Urinary Elimination and Factors Affecting Urination

• Urinary elimination involves the removal of waste products from the blood.
• Normal cellular body functions produce waste.
• Water and electrolyte balance are maintained.
• Acid-base balance is maintained.
• Inability to eliminate excess waste and fluid can result in illness and death.
• Healthy adults typically produce about 1500 ml of urine per day.

Factors Affecting Urine Production

• Age
• Disease
• The amount and kinds of fluid ingested
• Dietary salt
• Medication
• Other substances like coffee, tea, and alcohol

Key Terms

• Urination is the passing of urine from the body.
• Micturition is the process of expelling urine from the bladder.
• Voiding is the act of urinating or emptying the bladder.

Factors Affecting Frequency of Urination

• Amount of fluid intake
• Habits
• Availability of toilet facilities
• Activity
• Work
• Illness
• People usually void after getting up, before meals, and at bedtime.
• Incontinence is not a normal part of aging.
• Urine should be observed for colour, clarity, odour, amount, and particles; it is usually clear, has no particles, appears pale yellow straw-coloured or amber in colour and has a faint odour.
• Report any complaints of urgency, burning, pain with urination, or difficulty urinating, as these are usually signs of a urinary tract infection (UTI).

Common Urinary Elimination Problems

• Dysuria is painful or difficult urination and is caused by urinary tract infection, trauma, or urinary tract obstruction.
• Hematuria is blood in the urine and is caused by kidney disease, UTI, or trauma.
• Nocturia is frequent urination at night, resulting from increased perfusion to kidneys when lying down, increased urine production, excessive fluid intake, kidney disease, disease of the prostate, or congestive heart disease.
• Oliguria is a scant amount of urine, usually less than 500ml in 24 hours, and is caused by inadequate fluid intake, shock burns, kidney disease, or heart failure.
• Polyuria is the production of abnormally large amounts of urine and is caused by medications, excessive fluid intake, diabetes, or hormone imbalance.
• Urinary frequency is the need to urinate at frequent intervals and is caused by excessive fluid intake, bladder infection, pressure on the bladder, or medications.
• Overflow incontinence is the leakage of urine when the bladder is too full and is caused by weak bladder muscles, incomplete emptying of the bladder, blockage or obstruction, or neurological conditions like diabetic neuropathy, multiple sclerosis, and spinal cord injuries.
• Urinary incontinence is the inability to control the passage of urine from the bladder and is caused by trauma, disease, UTI, reproductive or urinary tract surgeries, aging, fecal impaction, constipation, or not getting to the bathroom in time.
• Urinary urgency is the need to void immediately and is caused by UTI, fear of incontinence, a full bladder, or stress.

Bedpans

• Used by clients who cannot get out of bed.
• Women use bedpans for voiding and bowel movements.
• Men use bedpans for bowel movements.

Two Types of Bedpans

• Standard
• Fracture pans are used for clients with casts, traction, limited back motion, fragile bones, painful joints, or hip fractures.
• Most men use urinals to void and can stand at the side of the bed if safe, sit on the edge of the bed if safe, or lie in bed.
• The patient may need support to stand or a PSW to place and hold the urinal.
• Remind men to call or signal after using the urinal.
• Do not place urinals on over-bed tables or bedside stands because you can get microbial cross-contamination with food.
• Never place a full urinal on the floor, to prevent it from being kicked over and spilled.
• Urinals need to be emptied, rinsed, and cleaned promptly to prevent odour.
• Do not empty urinals until the nurse indicates they do not need to observe or collect it.
• Keep the urinal for the nurse if you notice something abnormal such as blood or particles.
• Commodes are for clients unable to walk to the bathroom.
• Commodes allow a normal position for elimination, provide support, and help prevent falls.
• They can only be used if clients can support themselves in the commode.
• Some commodes are wheeled into bathrooms and placed over toilets.
• Ensure to remove the container if the commode is placed over the toilet.
• Ensure the wheels are locked.
• A client should never be tied or restrained to a commode

Urinary Incontinence

• Loss of bladder control.
• It may be temporary or permanent.

Basic Types of Incontinence

• Stress incontinence is dribbling.
• Urge incontinence is the sudden, intense, and uncontrollable urge to urinate, sometimes leading to involuntary leakage of urine before reaching a bathroom.
• Overflow incontinence occurs when the bladder can't empty completely, resulting in involuntary urine leakage.
• Functional incontinence is the inability to get to or use the toilet in time to urinate.
• Reflex incontinence occurs when bladder muscles involuntarily contract without warning or urge, causing urine leakage.
• Mixed incontinence is when someone experiences both urge incontinence and stress incontinence.
• If incontinence is a new problem, tell the nurse at once.
• Problems related to incontinence include embarrassment and discomfort for the client.
• Skin irritation, infection, and pressure ulcers are a risk.
• Falling is a risk because the client may rush to the washroom.
• The client's pride, dignity, and self-esteem are affected.
• Maintain good skin care and dry garments and linens.
• Promoting regular urinary elimination prevents incontinence in some clients; others need bladder training.
• Incontinence products help keep the client dry.
• Caring for clients with incontinence can be stressful.
• Clients with urinary incontinence need frequent, proper skin care and should be changed into clean, dry garments after each episode, and promptly changing wet bed linen is essential, and failure to do so is considered a form of neglect.

Ways a PSW helps Clients Maintain Normal Urination

• Offer regular use of the bathroom, urinal, bedpan, or commode often.
• Sometimes clients need reminders to empty their bladder frequently as they are getting used to a new elimination pattern or disability.
• Be quick to help clients to the bathroom when they ask.
• Clients may need to go urgently because their ability to hold even a little urine is decreased.
• Help the client use a normal position for elimination.
• Do not use briefs, bedpans, or urinals just because it takes too long to help your client to the bathroom or commode.
• Provide privacy and warmth.
• It is challenging to void under pressure and stress.

Incontinent Products

• Briefs ("Diaper"), pant liners, pull-on briefs.
• Risks include skin breakdown and psychological distress such as depression, anger, frustration, embarrassment, helplessness, and further loss of urinary control.
• Catheters: A urinary catheter is a tube that drains urine, inserted through the urethra and into the bladder.
• Straight catheters drain the bladder and then are removed, aka In and Out catheterization.
• An indwelling catheter is left in the bladder, with a balloon near the tip inflated with sterile water after insertion to prevent slipping.
• A suprapubic catheter is surgically inserted through the abdomen above the pelvic bone, with tubing connecting the catheter to the drainage bag.
• Catheterization is the process of inserting a catheter and is used before, during, and after surgery.
• Catheters are also used for clients who are too weak or disabled to use the bedpan, urinal, commode, or toilet, to protect wounds and pressure ulcers from contact with urine, allow hourly urinary output measurement, as a last resort for incontinence, for certain diagnostic purposes, and for clients with indwelling catchers, there is a high risk of infection.

Drainage Systems

• A drainage system is a type of bag which collects and holds urine as it drains from the urinary catheter and a closed drainage system is used for indwelling catheters.
• Nothing can enter the system from the catheter to the drainage bag.

Leg Bags

• Leg bags are worn by some clients when they are out of bed, rectangular in shape, and strapped to the client's thigh.
• Leg bags must be changed to drainage bags when the client is in bed.

Care for Catheters

• The drainage bag is always kept lower than the client's bladder and does not touch the floor.
• Never hang a drainage bag on the bed rail, because when raised, the bag will be higher than the bladder.
• When raising and lowering the side rail, the catheter could be pulled out of the body.
• Position or cover the drainage bag to reduce its visibility.
• Most people do not like others to see their urines.
• When measuring urine, follow standard practices and wear gloves
• The PSW empties the drainage bag directly into the toilet if the client is in the bathroom or into a separate container.
• Place a blue pad underneath the container and empty the urine into it.
• Take the urine to the bathroom and flush down the toilet.
• Never use measurements marked on the drainage bag, as they are inaccurate.
• Use a clear graduated measuring cup or the urometer attached to the bag for precise measurement.
• For accuracy, read measurement at eye level.
• Note and record the amount, colour, odour, and abnormal particles.

Accidental Disconnection

• If the drainage systems become disconnected, tell the nurse right away due to the high risk of UTIs, as the urinary system is now exposed to microbes.
• Do not touch the end of the catheter or drainage tube.
• Practice good hygiene and put on gloves.
• Wipe the ends of the tubes with alcohol wipes, without putting the ends down.
• Wipe the end of the catheter with alcohol wipes, without touching the ends after cleaning them.
• Connect the tubing into the catheter.
• Discard the wipes into a garbage bag.
• Remove the gloves and practice hand hygiene.

Condom Catheter

• Condom catheters are sometimes used for men who are incontinent.
• A condom catheter is a sheath that slides over the penis, and a condom-like sheath has a tube that connects to a drainage bag.
• No catheter enters the urethra.
• Wash the penis thoroughly with soap and water.
• Dry the penis well before applying the condom.
• There is a risk of pressure sores from the condom catheter.
• Condom catheters are applied with a special elastic tape.
• Never apply the tape in a complete circle, as it will cause constriction; apply it in a spiral motion.

When to Drain Bags and Empty Urine

• At the end of every shift
• If leaking
• When the bags are full
• When changing from a leg bag to a drainage bag and vice versa

Urine Specimens

• Urine samples are collected and tested to prevent, detect, and treat disease.
• The doctor orders what specimen to collect and the test needed, and most specimens are tested in the laboratory, so requisition is required.
• All urine voided during a 24-hour period is collected
• Urine is chilled on ice or refrigerated during this time in a container.
• The test must be restarted if a voiding was not saved or if toilet tissue or feces was discarded into the specimen.

Ureterostomy

• A urinary diversion between the ureter and the abdomen to treat cancer and bladder injury.
• Bladder is surgically removed to treat cancer and bladder injury.
• An artificial opening called a stoma.
• Stomas do not have nerve endings and are not painful.
• Ostomy Appliance: A pouch on the outside of the body that covers a surgically created stoma on the abdomen.
• The appliance is replaced anytime it leaks, as urine can cause skin irritation, skin breakdown, and infection.
• Because there is a risk of breakdown, always be sensitive to the client's feelings, such as embarrassment.