Chapter 24 Urinary Elimination Copyright 2017 Elsevier Inc

Chapter 24 Urinary Elimination Copyright © 2017, Elsevier, Inc. All rights reserved.

Urinary Elimination Eliminating waste is a physical need. The urinary system: Removes waste products from the blood Ø Maintains the body’s water balance Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 2

Normal Urination The healthy adult produces about 1500 m. L (milliliters), or 3 pints, of urine a day. Factors affecting urine production include: Ø Ø Ø 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 Ø Activity, work, and illness Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 3

Normal Urination (Cont. ) Observations Normal urine: • Is pale yellow, straw-colored, or amber • Is clear with no particles • Has a faint odor Ø Observe urine for color, clarity, odor, amount, particles, and blood. Ø Report complaints of urgency, burning on urination, or painful or difficult urination. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 4

Normal Urination (Cont. ) Bedpans are used by: Persons who cannot be out of bed Ø Women for voiding and bowel movements Ø Men for bowel movements Ø Standard bedpans and fracture pans are used. Ø Fracture pans are used: • • • By persons with casts By persons in traction By persons with limited back motion After spinal cord injury or surgery After a hip fracture After hip replacement surgery Copyright © 2017, Elsevier, Inc. All rights reserved. 5

Normal Urination (Cont. ) Men use urinals to void. The man stands if possible. Ø Some sit on the side of the bed or lie in bed. Ø Some men need support when standing. Ø You may have to place and hold the urinal for some men. Ø Remind men: To hang urinals on bed rails and signal after use Ø Not to place urinals on overbed tables and bedside stands Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 6

Normal Urination (Cont. ) Persons unable to walk to the bathroom often use commodes. The commode allows a normal position for elimination. Ø The commode arms and back provide support and help prevent falls. Ø Some commodes are wheeled into bathrooms and placed over toilets. They are useful for persons who need support when sitting. • The container is removed if the commode is used with Ø the toilet. • Wheels are locked after the commode is positioned over the toilet. Copyright © 2017, Elsevier, Inc. All rights reserved. 7

Urinary Incontinence The basic types of incontinence are: Stress Ø Urge Ø Overflow Ø Functional Ø Reflex Ø Mixed incontinence Ø Transient incontinence Ø If incontinence is a new problem, tell the nurse at once. Copyright © 2017, Elsevier, Inc. All rights reserved. 8

Urinary Incontinence (Cont. ) The following may be needed: Good skin care and dry garments and linens Ø Promoting normal urinary elimination Ø Bladder training Ø Catheters Ø Incontinence is linked to abuse, mistreatment, and neglect. Remember, incontinence is beyond the person’s control. Ø If you are becoming short-tempered and impatient, talk to the nurse at once. Ø The person has the right to be free from abuse, mistreatment, and neglect. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 9

Applying Incontinence Products Incontinence products help keep the person dry. Most products are disposable—used once. They usually have two layers and a waterproof back. Fluid passes through the first layer. It is absorbed by the lower layer. Many products come in bariatric sizes. Copyright © 2017, Elsevier, Inc. All rights reserved. 10

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 Ø Prompted voiding Ø Habit training/scheduled voiding Ø Catheter clamping Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 11