Damage to the spinal cord above the sacral region causes reflex incontinence. This condition causes loss of voluntary control of urination; but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void Overflow incontinence occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia Hyperreflexia, a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD). uremic syndrome- An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. As the uremic symptoms worsen, aggressive treatment is indicated for survival Nocturia - awakening to void one or more times at night An excessive output of urine is polyuria. . A urine output that is decreased despite normal intake is called oliguria. increased urine formation (diuresis) a stoma (artificial opening) Urinary Retention. Urinary retention is an accumulation of urine resulting from an inability of the bladder to empty properly. URINE OVERFLOW- The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape. With retention a patient may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. pain or burning during urination (dysuria) as urine flows over inflamed tissues blood-tinged urine (hematuria) Urinary incontinence is the involuntary leakage of urine that is sufficient to be a problem. It can be either temporary or permanent, continuous or intermittentUrinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes. Intact efferent and afferent nerves from the bladder to the spinal cord and brain must be present INTAKE AND OUTPUT OF URINE Assess the patient’s average daily fluid intake. at home, ask him or her to estimate his or her intake by showing a measurement on a commonly used glass or cup Special receptacles (urimeters) that attach between indwelling catheters and drainage bags are a convenient means of accurately measuring urine volume. A urimeter holds 100 to 200 mL of urine. After measuring urine from a urimeter, drain the cylinder

1. URINARY ELIMINATION
BY
ANUSHRI SRIVASTAVA

2. KEY WORDS
• DAMAGE TO THE SPINAL CORD ABOVE THE SACRAL REGION CAUSES REFLEX INCONTINENCE.
THIS CONDITION CAUSES LOSS OF VOLUNTARY CONTROL OF URINATION; BUT THE
MICTURITION REFLEX PATHWAY OFTEN REMAINS INTACT, ALLOWING URINATION TO OCCUR
WITHOUT SENSATION OF THE NEED TO VOID
• OVERFLOW INCONTINENCE OCCURS WHEN A BLADDER IS OVERLY FULL AND BLADDER
PRESSURE EXCEEDS SPHINCTER PRESSURE, RESULTING IN INVOLUNTARY LEAKAGE OF URINE.
CAUSES OFTEN INCLUDE HEAD INJURY; SPINAL INJURY; MULTIPLE SCLEROSIS; DIABETES;
TRAUMA TO THE URINARY SYSTEM; AND POSTANESTHESIA SEDATIVES/HYPNOTICS,
TRICYCLICS, AND ANALGESIA
• HYPERREFLEXIA, A LIFE-THREATENING PROBLEM AFFECTING HEART RATE AND BLOOD
PRESSURE, IS CAUSED BY AN OVERLY FULL BLADDER. IT IS USUALLY NEUROGENIC IN NATURE;
HOWEVER, IT CAN BE CAUSED FUNCTIONALLY BY BLOCKAGE

3. • DISEASES THAT CAUSE IRREVERSIBLE DAMAGE TO KIDNEY TISSUE RESULT IN END-STAGE
RENAL DISEASE (ESRD).
• UREMIC SYNDROME- AN INCREASE IN NITROGENOUS WASTES IN THE BLOOD, MARKED
FLUID AND ELECTROLYTE ABNORMALITIES, NAUSEA, VOMITING, HEADACHE, COMA, AND
CONVULSIONS CHARACTERIZE THIS SYNDROME. AS THE UREMIC SYMPTOMS WORSEN,
AGGRESSIVE TREATMENT IS INDICATED FOR SURVIVAL
• NOCTURIA - AWAKENING TO VOID ONE OR MORE TIMES AT NIGHT
• AN EXCESSIVE OUTPUT OF URINE IS POLYURIA.
• . A URINE OUTPUT THAT IS DECREASED DESPITE NORMAL INTAKE IS CALLED OLIGURIA.
• INCREASED URINE FORMATION (DIURESIS)
• A STOMA (ARTIFICIAL OPENING)
• URINARY RETENTION. URINARY RETENTION IS AN ACCUMULATION OF URINE RESULTING
FROM AN INABILITY OF THE BLADDER TO EMPTY PROPERLY.
• URINE OVERFLOW- THE SPHINCTER TEMPORARILY OPENS TO ALLOW A SMALL VOLUME OF
URINE (25 TO 60 ML) TO ESCAPE. WITH RETENTION A PATIENT MAY VOID SMALL
AMOUNTS OF URINE 2 OR 3 TIMES AN HOUR WITH NO REAL RELIEF OF DISCOMFORT OR
MAY CONTINUALLY DRIBBLE URINE.

4. • PAIN OR BURNING DURING URINATION (DYSURIA) AS URINE FLOWS OVER
INFLAMED TISSUES
• BLOOD-TINGED URINE (HEMATURIA)
• URINARY INCONTINENCE IS THE INVOLUNTARY LEAKAGE OF URINE THAT IS
SUFFICIENT TO BE A PROBLEM. IT CAN BE EITHER TEMPORARY OR
PERMANENT, CONTINUOUS OR INTERMITTENT.

5. SYMPTOMS DESCRIPTIONS CAUSES OR ASSOCIATED FACTORS
Urgency Feeling of need to void immediately Full bladder, bladder irritation or inflammation from infection, overactive bladder,
psychological stress
Dysuria Dysuria Painful or difficult urination Bladder
inflammation, trauma or inflammation of
urethral sphincte
Dysuria Painful or difficult urination Bladder inflammation, trauma or inflammation of
urethral sphincter
Frequency Voiding at frequent intervals (less than 2 hours) Increased fluid intake, bladder inflammation, increased pressure on bladder
(pregnancy), diuretic therapy
Hesitancy Difficulty initiating urination Prostate enlargement, anxiety, urethral edema
Polyuria Voiding large amounts of urine Excess fluid intake, diabetes mellitus or insipidus, use of diuretics, postobstructive
diuresis
Oliguria Diminished urinary output relative to intake
(usually 400 mL/24 hr)
Dehydration, renal failure, UTI, increased ADH secretion, heart failure
Nocturia Voiding one or more times at night Excessive fluid intake before bed (especially coffee or alcohol), renal disease, aging
process, prostate enlargement
Dribbling Leakage of urine despite voluntary control of
urination
Stress incontinence, overflow from urinary retention (e.g., from BPH
Incontinence Involuntary loss of urine Multiple factors: Unstable urethra, loss of pelvic muscle tone, fecal impaction,
neurological impairment, overactive bladder
Hematuria Blood in urine Neoplasms of kidney or bladder, glomerular disease, infection of kidney or bladder,
trauma to urinary structures, calculi, bleeding disorders
Retention Accumulation of urine in bladder, with inability
of bladder to empty fully
Urethral obstruction (stricture), decreased sensory activity, neurogenic bladder,
prostate enlargement, postanesthesia effects, side effects of medications (e.g.,
anticholinergics, opioids
Residual urine Volume of urine remaining after voiding (≥100
mL)
Inflammation or irritation of bladder mucosa from infection, neurogenic bladder,
prostate enlargement, trauma, or inflammation of urethra

6. URINARY ELIMINATION

7. INTRODUCTION
• URINARY ELIMINATION DEPENDS ON THE FUNCTION OF THE KIDNEYS, URETERS,
BLADDER, AND URETHRA. KIDNEYS REMOVE WASTES FROM THE BLOOD TO
FORM URINE. URETERS TRANSPORT URINE FROM THE KIDNEYS TO THE BLADDER.
THE BLADDER HOLDS URINE UNTIL THE URGE TO URINATE DEVELOPS. URINE
LEAVES THE BODY THROUGH THE URETHRA. ALL ORGANS OF THE URINARY
SYSTEM MUST BE INTACT AND FUNCTIONAL FOR SUCCESSFUL REMOVAL OF
URINARY WASTES. INTACT EFFERENT AND AFFERENT NERVES FROM THE
BLADDER TO THE SPINAL CORD AND BRAIN MUST BE PRESENT

8. FACTORS INFLUENCING URINATION
FACTORS
INFLUENCING
URINATION
DISEASE
CONDITION
SURGICAL
PROCEDURES
SOCIOCULTURAL
FACTORS
PSYCHOLOGIC
FACTORS
DIAGNOSTIC
EVALUATION
MEDICATIONS
FLUID BALANCE

9. • SOCIOCULTURAL FACTORS- DEGREE OF PRIVACY NEEDED FOR URINATION
VARIES WITH CULTURE
• PSYCHOLOGICAL FACTORS- ANXIETY AND EMOTIONAL STRESS CAUSE A SENSE
OF URGENCY AND INCREASED FREQUENCY OF URINATION

10. INTAKE AND OUTPUT OF URINE
• ASSESS THE PATIENT’S AVERAGE DAILY FLUID INTAKE.
• AT HOME, ASK HIM OR HER TO ESTIMATE HIS OR HER INTAKE BY SHOWING A MEASUREMENT
ON A COMMONLY USED GLASS OR CUP
• SPECIAL RECEPTACLES (URIMETERS) THAT ATTACH BETWEEN INDWELLING CATHETERS AND
DRAINAGE BAGS ARE A CONVENIENT MEANS OF ACCURATELY MEASURING URINE VOLUME. A
URIMETER HOLDS 100 TO 200 ML OF URINE. AFTER MEASURING URINE FROM A URIMETER,
DRAIN THE CYLINDER INTO THE URINARY DRAINAGE BAG OR INTO A RECEPTACLE FOR
DISPOSAL. USE URIMETERS WHEN PRECISE HOURLY MEASUREMENTS OF URINE ARE NECESSARY
• LABEL EACH CONTAINER WITH PATIENT NAME. THE CONTAINER NEEDS TO BE RINSED AFTER
EMPTYING, AND THE TUBING THAT DRAINS THE BAG SECURELY CLAMPED AND CLEANED WITH
ALCOHOL BEFORE PUTTING IT BACK IN THE HOLDER.

11. CHARACTERISTICS OF URINE
CHARACTERISTICS
OF URINE
NORMAL ABNORMAL
• Color
• pH (4.6-8.0)
Normal urine ranges
from a pale, straw color
to amber
• Bleeding from the kidneys or ureters causes dark red
urine
• bleeding from the bladder or urethra causes bright
red urine
• phenazopyridine, a urinary analgesic, colors urine
bright orange
• Eating beets, rhubarb, or blackberries causes red
urine
• e. Special dyes used in intravenous diagnostic studies
eventually discolor urine.
• Dark amber urine is the result of high concentrations
of bilirubin caused by liver dysfunction.

12. CHARACTERISTIC
S OF URINE
NORMAL ABNORMAL
CLARITY Normal urine appears
transparent at voiding
• Freshly voided urine in patients with renal
disease appears cloudy or foamy because of
high protein concentrations
• Urine may also appear thick and cloudy as a
result of bacteria and WBCs
CHARACTERISTIC
S OF URINE
NORMAL ABNORMAL
ODOUR • Urine has a characteristic odor.
The more concentrated the
urine, the stronger the odor
• Stagnant urine has an
ammonia odor, which is
common in patients who are
repeatedly incontinent
• A sweet or fruity odor occurs from acetone or
acetoacetic acid (by-products of incomplete
fat metabolism) seen with diabetes mellitus or
starvation.
• . A foul odor is often associated with a
possible infection
Specific gravity
(1.053-1.030)
• Specific gravity measures
concentration of particles in
urine. High specific gravity
reflects concentrated urine,
and low specific gravity
reflects diluted urine
• Dehydration, reduced renal blood flow, and
increased ADH secretion elevate specific
gravity. Overhydration, early renal disease,
and inadequate ADH secretion reduce specific
gravity

13. COLLECTION TYPE/ USE
OF SPECIMEN
NURSING CONSIDERATIONS
Random (routine
urinalysis
• Collect during normal voiding or from an indwelling catheter or urinary
diversion collection bag. Do not collect from an indwelling catheter
drainage bag.
• Use a clean specimen cup.
Clean-voided or
midstream (culture and
sensitivity
Use a sterile specimen cup.
Sterile specimen (culture
and sensitivity
• If the patient has an indwelling catheter, collect a sterile specimen by
using aseptic technique through the special sampling port found on the
side of the catheter.
• Clamp the tubing below the port, allowing fresh, uncontaminated urine to
collect in the tube. After wiping the port with an antimicrobial swab,
insert a sterile syringe hub and withdraw at least 3 to 5 mL of urine
(check agency policy). Using sterile aseptic technique, transfer the urine
to a sterile container
Timed urine specimens
(for measuring levels of
adrenocortical steroids
or hormones, creatinine
clearance, or protein
Time required may be 2-, 12-, or 24-hour collections. The timed period
begins after the patient urinates and ends with a final voiding at the end of
the time period. The patient voids into a clean receptacle, and the urine is
transferred to the special collection container, which often contains special
preservatives. Each specimen must be free of feces and toilet tissue. Missed

14. COMMON URINE TESTS
• URINALYSIS.
• THE LABORATORY PERFORMS A URINALYSIS ON A SPECIMEN OBTAINED BY ANY OF
THE PREVIOUSLY DESCRIBED METHODS. A LAB EXAMINES SPECIMENS AS SOON AS
POSSIBLE, PREFERABLY WITHIN 2 HOURS. MAKE SURE THAT IT IS THE FIRST VOIDED
SPECIMEN IN THE MORNING TO ENSURE A UNIFORM CONCENTRATION OF
CONSTITUENTS. FOR A QUICK SCREENING PERFORM CERTAIN PORTIONS OF THE
URINALYSIS WITH SPECIAL REAGENT STRIPS. DIP THE STRIPS INTO THE URINE AND
OBSERVE FOR A COLOR CHANGE IN THE TIME INTERVAL DESIGNATED ON THE
PACKAGE

15. • SPECIFIC GRAVITY.
• THE SPECIFIC GRAVITY IS THE WEIGHT OR DEGREE OF
CONCENTRATION OF A SUBSTANCE COMPARED WITH AN EQUAL
VOLUME OF WATER. POUR A URINE SPECIMEN INTO A SPECIAL CLEAN,
DRY CYLINDER. THE WEIGHTED URINOMETER IS SUSPENDED IN THE
CYLINDER OF URINE. THE CONCENTRATION OF DISSOLVED
SUBSTANCES IN THE URINE AIDS IN DETERMINATION OF A PATIENT’S
FLUID BALANCE. THIS MEASUREMENT IS ALWAYS PART OF A
COMPLETE URINALYSIS
• Urine Culture.
• A urine culture requires a sterile or clean voided sample of
urine. It takes approximately 24 to 48 hours before the
laboratory can report findings of bacterial growth. While
awaiting results, a broad-spectrum antibiotic is sometimes
ordered as soon as a culture has been obtained. The test for
sensitivity determines which specific antibiotics are effective.
The results (sensitivities) of a urine culture may show that
another antibiotic would be more effective. In this case a new

16. BIBLIOGRAPHY
• ERBS AND KOZIER. FUNDAMENTAL OF NURSING CONCEPTS, PROCESS AND
PRACTICE. EDITION VIII: USA
• LYNN PAMELA. TAYLORS CLINICAL NURSING SKILLS- A NURSING PROCESS
APPROACH. EDITION III: WOLTERS KLUWER HEALTH
• PERRY AND POTTER. FUNDAMENTALS OF NURSING.EDITION VIII. ELSEVIER
PUBLICATION. 3251 RIVERPORT LANE ST. LOUIS, MISSOURI 63043