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Chapter 44

Urinary Elimination

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Urinary System

Kidneys
Ureters
Bladder
Urethra
Act of urination

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Factors Influencing Urination

Disease conditions
Sociocultural factors
Psychological factors
Muscle tone

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Factors Influencing Urination


(cont'd)

Fluid balance
Surgical procedures
Medications
Diagnostic examinations

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Alterations

Urinary retention
Urinary tract infections
Urinary incontinence
Urinary diversions

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Urinary Incontinence

Functional
Overflow
Reflex
Stress
Urge

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Infection Control and Hygiene


Asepsis
Client education
Catheterization and other procedures

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Growth and Development

Infants
Toddlers and young children
Adults
Older adults

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Psychosocial Considerations
Self-concept
Culture
Gender

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Assessment of Urinary
Elimination
Nursing history
Pattern of urination
Symptoms of alterations
Factors affecting urination

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Assessment of Urinary
Elimination (cont'd)
Physical assessment
Skin and mucous membranes
Kidneys
Bladder
Urethral meatus

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Assessment of Urinary
Elimination (cont'd)
Assessment of urine
Intake and output
Characteristics: color, clarity, odor
Urine testing: specimen collection

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Assessment of Urinary
Elimination (cont'd)
Common urine tests
Urinalysis
Specific gravity
Culture

Diagnostic examinations
Consents
Allergies
Pre- and postprocedure interventions
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Nursing Diagnoses

Incontinence
Risk for infection
Toileting self-care deficit
Impaired urinary elimination
Urinary retention

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Planning
Goals and outcomes
Client will void within 8 hours after
catheter removal
Clients bladder is not distended on
palpation

Setting priorities
Continuity of care

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Implementation: Health
Promotion
Client education
Promoting normal micturition:
stimulation of reflex, maintenance of
habits and fluid intake
Promoting complete bladder
emptying
Preventing infection: hygiene and
acidifying urine
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Implementation: Acute Care

Maintaining elimination habits


Medications
Urethral catheterization
Alternatives to urethral
catheterization: suprapubic catheters,
condom catheters

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Urethral Catheterization

Types
Insertion
Drainage systems
Routine care: hygiene, fluids
Prevention of infection
Irrigations and instillations
Removal

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Implementation: Restorative Care

Strengthening pelvic floor muscles


Bladder retraining
Habit training
Self-catheterization
Maintenance of skin integrity
Promotion of comfort

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Evaluation
Client care
Client expectations

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