URINARY

ELIMINATION
LETS DISCUSS ABOUT ANATOMY OF
URINARY SYSTEM
 COMMON PROBLEMS IN URINARY
ELIMINATION
• Urinary retention
• LUTI
• Urinary incontinence
 TYPES OF URINARY INCONTINENCE
• TOTAL UI
• FUNCTIONAL UI
• STRESS UI
• URGE UI
• REFLEX UI
 FACTORS INFLUENCING URINARY
ELIMINATION
Growth and development
Sociocultural factors
Psychological factors
Personal habits
Muscle tone
Fluid intake
Pathophysiological conditions
Surgical conditions
Medications
 Common symptoms of urinary alterations
URGENCY
Feeling of the need to void immediately

CAUSES OR ASSOCIATED FACTORS

Full bladder
Inflammation or irritation to bladder mucosa from infection
Incompetent urethral sphincter
Psychological stress
Common symptoms of urinary alterations
• Dysuria
• Frequency
• Hesitancy
• Polyuria
• Oliguria
• Nocturia
• Dribbling
• Hematuria
• Retention
• Residual urine
 NURSING PROCESS

ASSESSMENT 
You need to complete a nursing history, perform a physical
assessment, assess the patient's urine, and review information
from laboratory and diagnostic tests to identify a urinary
elimination problem.
NURSING HISTORY:
Information from the scientific and nursing
knowledge bases assists you in completing a nursing
history. The nursing history includes a review of the
patient's elimination patterns, symptoms of urinary
alterations and assessment of factors that are
affecting the ability to urinate normally
Pattern of Urination
Ask the patient about daily voiding patterns, including
frequency and times of day, normal volume at each voiding,
and history of recent changes. Frequency varies among
individuals. Most people void an aver age of 5 or more times a
day. The patient who voids frequently during the night often
has renal or cardiovascular disease or cystitis. Information
about the pattern of urination is necessary to establish a
baseline for comparison
Symptoms of Urinary
• Alterations Certain symptoms of alterations occur in
more than one type of urinary disorder. During
assessment ask the patient about the presence of
symptoms like Total, Functional, Stress, Urge, Reflex
• Also determine whether the patient is aware of
conditions or factors that precipitate or aggravate the
symptoms
 Factors Affecting Urination
Focused assessment enables you to gather data relevant to your patient's
elimination pattern. Like fluid intake , urinary elimination, bladder function

In addition, there are important factors in the patient's history that normally affect
urination. These factors include the following:
Factors Affecting Urination
• 1. Medication usage: Ask the patient to identify any pre scription,
over-the-counter, and herbal supplements in use because they
sometimes affect fluid and electrolyte balance. Diuretics are used to
regulate fluid balance, however, side effects can include fluid and
electrolyte imbalances, Opioid analgesics cause urinary retention.
Some anesthetics temporarily depress renal or bladder function.
Factors Affecting Urination
2. Mobility status: Assess patients' use of walking aids, the
ability to remove clothing, or the ability to get in and out of
the bathroom or on and off the toilet.
3. Environmental barriers: Assess both home and health care
setting for barriers that prevent the patient from accessing the
toilet. Some patients need an elevated tolilet seat, grab bars,
or a portable commode. Also consider the lack of lighting and
distance to the toilet
Factors Affecting Urination
• 3. Sensory restrictions: Assess for those sensory changes that obstruct self-
toileting (e.g., patients with visual problems who have trouble reaching toilet
facilities safely). If the patient has difficulty with hand coordination, assess
the type of clothing and the patient's ease in using clothing fasteners.

• 4. Sensory restrictions: Assess for those sensory changes that obstruct self-
toileting (e.g., patients with visual problems who have trouble reaching toilet
facilities safely). If the patient has difficulty with hand coordination, assess
the type of clothing and the patient's ease in using clothing fasteners.
Factors Affecting Urination
• 5. Past illness: Assess for history of UTI or bladder surgery that may
increase the risk for recurrent problems. Chronic diseases (e.g.,
multiple sclerosis) that impair bladder function require you to
consider preventive care measures. Patients returning from surgery
often have difficulty voiding the first few hours until the effects of
anesthesia diminish.
• 6. Major surgery: Patients recovering from major surgery and
suffering critical illness or disability often have an indwelling catheter
to aid urinary drainage and provide a measurement of urinary
output. A catheter places a patient at risk for infection.
Factors Affecting Urination
• 7. Urinary diversion: If the patient has a urinary diversion, assess its type,
location, and function. Also assess the condition of surrounding skin and
usual methods for management (presence of appliance of pouch, type of skin
care products and application). If the patient has an incontinent diversion,
assess the methods and frequency of appliance changes and the type of night
time drainage system. In addition, in the patient with a continent urinary
diversion determine the frequency and type of catheters used to drain urine.

• 8. Personal habits: Some personal habits may inhibit uri nation or put the
patient at risk for infection (i.e., poor hand or perineal hygiene). If a patient is
hospitalized, assess how this alters his or her personal habits. Privacy is often
difficult to accomplish in a health care setting, particularly if a patient uses a
bedpan (see Chapter 34) or a urinal. Determine the patient's knowledge and
practices of perineal hygiene.
Factors Affecting Urination
• 9. Fluid intake: A patient's physical condition affects the frequency with
which you monitor fluid intake. Regular intake and output (I&O)
measurements help to assess a patient's overall fluid balance. Patients
who have UTIS with urgency, burning, and frequency often mistakenly
decrease their fluid intake to try to fix the symptoms.

• 10. Age: Toilet training and enuresis are concerns that arise in the
toddler and preschooler. In the adult, increasing age sometimes brings
disease and physiological changes that predispose to incontinence.
 PHYSICAL ASSESSMENT
• When conducting a physical assessment, particularly when you
suspect a patient has a urinary alteration, consider how you would
assess for typical signs and symptoms.
• For example…………………..
• In this situation, you would conduct an abdominal assessment. Older
adult with UTIs will often have an accompanying fever and exhibit
alterations in mental status such as acute confusion, requiring a
neurological assessment. Here are additional assessment tips.
• Skin and Mucosa Assess the skin's hydration a noting texture and turgor, Observe the
skin around periurethral tissues and stomas for excoriation, drainage, and
tenderness. Urinary incontinence, fluid imbalance, and electrolyte disturbances
increase the risk for skin d Observation of the oral mucosa also reveals whether
hydration is adequate.
• Kidneys If the kidneys become infected or inflamed flank pain typically develops. You
assess for tenderness in the disease by gently percussing the costovertebral (the
angle formed by the spine and twelfth rib). Inflammation of the kidney results in
pain on percussion
• Bladder Normally the bladder rests below the symppubis, and you are unable to
palpate it. When distended, the bladder rises above the symphysis pubis at the
midline of the abdomen and just below the umbilicus. Then, when you ply light
pressure to the bladder, the patient feels tenderness or even pain. Palpation also
causes the urge to urinate.

• Urethral Meatus The female patient assumes a dorsal recumbent position to provide
full exposure of the genitalia Using the gloved nondominant hand, retract the labial
folds to observe the urethral meatus. Look for drainage and lesions. and ask the
patient if there is discomfort. There is normally no discharge from the meatus.
Drainage indicates infection. Be sure you note the color and consistency of drainage.
• The male's urethral meatus is normally a small opening at the tip of the
penis. To inspect the meatus for discharge, lesions, and inflammation, it
is necessary for you to retract the foreskin in uncircumcised males.
Following inspection of the meatus, return foreskin over the meatus.
• The assessment of urine involves measuring the patient's fluid intake
and urinary output and observing the characteristics of the urine.
• Intake and Output When patients have altered or impaired urinary
elimination, you measure I&O to monitor their fluid and electrolyte
balance. Although often written as part of a health care provider's order,
placing a patient on I&O is often a nursing judgment. Obtaining an
accurate I&O measurement requires cooperation and assistance from the
patient and family. Intake measurements need to include all oral liquids
and semi liquids (including those given with oral medications); all enteral
feedings through nasogastric, gastrostomy, or jejunostomy tubes; and all
parenteral fluids such as intravenous solutions, blood components, and
parenteral nutrition
Laboratory and diagnostic testing
• Specimen collection
• Urinalysis sample
• Clean –voided or midstream specimen
• Sterile specimen
• 24 hour urine specimen
• Urine cuture
DIAGNOSTIC EXAMINATIONS

•Non invasive- KUB X-RAY

IV PYELOGRAM
Computerized axial tomography
•Invasive-endoscopy
Urodynamic testing