Chapter 44 Urinary Elimination

Mosby items and derived items 2005 by Mosby, Inc.

Urinary System
Kidneys Ureters Bladder Urethra Act of urination

Mosby items and derived items 2005 by Mosby, Inc.

Factors Influencing Urination

Disease conditions Sociocultural factors Psychological factors Muscle tone

Mosby items and derived items 2005 by Mosby, Inc.

Factors Influencing Urination (cont'd)

Fluid balance Surgical procedures Medications Diagnostic examinations

Mosby items and derived items 2005 by Mosby, Inc.

Alterations
Urinary retention Urinary tract infections Urinary incontinence Urinary diversions

Mosby items and derived items 2005 by Mosby, Inc.

Urinary Incontinence
Functional Overflow Reflex Stress Urge

Mosby items and derived items 2005 by Mosby, Inc.

Infection Control and Hygiene

Asepsis Client education Catheterization and other procedures

Mosby items and derived items 2005 by Mosby, Inc.

Growth and Development

Infants Toddlers and young children Adults Older adults

Mosby items and derived items 2005 by Mosby, Inc.

Psychosocial Considerations
Self-concept Culture Gender

Mosby items and derived items 2005 by Mosby, Inc.

Assessment of Urinary Elimination

Nursing history
Pattern of urination Symptoms of alterations Factors affecting urination

Mosby items and derived items 2005 by Mosby, Inc.

Assessment of Urinary Elimination (cont'd)

Physical assessment
Skin and mucous membranes Kidneys Bladder Urethral meatus

Mosby items and derived items 2005 by Mosby, Inc.

Assessment of Urinary Elimination (cont'd)

Assessment of urine
Intake and output Characteristics: color, clarity, odor Urine testing: specimen collection

Mosby items and derived items 2005 by Mosby, Inc.

Assessment of Urinary Elimination (cont'd)

Common urine tests
Urinalysis Specific gravity Culture

Diagnostic examinations
Consents Allergies Pre- and postprocedure interventions
Mosby items and derived items 2005 by Mosby, Inc.

Nursing Diagnoses
Incontinence Risk for infection Toileting self-care deficit Impaired urinary elimination Urinary retention

Mosby items and derived items 2005 by Mosby, Inc.

Planning
Goals and outcomes
Client will void within 8 hours after catheter removal Clients bladder is not distended on palpation

Setting priorities Continuity of care

Mosby items and derived items 2005 by Mosby, Inc.

Implementation: Health Promotion

Client education Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake Promoting complete bladder emptying Preventing infection: hygiene and acidifying urine
Mosby items and derived items 2005 by Mosby, Inc.

Implementation: Acute Care

Maintaining elimination habits Medications Urethral catheterization Alternatives to urethral catheterization: suprapubic catheters, condom catheters

Mosby items and derived items 2005 by Mosby, Inc.

Urethral Catheterization
Types Insertion Drainage systems Routine care: hygiene, fluids Prevention of infection Irrigations and instillations Removal
Mosby items and derived items 2005 by Mosby, Inc.

Implementation: Restorative Care

Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort

Mosby items and derived items 2005 by Mosby, Inc.

Evaluation
Client care Client expectations

Mosby items and derived items 2005 by Mosby, Inc.