Urinary System and Urine Specimen Types

• The urinary system filters, reabsorbs, and excretes to maintain fluid and electrolyte balance and remove water-soluble wastes.

Urine Characteristics and Influencing Factors

• Volume, color, clarity, and odor are physical characteristics of urine.
• Physiological, emotional, and social factors affect urinary elimination.
• Neuromuscular development, spinal cord integrity, fluid intake/output, food consumption, circadian rhythm, habits, opportunities, and anxiety are examples of factors affecting urinary elimination.

Urine Specimen Types

• A voided specimen is a fresh urine sample in a clean container; the first morning sample is preferred due to concentrated components.
• A clean-catch specimen is a sterile voided sample, also known as a midstream specimen, collected after cleansing the urethra and initiating the urine stream.
• A catheter specimen is collected by clamping the drainage tube for 30 minutes and aspirating a sample through a latex catheter lumen or self-healing port.
• A 24-hour specimen involves collecting all urine produced in a 24-hour period.

Alternative Urinary Elimination Devices

• Commode, urinal, and bedpan.

Continence Training

• Continence training, or bladder training, helps restore urination control by teaching individuals to delay urination until an appropriate time.

Urinary Catheter Types

• External/condom, straight, and retention.

Closed Drainage System Principles

• Avoid compressing the tubing to prevent obstruction.
• Keep the drainage bag below the bladder to prevent urine backflow.

Catheter Care Importance

• Catheter care prevents infection and the spread of colonizing pathogens by maintaining cleanliness of the meatus and adjacent area.
• Catheterized individuals are at risk for urinary tract infections (UTIs).

Catheter Irrigation

• Catheter irrigation restores or maintains catheter patency by flushing the lumen.
• Well-draining catheters typically do not require irrigation; adequate fluid intake can help prevent obstruction.
• Open, closed, and continuous irrigation.

Urinary Diversion

• Urinary diversion involves surgically implanting one or both ureters elsewhere, such as bringing the ureter through the abdominal skin or implanting it within the bowel (ileal conduit); this is done for life-threatening conditions.

Urostomy and Skin Integrity

• Continuous urine drainage from a urostomy increases skin breakdown risk.
• Moisture and weight from the urinary appliance can loosen it, so frequent emptying and changes are needed.
• Skin barrier products like antibiotic or steroid ointments are used.

Vocabulary

• Anuria is the absence of urine or a volume of 100mL or less in 24 hours.
• CAUTIs are catheter-associated urinary tract infections.
• A closed drainage system is a device used to collect urine from a catheter.
• The Credé maneuver involves bending forward and applying hand pressure over the bladder to stimulate urination.
• Cutaneous triggering involves lightly massaging or tapping the skin above the pubic area to stimulate urination.
• Dysuria is difficult or uncomfortable voiding, often due to trauma or bladder infection.
• An external catheter (condom catheter) is a urine-collecting device applied to the skin around the penis, not inserted in the bladder; more effective for male clients.
• A fenestrated drape is a drape with an open circle at its center.
• Frequency is the need to urinate often.
• Incontinence is the inability to control urinary or bowel elimination.
• Nocturia is nighttime urination.
• Oliguria is urine output less than 400mL in 24 hours, indicating inadequate elimination and possible incomplete bladder emptying.
• Peristomal skin is the skin around the stoma.
• Polyuria is greater-than-normal urinary elimination, potentially related to dietary variations.
• Residual urine is more than 50mL of urine remaining in the bladder after voiding, increasing the risk of microorganism growth and infection.
• A retention catheter (indwelling catheter) is left in place for a period of time, such as a Foley catheter.
• Stasis is the lack of urinary movement.
• A straight catheter, a urine drainage tube is inserted but not left in place; it drains urine temporarily or provides a sterile urine specimen.
• Urgency is a strong feeling that urine must be eliminated quickly.
• Urinary diversion is a procedure in which one or both ureters are surgically implanted elsewhere.
• Urinary elimination is the process of releasing excess fluid and metabolic wastes or urination.
• Urinary retention is when a client produces urine but does not release it from the bladder, indicated by a distended bladder.
• A urostomy is a urinary diversion that discharges urine from an opening on the abdomen.
• The voiding reflex is the spontaneous relaxation of the urinary sphincter in response to physical stimulation.