URINARY

ELIMINATION
DIGRACIA L. MANATIGA RN, PhD
PRETEST: IDENTIFY THE PARTS OF THE URINARY
SYSTEM
Pretest:
• The urinary system consists of
organs that produce and
excrete urine from the body.
• Urine contains waste: mostly
excess water, salts and
nitrogen compounds.
• Primary organs are the kidneys
• Normal adult bladder can store
up to .5 liters.
• Also responsible for regulating
blood volume and blood
pressure.
• Regulates electrolytes.
Organs of the Urinary System
The components
of the urinary
system include :
• the kidneys
• the ureters
• the urinary
bladder
• the urethra
Kidneys
The kidneys are (2) bean-shaped
organs located at the back of the
abdominal cavity.
They lie on either side of the spinal
column.
This area is known as the flank area and
is against the muscles of the back.
The external kidney has a notch at the
concave border known as the hilum.
The hilum is the entrance for renal artery,
veins, nerves and lymphatic vessels.
Hilum
Internal Structure of the Kidney

• The cortex is the

outer layer;
arteries, veins,
convoluted tubes
and glomerular
capsules
• The medulla is the
inner layer; renal
pyramids
 Nephrons
• 1 million nephrons
• The functional unit of the kidney
• Remove waste products of
metabolism from the blood plasma.
• Waste products are urea, uric acid,
creatinine, sodium, potassium
chloride and ketone bodies.
Urine formation:
 ACTIVITY
• Explain how urine is being formed?
Ureters, bladder and urethra
• Ureters -tubes that carry newly
formed urine from the bladder to
the kidneys.
• Bladder-muscular sac that serves
as a reservoir for urine; bladder
stretches to accommodate urine.
• Urethra- tube extends from the
bladder to the external opening of
the urinary system, the urinary
meatus
 Urine
• The formation of urine has 3
processes, filtration, reabsorption
and tubular secretion.
• Urine consists of 95% water and
5% solid substances.
• The need to urinate is usually felt
at 300-350ml of urine in the
bladder.
• Typically 1000-1500 mL is voided
daily.
Physical Characteristics of Urine

• Odor
– Fresh urine is slightly
aromatic
– Standing urine develops an
ammonia odor
– Some drugs and vegetables
(asparagus) alter the usual
odor
Physical Characteristics of Urine

• pH
– Slightly acidic (pH 6) with a
range of 4.5 to 8.0
– Diet can alter pH
• Specific gravity
– Ranges from 1.010 to 1.025
– Dependent on solute
concentration
Chemical Characteristics of Urine
• Urine is 95% water and 5% solutes
• Nitrogenous wastes (organic solutes) include
urea, ammonia, uric acid, and creatinine
• Other normal solutes include:
– Sodium, potassium, phosphate, and sulfate
ions
– Calcium, magnesium, and bicarbonate ions
• NaCl is the most abundant inorganic salt in the
urine.
• Urea is the chief organic solute.
• Abnormally high concentrations of any urinary
constituents may indicate pathology
• Disease states alter urine composition
dramatically
Lifespan considerations
Child
• At 10 weeks Older Adult
gestation the kidney • Kidney lose mass and the
begin to form blood vessels degenerate
• Newborns kidneys • Kidneys lose their ability
are not able to to filter
concentrate urine • Dehydration can happen
• Kidneys are more more quickly
susceptible to • Electrolyte balance
trauma happens more quickly
• Loss of muscles tome in
• Diapers- more
urinary structures
susceptible to UTI
• Decreased bladder
capacity
 Urination
• Micturation, voiding, and urination all
refer to the process of emptying the
urinary bladder
• Stretch receptors- special sensory nerve
endings in the bladder wall that is
stimulated when pressure is felt from the
collection of urine
– Adult: 250-450mL of urine
– Children: 50-200mL of urine
Factors affecting voiding
• Growth and development
• Psychosocial factors
• Fluid and food intake
• Medications
• Muscle tone and activity
• Pathologic conditions
• Surgical and diagnostic
procedures
Altered Urine Production
• Polyuria- a.k.a. diuresis
– production of abnormally large amounts of urine
by the kidneys
– 2500mL/day for adults
– Causes:
• Excessive fluid intake
• Intake of alcohol and caffeine
• Diabetes mellitus
• Hormone imbalances
• CKD
– Other signs associated with diuresis:
polydipsia, dehydration and weight loss
Oliguria • Voiding scant amounts of urine
• Less than 500mL/day

Anuria
• Voiding less than 100mL/day

• May result from low fluid intake, kidney

disease, severe heart failure, burns and
shock

• Usually accompanied by fever and heavy

respiration
Altered urinary Elimination
Frequency- voiding at frequent intervals that is
more often than usual.
• Total amount of urine voided may be normal but
amount of each voiding are small---50-100mL
• May result from increased fluid intake, cystitis,
stress, or pressure on the bladder

Nocturia or nycturia- increased frequency at

night that is not a result of an increased fluid
intake
• Expressed in terms number of times the person
gets out of bed to void
Altered Urgency- feeling that the person must void.
• Usually accompanies psychologic stress, and
urinary irritation of the urethra
Elimination • Common in young children who have poor
external sphincter control

Dysuria- voiding that is either painful or difficult

• May result from stricture of the urethra, urinary
infections, injury to the bladder and/ or the urethra.
• Described as a burning sensation during voiding
• Burning during micturation if often due to an
irritated urethra. Burning following urination may
be a result of bladder infection
• Often associated with urinary hesitancy (delay
and difficulty in initiating voiding)
Altered urinary Elimination

Enuresis- repeated involuntary

urination in children beyond the age
when voluntary bladder control in
normally acquired (4-5yrs)
Altered urinary Elimination
Urinary incontinence- is considered a symptom, not a disease.
Types:
• Functional incontinence- involuntary unpredictable passage of urine
• Reflex incontinence- involuntary loss of urine occurring at somewhat
predictable intervals when a specific bladder volume is reached.
• Stress incontinence- loss of urine of less than 50cc occurring with
increased intra-abdominal pressure
• Total incontinence- continuous and unpredictable loss of urine.
• Urge incontinence- involuntary passage of urine occuring soon after
a strong sense of urgency to void.
*urinary retention with overflow- dribbling incontinence that results
when the bladder is greatly distended with urine because of an
obstruction
Neurogenic bladder- describes any voiding problem related to
neurologic impairment or dysfunction.
Altered urinary Elimination
Urinary retention- accumulation of urine in the
bladder (as much as 3L) with associated
inability of the bladder to empty itself.

Adult- can hold 250-450ml of urine in the bladder

before micturation reflex in triggered.
• Prolonged retention leads to stasis (slowing of
the flow of urine) and stagnation of urine which
increases the possibility of UTI.
• Retention if distinguished from oliguria or
anuria by the distention of the bladder.
• Characterized by small, frequent voiding or
absence of urine output
Assessment
Nursing history
a. Data about voiding patterns and
habits, any problems voiding, and
past or present problems involving
the urinary system
b. Data about any problems that may
affect urination
Collecting urine specimens
• Clean catch or midstream specimens must be
free as possible from external contamination by
MO near the urethral opening.
• About 120ml of urine is generally required for
examination.
General guidelines:
• The specimen must be free of fecal
contamination
• Female clients should discard toilet tissue in the
toilet or trash bins rather than in the bedpan
• Put lid tightly on the container to prevent spillage
of the urine and contamination of other objects
• If the outside of the container has been
contaminated, clean it with a disinfectant.
Collecting a Timed Urine
Specimen
• May short periods (1-2hrs) or long periods
(12-24hrs)

Steps:
Place alert signs about the specimen
collection at the client’s bedside or
bathroom
Label specimen containers to include date
and time of each voiding as well as the
usual client ID data. Containers may be
numbered sequentially
Explain to the client the purpose of the test,
when it begins, or what to do with it.
Measuring Residual Urine
residual urine- urine remaining in the
bladder following the voiding

Purposes of measuring residual urine:

• To determine the degree to which the
bladder is emptying
• Assess the need to establish therapy that
will empty the bladder.

* To measure the residual urine, the nurse

asks the client to void then immediately
catheterizes the client.
 Diagnostic tests
• Urinalysis
• Blood tests: (BUN and Creatinine
clearance)
• Cystoscopy
• Intravenous pyelogram (IVP)/ excretory
pyelogram
• Retrograde pyelogram
• CAT/CT scan
• UTZ
Diagnosing:
Possible nursing diagnoses:
• Incontinence
– Functional incontinence
– Reflex incontinence
– Stress incontinence
– Total incontinence
– Urge incontinence
• Altered urinary elimination
• Urinary retention
• High risk for infection
• Self-esteem disturbance
• High risk for impaired skin integrity
• Social isolation
• Self care deficit: toileting
Implementing
Maintaining Normal Urinary Elimination
• Promoting normal fluid intake
• Maintaining normal voiding habits
– Relaxation
• Provide privacy
• Allow client sufficient time to void
• Suggest the client to read or listen to music
• Provide sensory stimuli
• Pour warm water over perineum or have the client sit in a warm bath to promote
muscle relaxation
• Apply hot-water bottle to the lower abdomen
• Turn on running water within hearing distance
• Relieve physical or emotional discomfort
– Timing
• Assist clients to have the urge to void immediately
• Offer toileting assistance at usual times of voiding
– Positioning
• Assist client in a normal position for voiding
• Use bedside commodes as necessary for females and urinals for males standing
at bedside
• Encourage client to push over the pubic area with hands or to lean forward
Managing Urinary Incontinence
(UI)
• Continence (bladder) training
• Bladder training- requires that the client
postpone voiding, resist or inhibit the
sensation urgency, and void according to a
timetable rather than according to the urge to
void. The goal is to lengthen the intervals
between urination to correct the client’s habit
of frequent urination
• Habit training- also referred to as timed
voiding or scheduled toileting. There is no
attempt to motivate the client to delay voiding
is the urge occurs.
• Prompt voiding- supplements the habit
training by encouraging the client to use the
toilet and reminding the client when to void
Managing Urinary Incontinence (UI)

Pelvic Muscle Exercises (PME)

• Referred to as perineal muscle tightening
or Kegel’s exercises
• Streghthen pubococcygeal muscles and
can increase the incontinent female’s
ability to start and stop the stream of urine
Managing Urinary Incontinence (UI)

• Positive reinforcements
• Maintaining skin integrity
• Applying external urinary devices
Managing Urinary Retention

• Urinary catheterization