Urinary System Functions and Urination

Functions of the Urinary System

• Waste products are removed from the blood via the urinary system.
• The urinary system ensures water balance.
• This system maintains electrolyte balance.
• Acid-base balance is maintained by the urinary system.
• Eliminating waste and fluid prevents illness and death.

Normal Urination

• Healthy adults produce about 1,500 mL of urine a day.
• Age can affect urine production.
• Diseases can affect urine production.
• The amount and kinds of consumed fluid affects it.
• Dietary salt levels affect normal urination.
• Medication can affect normal urination.
• Consumption of substances like coffee, tea, and alcohol affect urination.

Frequency of Urination Factors

• The amount of fluid intake, habits, available toilet facilities, activity, work, and illness all affect the frequency of urination.
• People usually void after getting up, before meals, and at bedtime.
• Incontinence is not a normal part of aging.

Observations of Normal Urine

• Normal urine is pale yellow, straw, or amber-colored.
• Clear with no particles in it.
• Has a faint odor.
• Complaints of urgency burning or pain must be reported.

Urinary Elimination Problems

• Dysuria: Painful or difficult urination, caused by urinary tract infection, trauma, or obstruction.
• Hematuria: Blood in the urine, caused by kidney disease, or urinary tract infection.
• Nocturia: Frequent urination at night, caused by increased kidney perfusion when lying down, excessive fluid intake, kidney disease, prostate disease or congestive heart failure.
• Oliguria: Scant urine amount usually less than 500mL in 24 hours, caused by inadequate fluid intake, shock, burns, kidney disease, or heart failure.
• Polyuria: Abnormally large amount; caused by medications, excessive fluid intake, diabetes, or hormone imbalance.
• Urinary frequency: The need to urinate at frequent intervals; caused by excessive fluid intake, bladder infections, pressure on the bladder, or medications.
• Overflow incontinence: Leaking of urine when the bladder is too full; caused by weak bladder muscles, blockage, or neurological conditions.
• Urinary incontinence: Inability to control the passage of urine, caused by trauma, disease, urinary tract infections, reproductive or urinary tract surgeries, aging, or fecal impaction.
• Urinary urgency: The need to void immediately, caused by urinary tract infection, fear of incontinence, a full bladder, or stress.

Bedpans

• Used by clients who cannot get out of bed.
• There are two types of bedpans: standard and fracture pans.
• Women use bedpans for voiding and bowel movements.
• Men use bedpans for bowel movements.

Urinals - Male Clients

• Most men use urinals to void.
• To use the urinal, the male client stands at the side of the bed if safe.
• Remind men to call after using the urinal.
• Do not place urinals on over-bed tables or bedside stands due to microbial cross-contamination with food.
• Empty, rinse, and clean urinals promptly to prevent odor.
• DO NOT empty urinals until it is confirmed the nurse does not need to observe or collect it.
• Note any abnormalities noticed in the urine and tell the nurse.

Commodes

• Clients unable to walk to the bathroom use commodes.
• The commode allows a normal position for elimination.
• Provides support and helps prevent falls.
• Has to be possible for the client to support themselves in the commode.
• Commodes are wheeled into bathrooms and placed over toilets.
• The container is removed if the commode is used with the toilet.
• Wheels are locked after the commode is positioned over the toilet.
• A client should never be tied or restrained to a commode.

Urinary Incontinence

• Urinary incontinence is the loss of bladder control.
• May be temporary or permanent.
• Stress incontinence involves dribbling.
• Urge incontinence is a basic type.
• Overflow incontinence is a basic type.
• Functional incontinence is a basic type.
• Reflex incontinence is a basic type.
• Mixed incontinence is a basic type.
• If incontinence is a new problem, tell the nurse at once.

Problems Related to Incontinence

• Incontinence is embarrassing.
• The client is uncomfortable.
• Skin irritation, infection, and pressure ulcers are risks.
• Falling is a risk because the client may rush to the washroom.
• The client's pride, dignity, and self-esteem are affected. Good skin care, dry garments, and linens are essential.

Promoting Normal Urinary Elimination

• Prevents incontinence in some clients.
• Bladder training may be needed.
• Catheters are needed in some instances.
• Incontinence products help keep the client dry.
• Caring for clients with incontinence can be stressful.
• If you are becoming short-tempered and impatient, talk to the nurse at once.
• The client has the right to be free from abuse, mistreatment and neglect.

Ways the PSW Helps Maintain Urination

• Regular bathroom, urinal, bedpan, or commode use is offered.
• Reminders to empty the bladder are given.
• Help clients to the bathroom quickly when asked.
• A normal position for elimination should be facilitated.
• Privacy, warmth, and relaxation are provided.

Incontinence Products

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

Risks Associated With Briefs

• Skin breakdown can occur
• Psychological distress caused by:
• Depression
• Frustration
• Embarrassment
• Helplessness
• The further loss of urinary control

Catheters

• A urinary catheter is a tube that drains urine.
• The catheter is inserted through the urethra.
• A straight catheter drains the bladder and then is removed.
• An indwelling catheter is left in the bladder.
• A suprapubic catheter is surgically inserted.
• Catheterization is the process of inserting a catheter.
• The tip is inflated with water to prevent slipping.
• Tubing connects the catheter to a drainage bag.

Catheter Use

• Before, during, and after surgery
• For clients who are too weak or disabled.
• Protect wounds and pressure ulcers.
• Allow hourly urine output measurements.
• As a last resort measure for incontinence, but catheters do not treat the cause.
• Used for certain diagnostic purposes.
• There is a higher risk of infection for clients with indwelling catheters.

Drainage Systems

• Used to collect and hold urine.
• A closed drainage system must be used for indwelling catheters, nothing can enter and it must be sterile.

Leg Bags

• Some clients who are out of bed can wear leg bags.
• They are rectangular bags that strap to the client's thigh.
• The leg bags are changed back to drainage bags when the client is in bed.

Care Considerations for Drainage Bags

• Keep drainage bag below the client's bladder level.
• Do not touch the floor.
• Hang drainage bag on a bed rail.
• Always ensure that the bag is lower than the bladder.
• Do not pull on the catheter when moving/raising the side rail, and be mindful of the client's body.
• Promote DIPPS by covering the bag as most people do not like other people to see urine.

Measuring Urine

• The PSW empties the drainage bag with gloves on.
• Empty into a separate container.
• The urine may need to be placed underneath with an incontinence pad if there are any issues with potential mess.
• The urine can be discarded in the toilet if the client is in the bathroom.
• Do not use the measurements that are marked on the drainage bag as the reading could be inaccurate.
• Read a clear graduated measuring cup or the urometer attached to the bag to get a measurement and a plastic square for readings.
• To get an accurate reading, it must be at eye level.

What to Record for Urine

• Amount
• Colour
• Odor
• If any abnormal particles are present
• Tell the nurse of anything off or unusual

Accidental Disconnection

• A high risk of urinary tract infection is present when the catheter tube disconnects.
• The nurse must be notified immediately after a disconnection has happened.
• Do not touch the end of the catheter, if touched with ungloved hands, microbes can be spread to the urinary tract.
• Do not put the ends down on any surface.

To reconnect, practice hand hygiene before and after putting on gloves.

• Wipe the disconnect ends of the catheter tubes to ensure no debris is present.
• Discard used wipes in the appropriate biohazard bag.

Condom Catheter

• A condom catheter is a sheath that slides over the penis.
• Apply with a special elastic tape
• A condom-like sheath is connected to a drainage bag.
• No part has to enter the urethra
• The penis must be washed regularly with soap and water
• Thoroughly dry the penis before applying the condom.
• Risk of pressure sores exist with a condom catheter
• It is never good practice to apply tape in a complete circle, causing constriction.

When To Drain Bags and Empty Urine:

• 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 becomes too much to handle or becoming full.
• In the case of leaking.

Urine Specimens

• Specimens (samples) are collected and tested to prevent, detect, and treat disease.
• A doctor needs to be made aware by the healthcare worker by collecting an order to be tested.
• All specimens need to be tested in the laboratory.
• Specimen slips need to be available at all times.
• Some tests may need to take place on the bedside.

24-Hour Urine Specimen

• Save urine from an entire 24-hour period.
• Store it chilled on ice.
• If a voiding has not been saved, the test must be restarted.
• If toilet paper or feces came into contact; then the test must be restarted.

Ureterostomy

• The ureter or a new opening will appear on a patient's stomach or abdomen.
• Artificial opening will allow access without a bladder.
• In many cases, the bladders are surgically removed to help with cancer.
• Openings do not have sensory functions and are often not painful

Ostomy Appliance

• If leakage is detected, immediately replace it.
• If left, the urine may cause skin infection and/or discomfort.
• Must be provided good skincare and cleaning to prevent skin breakdown.
• The healthcare worker should always remain sensitive to the client's feelings.

Review

• Waste products are removed and regulated by the urinary system.
• Various factors come to play in urine activity/frequency/the amount that is expelled.
• Always look at the color and clarity of urine which indicates signs to relay with healthcare officials.
• All urine will normally have a very faint scent.
• Foul-smelling urine could indicate a potential issue or infection.
• Promptly relay any burning, irritation or difficulty urinating. These are all good signs of infections.
• Clients who are known with urinary incontinence will need frequent care, skincare and changing when accidents happen.
• Linen must also be changed on the bed as soon as possible, otherwise falls into a level of neglect of the client.