Urinary System Functions and Urination

Functions of the Urinary System

• Waste products are removed from the body via the blood
• Helps in maintaining the body’s water, electrolyte, and acid-base balance
• Normal cellular body functions produce waste
• Excess fluid that is ingested but not used is a part of water balance
• Excess electrolytes, minerals, and vitamins from food are needed to maintain electrolyte balance
• Imbalance to these functions can lead to severe illness and death

Normal Urination

• A healthy adult produces approximately 1,500 mL of urine daily
• Factors affecting urine production include:
  • Age and individual diseases
  • Amount and kinds of fluid ingested
  • Dietary salt and medications used
  • Coffee, tea and alcohol consumption

Urination, Micturition, Voiding

• Frequency affected by:
  • Fluid intake, habits, and available toilet facilities
  • Activity level, work type, and illness
• Voiding typically occurs after waking up, before eating, and at bedtime
• Incontinence is not a normal part of aging

Observations

• Normal urine should be pale yellow, straw, or amber colored
• Normal urine is clear with no particles and has a faint odor
• Report: Complaints of urgency, burning, or pain

Common Urinary Elimination Problems

• Dysuria: Painful or difficult urination often caused by urinary tract infection, trauma, or obstruction
• Hematuria: Blood in urine, indicating kidney disease, urinary tract infection, or trauma
• Nocturia: Frequent urination at night that can be due to increased fluid consumption, kidney disease, prostate issues, or heart failure
• Oliguria: Scant urine output (less than 500mL in 24 hours) - caused by fluid intake issues, shock, burns, kidney disease, or heart failure
• Polyuria: Large amounts of urine, resulting from medications, excessive fluid intake, diabetes, or hormone imbalance
• Urinary Frequency: Frequent need to urinate - can be caused by excessive fluid intake, bladder infections, pressure on the bladder, or medications
• Overflow Incontinence: Leaking urine due to weak bladder muscles or blockages; neurological conditions like diabetic neuropathy, multiple sclerosis, and spinal cord injuries
• Urinary Incontinence: Inability to control urine passage; may result from trauma, disease, urinary tract infections, reproductive issues, aging, constipation, or lack of timely access to a bathroom
• Urinary Urgency: Immediate need to void. It may be linked to urinary tract infections, fear of incontinence, 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 only
• 2 Types:
  • Standard bedpans
  • Fracture pans designed for clients with fragile bones or painful joints

Urinals

• Urinals are primarily for men to use for voiding
• Considerations for male clients:
  • Male clients can stand, sit, or lie in bed and lean against a wall
  • May need help from PSW to stand or position the urinal
• Key steps to remind clients:
  • Signal after use
  • A full urinal on the floor can spill if kicked
• Urinals should not be placed on over-bed tables or bedside stands
• Empty, rinse, and clean urinals promptly to prevent odour
• Important to not empty a client's urine for observation / collection by the nurse

Commodes

• Use of commodes is for clients who are unable to walk to the bathroom
• Commodes may be positioned to allow for a normal position for elimination
• Commodes provide fall prevention and support
• Can only be used by clients who can support themselves
• Commodes are wheeled into the bathroom and placed over toilets
• Wheels are locked after positioning over toilet
• Clients should never be tied to a commode

Urinary Incontinence

• Urinary incontinence is the loss of bladder control which may be temporary or permanent
• Basic types:
  • Stress (dribbling)
  • Urge, overflow, functional, reflex, & mixed

Problems Related to Incontinence

• Embarrassment and discomfort
• Risk of skin irritation, infection, and pressure ulcers
• Risk of injury due to rushing
• Loss of dignity and self-esteem
• Promoting normal urinary elimination prevents incontinence in some clients
• Incontinence products help keep client dry
• It’s important to provide good skin care and keep garments and bed linens dry
• Caring for clients with incontinence can be stressful
• If feeling short-tempered or impatient speak to the nurse at once
• All clients have the right to be treated with respect

Ways to Help Maintain Normal Urination

• Offer use of bathroom, urinal, bedpan, or commode often
• Remind clients with new elimination patterns or disabilities to empty their bladder frequently
• Be quick to support clients who ask for help
• Help clients use a normal position for elimination as much as possible
• Provide privacy, warmth, and relaxation

Incontinence Products

• Includes garment protectors, briefs, pant liners and pull-on briefs

Risks With Briefs

• Includes risk of skin breakdown
• Psychological distress
  • Depression, anger, frustration, embarassment, helplessness & further loss of urinary control

Catheters

• Catheters are tubes that drain urine
• Inserted through Urethra

Indwelling Catheters

• Foley or retention, remains in the bladder

Straight Catheters

• Drains the bladder and then is removed

Suprapubic Catheter

• Surgically inserted through the abdomen above the pubic bone

Catheterization

• The process of inserting a catheter
• Catheters are used before, during and after surgery
• Used for clients too weak or disabled to use the bedpan, urinal, commode or toilet
• Protect wounds and pressure ulcers from contact with urine
• Allows hourly measurements of urinary output
• As a last resort for incontinence
• Does not treat the cause
• Catheters are also used for certain diagnostic purposes

Risk of infection is high with Indwelling Catheters

Drainage Systems

• Help in collecting and holding urine that drains from the catheter
• Closed systems are used for indwelling catheters
• The catheter must always enter the system from the catheter to the drainage bag, the system is sterile

Leg Bags

• Some wear them being out of bed.
• The are rectangle with straps to the client’s thigh
• Leg bags that need to be changed back into drainage bags must be done as the client is in bed.

Care Considerations for Drainage Bags

• Never hang a drainage bag on a bed rail.
• Always make certain the drainage bag is lower than the client's.
• Keep the bag off of the floor
• When the bag is lifted higher than the client the bag will be higher than the bladder
• Promotes DIPPS
• When side rails are raised you could pull the catheter, make certain the tubing is long enough
• Keep bag visibility low and/or covered, because most residents do not like other people seeing their urine

Measuring Urine

• Emptying Drainage bags
• The PSW empties the drainage bag
• Empties content into separate container or toilet
• Can be emptied directly into the toilet
• Place incontinence pad (blue pad) underneath before emptying

Measuring urine considerations

• Gloves are required
• Graduated measuring cup or the urometer (plastic square device) attached to the bad is used for precise measurement.
• Measurement are read at eye level
• Remember to note and record volume, colour, odour & particles (abnormal).

Accidental Disconnection

• If the drainage system becomes disconnected, notify the nurse right away
• If catheter or tubing is disconnected:
  • Do not touch the ends of the catheter or tubing
  • Practice hand hygiene and put on gloves
  • Wipe the end of tubes with alcohol
  • Avoid putting the ends down
  • Wipe the end of the catheter and the tubing with an antiseptic wipe then connect
  • Clean, disinfect, and tell the nurse
  • Discard wipe into biohazard bag
  • Remove gloves & perform hand hygiene

Condom Catheter

• Condom Catheter is a sheath that slides over the penis
• Condom-like sheath has a tube to connect to drainage bag
• There is no catheter entering the urethra
• Wash penis with soap and water
• Apply penis well before applying the catheter because it could cause sores
• Never complete, constricts circulation & causes edema

When to Drain Bags and Empty Urine

• Bags are drained at the end of the shift
• Bags also should be emptied when:
  • You are transferring between leg bags and catheters
  • When the bag is full
  • If there is leaking

Urine Specimen Guidelines

• Specimens/Samples are collected, tested & treated.
• Doctors orders specimens
• Most tests done in labs
• Send all specimens to the laboratory
• All specimens sent require requisitions

24 Hour Urine Specimen Collection Info

• All Urine voided for 24-hour period.
• Urine chilled in ice or refrigerator
• Must RESTART Test if;
  • Voiding not received
  • Tissue in Specimen
  • Specimen contain Feces

Ureterostomy Info

• Ureter (Artificial Opening) to Abdomen
• Bladder removed to treat blatter injuries / CA
• Stoma doesn't have nerve Endings and not painful.

Ostomy Appliance

• Any time it leaks appliance is replaced
• Urine in Skin CAUSE irritation, breakdown and infection
• Care and skin breakdown and Embarrassment