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Stressors Affecting Elimination Urinary. NUR101 Fall 2010 Lecture # 22 K. Burger, MSED, MSN, RN, CNE PPP By Sharon Niggemeier RN, MSN. Anatomy & Physiology. Kidneys Ureters Bladder Urethra. Nephron Function. Functional unit of kidney 1 million per kidney

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Stressors affecting elimination urinary l.jpg

Stressors Affecting EliminationUrinary

NUR101 Fall 2010

Lecture # 22

K. Burger, MSED, MSN, RN, CNE


Sharon Niggemeier RN, MSN

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Anatomy & Physiology

  • Kidneys

  • Ureters

  • Bladder

  • Urethra

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Nephron Function

  • Functional unit of kidney

  • 1 million per kidney

  • 1200 ml blood pass through the kidney/min

  • Wastes cannot be excreted as solids; must be excreted in solution

  • Normal urine production = 1 ml / minute

  • Kidneys must produce 30 ml/hr minimum

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Nephron Function

  • Blood filtered through glomerulus

  • this filtrate moves into Bowman’s capsules

  • proceeds into proximal tubule where water /electrolytes/glucose & protein are reabsorbed

  • Loop of Henley – water andsolutes such as Na & Cl, are reabsorbed (urine becomes more concentrated)

  • distal convoluted tubules allows for water and NA reabsorbtion. Controlled reabsorption (by ADH antidiuretic hormone) regulates F/E balance…..collecting duct

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Act of Micturition

  • Urine moves from the kidneys through ureters via peristaltic waves into bladder.

  • Bladder fills & detrusor muscles sense pressure

  • Structures and functions for voluntary control of voiding:

    -External sphincter- restrain or interrupt act

    -Conscious brain- starts act

    -Intact spinal cord- needed or else message from the brain is not received.

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Alterations in Urinary Function

  • Incontinence- brain is not receiving impulse or loss of external sphincter control

  • Retention- distended bladder due to nerve impulses not perceived or muscles unable to function

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Amount1200 ml/day average


OdorSee Next Slide

pH 4.6 – 8.0


Specific gravity1.010 – 1.025


Characteristics of Urine

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Food/fluidintake + loss

Developmental factorsSee Next Slide


Activity/Muscle tone

Life style



Factors That Affect Voiding

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Geriatric Considerations

  • Decreased ability of kidneys to concentrate urine and decreased bladder capacity = nocturia

  • Decreased muscle tone of bladder = increased frequency

  • Decreased bladder contractility & stasis= increased frequency of UTI

  • Changes in cognition and mobility (in some)= increased incontinence issues

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Assessing Urinary Status

  • Usual patterns

  • Recent changes

  • Difficulties

  • Artificial Orifices

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R kidney located 12 rib

L kidney lower

Tenderness during palpation at costoverterbral angle?


Below symphysis pubis

Supine position to examine


Palpate-tenderness, how high it distends

Percussion- full bladder dull sound

Physical Assessment

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Assessment: Lab Results

  • Urinalysis- WBC, RBC, protein,

    glucose, bacteria = abnormal constituents

  • BUN (blood urea nitrogen) end product of protein metabolism… 10-20 mg/dLIncreased BUN (azotemia) signifies impaired kidney function… affected by diet (hi protein intake) and fluids (dehydration)Decreased BUN signifies impaired liver functionMany drugs elevate BUN (antibiotics, lasix +++)

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Assessment: Lab Results

  • Serum creatinine - by product of muscle metabolism…excreted entirely by kidneys… Normal = 0.5-1.2 mg/dLIncreased levels signify renal impairment

  • BUN: Creatinine ratio- 20:1… when both rise together indicates kidney failure or disease

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Altered Urinary Functioning Terms to Know

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Assessing Urinary Retention

  • Feeling of fullness

  • Voiding small amounts< 50 ml

  • Normal intake/inadequate output

  • Distended bladder

  • Discomfort

  • Bladder ScanIf > 300 ml should catheterize

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Nursing Dx R/T Urinary Elimination

  • Impaired urinary elimination

  • Urinary retention

  • Functional urinary incontinence

  • Overflow urinary incontinence

  • Stress urinary incontinence

  • Reflex urinary incontinence

  • Urge urinary incontinence

  • Total urinary incontinence

  • Risk for infection r/t urinary retention and/or urinary catheterization

  • Risk for impaired skin integrity r/t urinary incontinence

  • Situational low self esteem r/t incontinence

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Outcome Criteria

Patient will:

  • Empty bladder completely at regular intervals

  • Decrease episodes of incontinence

  • Maintain regular urinary elimination pattern

  • Develop adequate Intake/Output

  • Have decreased dysuria

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Nursing Interventions

  • Maintain voiding habits

  • Promote fluid intake

  • Strengthen muscle toneKegels 30-80/day

  • Stimulate urinationAuditoryTactile

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Disposable“ Hat”

Fx pan

Safety Concerns

Female Hygiene

Interventions: Toileting

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Interventions for Urinary Incontinence

  • Bladder training/ Habit training

  • External urinary device- Condom Catheter

  • Indwelling catheter-LAST resort

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Condom Catheter (Texas Cath)

  • Rubber condom placed on penis of incontinent males

  • Connects to drainage bag to collect urine

  • Easy to apply and observe

  • Comfortable

  • Doesn’t require intubation

  • Prevents skin irritation from incontinence

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Condom Catheter

  • Check every 2-4 hrs.

  • Remove and replace every 24 hrs.

  • Maintain free urinary drainage

  • Never tape to skin

  • Leave 1-2 inch space at tip of penis

  • Secure snuggly but not too tight

  • Follow manufacturer instructions

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Urinary Catheterization

Used to:

  • Keep bladder deflated during surgery

  • Measure residual urinePVR (post void residual) should be < 50 ml

  • Relieve retention

  • Obtain sterile urine specimen

    May use either:

  • Straight catheter or indwelling catheter

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Indwelling catheter Refer to Lab Worksheet

  • Catheter inserted into urinary meatus through urethra into bladder to drain urine

  • Last resort as it introduces microbes into bladder…leading to UTI (urinary tract infection)

  • Performed using sterile technique...MD order needed

  • Remains in place via inflated balloon

ALSOSuprapubic Catheter – diverts urethraUrologic Stents- temporary in ureters permanent in urethraIleal Conduit – diversion of ureters to ileum and stoma; requires appliance

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Medications Affecting Urinary Elimination

  • Antibiotics …work against infectionBactrim, Levaquin, Cipro

  • Urinary antispasmotics …relieve spasms with UTIDitropan, Pro-Banthine

  • Diuretics….increase urinary outputLasix, Diuril

  • Cholinergics…increase muscle tone & functionUsed for urinary retention, neurogenic bladderUrecholine

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Urinary Specimen CollectionRefer to Lab Worksheet

  • Routine urinalysis

  • Clean-catch/midstream urine

  • Sterile specimen ( catheterization or from indwelling catheter)

  • 24 hr. urine

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Evaluating Urinary Elimination

  • Frequency

  • Amount

  • Ease/Difficulty

  • Color

  • Appearance

  • Odor