Chapter 30

Urinary Elimination Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 1 First semester 19 - 20

Islamic University of Gaza Faculty of Nursing

2 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Overview of Urinary Elimination

Components of the urinary system: kidneys,

ureters, bladder, and urethra

Accessory structures of the urinary system: ring-

shaped muscles called the internal and external

sphincters

Components, along with accessory structures,

work together to produce urine, collect it, and

excrete it from the body

First semester 19 - 20

3 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Major Structures of Urinary System

First semester 19 - 20

4 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Overview of Urinary Elimination ……..cont’d

Urinary elimination: the process of releasing

excess fluid and metabolic wastes

Normal conditions: average person

eliminates approximately 1500 to 3000 mL of

urine each day

Need to urinate becomes apparent when the

bladder distends with approximately 150 to

300 mL of urine

First semester 19 - 20

5 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Factors affecting urinary elimination

Patterns of urinary elimination depend on

Physiologic

Emotional

Social

o Examples: amount of food consumed, volume of

fluid intake, and the amount of fluid losses

o Degree of neuromuscular development

o Integrity of the spinal cord

o Circadian rhythm, habits, opportunities, anxiety

First semester 19 - 20

6 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Factors affecting urinary elimination (cont’d)

Measures to promote urination

Providing privacy; assuming a natural position for

urination

Maintaining an adequate fluid intake

Using stimuli such as running water from a tap to

initiate voiding

First semester 19 - 20

2 - 12 - 2014 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B 7

8 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Urine Specimen Collection

Health care professionals collect urine specimens, or

samples of urine, to identify microscopic or chemical

constituents.

Common urine specimens that nurses collect include

voided specimens, clean-catch specimens , catheter

specimens, and 24-hour specimens.

First semester 19 - 20

9 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Voided Specimens

Is a sample of fresh urine collected in a clean container.

The first voided specimen of the day is preferred because

it is most likely to contain substantial urinary components

that have accumulated during the night.

If the specimen cannot be examined in less than 1 hour

after collection, it is labeled and refrigerated.

A clean-catch specimen

Is a voided sample of urine considered sterile.

Sometimes called a mid-stream specimen because of

how it is collected.

As soon as the specimen is collected, it is labeled and

taken to the laboratory. First semester 19 - 20

10 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Catheter Specimens

A urine specimen can be collected under sterile

conditions using a catheter, which is usually done

when clients are catheterized for other reasons such

as to control incontinence in an unconscious client

24-Hour Specimens

Collection of all urine produced in a full 24-hour period

First semester 19 - 20

11 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Abnormal Urine Characteristics

Laboratory analysis is a valuable diagnostic tool for identifying

abnormal characteristics of urine.

Hematuria: urine containing blood

Pyuria: urine containing pus

Proteinuria: urine containing plasma proteins

Albuminuria: urine containing albumin, a plasma

protein

Glycosuria: urine containing glucose

Ketonuria: urine containing ketones

First semester 19 - 20

12 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Abnormal Urinary Elimination Patterns

Assessment findings may indicate abnormal urinary

elimination patterns.

Some common problems include anuria, oliguria,

polyuria, nocturia, dysuria, and incontinence.

1. Anuria

Anuria means absence of urine or a volume of 100 mL

or less in 24 hours.

It indicates that the kidneys are not forming sufficient

urine.

Note: Urinary retention: the client produces urine but

does not release it from the bladder

First semester 19 - 20

13 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

2. Oliguria

Urine output less than 400 mL per 24 hours,

indicates inadequate elimination of urine.

Residual urine : more than 50 mL of urine that

remains in the bladder after voiding

Urinary stasis: lack of movement of urine from

bladder

First semester 19 - 20

14 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

3. Polyuria

Greater than normal urinary volume and may

accompany minor dietary variations, such as

increased fluid intake

For example, consuming higher than normal amounts

of fluids, especially those with mild diuretic effects

(e.g., coffee, tea), or taking certain medications

actually can increase urination.

4. Nocturia

Nocturia (nighttime urination) is unusual because the

rate of urine production is normally reduced at night.

First semester 19 - 20

15 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

5. Dysuria

Dysuria is difficult or uncomfortable voiding and a

common symptom of trauma to the urethra or a

bladder infection.

Frequency :need to urinate often.

Urgency :strong feeling that urine must be

eliminated quickly often accompany dysuria.

6. Incontinence

Incontinence means the inability to control either

urinary or bowel elimination and is abnormal after

a person is toilet-trained.

First semester 19 - 20

16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Assisting Clients with Urinary Elimination

Stable clients who can ambulate are assisted to the

bathroom to use the toilet .

Clients who are weak or cannot walk to the bathroom

may need a commode; clients confined to bed use a

urinal or bedpan

1. Commode: chair with an opening in the seat

under which a receptacle is placed

2. Urinal: cylindrical container for collecting urine;

it is more easily used by males

First semester 19 - 20

17 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination First semester 19 - 20

Urinal and urinal

18 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

3. Using a Bedpan

A bedpan (seat like container for elimination) is used

to collect urine or stool.

Figure 30-5 • Two types of bedpans: fracture pan)left ( and conventional bedpan ) right) .

First semester 19 - 20

19 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Urinary incontinence, depending on its type, may be

permanent or temporary.

The six types of urinary incontinence are stress, urge,

reflex, functional, total, and overflow (Table 30-2).

Continence training: to restore control of urination

involves teaching the client to refrain from urinating

until an appropriate time and place.

Managing Incontinence

First semester 19 - 20

20 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Types of urinary incontinence

First semester 19 - 20

21 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Catheterization

Catheterization: act of applying or inserting a hollow

tube

Various Reasons for Urinary Catheter Use

Keeping incontinent clients dry (last resort, when all

other continence measures have been tried)

Relieving bladder distention when clients cannot void

Assessing fluid balance accurately

Keeping the bladder from becoming distended during

procedures such as surgery

Measuring the residual urine

Obtaining sterile urine specimens

Instilling medication within the bladder First semester 19 - 20

22 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Types of Catheters

Various Reasons for Urinary Catheter Use

An external catheter (urine-collecting device applied

to the skin) is not inserted within the bladder; instead, it

surrounds the urinary meatus.

Examples of external catheters are a condom

catheter (Fig. 30-7) and a urinary bag or U-bag.

External catheters are more effective for male clients.

First semester 19 - 20

23 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Straight catheters: urine drainage tube inserted but

not left in place. It drains urine temporarily or provides

a sterile urine specimen

Retention catheters (also called indwelling catheters),

left in place for a period of time

Example: Foley catheter

A. Retention (Foley) catheter

with a balloon

B. Straight catheter

First semester 19 - 20

24 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Unlike straight catheters, retention catheters are

secured with a balloon that is inflated once the distal

tip is within the bladder. Both straight and retention

catheters

Available in various diameters, sized according to the

French scale: for adults, sizes 14, 16, and 18 F are

commonly used.

First semester 19 - 20

25 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Inserting a catheter:

The techniques for inserting straight and retention

catheters are similar, although the steps for inflating

the retention balloon do not apply to a straight

catheter

The best position for urinary catheterization is

Dorsal recumbent position

Closed drainage system:

Device used to collect urine

from a catheter

First semester 19 - 20

26

Figure 30-11 • Techniques for suspending a drainage system below the bladder( :

A )wheelchair patient ;( B )ambulating patient with and without an IV pole.

Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination First semester 19 - 20

27 Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

28 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

A catheter irrigation

A catheter irrigation (flushing the lumen of a catheter)

is a technique for restoring or maintaining catheter

patency.

A catheter that drains well, however, does not need

irrigating.

1. Open system: retention catheter is separated

from the drainage tubing to insert the tip of an

irrigating syringe (least desirable).

2. Closed system: irrigated without separating the

catheter from the drainage tubing.

3. Continuous irrigation: ongoing instillation of

solution using a 3-way catheter First semester 19 - 20

29 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination First semester 19 - 20

Attaching irrigation tubing to a port on a

three-way catheter.

Bladder irrigation using a three-way catheter

30 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Indwelling catheter removal:

Catheter is removed when it needs to be replaced or

when its use is discontinued

The best time to remove a catheter is in the morning

when there is more opportunity to address any

urination difficulties without depriving a client of

sleep.

First semester 19 - 20

Catheter removal

2 - 12 - 2014 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B 31

32 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Urinary Diversions

Urinary diversion: one or both ureters are surgically

implanted elsewhere

This procedure is done for various life-threatening

conditions

Urostomy: urinary diversion that discharges urine

from an opening on the abdomen

o Peristomal skin: skin around the stoma

o Difficult to maintain skin integrity due to

frequent appliance changes and ammonia in

urine

First semester 19 - 20

33 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Urinary Elimination

Figure 30-14 • Examples of urinary diversions( .A )Ileal conduit( .B )Cutaneous ureterostomy .

First semester 19 - 20