Fundamentals of Nursing (NUR 101)

Prepared by

Nabeel Al-Mawajdeh RN.Mcs.

King Saud University- Aflaj College

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Chapter 14
Urinary Elimination

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 Urinary Elimination
 Kidneys and Ureters.
 Maintain composition and volume of body fluids.
 Filter and excrete blood constituents not needed
and retain those that are needed.
 Excrete waste product (urine)
 Nephrons remove the end products of
metabolism and regulate fluid balance.
 Urine from the nephrons empties into the
kidneys.

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 Act of Micturition

 Process of emptying the bladder.

- Detrusor muscle contracts, internal
sphincter relaxes, urine enter posterior
urethra.
- Muscles of perineum and external sphincter
relax.
- Muscle of abdominal wall contracts slightly.
- Diaphragm lowers, Micturition occurs.

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 Factors Affecting Micturition

 Developmental considerations.
 Food and fluid intake.
 Psychological variables.
 Activity and muscle tone.
 Pathologic conditions.
 Medication.

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 Diseases Associated With Renal
Problems

 Congenital urinary tract abnormalities.

 Polycystic kidney disease.
 Urinary tract infection.
 Urinary calculi.
 Hypertension.
 Diabetes mellitus.
 Gout.
 Connective tissue disorders.

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 Effects of Medications on Urine
Production and Elimination
 Diuretics-prevent reabsorption of water and
certain electrolytes in tubules
 Cholingeric medications – stimulate
contraction of detrusor muscle, producing
urination.
 Analgesics and tranquilizers – suppress CNS
diminish effectiveness of neural reflex.

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 Medications Affect in Color of Urine

 Anticoagulants – red color.

 Diuretics – lighten urine to pale yellow.
 Pyridium – orange to orange-red urine.
 Elavil – green or blue-green.
 Levodopa — brown or black.

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 Using the Nursing Process

 Assessing data about voiding patterns, habits,

past history of problems.
 Physical examination of urinary system, skin
hydration, urine.
 Correlation of these findings with results of
procedures and diagnostic tests.

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 Assessing a Problem With Voiding

 Explore its duration, severity, and precipitating

factors.
 Note patient's perception of the problem.
 Check adequacy of patient's self-care
behaviors.

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 Physical Assessment of Urinary
Functioning

 Kidneys — check for costovertebral

tenderness.
 Urinary bladderpalpate and percuss the
bladder or use bedside scanner.
 Urethral meatus — inspect for signs of
infection, discharge, or odor.
 Skin — assess for color, texture, turgor, and
excretion of wastes.
 Urine — assess for color, odor, clarity, and
sediment.

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 Measuring Urine Output
 Ask patient to void into bedpan, urinal, or
specimen container in bed or bathroom.
 Pour urine into appropriate measuring device.
 Place calibrated container on flat surface and
read at eye level.
 Note amount of urine voided and record on
appropriate form.
 Discard urine in toilet unless specimen is
needed.

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 Diagnoses

 Urinary functioning as the problem.

 Incontinence, pattern alteration, urinary
retention.
 Urinary functioning as the etiology.
 Anxiety, caregiver role strain, risk for
infection.

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 Planned Patient Goals
 Urine output about equal to fluid intake.
 Maintain fluid and electrolyte balance.
 Empty bladder completely at regular intervals.
 Report ease of voiding.
 Maintain skin integrity.
 Promoting Normal Urination.
 Maintaining normal voiding habits.
 Promoting fluid intake.
 Strengthening muscle tone.
 Stimulating urination and resolving urinary
retention.

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 Reasons for Catheterization

 Relieving urinary retention.

 Obtaining a sterile urine specimen.
 Measuring amount of urine in bladder.
 Obtaining a urine specimen.
 Emptying bladder before during or after
surgery.
 Monitoring of critically ill patients.

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 Patient Education for Urinary
Diversion
 Explain reason for diversion and rationale for
treatment.
 Demonstrate effective self-care behaviors.
 Describe follow-up care and support resources.
 Report where supplies may be obtained in
community.
 Verbalize related fears and concerns.
 Demonstrate a positive body image.

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 Evaluating Effectiveness of Plan
 Maintain fluid, electrolyte, and acid-base
balance.
 Empty bladder completely at regular intervals
with no discomfort.
 Provide care for urinary diversion and when to
notify physician.
 Develop a plan to modify factors contributing
to problem.
 Correct unhealthy urinary habits.

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 Maintaining Normal Voiding
 Timing.
 Positioning.
 Provide privacy.
 Assisting with toileting.

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The End

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