King Saud UniversityKing Saud UniversityCollege of NursingCollege of Nursing

Fundamentals of NursingFundamentals of Nursing

URINARY ELIMINATIONURINARY ELIMINATION

Urinary EliminationUrinary Elimination

Urinary Elimination is a basic function of the Urinary Elimination is a basic function of the kidneys, whereby the waste products are excreted kidneys, whereby the waste products are excreted (urea, ammonia, creatinine, and uric acid).(urea, ammonia, creatinine, and uric acid).

Urine consists of organic solutes such as urea, Urine consists of organic solutes such as urea, ammonia, creatinine, and uric acidammonia, creatinine, and uric acid

Inorganic solutes include sodium, chloride, Inorganic solutes include sodium, chloride, potassium sulfate, magnesium, & phosphoruspotassium sulfate, magnesium, & phosphorus

Urination, micturation, and voiding are terms Urination, micturation, and voiding are terms describe the process of urine elimination from the describe the process of urine elimination from the urinary bladder.urinary bladder.

Urinary System Urinary System

Kidneys Kidneys uretersureters BladderBladder UrethraUrethra

Kidneys and UretersKidneys and Ureters Maintain composition and volume of body fluidsMaintain composition and volume of body fluids Filter and excrete blood constituents not needed, Filter and excrete blood constituents not needed,

retain those that are neededretain those that are needed Loop of HenleLoop of Henle

– Solutes such as glucose reabsorbed hereSolutes such as glucose reabsorbed here– Other substances secretedOther substances secreted

Nephrons (functional unit of the kidney) remove Nephrons (functional unit of the kidney) remove the end products of metabolism and regulate fluid the end products of metabolism and regulate fluid balancebalance

Urine from the nephrons empties into the renal Urine from the nephrons empties into the renal pelvispelvisuretersuretersbladder.bladder.

BladderBladder Bladder is a hollow, muscular organ that serves as a Bladder is a hollow, muscular organ that serves as a

reservoir for urine and as the organ of excretion.reservoir for urine and as the organ of excretion. Composed of three layers of muscle tissue called Composed of three layers of muscle tissue called

detrusor muscle.detrusor muscle. Detrusor muscle allows the bladder to expand as it Detrusor muscle allows the bladder to expand as it

fills with urine, and to contract to release urine.fills with urine, and to contract to release urine. Sphincter guards the opening between urinary Sphincter guards the opening between urinary

bladder and urethra.bladder and urethra. Normal bladder capacity is between 300-600 ml of Normal bladder capacity is between 300-600 ml of

urine.urine.

UrethraUrethra The urethra extends from the bladder to the The urethra extends from the bladder to the

urinary meatus (opening).urinary meatus (opening). Serves as a passageway of urine from the Serves as a passageway of urine from the

bladder to the exterior of the body.bladder to the exterior of the body. Male urethra is about 20 cm long and serves Male urethra is about 20 cm long and serves

as a passageway of semen as well as urine.as a passageway of semen as well as urine. Female urethra is about 3-4 cm, that’s why Female urethra is about 3-4 cm, that’s why

women are particularly prone to urinary tract women are particularly prone to urinary tract infections.infections.

Process of MicturationProcess of Micturation Process of emptying the bladderProcess of emptying the bladder Urine collects in the bladder until the pressure stimulates Urine collects in the bladder until the pressure stimulates

the nerve endings in the bladder wall called (strech the nerve endings in the bladder wall called (strech receptors).receptors).

This occurs when the adult bladder contains about 250-450 This occurs when the adult bladder contains about 250-450 ml of urine, while in children, this can occur at a smaller ml of urine, while in children, this can occur at a smaller volumes (50-200) ml.volumes (50-200) ml.

Those receptors transmit impulses to the spinal cord Those receptors transmit impulses to the spinal cord causing the internal sphincter of the bladder to relax and causing the internal sphincter of the bladder to relax and stimulate the urge to urinate.stimulate the urge to urinate.

Factors Affecting voidingFactors Affecting voiding

1.1. Developmental considerationsDevelopmental considerations

2.2. Food and fluid intakeFood and fluid intake

3.3. Psychological factorsPsychological factors

4.4. Muscle toneMuscle tone

5.5. Pathologic conditionsPathologic conditions

6.6. MedicationsMedications

Developmental ConsiderationsDevelopmental Considerations

ChildrenChildren– Toilet training can start at the age of 2 years.Toilet training can start at the age of 2 years.– Nocturnal enuresis or bed wetting, is the Nocturnal enuresis or bed wetting, is the

involuntary passing of urine during sleep.involuntary passing of urine during sleep.

Effects of agingEffects of aging– Nocturia, increased frequency, urine retention Nocturia, increased frequency, urine retention

and stasis, voluntary control affected by physical and stasis, voluntary control affected by physical problems. (bladder muscle tone and contractility problems. (bladder muscle tone and contractility diminish).diminish).

Diseases Associated With Renal Diseases Associated With Renal ProblemsProblems

Congenital urinary tract abnormalitiesCongenital urinary tract abnormalities Polycystic kidney diseasePolycystic kidney disease Urinary tract infectionUrinary tract infection Urinary calculiUrinary calculi HypertensionHypertension Diabetes mellitusDiabetes mellitus Prostate hypertrophyProstate hypertrophy

Alteration of the urinary patternsAlteration of the urinary patterns

Altered urine productionAltered urine production: : Adult urine output is about 1500 ml per day

a- Oliguria: low urine output (less than 30 ml/hr)a- Oliguria: low urine output (less than 30 ml/hr)

b- Anuria: lack of urine production.b- Anuria: lack of urine production.

c- Polyuria: large amount of urine.c- Polyuria: large amount of urine.

Alteration of the urinary patternsAlteration of the urinary patterns

Altered Urinary Elimination:Altered Urinary Elimination:

a- Urinary Frequency:a- Urinary Frequency:

- Voiding at frequent intervals that is more than usual.- Voiding at frequent intervals that is more than usual.

- Caused by: Increase fluid intake, stress, UTI, pregnancy- Caused by: Increase fluid intake, stress, UTI, pregnancy

b- Nocturiab- Nocturia:: Frequent voiding at night. Frequent voiding at night.

c- Urinary Incontinence:c- Urinary Incontinence: inability to control urination. (involuntary inability to control urination. (involuntary urination)urination)

d- Urinary Retention:d- Urinary Retention: impaired emptying the bladder impaired emptying the bladder

e- Dysuriae- Dysuria: means that voiding is either painful or difficult.: means that voiding is either painful or difficult.

f- Urgencyf- Urgency: is the sudden strong desire to void e.g. with stress.: is the sudden strong desire to void e.g. with stress.

Nursing Assessment ofNursing Assessment ofUrinary FunctionUrinary Function

Nursing historyNursing history Physical assessment of urinary systemPhysical assessment of urinary system Hydration statusHydration status Examination of urineExamination of urine Data from diagnostic tests and proceduresData from diagnostic tests and procedures

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

NANDA Nursing DiagnosisNANDA Nursing Diagnosis

Impaired Urinary EliminationImpaired Urinary Elimination Functional Urinary IncontinenceFunctional Urinary Incontinence Reflex Urinary IncontinenceReflex Urinary Incontinence Stress Urinary IncontinenceStress Urinary Incontinence Total Urinary IncontinenceTotal Urinary Incontinence Urge Urinary Incontinence Urge Urinary Incontinence Urinary Retention Urinary Retention

Patients at Risk for UTIsPatients at Risk for UTIs

Women due to short urethra.Women due to short urethra. Postmenopausal womenPostmenopausal women Individuals with indwelling urinary catheterIndividuals with indwelling urinary catheter Individual with diabetes mellitusIndividual with diabetes mellitus Elderly peopleElderly people

Interventions to promote Normal Interventions to promote Normal UrinationUrination

1.1. Maintaining normal voiding habits Maintaining normal voiding habits (schedule, privacy, position, hygiene).(schedule, privacy, position, hygiene).

2.2. Promoting fluid intake (1500 ml per day).Promoting fluid intake (1500 ml per day).

3.3. Strengthening muscle toneStrengthening muscle tone

4.4. Stimulating urination and resolving urinary Stimulating urination and resolving urinary retention retention

5.5. Preventing urinary tract infectionsPreventing urinary tract infections

6.6. Managing urinary incontinenceManaging urinary incontinence