2. OBJECTIVES
1. Describe factors that can alter urinary
function
2. Discuss common problem of Urinary
Elimination
3. Identify nursing intervention for common
urinary problems
3. Bladder Quiz
To test your knowledge, answer the following true or
false questions.
1.The bladder of a healthy adult can hold up to 2 cups of
urine comfortably for 2 to 5 hours.
True / False
True
4. 2. Holding urine in the bladder too long can lead to
infections.
True / False
True
Regular urination flushes away bacteria and helps keep
the urinary tract sterile.
5. 3. Diabetes is one of the diseases that can affect the
bladder
True / False
True
Over time, diabetes can affect the nerves that control the
bladder and intestinal tract. The bladder can become
paralyzed and stop responding to signals that it is filling
6. 4. All kids are ready to start toilet training by 18 months.
True / False
False
It's true that kids are bladders and digestive systems
ready for toilet training at 18 months—But
(understanding the urge to go to the bathroom, resisting
distractions and remembering)are learnt at different
pace.
7. 5. There are several types of urinary incontinence
True / False
True
Urinary incontinence is only a general term used.
8. 6. Bladder control problems are common in older
people
True / False
True
With age, tissues in the urinary tract change, muscles
weaken and nerves can be damaged.
9. 7. Urinating more than 8 or 10 times a day is normal.
True / False
False
Urinating more than 8 times in 24 hours—or more than
twice each night—can be a sign of an overactive bladder.
This condition can affect people's self-esteem and
confidence, sometimes making them afraid to be far
from home,
10. 8. Healthcare team can't do much about an overactive
bladder
True / False
False
most problems can be improved with treatment.
exercises to strengthen the pelvic muscles, lifestyle
changes, medicines to calm the bladder's muscles and
nerves, or devices to hold up the bladder could be
helpful
11. 9. Prostate problems can affect bladder control in men
True / False
True
Men with this problem may have a weak flow or have to
urinate often during the day and night.
12. 10. Caffeine can affect the bladder
True / False
True
Caffeinated drinks such as coffee, cola irritate the
bladder and cause the bladder to fill quickly. This, in
turn, can increase the urge to urinate and sometimes can
lead to leaking. Medications, infection, being overweight,
nerve damage, weak muscles and various health
conditions can cause urine to leak as well
13. Result
• Those who scored 10/10. welldone!
• Those who scored 7-9/10. Great!
• Those who scored 1-7/10. Good try!
Pay attention to the class to get more knowledge
about maintaining bladder function.
14. Urinary elimination system
The act of bodily system consisting of the organs that
eliminate urine which includes the kidneys, ureters,
urinary bladder, and urethra.
15. Urination:
Micturation, voiding and urination all refer
to the process of emptying the urinary
bladder. urine collects in the bladder until
the pressure stimulates special sensory nerve
ending in the bladder wall called stretch
receptors.
16. FACTORS INFLUENCING URINARY
ELIMINATION
Growth & Development
• Infants and children: urine appears light yellow, not
concentrated.
• Voluntary control of urine begins at 18–24 months of age and
full control at 4–5 yrs.
• After 50yrs: kidney shrinks
• Elderly adults: increased frequency because of loss of muscle
tone. Residual urine may increase leading to high risk of
infection
Psychosocial Factors
• Privacy
• Sufficient time
• Appropriate position
• Anxiety, stress
17. Fluid intake
• Increase fluid intake
• Fruits & vegetable
• Caffeine increases urinary frequency
Medications
• Diuretics
• Certain drugs changes color of urine
Muscle tone
• Regular exercise lead to strong muscle contraction and control of the
external sphincter.
19. ALTERED URINE PRODUCTION:
• Polyuria or Diuresis-- 2500-4000mls/day (too much) increase intake—
• Diuresis—more production, more excretion of urine
• Polydipsia—intense thirst(associated with diuresis)
• Oliguria--scant urine output-- less than 500 cc/day—in renal failure, nephrons not
functioning.
• Anuria—less than 100.
• Complete kidney shutdown ,renal failure and urinary
shutdown-- have the same meaning
20. ALTERED IN URINARY ELIMINATION:
• Frequency. Void at frequent intervals due to cystitis ,stress pressure on
bladder are some of the causes listed.
• Nocturia/ Nycturia—increased frequency at night—Don’t give diuretics at
night. Take by 5 p.m.
• Urgency—Urgent need to void
• Dysuria—Painful voiding, injury, infection, structural problems
• Enuresis—involuntary passage of urination after age 4-5 years (primary and
secondary)
• Urinary Incontinence—urine overflows or dribbles
Types: total, stress, urge, functional and reflex incontinence
21. Types of Urinary incontinence
1. Functional Urinary incontinence-Inability of usually
continent person to reach toilet in time to avoid
unintentional loss of urine.
2. Reflex Urinary Incontinence-Involuntary loss of
urine at somewhat predictable intervals when a
specific bladder volume is reached.
3. Stress Urinary Incontinence-Sudden leakage of
urine occurring with activities that increase
abdominal pressure,
4. Total Urinary Incontinence-Continuous and
unpredictable passage of urine.
5. Urge Urinary Incontinence- lnvoluntary passage of
urine occurring soon after a strong sense of urgency
to void.
22.
23. 37-23 Copyright 2004 by Delmar
Learning, a division of Thomson
Common Alterations in Elimination
• Urinary Elimination
– Acute urinary incontinence
– Chronic urinary incontinence
24. 37-24 Copyright 2004 by Delmar
Learning, a division of Thomson
Common Alterations in Elimination
Stress Urinary Incontinence (SUI)
– Uncontrolled loss of urine caused by physical
exertion in the absence of a detrusor muscle
contraction
– Associated with urethral hypermobility or intrinsic
sphincter deficiency
25. 37-25 Copyright 2004 by Delmar
Learning, a division of Thomson
Common Alterations in Elimination
• Urgency and Urge Urinary Incontinence
(overactive bladder syndrome)
– Involuntary leakage accompanied by urge to void
• Functional Urinary Incontinence
– Altered mobility, manual dexterity
– Ability to access toilet
– Cognitive changes
26. 37-26 Copyright 2004 by Delmar
Learning, a division of Thomson
Common Alterations in Elimination
• Extraurethral Incontinence
– Uncontrolled loss of urine that exists when the
sphincter mechanism has been bypassed
27. • Retention—accumulation of urine in the bladder. Urine accumulates in
bladder as much as 3000ml. Prolonged retention increases the
possibility of UTI. On percussion a kettle drum (dull sound) can be
heard
• Hematuria--blood in urine
• Residual—what’s left in the bladder after voiding
• Calculi: - can occur in the kidney, bladder, or urethra.
• Infections mean that disease producing bacteria are present in the
urinary tract..
• Cyctitis :-is an inflammation of the bladder. Symptoms include frequent
need to urinate, slow dribbling urination, burning during urination,
pain, and blood in the urine.
28. Subjective data
• Normal Pattern Identification
– client description for alteration in urine
output
– Specific question regarding
last voiding
how many times per day
Quantity of urine each time you void
any night wakeup for micturation (be sensitive to the clients
privacy and embarrassment)
Assessment
29. Cont.
• Risk Identification
– Any previous problem related elimination i.e. renal
calculi, UTI
– How it was treated or resolved?
– Any GU related previous surgery ?
– Evaluate any other clinical problems?
– Recent changes in daily routine
(Increase activity, exercise, , fluid intake)?
- Any significant changes in oral intake of beverages that
contain alcohol or caffeine?
– Medication that can effect on micturation such as
diuretics ?
– Assess motor or cognitive dysfunction ?
– Visual impairment or communication impairment ?
30. Cont.
Dysfunction Identification
-Ask open ended questions
– Have u notice any problem with voiding lately, is a good
way to begin.
– Do u have any pain or burning with urination?
– Have u noticed any pink or radish color in your urine?
– Do u feel you are able to empty your bladder completely
every time you urinate?
– Do u accidentally loose any urine when u cough and
sneeze?
– Do u have any difficulty in stopping and starting urine
stream?
31. Cont.Objective Data
• Assessment of urine
• I/O, Bladder ultrasound
• Physical Assessment
– Inspection
– Percussion
– palpation
• Diagnostic test and procedures
– Collection of urine specimen
• Random specimen
• midstream specimen
• 24 hr Specimen
• Specimen from a catheter
• Urine test
• Blood test
32. Nursing Diagnosis
Stress incontinence
Self esteem disturbance
Social Isolation
Self care deficit: Toileting
High risk for impaired skin integrity
High risk for infection
33. Implementation
Maintaining Normal Urinary Elimination
Promoting fluid intake
Maintaining normal voiding habits
Assisting with toileting
Managing Urinary Incontinence
Continence training
Pelvic muscle exercises
Positive reinforcement
Maintaining skin integrity
Kegal exercises to strengthen muscles.
34. Wellness Teaching
1. Respond as soon as possible to the urge to void
2. Drink 8 to 10 glasses of water a day
3. After urination, females should wipe from the urinary meatus
towards the anus
4. Maintain perineal-genital cleanliness
5. Avoid any harsh soap.
6. Avoid foods and fluids that contain excessive sodium which can
lead to fluid retention
7. Empty the bladder completely at each voiding
8. Obtain medical assistance if burning accompanies voiding or if
the urine changes color, clarity, odor or amount.
