Urinary elimination

The urinary system filters and excretes

urine from the body, thereby maintaining
fluid, electrolyte, and acid-base balance.
Normal bowel function provides for the
regular elimination of solid wastes.
 Physiology of Elimination
The urinary system is composed of the
kidneys, ureters, bladder, and urethra. The
kidneys form the urine, the ureters carry
urine to the bladder, the bladder acts as a
reservoir for the urine, and the urethra is the
passageway for the urine to exit the body.
 The physiological mechanisms that govern
urinary elimination are complex and not yet
completely understood. Continence in the adult
requires anatomic integrity of the urinary system,
nervous control of the detrusor muscle, and a
competent sphincter mechanism. Urinary
incontinence occurs when abnormalities of one or
more of these factors causes an uncontrolled loss
of urine that producessocial, physiological, or
hygienic difficulties for the client
Structures of the Urinary Tract

The urinary system is typically divided into upper

and lower urinary tracts.
The upper urinary tract, kidneys, renal pelvis, and
ureters.
The lower urinary tract includes the urinary
bladder, urethra,.and pelvic muscles.
 The primary function of the kidney is to maintain
internal homeostasis through filtration of the blood
and production of urine.
 In addition, the kidney is an endocrine organ
(producing erythropoietin, a hormone that aids in
the production of red blood cells).
 After production within the nephron, urine passes
into the renal pelvis. Holds approximately 15 ml
of urine, and serves as a temporary storage area for
urine before transport to the lower urinary tract.
 The ureter is a long tube, shaped like an inverted
S, that begins at the renal pelvis, passes under the
psoas muscle of the back, and enters the pelvis
near the sacroiliac junction.
 When entering the pelvis, the ureters curve
medially to end in the base of the bladder.
 union between bladder and ureter is called the
ureterovesical junction.
 Both the renal pelvis and ureters consist primarily of
smooth muscle, and they move urine from the upper to
the lower urinary tract by muscular contraction
 This process is called peristalsis, and it is similar to
the peristaltic waves of the gastrointestinal system,
but it is temporarily interrupted during micturition
 Lower Urinary Tract
a. The bladder is a hollow, muscular organ located in
the Pelvis,
b. The urethra is a tube that is a conduit for urinary
elimination.
 In women, the urethra exits the bladder base and
travels at a 16° angle to the external meatus located at
the vestibule. The female urethra is approximately 3.5
to 5.5 cm long,
 In men, the urethra is approximately 23 cm long. It
begins at the bladder base
Nervous Control of the Detrusor Muscle
 The detrusor muscle, the smooth muscle of the bladder
is under indirect voluntary control,
 Micturition center, located near the base of the brain,
has two groups of neurons that mark the origin of the
urination(micturition), the evacuation of urine from
the bladder
 Factors affecting elimination
 Age
Infants18 months of age
 Diet
Adequate fluid and fiber intake are critical factors to a
client’s urinary and bowel health.
 Exercise
Exercise enhances muscle tone, which leads to better
bladder and sphincter control. Peristalsis is also aided
by activity, thus promoting healthy bowel elimination
patterns.
 Medications
antihypertensive may lead to urinary retention.
 Common alterations in elimination
 Urinary incontinence
 urinary retention
Urinary incontinence
 is the uncontrolled loss of urine that constitutes a social
or hygienic problem.
Urinary retention
 is the inability to completely evacuate urine from the
bladder during micturition.
Acute Urinary Incontinence
 is a transient and reversible loss of urine.
 It may occur during an acute illness or after an injury.eg
urinary tract infection
Chronic Urinary Incontinence
There are four predominant types of chronic urine loss:
1. Stress urinary incontinence,
2. Instability incontinence,
3. Functional incontinence,
4. Extraurethral incontinence.
Stress Urinary Incontinence
 Stress urinary incontinence (SUI) is the uncontrolled
loss of urine caused by physical exertion in the absence
of a detrusor muscle contraction.
Instability Incontinence
Instability incontinence is the loss of urine caused by a
premature or hyperactive contraction of the detrusor.
Extraurethral Incontinence
Extraurethral incontinence is the uncontrolled loss of
urine that exists when the sphincter mechanism has
been bypassed.
Functional Incontinence
 Functional incontinence is the loss of urine caused by
altered mobility, dexterity, access to the toilet, or changes in
mentation.

Urinary Retention
Urinary retention is caused by two conditions:
a. Bladder outlet obstruction
b. deficient detrusor muscle contraction strength.
Others :
 Dysuria (painful urination),
 Frequency , hesitancy,
 Nocturia, (more than two times per night)
 urgency
 Assessment
The nursing assessment of elimination is based on:
1. A client interview.
2. evaluation of an objective log or record of urinary or
fecal elimination patterns.
3. Focused physical examination.
4. Review of diagnostic laboratory
Health History
 Clients are asked to describe their usual elimination habits.
Diagnostic and laboratory data
 Urinalysis is obtained ( nitrites, leukocytes,
hemoglobin, glucose, and specific gravity)
 Microscopic analysis presence of white blood cells in
the urine (pyuria)
 Urine culture and sensitivity testing
 Nursing diagnose
Impaired Urinary Elimination
 Stress Urinary Incontinence
Stress urinary incontinence is the state in which an individual
experiences a loss of urine less than 50 ml occurring with increased
abdominal pressure
 Reflex Urinary Incontinence
The state in which an individual experiences an involuntary loss of
urine, occurring at somewhat predictable intervals when a specific
bladder volume is reached.
 Urge Urinary Incontinence
Urge Urinary Incontinence is the state in which an individual
experiences involuntary passage of urine occurring
soon after a strong sense of urgency to void.
Functional Urinary Incontinence : a state in
which an individual experiences an involuntary,
unpredictable passage of urine.
Major characteristics include urge to void or bladder
contractions sufficiently strong to result in loss of
urine before reaching an appropriate receptacle.

 Total Urinary Incontinence

Total urinary incontinence is the state in which an
individual experiences a continuous and
unpredictable loss of urine.
Other Diagnoses
 Other nursing diagnoses that may be important for
clients experiencing alterations in elimination
patterns include:
o Situational Low Self-Esteem.
o Deficient Knowledge.
o Risk for Infection.
o Risk for Impaired Skin Integrity.
o Toileting Self-Care Deficit.
Outcome identification and planning
 Restoring and maintaining regular elimination habits
and preventing potential associated complications such
as infections and altered skin integrity.
Maintain Elimination Health
 intake and urinary output
 Clients should be taught to drink an adequate volume
of fluid each day.
 Ensure adequate daily fluid intake (15 ml/lb
 body weight).
 Reduce or avoid bladder irritants.
 Stop smoking.
 Teach pelvic muscle exercises to women