URINARY ELIMINATION

  • Polyuria: Excessive urination

  • Oliguria: Reduced urination

  • Frequency: Urinating more often than usual

  • Urgency: A sudden, strong need to urinate

  • Hesitancy: Difficulty starting urination

  • Dysuria: Painful urination

  • Enuresis: Involuntary urination, often used to refer to bedwetting

  • Nocturia: Frequent urination at night

  • Micturition: The act of urination

  • Pyuria: Presence of pus in the urine, indicating infection

  • Anuria: Absence of urine production

  • Incontinence: Inability to control urination; types include stress and urge incontinence

  • Hematuria: Blood in the urine

URINARY SYSTEM

  • Kidneys: Filter blood and produce urine

  • Ureters: Tubes that carry urine from the kidneys to the bladder

  • Bladder: Muscular sac that stores urine

  • Urethra: Tube that carries urine from the bladder to the outside of the body

URINARY ELIMINATION

  • Also known as voiding, micturition, or urination

  • Process of Urination:

    • Bladder fills with urine, reaching a volume of 200–450 mL

    • Stretch receptors in the bladder wall activate

    • Signals are sent to the voiding reflex center in the spinal cord

    • Contraction of the detrusor muscle occurs, creating a conscious urge to void

    • Conscious relaxation of the external urethral sphincter allows urine to pass out of the body

URINARY LIFESPAN CONSIDERATIONS

Infants

  • Urine output of 15–60 mL per kg of body weight

  • Typically produce 8–10 wet diapers per day

  • No voluntary control over urination

Children

  • Toilet training requires:

    • A mature neuromuscular system

    • Adequate communication skills

Older Adults

  • Decreased kidney function is common

  • Frequent urgency and frequency of urination

  • Loss of bladder elasticity and muscle tone leads to:

    • Nocturia (nighttime urination)

    • Incomplete bladder emptying

FACTORS AFFECTING URINARY ELIMINATION

  • Personal Factors: Individual habits, health conditions

  • Sociocultural Factors: Cultural beliefs and social practices affecting toilet use

  • Environmental Factors: Access to clean toilets, privacy

  • Nutrition: Diet can affect hydration levels and urinary output

  • Medications: Certain pharmaceuticals may alter urinary function

  • Surgery/Anesthesia: Surgical procedures and anesthesia can impact bladder function

FACTORS AFFECTING URINARY ELIMINATION (CONT’D)

  • Health Conditions:

    • Bladder or kidney infections

    • Kidney stones

    • Hypertrophy of the prostate (especially in males)

  • Additional Issues:

    • Mobility problems affecting toilet access

    • Neurological conditions impacting nerve signals

    • Communication problems hindering the ability to articulate need to void

    • Altered cognition affecting understanding of when to go to the toilet

PROMOTING NORMAL URINATION

  • Nursing Interventions:

    • Provide privacy during elimination

    • Assist with positioning:

      • Men should be encouraged to stand

      • Women should be seated upright

    • Facilitate regular toileting routines

    • Encourage adequate fluid intake

    • Assist with proper hygiene practices

ALTERATIONS IN URINARY ELIMINATION

  • Conditions Include:

    • Urinary tract infections (UTIs)

    • Urinary retention (inability to empty the bladder completely)

    • Urinary incontinence (various types including stress, urge, etc.)

    • Urinary diversion (surgical procedure to reroute urine)

    • Urostomy (surgical creation of an opening in the abdominal wall for urine)

    • Suprapubic catheterization (placement of a catheter via the abdomen to the bladder)

MANAGING URINARY RETENTION

  • Monitor for bladder distention

  • Measure Post-Void Residual (PVR):

    • Assess the amount of urine left in the bladder after voiding

  • Drain the Bladder If Necessary:

    • Introduction of a sterile tube into the bladder

      • Types of catheters:

        • Straight catheter: A temporary catheter that is inserted to drain urine

        • Indwelling catheter (Foley): A catheter that remains in place for a period of time

URINARY CATHETER CARE

  • Infection Prevention:

    • Handle catheters with sterile techniques

    • Prevent backflow of urine into the bladder

  • Encouragement of Fluid Intake:

    • Adequate hydration is important

  • Perineal Hygiene:

    • Maintain cleanliness to reduce the risk of infection

COMMON URINE STUDIES

Specimen Collection

  • Types of Specimens:

    • Freshly voided specimen

    • Clean catch specimen

    • Sterile specimen

    • 24-hour urine collection: Used to assess various factors over a full day

  • Urinalysis: A test examining urine components

  • Dipstick Testing: Provides quick flags for various substances

  • Specific Gravity: Measure of urine concentration

  • Bladder Scan: Used to assess bladder volume and retention issues