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.