1. Chapter 22 Urinary Elimination
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Urinary Elimination Eliminating waste is a physical need.
Common terms include: urination, micturition, voiding, peeing, passing water, making water
The urinary system:
Removes waste products from the blood
Maintains the body’s water balance
Review the contents of Box 22-1 on p. 376 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Urinary System
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Normal Urination
The healthy adult produces about 1500 mL (milliliters), or 3 pints, of urine a day.
Factors affecting urine production include:
Age
Disease
Amount and kinds of fluid ingested
Dietary salt
Body temperature and perspiration
Drugs
Frequency of urination is affected by:
Amount of fluid intake, habits, and available toilet facilities
Activity, work, and illness
People usually void at bedtime, after sleep, and before meals. Some people void every 2 to 3 hours.
Some persons need help getting to the bathroom. Others use bedpans, urinals, or commodes.
Review the rules in Box 22-1 on p. 376 in the Textbook and the person’s care plan.
Review Focus on Children and Older Persons: Normal Urination on p. 000 in the Textbook.
Review Focus on Communication: Normal Urination on p. 377 in the Textbook.
Review Teamwork and Time Management: Normal Urination on p. 377 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Normal Urination (cont’d)
Observations
Normal urine:
Is pale yellow, straw-colored, or amber
Is clear with no particles
Has a faint odor
Observe urine for color, clarity, odor, amount, particles, and blood.
Report complaints of urgency, burning on urination, or painful or difficult urination-may signal kidney stones etc.
Some foods affect urine color. Red food dyes, beets, blackberries, and rhubarb cause red-colored urine. Carrots and sweet potatoes cause bright yellow urine. Certain drugs change urine color. Asparagus causes a change in urine color.
Ask the nurse to observe urine that looks or smells abnormal.
Review Table 22-1 on p. 377 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Urine
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. Kidney Stones
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8. Urinary Problems Dysuria-difficult or painful (dys) urination (uria)
Nocturia-frequent urination (uria) at night (noct)
Hematuria-blood (hemat) in the urine (uria)
Oliguria-scant amount (olig) or urine (uria)
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Normal Urination (cont’d)
Bedpans are used by:
Persons who cannot be out of bed
Women for voiding and bowel movements
Men for bowel movements
Standard bedpans and fracture pans are used.
Fracture pans are used by patients with:
Casts, in traction, limited back movement
After spinal cord injury, surgery
After a hip fracture or replacement
A fracture pan has a thin rim. It is only about ½-inch deep at one end. The smaller end is placed under the buttocks.
Review the Delegation Guidelines: Bedpans Box on p. 378 in the Textbook.
Review the Promoting Safety and Comfort: Bedpans Box on p. 379 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Normal Urination (cont’d)
Men use urinals to void.
The man stands if possible.
Some sit on the side of the bed or lie in bed.
Some men need support when standing.
You may have to place and hold the urinal for some men.
Remind men:
To hang urinals on bed rails and signal after use
Not to place urinals on overbed tables and bedside stands
Plastic urinals have caps and hook-type handles. The urinal hooks to the bed rail within the man’s reach. Some beds may not have bed rails. Follow agency policy for where to place urinals.
After voiding, the urinal cap is closed. This prevents urine spills.
Review Focus on Communication: Urinals Box on p. 381 in the Textbook.
Review the Delegation Guidelines: Urinals Box on p. 382 in the Textbook.
Review the Promoting Safety and Comfort: Urinals Box on p. 382 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. Normal Urination (cont’d)
Persons unable to walk to the bathroom often use bedside commodes.
The commode allows a normal position for elimination.
The commode arms and back provide support and help prevent falls.
Some commodes are wheeled into bathrooms and placed over toilets. They are useful for persons who need support when sitting or need an elevated seat.
A commode is a chair or a wheelchair with an opening for a container.
Review the Delegation Guidelines: Commodes Box on p. 383 in the Textbook.
Review the Promoting Safety and Comfort: Commodes Box on p. 383 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

12. Urinary Incontinence The basic types of incontinence are:
Stress
Urge
Overflow
Functional
Reflex
Mixed incontinence
Transient incontinence
If incontinence is a new problem, tell the nurse at once.
Urinary incontinence is the involuntary loss or leakage of urine.
Though it occurs in some older persons, it is not a normal part of aging.
Older persons are at risk for incontinence because of changes in the urinary tract, medical and surgical conditions, and drug therapy.
Incontinence may be temporary or permanent.
Sometimes incontinence results from intestinal, rectal, and reproductive system surgeries.
Incontinence may result from a physical illness or drugs.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. Urinary Incontinence (cont’d)
The following may be needed:
Good skin care and dry garments and linens
Promoting normal urinary elimination
Bladder training
Catheters
Incontinence is linked to abuse, mistreatment, and neglect.
Remember, incontinence is beyond the person’s control.
If you are becoming short-tempered and impatient, talk to the nurse at once.
The person has the right to be free from abuse, mistreatment, and neglect.
The Centers for Medicare and Medicaid Services (CMS) requires appropriate treatment and services for persons who are incontinent. The goals are to prevent UTIs (urinary tract infections) and restore as much normal bladder function as possible.
Incontinence is embarrassing and uncomfortable. Pride, dignity, and self-esteem are affected. Social isolation, loss of independence, and depression are common. Quality of life suffers.
Review Box 22-2 on p. 385 in the Textbook.
Review Focus on Children and Older Persons: Managing Incontinence Box on p. 386 in the Textbook.
Review Focus on Long-Term Care and Home Care: Managing Incontinence Box on p. 386 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

14. Catheters
Inserted through the urethra into the bladder, a urinary catheter drains urine into a drainage bag.
A straight catheter drains the bladder and then is removed.
An indwelling catheter (retention or Foley catheter) is left in the bladder.
Catheterization is the process of inserting a catheter.
In an indwelling catheter, a balloon near the tip is inflated with sterile water after the catheter is inserted. The balloon prevents the catheter from slipping out of the bladder.
Catheterization is done by a doctor or nurse. With the proper education and supervision, some states and agencies let nursing assistants insert and remove catheters.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

15. Catheters (cont’d) Catheters are used:
Before, during, and after surgery
For people who are too weak or disabled to use the bedpan, urinal, commode, or toilet
To protect wounds and pressure ulcers from contact with urine
To allow hourly urinary output measurements
To collect sterile urine specimens
For measuring residual urine
When caring for persons with indwelling catheters, the risk of infection is high.
Catheters keep the bladder empty and thereby reduce the risk of bladder injury during surgery. After surgery, a full bladder causes pressure, which can lead to pain or discomfort.
Catheters do not treat the cause of incontinence.
Residual urine is the amount of urine left in the bladder after the person voids.
Follow the rules in Box 22-4 on p. 393 in the Textbook to promote safety and comfort.
Review the Focus on Communication: Catheters Box on p. 394 in the Textbook.
Review the Delegation Guidelines: Catheters Box on p. 394 in the Textbook.
Review the Promoting Safety and Comfort: Catheters Box on p. 394 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

16. Catheters (cont’d) Drainage systems
A closed drainage system is used for indwelling catheters.
Nothing can enter the system from the catheter to the drainage bag.
Some people wear leg bags that attach to the thigh or calf when standing up.
The drainage bag is always kept lower than the bladder to prevent urinary tract infections (UTIs).
The catheter bag is attached to the bed frame when the patient is in bed.
The urinary system is sterile.
The drainage system has drainage tubing and a drainage bag. Tubing attaches at one end to the catheter, and at the other end, to the drainage bag.
The bag hangs from the bed frame, chair, or wheelchair. It must not touch the floor.
If the drainage bag is higher than the bladder, urine can flow back into the bladder. A UTI can occur.
Do not hang the drainage bag on a bed rail.
When the person walks, the bag is held lower than the bladder.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

17. Catheters (cont’d)
If the drainage system is disconnected accidentally, tell the nurse at once.
Do not touch the ends of the catheter or tubing.
Practice hand hygiene and put on gloves.
Wipe the end of the tube with an antiseptic wipe.
Wipe the end of the catheter with another antiseptic wipe.
Do not put the ends down.
Do not touch the ends after you clean them.
Connect the tubing to the catheter.
Discard the wipes into a biohazard bag.
Remove the gloves and practice hand hygiene.
Be sure to know what to do if a drainage system is disconnected accidentally.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

18. Catheters (cont’d)
Leg bags are changed to drainage bags when the person is in bed.
You open the closed drainage system.
Prevents microbes from entering the system.
Drainage bags are emptied and urine is measured:
At the end of every shift
When changing from a leg bag to a drainage bag
When changing from a drainage bag to a leg bag
When the bag is becoming full
Nothing should touch the drain when emptying!
Review the Delegation Guidelines: Drainage Systems Box on p. 396 in the Textbook.
Review the Promoting Safety and Comfort: Drainage Systems Box on p. 397 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

19. Catheters (cont’d) Removing indwelling catheters
An indwelling catheter has two lumens (passage-ways).
Sterile water is injected through one lumen to inflate the balloon.
Urine drains from the bladder through the other lumen.
A physician’s order is needed to remove a catheter.
Most people need bladder training first-the purpose is to regain control of urination
Dysuria and urinary frequency are common after removing catheters.
To remove the catheter, the balloon is deflated. You need a syringe large enough to hold all of the water in the balloon. Balloon size is marked at the end of the catheter.
Review the Focus on Communication: Removing Indwelling Catheters Box on p. 400 in the Textbook.
Review the Delegation Guidelines: Removing Indwelling Catheters Box on p. 400 in the Textbook.
Review the Promoting Safety and Comfort: Removing Indwelling Catheters Box on p. 400 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

20. Catheters (cont’d)
Condom catheters (external catheters, Texas catheters, urinary sheaths) are often used for incontinent men.
A condom catheter is a soft sheath that slides over the penis.
To apply a condom catheter:
Follow the manufacturer’s instructions.
Thoroughly wash the penis with soap and water.
Dry the penis before applying the catheter.
Condom catheters are self-adhering or applied with elastic tape.
Never use adhesive tape to secure catheters.
Condom catheters are changed daily after perineal care.
Adhesive tape does not expand. Blood flow to the penis is cut off, injuring the penis.
Review the Delegation Guidelines: Condom Catheters Box on p. 402 in the Textbook.
Review the Promoting Safety and Comfort: Condom Catheters Box on p. 402 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

21. Condom catheter
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

22. Bladder Training Control of urination is the goal.
The person uses the toilet, commode, bedpan, or urinal at certain times.
The rules for normal elimination are followed.
The normal position for urination is assumed if possible.
Privacy is important.
Four methods are:
Bladder retraining
Prompted voiding
Habit training/scheduled voiding
Catheter clamping
Bladder training helps some persons with urinary incontinence. Some persons need bladder training after indwelling catheter removal.
Bladder control promotes comfort and quality of life. It also increases self-esteem.
You assist with bladder training as directed by the nurse and the care plan.
Successful bladder retraining may take several weeks.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.