voided, clean catch/midstream, sterile, or a 24-hour urine collection.

Nursing Diagnosis Related to Urinary Issues

  • Urinary Incontinence: Types include functional, overflow, reflex, stress, and urge.
  • Urinary Retention
  • Risk for Infection
  • Impaired Self-Toileting
  • Impaired Skin Integrity

Nursing Process: Assessment

  1. Through the Patient's Eyes
    • Self-care abilities, cultural considerations, health literacy, nursing history, pattern of urination, and urinary alteration symptoms.
  2. Physical Assessment
    • Assessment of kidneys, bladder, external genitalia, urethral meatus, and perineal skin.

Nursing Process: Planning

  • Set realistic, individualized goals in collaboration with the patient.
  • Establish priorities based on immediate physical and safety needs and patient expectations regarding self-care.

Implementation

  • Urinary Catheterization: use strict sterile technique to minimize UTI risk.
    • Regular perineal hygiene and maintain free-flow of urine by keeping drainage bags off the floor and below the bladder level.
    • Remove indwelling catheters, considering alternatives such as suprapubic catheterization where required.

Evaluation

  • Assess the patient’s self-image, social interactions, sexuality, and emotional status.
  • Determine the effectiveness of interventions by evaluating changes in voiding patterns and compliance with care plans.

Safety Guidelines for Nursing Skills

  • Follow principles of surgical and medical asepsis.
  • Identify patients at risk for latex allergies and provide alternatives to povidone-iodine for those with allergies.