Urinary Elimination

Prepared by: Karla S. Flores, RN, MAN

Objectives
After the discussion, the learner should be able to do the following:
• Identify the characteristics of normal urine
• Describe the guidelines for maintaining normal urinary elimination
• List the observations to make about urine
• Describe urinary incontinence and the care required
• Explain why catheters are used
• Explain the differences among straight, in-dwelling, suprapubic and
condom catheters
Objectives
• Describe the guidelines for caring for clients with in-dwelling
catheters
• Describe the methods of bladder training
• Describe the guidelines for collecting urine specimens
• Explain how to care for a client with a ureterostomy
• Apply the procedures described in this chapter to clinical practice
properly
Urination
• Urination / micturition / voiding – process of emptying urine from the
bladder
• Healthy adult – excretes 1500 mL of urine per day
• Factors affecting urine production – age, disease, amount and kinds
of fluid ingested, dietary salt and medications
• Factors affecting frequency of urination – amount of fluid intake,
personal habits, available toilet facilities, activity, work, illness
• Incontinence – NOT a normal part of aging
Observations to Make About Urine
• Normally appears yellow, straw-coloured or amber, and is clear with
no particles
• A faint odour is normal
• Observe for: colour, clarity, odour, amount and particles
• If you observe that the urine looks or smells abnormal:
> DO NOT discard the urine – cover it with a labelled paper towel
and keep it in the client’s bathroom
> report to your supervisor
• Report complaints of urgency, burning on urination or dysuria
 Common Urinary Elimination Problems
Term Definition Causes
Dysuria Painful or difficult urination UTI, trauma, urinary tract obstruction
Hematuria Blood in urine Kidney disease, UTI, trauma
Increased perfusion to kidneys when lying
down, resulting in increased urine
Nocturia Frequent urination at night
production; excessive fluid intake; kidney
disease; disease of the prostate; CHF
Scant amount of urine –
Inadequate fluid intake, shock, burns,
Oliguria usually less than 500 mL in
kidney disease, heart failure
24 hours
Production of abnormally Medications, excessive fluid intake,
Polyuria
large amounts of urine diabetes, hormone imbalance
Urinary The need to urinate at Excessive fluid intake, bladder infections,
frequency frequent intervals pressure on the bladder, medications
 Common Urinary Elimination Problems
Term Definition Causes
Weak bladder muscles, resulting in
incomplete bladder emptying;
Overflow The leaking of urine when
blockage/obstruction; neurological
incontinence the bladder is too full
conditions (e.g. diabetic neuropathy,
multiple sclerosis and SCIs)
Trauma, disease, UTI, reproductive or
Inability to control the
Urinary urinary tract surgeries, aging, fecal
passage of urine from the
incontinence impaction, constipation, not getting to the
bladder
bathroom in time
Urinary The need to void UTI, fear of incontinence, full bladder,
urgency immediately stress
Transmission-based practices when assisting
with elimination
• Perform hand hygiene before and after wearing gloves
• Wear gloves whenever there is a risk for contact with urine, feces
secretions or mucous membranes
• Change gloves between procedures on the same client
• Remove contaminated gloves before touching a clean surface
• Remember that soiled incontinence briefs should never be placed on
the floor
• Wear a protective apron or gown if there is a chance that you might
be sprayed or splashed with blood, body fluids, etc
Transmission-based practices when assisting
with elimination
• Cover bedpans and tightly cap urinals when carrying them
• Dispose of body wastes immediately and carefully to avoid splashing
• If splashing occurs, clean the area immediately
• Clean and disinfect bedpans, urinals and commodes immediately
after use
• Place soiled disposable materials in leak-proof plastic bags. Seal them
tightly. Immediately discard bags according to employer policy
• Place soiled linen and clothing in a leak-proof plastic bag. Launder it
ASAP according to employer policy
• In a client’s home, wash soiled linen separately from other laundry
Guidelines for Maintaining Normal
Elimination
• Practice medical asepsis and follow Standard Practices
• Provide fluids as instructed in the care plan
• Monitor the client’s normal voiding routines and habits. Check with
your supervisor and the care plan
• Help the client to the bathroom (or provide a commode) when the
request is made
• Help client assume a normal position for voiding if possible
• Warm the bedpan or urinal under warm water
Guidelines for Maintaining Normal
Elimination
• Cover the client for warmth and privacy
• Ensure privacy. Leave the room if the client can be left alone
• Ease discomfort of clients who feel embarrassed about voiding with others
close by
• Remain nearby if the client is weak or unsteady
• Place the call bell and toilet tissue within reach
• Allow enough time to void
• Promote relaxation
• If client has difficulty initiating urination, try to place his fingers in warm
water or wrap a warm blanket around the client
Guidelines for Maintaining Normal
Elimination
• Provide thorough perineal care
• Assist with proper hand hygiene
• Assist client to the bathroom of offer the bedpan, urinal or commode
at regular intervals in case the client is too embarrassed or too weak
to ask
Bedpans
• Used for clients who are not able to get out of bed
• Female clients use bedpans for voiding and bowel movements
• Male clients use bedpans for bowel movements
• Types:
> regular bedpan
> fracture pan / slipper pan – has a thinner rim and is only 1 cm
deep at one end
• Follow medical asepsis, Standard Practices and employer policy when
handling bedpans and their contents
• Must be thoroughly cleaned after each use
Bedpans
• Slipper pan considerations:
- place smaller end under the buttocks
- used by the following clients: > in casts
> in traction
> with limited back motion
> with fragile bones / painful joints
> who have had hip fracture
 Giving the bedpan
If the client can assist
• From supine position, ask the client
to flex his knees
• Raise the buttocks by pushing against
the mattress with feet
• Slide your hand under the lower back
and help raise the buttocks
• Slide the bedpan under the client
 Giving the bedpan
If the client cannot assist
• Turn the client onto the side away from
you
• Place the bedpan firmly against the
buttocks (Figure A)
• Push the bedpan down and toward the
client (Figure B)
• Hold the bedpan securely. Turn the client
onto the back
• Make sure the bedpan is centered and
under the client
After getting the client on the bedpan…
• Raise the head of the bed so the
client is in the sitting position
• If the bed is not adjustable, assist
the client into the sitting position,
using pillows for support
• Make sure the client is correctly
positioned on the bedpan so that
the urethra and anus are directly
over the opening
Urinals
• Used by male clients when voiding
• Should never be placed on the client’s overbed table, bedside table or
stand
• Follow employer policy where to place urinals
• The client may stand (the best position), sit on the side of the bed, or
lie in bed while using the urinal
• Assist client with the procedure when necessary
Commodes
• A portable chair or wheelchair with an opening for a bedpan or
container
• Allows a normal position for elimination
• Some have wheels so they can be moved
• The bedpan or container should be cleaned after each use
• If a specimen is not required, placing a small amount of water in the
commode container / bedpan will allow for easier cleaning after use
Commodes
• For clients who cannot sit unsupported on the toilet, a commode may
be wheeled into the bathroom and positioned over the toilet, without
the bedpan or container in place
• Ensure that the commode wheels are locked
• Ensure that the commode is positioned correctly over the toilet
• Ensure that the client’s buttocks do not rub against the toilet while
you are positioning the commode chair over it
Commodes
• Clients should never be tied or restrained to a commode
• Clients who cannot sit up on their own should not be place on a
commode
• The longest time a client should be on a commode is 20-30 minutes
Urinary Incontinence
• The loss of bladder control
• May be temporary or permanent
• Problems r/t urinary incontinence: clothing and linens
get wet, odours develop, client is usually cold and
uncomfortable, the client can develop skin irritation, skin
breakdown and infection, the client may sustain injuries
by slipping or falling when rushing to the washroom
Urinary Incontinence
• Types:
- stress incontinence
- urge incontinence
- overflow incontinence
- functional incontinence
- reflex incontinence
- mixed incontinence
Urinary Incontinence
• Essentials:
- provide, frequent skin care
- change client into clean, dry garments after each episode
- promptly change wet bed linens*

*Failure to do so is a considered a form of neglect.

Care measure for clients with urinary
incontinence
• Record client’s voidings • Monitor bladder training
• Answer ALL calls for assistance program
promptly • Encourage to wear clothing that
• Promote normal urinary is easy to remove
elimination • Encourage to do pelvic muscle
• Promote normal bowel exercises, as directed by the care
elimination plan
• Encourage urination at • Help prevent UTIs
scheduled intervals • Provide proper skin care
 Care measure for clients with urinary
incontinence
• Provide dry garments and linens
• Observe for signs of skin
breakdown
• Use incontinence products
(“briefs”) as directed by the care Pull-on incontinence brief
plan
• Do not place soiled briefs on the
floor
• For clients who are catheterized, Complete incontinence brief
follow employer policy for securing
catheter to the client’s leg

Pant liner
Catheters
• Urinary catheter – a tube that is Purposes:
inserted into the bladder to drain • Used before, during and after
urine surgery to keep bladder empty
• Types: • Allow hourly urinary output
- straight measurements in clients with
- in-dwelling (aka retention / critical illnesses
Foley) • Last resort for managing
- suprapubic incontinence
- condom • Clients who are extremely weak /
have disabilities
• Diagnostic uses
Catheters
Catheters
Catheters
Catheters https://www.youtube.com/watch?v=yTFS3FILWGY
 When applying a condom catheter:
➢ Hold the penis firmly. Roll the condom onto the penis.
Catheters Leave a 2.5-cm space between the penis and the
catheter end
➢ Secure the condom with elastic tape. Apply in a spiral
manner
Giving catheter care
• Follow rules of medical asepsis and • Move drainage bag to the side of
Standard Practices the bed to which the client will be
• Make sure urine flows freely turned. You must move the bag
before the client
• Make sure that the tube remains • Do not let the bag rest on the floor
slack, never taut or pulled
• Make sure the catheter is • Coil the drainage tubing on the bed
connected to the drainage tubing • In women, secure the catheter to
• Keep drainage bag below the level the inner thigh. In men, to the
of the bladder thigh or lower abdomen
• Attach drainage bag to the bed • Check for leaks
frame or the back of the chair • Provide catheter care, if ordered,
once or twice a day
 • Also report the colour, clarity and
odour of urine and the presence of
particles
Giving catheter care • Encourage fluid intake as instructed
• Provide perineal care daily by the care plan
• Empty the drainage bag at the end • Always check the care plan before
of the shift or at intervals specified changing an in-dwelling catheter
in the care plan bag to a leg bag
• Use a clean, dry measuring
container to measure each client’s
urine
• Do not let the drain or the drainage
bag touch any surface
• Immediately report any complaints
of pain, burning, urge to urinate or
irritation
https://www.youtube.com/watch?v=mhDjHVvEaaA
https://www.youtube.com/watch?v=3u7OVDdCnuI
Cath-secure® Statlock®
Bladder training
• Helps restore bladder tone
• Developed for clients with urinary incontinence
• Some clients need this after removal of an in-dwelling catheter
• Goal: control of urination
Bladder training
First Method Second Method
• The client uses the toilet, • The client has a catheter
commode, bedpan or urinal at • The catheter is clamped usually
scheduled times for 1 hour at first, and eventually
• The client is given 15 or 20 mins 3-4 hours at a time
to initiate voiding • When the catheter is removed,
• Follow guidelines for encourage client to void every 3-
maintaining normal urination 4 hours or as directed by the
• Assume normal position if supervisor and the care plan
possible
References

Sorrentino, S. A., Remmert, L. N., & Wilk, M. J. (2018). Mosby's Canadian textbook for the
support worker (4th ed.). Toronto, ON: Elsevier.