Taylor10e PowerPoint Presentations Chapter 38

Chapter 38
Urinary Elimination
Copyright © 2011
Copyright Wolters
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Urinary System
❖ Kidneys and ureters

❖ Bladder
❖ Urethra
Copyright © 2023 Wolters Kluwer • All Rights Reserved

Female and Male Urinary Tracts

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
o Urine from the nephrons empties into the
kidneys

Bladder
❖ Smooth muscle sac innervated by ANS

❖ 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

The Urinary Bladder

Urethra
❖ Conveys urine from the bladder to the exterior

❖ Male urethra functions in excretory and reproductive
systems
❖ No portion of female urethra is external to the body

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

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

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.

Factors Affecting Micturition
❖ Developmental considerations
o Toilet training
o Effects of aging
❖ Food and fluid intake
❖ Psychological variables
❖ Activity and muscle tone
❖ Pathologic conditions
❖ Medications

Developmental Considerations
❖ Children
o Toilet training 2 to 3 years old, enuresis
❖ Effects of aging
o Nocturia
o Increased frequency
o Urine retention and stasis
o Voluntary control affected by physical problems

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

Answer: A. True
Rationale: Diuretics cause increased urine

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

Diseases Associated With Renal Problems
❖ Congenital urinary tract abnormalities

❖ Polycystic kidney disease
❖ Urinary tract infection
❖ Urinary calculi
❖ Hypertension
❖ Diabetes mellitus
❖ Gout
❖ Connective tissue disorders

Effects of Medications on Urine
Production and Elimination
❖ Diuretics: prevent reabsorption of water and certain

electrolytes in tubules
❖ Cholinergic medications: stimulate contraction of
detrusor muscle, producing urination
❖ Analgesics and tranquilizers: suppress CNS, diminish
effectiveness of neural reflex

Medications Affecting Color of Urine
❖ Anticoagulants: red urine

❖ Diuretics: pale yellow urine
❖ Pyridium: orange to orange-red urine
❖ The antidepressant amitriptyline or B-complex
vitamins: green or blue-green urine
❖ Levodopa: brown or black urine

Nursing History
❖ Usual patterns of urinary elimination

❖ Recent changes in urinary elimination
❖ Aids to elimination
❖ Present or past occurrence of voiding difficulties
❖ Presence of urinary diversion

Physical Assessment of
Urinary Functioning
❖ Kidneys: Palpation of the kidneys is usually

performed by an advanced health care practitioner
as part of a more detailed assessment
❖ Urinary bladder: Palpate and percuss the bladder or
use a bedside scanner
❖ Urethral orifice: Inspect for signs of infection,
discharge, or odor
❖ Skin: Assess for color, texture, turgor, and excretion
of wastes
❖ Urine: Assess for color, odor, clarity, and sediment

Additional Assessment Techniques
❖ Measuring urinary output

o Continent patients
o Incontinent patients
o Indwelling catheter
❖ Routine urinalysis
o Clean-catch or midstream specimen
o Sterile specimen
o Urinary diversion specimen
o 24-hour specimens

Question #3

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

Answer: B. False
Rationale: Normal fresh urine has an aromatic odor.

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

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

Question #4

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

Answer: B. False
Rationale: A urine specimen from a patient with an

indwelling catheter should be obtained from the
catheter itself.

Patient Health Problems
❖ 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

Promoting Urinary Elimination
❖ Maintaining regular voiding habits

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

Planned Patient Goals
❖ Produce urine output about equal to fluid intake

❖ Maintain fluid and electrolyte balance
❖ Empty bladder completely at regular intervals
❖ Report ease of voiding
❖ Maintain skin integrity
❖ Demonstrate appropriate self-care behaviors

Promoting Normal Urination
❖ Maintaining normal voiding habits

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

Patients at Risk for UTIs
❖ Sexually active people with female genitalia

❖ People who use diaphragms for contraception
❖ Postmenopausal people
❖ People with indwelling urinary catheter in place
❖ People with diabetes mellitus
❖ Older adults

Types of Urinary Incontinence
❖ Transient: appears suddenly and lasts 6 months or less

❖ Mixed: urine loss with features of two or more types of
incontinence
❖ Overflow: overdistention and overflow of bladder
❖ Functional: caused by factors outside the urinary tract
❖ Reflex: emptying of the bladder without sensation of need to
void
❖ Total: continuous, unpredictable loss of urine
❖ Stress: involuntary loss of urine related to an increase in
intra-abdominal pressure

External Urine Collection Devices
❖ Urinary sheath
❖ Urine collection system

Reasons for Catheterization
❖ Relieving acute urinary retention

❖ 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
❖ Prolonged patient immobilization

Types of Catheters
❖ Intermittent urethral catheters

❖ Indwelling urethral catheter
❖ Suprapubic catheter

Nursing Interventions
❖ Urethral catheter insertion and care for patients with

an indwelling catheter
❖ Caring for a patient with a urologic stent
❖ Caring for a patient with a urinary diversion
❖ Caring for a patient receiving dialysis

Question #5

There are no interventions effective for preventing
urinary incontinence.
A. True
B. False

Answer: B. False
Rationale: There are appropriate interventions

effective for preventing urinary incontinence.

Factors to Consider With
Use of Absorbent Products
❖ Functional disability of the patient

❖ Type and severity of incontinence
❖ Gender
❖ Availability of caregivers
❖ Failure with previous treatment programs
❖ Patient preference

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Chapter 38

❖ Kidneys and ureters

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Maintain composition and volume of body fluids

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Smooth muscle sac innervated by ANS

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Conveys urine from the bladder to the exterior

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Process of emptying the bladder

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Which term describes a condition in which 24-hour

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Rationale: Anuria is synonymous with kidney

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Tell whether the following statement is true or false.

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Rationale: Diuretics cause increased urine

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Congenital urinary tract abnormalities

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Diuretics: prevent reabsorption of water and certain

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Anticoagulants: red urine

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Usual patterns of urinary elimination

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Kidneys: Palpation of the kidneys is usually

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Measuring urinary output

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Tell whether the following statement is true or false.

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Rationale: Normal fresh urine has an aromatic odor.

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Ask the patient to void into a bedpan, urinal, or

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Tell whether the following statement is true or false.

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Rationale: A urine specimen from a patient with an

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Urinary functioning as the problem

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Maintaining regular voiding habits

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Produce urine output about equal to fluid intake

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Maintaining normal voiding habits

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Sexually active people with female genitalia

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Transient: appears suddenly and lasts 6 months or less

Copyright © 2023 Wolters Kluwer • All Rights Reserved

Copyright © 2023 Wolters Kluwer • All Rights Reserved

❖ Relieving acute urinary retention