Urinary Elimination and Normal Urination

Urinary Elimination

• Urinary elimination involves the removal of waste from the body.
• It also includes the maintenance of water, electrolyte, and acid-base balance.
• The inability to eliminate waste and fluids can lead to illness and death.
• Normal cellular functions produce waste products.

Normal Urination

• Healthy adults produce about 1,500 mL of urine per day.
• Factors affecting urine production include age, disease, fluid intake, dietary salt, medications, coffee, tea and alcohol.

Urination, Micturition, Voiding

• Frequency of urination is affected by fluid intake, habits, available toilet facilities, activity, work, and illness.
• People usually void after getting up, before meals, and at bedtime.
• Incontinence is not a normal part of aging.

Observations

• Assess and record the urine colour, clarity, odour, amount, and any particles present.
• Normal urine is pale yellow, straw or amber in colour; clear with no particles, and, has a faint odour.
• Any reports of urgency, burning or pain are significant indicators.

Common Urinary Problems

• Dysuria is painful or difficult urination most commonly caused by a urinary tract infection, trauma, or a urinary tract obstruction.
• Hematuria, or blood in the urine, can be caused by kidney disease or a urinary tract infection.
• Nocturia is frequent urination at night which can be caused by increased perfusion to the kidneys when lying down, excessive fluid intake, kidney disease, disease of the prostate, or congestive heart failure.
• Oliguria is a scant amount of urine, usually less than 500mL in 24 hours, that can be caused by inadequate fluid intake, shock, burns, kidney disease, or heart failure.
• Polyuria, which is the production of abnormally large amounts of urine, can be caused by medications, excessive fluid intake, diabetes, or a hormone imbalance.
• Urinary frequency is the need to urinate at frequent intervals, and excessive fluid intake, bladder infections, pressure on the bladder, and medications can cause this.
• Overflow incontinence is the leaking of urine when the bladder is too full, which can occur due to weak bladder muscles, 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. Trauma, disease, urinary tract infections, reproductive or urinary tract surgeries, aging, fecal impaction, or constipation can cause it.
• Urinary urgency is the need to void immediately and can be caused by a urinary tract infection, fear of incontinence, a full bladder, or stress.

Bedpans

• Bedpans are for clients who cannot get out of bed.
• Women use bedpans for voiding and bowel movements.
• Men use bedpans for bowel movements.
• Key points to consider for clients who use bedpans are fragile bones and painful joints.
• Two types of bedpans exist: standard and fracture pans.

Urinals

• Most men use urinals to void.
• To use a urinal, the male client can either stand, sit on the side of the bed if safe, or lie in bed. Assistance and support may be needed.
• Remind men to call or signal after using the urinal.
• A full urinal on the floor could spill.
• Do not place urinals on over-bed tables or bedside stands in order to prevent microbial cross-contamination.
• Empty, rinse, and clean urinals promptly to prevent odours.
• Do not empty urinals before the nurse has observed or collected the urine.
• Notify the nurse of any abnormalities observed like blood or particles in the urine.

Commodes

• Commodes are for clients unable to walk to the bathroom
• A commode allows a normal position for elimination
• A commode provides support and helps prevent falls.
• To use a commode, the client needs to support themselves.
• Some commodes are wheeled into bathrooms and placed over toilets.
• If used over the toilet, the container is removed.
• Lock the wheels after positioning the commode.
• Do not tie or restrain a client to a commode

Urinary Incontinence

• The loss of bladder control can be temporary or permanent.
• Basic types of incontinence are stress, urge, overflow, functional, reflex, and mixed.
• Tell the nurse if incontinence is a new problem.

Problems Related to Incontinence

• Incontinence can cause embarrassment and discomfort.
• There may be an increased risk of skin irritation, infection, and pressure ulcers.
• Risk of falls increases as the client rushes to the washroom.
• Can also affect on the client’s pride, dignity, and self-esteem.
• Good skin care and dry garments are essential.

Promoting Normal Urinary Elimination

• Preventing incontinence may be possible with normal urinary elimination.
• Others may need bladder training.
• Sometimes catheters are needed.
• Incontinence products help keep the client dry.
• Caring for clients with incontinence can be stressful.
• Notify the nurse it personal becomes overly stressful.
• Every client has the right to be free from abuse, mistreatment, and neglect.

How to Assist Clients

• Offer regular use of the bathroom, urinal, bedpan, or commode.
• Remind clients to empty their bladder frequently.
• Taking the time to assist can lessen the workload by preventing soiling of lines and clothing.
• Be quick to help clients to the bathroom on their request.
• Help the client to use a normal position for elimination as much as possible.
• Provide privacy, warmth, and relaxation.
• It is difficult to void under pressure and stress.
• Taking the time to assist clients is important for normalcy and psychological well-being.
• It also helps with range of motion and skin integrity.
• Do not use briefs, bedpans, or urinals because it does not take as long to help your client to the bathroom or commode.

Incontinence Products

• Types of incontinence garment protectors include briefs, pad liners, and pull-on briefs.
• Skin breakdown, psychological distress, depression, anger, frustration, embarrassment, helplessness, and further loss of urinary control are the risks associated with briefs.

Catheters

• Urinary catheter: a tube that drains urine inserted through the urethra and into the bladder.
• A straight catheter drains the bladder once and is then removed.
• An indwelling catheter or Foley catheter remains inside the bladder.
• A suprapubic catheter is surgically inserted through the abdomen above the pubic bone.
• Catheterization is the process of inserting a catheter.
• Catheters are often used before, during, and after surgery.
• Often used for clients who are too weak or disabled to use the bedpan, urinal, commode, or toilet.
• Wounds and pressure ulcers can be protected from contact with urine via catheters.
• Catheters enable hourly urine output measurements.
• It is a last resort for incontinence and does not treat the cause.
• Catheters are used for certain diagnostic purposes.
• Risk of infection is high for clients with indwelling catheters.

Drainage Systems

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

Leg Bags

• Some clients wear leg bags when they are out of bed.
• The bag is rectangular and strapped to the client's thigh.
• Leg bags must be changed back to drainage bags when the client is in bed.

Drainage Bags: Considerations

• Always keep the drainage bag lower than the client's bladder.
• The drainage bag must not touch the floor.
• Never hang a drainage bag on the bed rail,
• The bag will be higher than the bladder, when the bed rail is raised.
• The catheter could be pulled by you when raising and lowering the side rail.
• Position or cover the drainage bag to reduce its visibility.
• Reduce visual observation of others urine for Promoting Dignity, Independence, Preferences, Privacy, and Safety (DIPPS).

Measuring Urine

• Standard practices are to use gloves.

• Empty the drainage bag.

• Usually emptied into a separate container

• An incontinence pad must be placed underneath.

• If the client is in the bathroom, it can be emptied directly into the toilet.

• Never use measurements marked on the drainage bag due to their innacuracy.

• Important to use a clear graduated measuring cup or urometer.

• Accurately read measurements at eye level.

• Record the amount, colour, odour, and note and report for any abnormal particles.

Accidental Disconnection

• If there is accidental disconnection, the nurse should be notified right away!
• There is a high risk for urinary tract infection (UTI).
• Sterile and exposed areas must be respected.
• Practice hand hygiene and use gloves . Wipe the ends of the tube with an alcohol wipe & do not put the ends down. Wipe the end of the catheter with an antiseptic wipe (do not touch after cleaning). Connect the tubing to catheter & discard wipes in biohazard bag. Remove glove and practice hand hygiene.

Condom Catheter

• Secured with a special elastic tape.
• Perform skin care, inspect perineum, and record observations.
• If foreskin is present, return it to its natural position.
• Never apply the tape in a complete circle.

When To Drain/Empty

• At the end of every shift
• When changing from a leg bag to a drainage bag
• When changing from a drainage bag to a leg bag
• When the bag is becoming full
• If leaking

Urine Specimens

• Specimens (samples) are collected and tested to prevent, detect, and treat disease.
• A doctor will order what specimen to collect and the test needed.
• All specimens are tested in the laboratory.
• All specimens sent to the laboratory require a requisition slip.
• Some tests are done at the bedside.

24-Hour Urine Specimen

• All urine voided during a 24-hour period is collected.
• The urine is chilled on ice or refrigerated during this time.
• The test must be restarted if voiding was not saved; toilet tissues were discarded into the specimen or the specimen contains faces.

Ureterostomy

• A urinary diversion/artificial opening between the ureter and the abdomen in the event the bladder is surgically removed.
• Can treat cancer/bladder injuries in this case.
• Artificial opening is known as stoma
• Stomas do not have nerve endings so the process is painless.

Ostomy Appliance

• An ostomy appliance is a pouch that covers the stoma, and skin requires routine skin care, as well as sensitivities to the client's feelings.
• An ostomy appliance is replaxed when urine leaks as it can cause skin irritation, skin breakdown, and the infection of the stoma site.
• This can lead to potential client embarrassement, so carefullness is needed.