Urinary Elimination

Characteristics of Normal and Abnormal Urine

Amount in 24 hours

Normal 1, 200 1,500 ml ( 30 ml/hr) Abnormal Under 1,200 ml A large amount over intake

Nursing Considerations
Urinary output normally is approx. equal to fluid intake. Output of less than 30 ml/hr may indicate decrease blood flow to the kidneys and should be immediately reported

Characteristics of Normal and Abnormal Urine

Color, clarity Normal Straw, Amber (Clear ) Abnormal Dark Amber Cloudy Dark Orange Red/Dark Brown

 Concentrated urine is darker in color ,/Dark yellow urine is often indicative of dehydration Dilute urine may appear almost clear or very pale yellow. RBC in urine (hematuria) may be evident as pink, bright red or rusty brown urine -sign of a bladder infection or carcinoma

Nursing Considerations

Nursing Considerations
Dark orange to brown urine can be a symptom of jaundice Green tinged urine after six days of sedation with propofol at a moderately high dose

 Note: Some drugs may alter urine color Rifampicin bright orange red Laxative red Chloroquine rusty yellow Phenazopyridine orange brown Yellowing/light orange may be caused

Nursing Considerations

Characteristics of Normal and Abnormal Urine

Odor Normal Faint Aromatic

Abnormal Offensive

Nursing Considerations Some food (eg asparagus) cause a musty odor

Infected urine can have a fetid odor. Urine high in glucose has a sweet odor

Characteristics of Normal and Abnormal Urine

Normal No Microorganism Sterility

Abnormal Microorganism Present

Nursing Considerations
Urine specimen may contaminate by bacteria from perineum during collection.

Characteristics of Normal and Abnormal Urine

Normal pH 4.5 8

Abnormal Over 8 Under 4.5

 Freshly voided urine is normally somewhat acidic.

Nursing Considerations

Alkaline urine may indicate a state of alkalosis, UTI or diet high in fruits and vegetables. More acidic urine

Characteristics of Normal and Abnormal Urine

Specific Gravity Normal 1.010 1.025

Abnormal

Nursing Considerations

Concentrated urine has a higher specific gravity. Diluted urine has a lower specific gravity

Characteristics of Normal and Abnormal Urine

Glucose Normal Absent

Glucose in the urine indicates high blood glucose level (>180 mg/dl) and

Abnormal Present

Characteristics of Normal and Abnormal Urine

Protein Abnormal Present Protein in the Normal Absent

Characteristics of Normal and Abnormal Urine

Normal Absent

Ketones

Abnormal Ketones, the end Present product of the breakdown of fatty acids, are not normally

Characteristics of Normal and Abnormal Urine

Normal Absent Pus Abnormal Present Pus in urine may indicative of UTI

Characteristics of Normal and Abnormal Urine

Normal Absent Blood Abnormal Present

Blood may be present in the urine of the clients who have

 Problem :

Alteration on Urinary Elimination

Polyuria ( diuresis)

Definition : Production of excessive amount of urine (> 100ml/hr or >2500 ml/day) Selected Associated Factors - Fluids containing caffeine or alcohol - - Prescribed diuretics

 Problem :

Alteration on Urinary Elimination

Oliguria

Definition : Production of decreased amount of urine (<30ml/hr or <500ml/day) Selected Associated Factors - Decrease fluid intake , dehydration - Hypotension, shock or kidney dse.

 Problem : Anuria

Alteration on Urinary Elimination

Definition : Absence of production of urine by the kidneys such as 0-10 ml/hr Selected Associated Factors - Decrease fluid intake , dehydration - Hypotension, shock or kidney dse.

 Problem : Urinary Frequency

Alteration on Urinary Elimination

Definition : Voiding in frequent interval Selected Associated Factors Pregnacy Increase fluid intake UTI

 Problem : Nocturia

Alteration on Urinary Elimination

Definition : Increased urination at night Selected Associated Factors Pregnacy Increase fluid intake UTI

 Problem : Dysuria

Alteration on Urinary Elimination

Definition : Voiding that is either painful or difficult

Selected Associated Factors - UTI, Infection and Trauma

 Problem : Enuresis

Alteration on Urinary Elimination

Definition : Bed wetting, repeated involuntary voiding beyond 4-5 years of age

Selected Associated Factors - Family History, Home stresses

 Problem : Urinary Incontinence

Alteration on Urinary Elimination

Definition : A continuous and unpredictable loss of urine Selected Associated Factors - Bladder inflammation - UTI
- Kidney diseases

 Problem : Urinary Retention Definition : The accumulation of urine in the bladder with associated inability of the bladder to empty itself. Note: 250-450 ml. of urine in the bladder triggers micturition reflex Selected Associated Factors
- Recent anesthesia - Recent surgery

Alteration on Urinary Elimination

Nursing Interventions for Clients with Urinary Incontinence

Bladder Retraining Program. Determine the clients voiding pattern or establish a regular voiding time. Lengthen the intervals of voiding once the clients voiding can be controlled. Regulate fluid intake

Nursing Interventions for Clients with Urinary Incontinence

Avoid stimulants at bedtime Schedule diuretics in the morning. Adequate fluid intake in the morning. Kegels Exercise ( alternating tension and relaxation of the pubococcygeal muscles )

 Provide privacy

Nursing Interventions to Induce Voiding/Urination

Provide fluids to drink Assist the patient in the anatomical position of voiding Serve clean, warm and dry bedpan (female) or urinal (male)

 Allow the client to listen to the sound of running water Dangle fingers in warm water Pour warm water over the perineum Promote relaxation

Nursing Interventions to Induce Voiding/Urination

 Perform Credes Maneuver as ordered Administer cholinergics as ordered Last resort: URINARY CATHETERIZATION

Nursing Interventions to Induce Voiding/Urination