Urinary Elimination

Dr.Karima Elshamy
Faculty of Nursing

Mansoura University
Egypt
Learning Objectives:

At the end of this lecture, the

student will be able to:

Define related terms: micturation, urine,

Ployuria, Oliguria, Anuria, Urinary
incontinence, Retention, Retention with
overflow, Dysuria, Enuresis, Nocturia,
Urgency, Residual urine.
Discuss the characteristics of normal urine.

Differentiate between urinary problems.

Identify abnormal findings of urine.

Discuss the factors, which affect the

individual's urinary elimination.
Discuss the nursing measures for patient
with urinary incontinence.

Discuss the nursing measures for patient

suffering retention.
Outlines:

Anatomy and physiology of the urinary

system.

Characteristics of normal urine.

Signs and symptoms of urinary problems.

Abnormal findings of urine.

Factors which affect the individual's

urinary elimination.

Nursing measures for patient with urinary

incontinence.
Nursing measures to promote proper
urinary elimination for patients suffering
from urinary retention.

Urinary catheterization.
Anatomy and physiology of the
urinary system:

The urinary system is composed

of 2 kidneys, 2 ureters, the
bladder and the urethra.
The Kidneys:

The right and left kidneys, they are

complex organ whose chief function
is the elimination of waste products
of body metabolism and the control
of concentration of the various
constituents of the body fluid,
including the blood.
Blood reaches the kidneys through the renal
arteries and is filtered in the glomeration of the
nephrons.
The nephrons are the functioning unit of the
kidney.
It is estimated that each kidney has about one and
half million nephrons.

The filtrate contains water, the waste products of

metabolism, electrolytes and glucose. This filtrate
is known as urine.
Kidney Functions:

Excretion of metabolic wastes (urea, uric

acid, creatinine and amonia).

Regulation of acid -base balance of the

blood.

Regulation of the amount of extracellular

fluid through elimination of excess fluid or
fluid retention.
Regulation of osmotic pressure of
extracellular fluid by regulating the amount
of sodium chloride and water.

Regulation of extracellular electrolytes by

either selective reabsorption of important
electrolytes or excretion of excess such as
glucose.
Regulation of blood pressure : The kidney
produces an enzyme like substance called
renin that can raise blood pressure.

Regulation of red blood cell production:

Under stress, the kidney produces
erythropoietin, which stimulates the
production or red blood cells in bone
marrow.

Control of water excretion: The reassertion

of water in the tubules is controlled by
pituitary and hypothalamic action.
The Ureters:

Are 2 tubes, each one is connected to the

pelvis of the kidney.

Its chief function is to convey the urine

formed in the kidney pelvis to the bladder.
It is about 25-30 cm long and it has a narrow
diameter.
The Bladder:

Is a hollow, muscular organ that serves as a

reservoir for urine.

The bladder can retain urine until it can be

excreted.

The average adult bladder holds from 300 -

500 cc of urine.
This depends upon the efficient
muscle tone of the bladder wall
and upon the integrity of the
nervous system enervating the
bladder and the condition of the
internal sphincter which' controls
the passage of urine from the
bladder to the urethra.
Stimulation of the bladder is
transmitted by the sympathetic
nervous system through the hypo
gastric nerves and by the
parasympathetic nervous system
through the pelvic nerves, i.e. the
smooth muscle wall of the
bladder has a double nerve
supply.
The sympathetic nervous system relaxes
the bladder wall to permit filling and it
also contracts the internal sphincter to
prevent urine escaping to the exterior.

The external sphincter is under voluntary

control so that urine can be held in until
the toilet is reached and the person is
ready to void.
The parasympathetic nervous system
stimulates contraction of the bladder
muscle to squeeze urine out, at the
same time relaxing the internal
sphincter to permit flow of urine
along the urethra.
The Urethra:

Is a short, hollow muscular tube

approximately 3.7 cm. long in the female and
20 cm. in the male; the chief function of the
urethra is to provide a passage-way through
which urine can be voided from the bladder.

The entire urinary tract is lined with mucous

membrane.
Micturation or Voiding:

It is the act by which urine is

expelled from the bladder. The acts
of initiating and stopping maturation
are normally under voluntary control
via external sphincter muscle.
Urine:

Is the waste product of metabolism.

It is a complex aqueous solution of

organic and inorganic substances.
Characteristics of Normal
Urine:

Amount : 1200 - 1800 cc/24 h.

Colour : Clear, straw, amber yellow.

Transparency : Transparent.
Reaction: Slightly Acidic ph 4.5 - 6.

Odor: Aromatic odor.

Specific gravity: 1.005 -1.030

Constituents: Urine contains

creatinine, uric acid, urea and a few
white blood cells.
Frequency of Voiding:

The frequency of voiding varies

with the bladder capacity,
sensation, acceptability and
availability of toilet facilities.

Voiding 5-10 times a day is

common.
Signs and Symptoms of Urinary
Problem:
1. Polyuria: voiding a large amount of urine.

2. Oliguria: Voiding a scanty amount of

urine. (Less than 600 cc/day)

3. Anuria: or urinary suppression: Total

absence or marked deficiency i.e. absence
of urine emerged from the kidneys.

4. Urinary incontinence: Involuntary

voiding or constant dribbling of urine.
Types of urinary incontinence:

A constant incontinence.

Occasional incontinence.

Stress incontinence.

Overflow incontinence.
5. Retention:

Retention: The urine is formed in the
kidneys, but the patient is unable to
excrete it from his urinary bladder.
Retention is recognized by palpating the
distended bladder above the symphysis
pubis as the urine is stagnated in. it.

Retention with over flow: the patients

void small amounts of urine frequently
but continue to have distended bladder.
6. Dysuria: Difficulty in voiding or pain in
voiding.

7. Nocturia: It is the need to get up from

sleep in order to void.

8. Enuresis: It is involuntary loss of urine

at night (bed wetting). It persist in some
children as late as 10 years old or more.

9. Urgency: Is the sensation that one must

void.

10. Residual urine: When a bladder

empties normally, it retains little amount
of urine.
Abnormal Findings of Urine:

Hematuria: Presence of blood in the

urine.

Pyuria: Presence of pus in the urine.

Albuminuria: Presence of albumin

in the urine.
Pale urine: Means diluted urine may be due
to excessive fluid intake or intake of
diuretics.

Glycosuria: Presence of sugar in the urine.

Casts: Presence of coagulated protein from

the kidney tubule.
Dark urine: Means urine is concentrated,
may be due to:
 Dehydration, or low fluid intake,
 Presence of bile pigments (urobilin or
bilirubin) due to disease of the liver or
gall bladder.
 Intake of certain drugs such as
antibiotics turns the colour of urine into
orange or red.
 Intake of certain food, vegetables and
fruits such as carrots, beetroot and
blackberries.
 Presence of blood.
Factors which affect the individual's
urinary elimination:

• Change in the patient's environment: Such as

improper toilet facilities, unclean toilets or
lack of privacy. The hospital routine might
affect patient's habits.

• Amount of fluid intake: It can either increase

or decrease amount of urine.
• Intake of drugs: Might lead to change
color of urine, or can increase urinary out
put (diuretics).

• Psychological factors: Such as stress,

fear, anxiety and emotional factors.

• Pathologic conditions: Such as fever,

diabetes, infection of the urinary tract.
• Disease of the nervous system or injuries
which might lead to urinary incontinence.

• Physical activities: Such as immobility.

• Blood pressure: Low blood pressure

(Hemorrhage) lead to low production of
urine.
• Obstruction: Will cause stasis of urine.
Obstruction may be due to congenital
defect, calculi, tumor, etc.

• Hormonal influences: Anti diuretic

hormone secreted by the posterior lobe of
pituitary gland and suppresses the amount
of urine produced.
Nursing measures for patient with
urinary incontinence:

• Skin care to prevent irritation and

breakdown.

• Cleanliness of linen and clothes.

• Frequent turning of patient to prevent

decubitus ulcer.

• Perineal and abdominal exercises.

• Strengthening the abdominal muscle by
using it to aid air inhalation, Tightening
and relaxing the perineal muscles 10 times
(3 times daily).

• Bladder retraining programs.

• Adjusting the fluid intake schedule.

• Emotional support.
Measures to promote proper urinary
elimination for patients Suffering
from urinary retention:

• Restrict fluid intake because urine is

accumulated in the urinary bladder be
aware of fluid intake of patient during the
first 24 hours.

• Provide privacy to the patient by using

curtains or closed doors.
• Help the patient to assume a sitting
position to help him void.

• Provide a bedside commode if the patient

cannot use the bedpan or urinal.

• Listening to the sound of running water,

will help the patient to void.

• Pour warm water over the perineum of the

female patient, or help the patient to sit in a
warm bath tub.
• Provide a warm bedpan or urinal.
• Supply a warm hot water bottle to the
patient or lower abdomen.

• Put the patient hands in warm water.

• Catheterization: Should be ordered by
the physician if the pervious
Measures are not successful.
Urinary Catheterization:

Urinary catheterization consists of inserting a

thin hollow tub through the urethra into the
bladder to remove urine from the bladder or to
establish a patient urine drainage method.