Nursing: Urinary Elimination

• These notes refer to the Fundamentals of Nursing (Potter & Perry, 11th Edition), focusing on urinary elimination

Urinary Tract Infections

• Cloudy urine with a foul odor is a common sign.
• Dark amber urine indicates dehydration, not a UTI.

Urinary Incontinence

• Stress incontinence is caused by weakened pelvic floor muscles, leading to leakage when coughing or sneezing.
• Implementing a scheduled toileting program is most appropriate for functional incontinence which is due to physical or cognitive impairment.
• Scheduled toileting helps prevent accidents.
• Regular Kegel exercises can strengthen pelvic floor muscles, preventing incontinence.

Clean-Catch Urine Samples

• Allow the first urine to pass before collecting the sample.
• The first part of the urine flushes bacteria from the urethra, ensuring a cleaner midstream sample.

Urinary Catheters

• A fever and cloudy urine in a patient with a urinary catheter suggests a UTI.
• Collect a urine specimen for culture to confirm infection and guide treatment.
• Prevent catheter-associated urinary tract infections (CAUTI) by keeping the drainage bag below bladder level.
• This prevents urine backflow, reducing infection risk.
• Fever and flank pain in a patient with a urinary catheter suggests a kidney infection (pyelonephritis).
• This condition requires immediate attention.
• Obtain a sterile urine sample from an indwelling catheter using a sterile syringe to withdraw urine from the catheter port.
• This method maintains sterility and provides an uncontaminated sample.

Diet and Urinary Health

• Drinking cranberry juice can reduce the risk of recurrent UTIs.
• Cranberry juice contains compounds that prevent bacteria from adhering to the bladder wall.
• Patients with kidney disease should limit protein intake, as excess protein increases kidney workload, worsening kidney disease.

Post-Surgical Urinary Retention

• Perform a bladder scan as the nurse's first action when a post-surgical patient has not voided for 8 hours.
• A bladder scan determines if there is urine retention before taking further action.

Nocturia

• Limit fluid intake in the evening to reduce nighttime urination frequency.

Difficulty Initiating Urination

• Encourage the patient to use a warm bedpan to relax the urinary sphincter and promote voiding naturally.

Medications for Urge Incontinence

• Anticholinergic medications reduce bladder spasms but can cause dry mouth.