Altered Urinary Elimination

Altered Urinary Elimination

• Polyuria (diuresis): production of large amounts of urine without increased fluid intake, can lead to intense thirst (polydipsia), often seen in patients with diabetes, diabetes insipidus, and chronic nephritis.
• Oliguria: low urine output.
• Anuria: lack of urine production.

Altered Urinary Elimination

• Urinary frequency: need to urinate often.
• Nocturia: voiding two or more times at night.
• Urgency to urinate: feeling that one must urinate immediately.
• Dysuria: painful or difficult voiding.
• Enuresis/bed-wetting: involuntary passing of urine in children after bladder control is achieved.
• Urinary incontinence: temporary or permanent inability of the external sphincter muscles to control the flow of urine from the bladder.

Types of Urinary Incontinence

• Stress urinary incontinence: involuntary loss of urine secondary to increased intraabdominal pressure, often triggered by physical activities like laughing, sneezing, straining, coughing, or exercising.
• Urge urinary incontinence: sudden, intense urge to urinate followed by an involuntary loss of urine.
• Mixed urinary incontinence: symptoms of both stress and urge urinary incontinence.
• Overflow urinary incontinence: involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and/or bladder outlet obstruction.

Urinary Retention

• Condition in which one is unable to empty all the urine from the bladder.

Average Daily Urine Output by Age

• Not specified.

Nursing Management

Assessing

• Nursing history: assess voiding pattern, frequency, appearance of urine, and any recent changes or past/current problems with urination.
• Physical assessment: percussion of kidneys to detect areas of tenderness, palpation and percussion of bladder, inspection of urethral meatus for swelling, discharge, or inflammation, and assessment of skin color, texture, and tissue turgor for edema.
• Assessing urine: measure urine output, which is normally 60mL/h or about 1500mL/day in adults, and factors affected by fluid intake, perspiration, breathing, diarrhea, cardiovascular, and renal status.
• Urine output below 30 mL/h may indicate low blood volume or kidney malfunction.

Diagnostic Tests

• Blood tests: Blood Urea Nitrogen (BUN) and creatinine.
• 24-hour urine collection: measures creatinine clearance.
• Collecting urine specimens: measures specific gravity.

Nursing Intervention

Maintaining Normal Urinary Elimination

• Promoting fluid intake: increase fluid intake to increase urine production, stimulate the micturition reflex, and maintain normal daily intake of 1500mL for normal adults.
• Maintaining normal voiding habits.

Preventing Urinary Tract Infections

• Fluid intake: drink eight 8-ounce glasses of water per day to flush bacteria out of the urinary system.
• Hygiene: practice frequent voiding (every 2 to 4 hours) to flush bacteria out of the urethra and prevent organisms from ascending into the bladder.

Managing Urinary Incontinence

• Continence (bladder) retraining.
• Pelvic floor muscle exercise (Kegels).
• School-age children: enuresis, bed-wetting, and nocturnal enuresis.

Factors Affecting Voiding

• Development factors: infants, preschoolers, and older adults.
• Psychosocial factors: privacy, normal position, sufficient time, and running water.
• Fluid and food intake: caffeine, sodium, and certain foods can affect urine production.
• Medication: diuretics, chlorothiazide, or furosemide (Lasix).
• Muscle tone: good muscle tone maintains stretch and contractility of the detrusor muscle and pelvic muscle tone.
• Pathologic conditions: renal failure, heart failure, urinary calculus, and hypertrophy of the prostate gland.
• Surgical and diagnostic procedures: cystoscopy, spinal anesthetics.