Urinary EliminationBy Richard Araneta

Characteristics of Urine

•Color▫Amber/ straw

•Odor▫Aromatic upon voiding

•Transparency▫Clear

•pH▫Slightly acidic (4.6-8; average 6)

Characteristics of Urine

•Specific gravity▫1.010-1.025

High – concentrated urine Low – diluted urine

•Amount▫30-60 cc./hour = 1500 cc./day

Problems in Urinary Elimination

•Altered Urine Composition▫RBC – hematuria▫WBC▫Pus – pyuria▫Bacteria – bacterunia▫Albunin – albuminuria▫Protein – proteinuria▫Casis – cylindruria ▫Glucose – glycosuria▫Ketoes – ketonuria

Problems in Urinary Elimination

•Altered urine production▫Polyuria – excessive urination

More than 100 cc/hour Above 2500 cc/day (diuresis)

▫Oliguria – decreased urination Less than 30 cc/hour 100-500 cc/day

▫Anuria – absence of urine 0-10 cc/hour = less than 100 cc/day Urinary suppression

Altered Urinary Elimination

•Frequency•Nocturia – frequent during the night•Urgency – strong feeling that a person wants to

void•Dysuria•Hesitancy – difficulty in initiating voiding•Enuresis – repeated involuntary voiding beyond

4-5 yr old

Altered Urinary Elimination

•Pollakuria – frequent daytime urination•Urinary incontinence▫Total incontinence

A continuous and unpredictable loss of urine Ex: injury to external urinary sphincter in males

▫Functional incontinence The involuntary unpredictable passage of urine With intact urinary and nervous system Cause – change in environment, sensory , in

cognitive, or mental defects

Altered Urinary Elimination▫Stress incontinence

Leakage less than 50 cc as a result of sudden increase in intra-abdominal pressure Ex: when one coughs, sneezes, laughs or exerts physically

▫Urge incontinence Follows a sudden strong desire to urinate Unable to stop urine flow one it start as in the elderly

▫Reflex incontinence Is an involuntary loss of urine occurring at somewhat

predictable intervals when a specific bladder volume is reacted

Altered Urinary Elimination

•Urinary retention▫Accumulation of urine in bladder with associated

inability of bladder to empty itself -> 250-400 cc. urine in bladder triggers urination

For Urinary Incontinence

•Bladder retraining program – establishes regular voiding time

•Avoid large amounts of fruit juices and carbonated drinks

•Schedule diuretics in AM•Adequate fluid intake•Avoid stimulants at night•Kegel’s exercise

Clinical Signs of Urinary Retention

•Discomfort in the pubic area•Bladder distention• Inability to void or frequent voiding of small

volumes•A disproportionately small amount of fluid output

in relation to intake• Increasing restlessness and need to void

Nursing Measures to Induce Voiding

•Provide privacy•Provide fluids to drink•Assist in proper positioning for voiding•Serve clean, warm, and dry bedpan•Allow to listen to sound of running water etc.•Alternate warm and cold water over perineum •Promote relaxation•Provide adequate time for voiding