NURS 201 Spring 2020-21

URINARY ELIMINATION
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Urinary System

Kidneys and ureters

Bladder
Urethra

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Kidneys and Ureters

 Maintain composition and volume of body fluids

 Filter and excrete blood constituents not needed; retain
those that are needed
 Excrete waste product (urine)
o The nephrons maintain and regulate fluid balance
through the mechanisms of selective reabsorption
and secretion of water, electrolytes, and other
substances.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Bladder

 Smooth muscle sac innervated by Autonomic Nervous

System
 Serves as a temporary reservoir for urine
 Composed of three layers of muscle tissue called detrusor
muscle
o The inner longitudinal layer, the middle circular layer,
and the outer longitudinal layer
 Sphincter guards opening between urinary bladder and
urethra
 Urethra conveys urine from bladder to exterior of body

Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Urinary Bladder

Copyright © 2019 Wolters Kluwer • All Rights Reserved

 Conveys urine from the bladder to the
exterior

Male urethra functions in excretory and

Urethra reproductive systems.

In women, urethra lies directly anterior to the

vagina is 3 to 6cm long ( versus men which is
around 16cm) . Serves only as a passage-way for
urine.

In both men & women, the urethra has a mucous

lining continuous with the bladder and the
ureters. An infection in the urethra may extend
to the kidneys
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Act of Urination (Micturition, Voiding)

 Process of emptying the bladder

o Detrusor muscle contracts, internal sphincter relaxes,
urine enters posterior urethra
o Muscles of perineum and external sphincter relax
o Muscle of abdominal wall contracts slightly
o Diaphragm lowers, micturition occurs

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Urination

Micturition – voiding
This occurs when the adult bladder
contains between 250-600 ml of urine
Children: bladder accommodates
between 50-200 ml of urine
Sometimes, increased abdominal
pressure—such as occurs during
coughing and sneezing—forces an
involuntary escape of urine. This is a
particular problem for some women
because the urethra is shorter. Any
involuntary loss of urine that causes
such a problem is referred to as
urinary incontinence

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Act of Urination

Urinary retention Any involuntary loss of

occurs when urine is urine that causes such
produced normally but a problem is referred
is not excreted to as urinary
completely from the incontinence.
bladder. Factors
associated with urinary
retention include
medications, an
enlarged prostate, or
vaginal prolapse.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Factors Affecting Micturition

 Developmental considerations
o Effects of aging
 Nocturia
 Increased frequency
 Urine retention and stasis
 Food and fluid intake
 Psychological variables
 Pathologic conditions
 Medications

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Fluid and food intake

 Fluid intake = the output

 Certain fluids, e.g alcohol, ↑ fluid output by inhibiting ADH
production.
 Fluid that contain caffeine (e.g coffee, tea, cola)
↑ urine production.
 Foods & fluids high in Na cause fluid retention.
 Some foods and fluids can change the color of urine.

 Beetroot can cause urine to appear red.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Terms to describe urinary problems
Anuria: 24-hour urine output less than 50mL  Albuminuria
Dysuria: Painful or difficult urination  Glucosuria
Frequency: voiding at frequent intervals, that  Proteinuria
is, more often than 4 to 6 times per day
 Pyuria
Urgency: strong desire to void.
 Retention
Polyuria: Production of abnormally large
amounts of urine

Oliguria: low urine output, usually less than 400

ml a day or less than 30 ml an hour for an adult

Nocturia: awakening at night to urinate

Incontinence : involuntary loss of urine

Copyright © 2019 Wolters Kluwer • All Rights Reserved
Question #1

Which term describes a condition in which 24-hour urine

output is less than 50 mL?
A. Dysuria
B. Glycosuria
C. Pyuria
D. Anuria

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #1

Answer: D. Anuria

Rationale: Anuria is synonymous with kidney shutdown

or renal failure. Dysuria is painful or difficult urination.
Glycosuria is the presence of sugar in the urine. Pyuria is
pus in the urine.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Question #2

Tell whether the following statement is true or false.

Diuretics cause increased urine production, resulting in
the need for increased urination and possibly urge
incontinence.
A. True
B. False

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #2

Answer: A. True

Rationale: Diuretics cause increased urine production,

resulting in the need for increased urination and possibly
urge incontinence.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Using the Nursing
Process

Assessing data about

voiding patterns, habits,
past history of problems
Physical examination of
the bladder, if indicated,
and urethral meatus;
assessment of skin
integrity and hydration;
and examination of the
urine
Correlation of these
findings with results of
procedures and
diagnostic tests

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Assessing a Problem With Voiding

 Explore its duration, severity, and precipitating factors.

 Note the patient’s perception of the problem.
 Check the adequacy of the patient’s self-care behaviors.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Question #3

Tell whether the following statement is true or false.

Normal fresh urine has an ammonia odor.
A. True
B. False

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #3

Answer: B. False

Rationale: Normal fresh urine has an aromatic odor. As

urine stands, it often develops an ammonia odor because
of bacterial action.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Measuring Urine Output

 Ask the patient to void into a bedpan, urinal, or specimen

container in bed or bathroom.
 Put on gloves. Pour urine into the appropriate measuring
device.
 Place the calibrated container on a flat surface and read
at eye level.
 Note amount of urine voided and record on the
appropriate form.
 Discard urine in the toilet unless specimen is needed. If a
specimen is required, pour the urine into an appropriate
specimen container

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Urine Specimens

 Routine urinalysis
 Clean-catch or midstream specimens: a sterile specimen
 Sterile specimens from indwelling catheter
 24-hour urine specimen
 Point of care urine testing

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Characteristic Normal Findings Special Considerations
Urine analysis
Color • Freshly voided urine: • Darker in color when scanty &
Pale yellow, straw colored, or concentrated
amber • Certain drugs may change color
• Some foods can alter color

Odor o Normal urine – aromatic o High in glucose - sweet odor

o Standing urine develops o Heavily infected - fetid odor
ammonia odor (bacteria)

Turbidity  Fresh urine-Clear or  Presence of RBCs, WBCs,

translucent bacterial, vaginal discharge,
 Standing - cloudy sperm, prostatic fluid

pH Normal 4.6-8 High protein diet – acidic

Citrus , vegetables, dairy-alkaline

Specific Dissolved solids in urine Concentrated – higher than normal

Gravity 1.015-1.025 Diluted – lower then normal

Constituents Organic-Urea, uric acid, Abnormal constituents contain

creatinine … blood, pus, glucose, ketone bodies..
Inorganic-ammonia, Na, Cl, K,
S, Ca, traces of Fe
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Question #4

Tell whether the following statement is true or false.

A urine specimen from a patient with an indwelling
catheter should be obtained from the collection
receptacle.
A. True
B. False

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #4

Answer: B. False

Rationale: A urine specimen from a patient with an

indwelling catheter should be obtained from the catheter
itself.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Devices for Collecting and Measuring
Urine

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Nursing Diagnoses

 Urinary functioning as the problem

o Incontinence
o Pattern alteration
o Urinary retention
 Urinary functioning as the etiology
o Anxiety
o Caregiver role strain
o Risk for infection

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Planned Patient Goals

 Produce sufficient quantity of urine to maintain fluid,

electrolyte, and acid–base balance.
 Empty bladder completely at regular intervals without
discomfort.
 Develop plan to modify factors contributing to current or
future urinary problems.
 Correct unhealthy urinary habits.

Copyright © 2019 Wolters Kluwer • All Rights Reserved

Promoting Normal Urination

 Maintaining normal voiding habits

 Promoting fluid intake
 Strengthening muscle tone
 Assisting with toileting

Copyright © 2019 Wolters Kluwer • All Rights Reserved

 Reasons for Catheterization
 Relieving urinary retention
 Prolonged patient immobilization
 Obtaining a sterile urine specimen when patient is unable
to void voluntarily
 Accurate measurement of urinary output in critically ill
patients
 Assisting in healing open sacral or perineal wounds in
incontinent patients
 Emptying the bladder before, during, or after select
surgical procedures and before certain diagnostic
examinations.
 Providing improved comfort for end-of-life care

Copyright © 2019 Wolters Kluwer • All Rights Reserved