Chapter 46: Urinary Elimination

Overview

• Urinary elimination is a basic human function critical for maintaining health.
• Can be compromised by illnesses or conditions; nurses play a key role in treating urinary problems.

Anatomy and Physiology

• Kidneys: Located retroperitoneal, involved in regulation of fluid and electrolyte balance.
  • Left kidney is higher than the right due to the liver.
  • Nephrons: Functional unit of kidneys, remove waste from blood.
• Ureters: Carry urinary waste to the bladder.
• Bladder: Muscular organ that holds urine, located behind the symphysis pubis.
• Urethra: Passes urine to outside the body through the urethral meatus.

Urinary Problems

• Urinary Retention: Inability to empty bladder, causes discomfort.
  • Acute retention stretches the bladder.
• Urinary Tract Infections (UTIs): Common healthcare-associated infection, often due to instrumentation.
• Urinary Incontinence: Involuntary loss of urine.
  • Affects many over 40, especially elderly.
  • Types include stress and urge incontinence.
• Urinary Diversions: Surgical procedures for urine passage after bladder removal or dysfunction.

Assessment and Diagnosis

• Symptoms of Retention: Small amounts of urine voided frequently.
• Skin Care: Monitor for erythema, erosion due to moisture exposure.
• Urine Characteristics: Color ranges from pale straw to amber; should be transparent and have ammonia odor.
• Bladder Palpation: Detect distension; observe voiding patterns.

Nursing Care and Interventions

• Infection Control: Maintain sterile techniques, especially during catheterization.
• Patient Education: Importance of hydration, regular voiding habits, preventing UTIs.
• Behavioral Interventions: Scheduled toileting, pelvic floor exercises for incontinence management.
• Catheterization: Risks include infection; use appropriate catheter size and material.
  • Indwelling Catheters: Require perineal hygiene.
  • Superpubic Catheter: Inserted surgically above symphysis pubis.

Goals and Outcomes

• Set realistic goals with patient involvement.
• Monitor for relief in symptoms, such as dribbling or urgency.
• Encourage patients to maintain a healthy bladder through lifestyle adjustments.

Teaching Strategies

• Build rapport, assess existing knowledge, and provide clear instructions.
• Use visuals and written materials to aid understanding.
• Emphasize proper perineal hygiene and fluid intake.

Surgical Precautions

• Use aseptic techniques; be aware of allergies (latex, iodine).

Conclusion

• Holistic care includes understanding patient needs, cultural considerations, and ensuring effective communication for optimal urinary health.