Urinary elimination
Objectives
• Define the key terms and key abbreviations listed in this chapter.
• Describe the rules for normal urinary elimination.
• Identify the observations to report to the nurse.
• Describe urinary incontinence and the care required.
• Describe straight, indwelling, and condom catheters.
• Explain why catheters are used.
• Explain how to care for persons with catheters.
• Describe two methods of bladder training.
• Perform the procedures described in this chapter.
Key terms
catheter A tube used to drain or inject fluid through a body opening
catheterization The process of inserting a catheter
dysuria Painful or difficult (dys) urination (uria)
Foley catheter See “indwelling catheter”
functional incontinence The person has bladder control but cannot use the toilet in time
hematuria Blood (hemat) in the urine (uria)
indwelling catheter A catheter left in the bladder so urine drains constantly into a drainage bag; retention or Foley catheter
mixed incontinence The combination of stress incontinence and urge incontinence
nocturia Frequent urination (uria) at night (noct)
oliguria Scant amount (olig) of urine (uria); less than 500 mL in 24 hours
overflow incontinence Small amounts of urine leak from a full bladder
polyuria Abnormally large amounts (poly) of urine (uria)
reflex incontinence Urine is lost at predictable intervals when the bladder is full
retention catheter See “indwelling catheter”
straight catheter A catheter that drains the bladder and then is removed
stress incontinence When urine leaks during exercise and certain movements that cause pressure on the bladder
transient incontinence Temporary or occasional incontinence that is reversed when the cause is treated
urge incontinence The loss of urine in response to a sudden, urgent need to void; the person cannot get to a toilet in time
urinary frequency Voiding at frequent intervals
urinary incontinence The involuntary loss or leakage of urine
urinary urgency The need to void at once
urination The process of emptying urine from the bladder; micturition or voiding
KEY ABBREVIATIONS
| C | Centigrade |
| CMS | Centers for Medicare & Medicaid Services |
| F | Fahrenheit |
| ID | Identification |
| IV | Intravenous |
| mL | Milliliter |
| OBRA | Omnibus Budget Reconciliation Act of 1987 |
| UTI | Urinary tract infection |
Eliminating waste is a physical need. The respiratory, digestive, integumentary, and urinary systems remove body wastes. The digestive system rids the body of solid wastes. The lungs remove carbon dioxide. Sweat contains water and other substances. Blood contains waste products from body cells burning food for energy. The urinary system removes waste products from the blood. It also maintains the body’s water balance.
Normal urination
The healthy adult produces about 1500 mL (milliliters) or 3 pints of urine a day. Many factors affect urine production. They include age, disease, the amount and kinds of fluid ingested, dietary salt, body temperature, perspiration, and drugs. Some substances increase urine production—coffee, tea, alcohol, and some drugs. A diet high in salt causes the body to retain water. When water is retained, less urine is produced.
Urination, micturition, and voiding mean the process of emptying urine from the bladder. The amount of fluid intake, habits, and available toilet facilities affect frequency. So do activity, work, and illness. People usually void at bedtime, after sleep, and before meals. Some people void every 2 to 3 hours. The need to void at night disturbs sleep.
Some persons need help getting to the bathroom. Others use bedpans, urinals, or commodes. Follow the rules in Box 22-1 and the person’s care plan.
See Focus on Communication: Normal Urination.
See Teamwork and Time Management: Normal Urination.
Observations
Normal urine is pale yellow, straw-colored, or amber (Fig. 22-1). It is clear with no particles. A faint odor is normal. Observe urine for color, clarity, odor, amount, and particles.
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 urine odor.
Ask the nurse to observe urine that looks or smells abnormal. Report complaints of urgency, burning on urination, or painful or difficult urination. Also report the problems in Table 22-1. The nurse uses the information for the nursing process.
Table 22-1
| Problem | Definition | Causes |
| Dysuria | Painful or difficult (dys) urination (uria) | Urinary tract infection (UTI), trauma, urinary tract obstruction |
| Hematuria | Blood (hemat) in the urine (uria) | Kidney disease, UTI, trauma |
| Nocturia | Frequent urination (uria) at night (noct) | Excess fluid intake, kidney disease, prostate disease |
| Oliguria | Scant amount (olig) of urine (uria); less than 500 mL in 24 hours | Poor fluid intake, shock, burns, kidney disease, heart failure |
| Polyuria | Abnormally large amounts (poly) of urine (uria) | Drugs, excess fluid intake, diabetes, hormone imbalance |
| Urinary frequency | Voiding at frequent intervals | Excess fluid intake, UTI, pressure on the bladder, drugs |
| Urinary incontinence | The involuntary loss or leakage of urine | Trauma, disease, UTI, reproductive or urinary tract surgeries, aging, fecal impaction, constipation, not getting to the bathroom in time |
| Urinary urgency | The need to void at once | UTI, fear of incontinence, full bladder, stress |
Bedpans
Bedpans are used by persons who cannot be out of bed. Women use bedpans for voiding and bowel movements. Men use them for bowel movements.
GIVING THE BEDPAN
Quality of life
Remember to:
Pre-procedure
Procedure
7 Lower the bed rail near you if up.
8 Position the person supine. Raise the head of the bed slightly.
9 Fold the top linens and gown out of the way. Keep the lower body covered.
12 Slide the bedpan under the person (Fig. 22-4).
13 If the person cannot assist in getting on the bedpan:
a Place the waterproof pad under the person’s buttocks if using one.
b Turn the person onto the side away from you.
c Place the bedpan firmly against the buttocks (Fig. 22-5, A, p. 338).
d Push the bedpan down and toward the person (Fig. 22-5, B, p. 338).
e Hold the bedpan securely. Turn the person onto his or her back.
f Make sure the bedpan is centered under the person.
16 Make sure the person is correctly positioned on the bedpan (Fig. 22-6, p. 338).
17 Raise the bed rail if used.
18 Place the toilet tissue and signal light within reach.
19 Ask the person to signal when done or when help is needed.
20 Remove the gloves. Practice hand hygiene.
21 Leave the room, and close the door.
22 Return when the person signals. Or check on the person every 5 minutes. Knock before entering.
23 Practice hand hygiene. Put on gloves.
24 Raise the bed for body mechanics. Lower the bed rail (if used) and lower the head of the bed.
27 Cover the bedpan. Take it to the bathroom. Raise the bed rail (if used) before leaving the bedside.
28 Note the color, amount, and character of urine or feces.
29 Empty the bedpan contents into the toilet and flush.
30 Rinse the bedpan. Pour the rinse into the toilet and flush.
31 Clean the bedpan with a disinfectant.
32 Remove soiled gloves. Practice hand hygiene, and put on clean gloves.
33 Return the bedpan and clean cover to the bedside stand.
34 Help the person with hand washing. (Wear gloves for this step.)
Post-procedure
36 Provide for comfort. (See the inside of the front book cover.)
37 Place the signal light within reach.
38 Lower the bed to its lowest position.
39 Raise or lower bed rails. Follow the care plan.
41 Complete a safety check of the room. (See the inside of the front book cover.)
42 Follow center policy for soiled linen.
The standard bedpan is shown in Figure 22-2. A fracture pan has a thin rim. It is only about ½-inch deep at one end (see Fig. 22-2). The smaller end is placed under the buttocks (Fig. 22-3, p. 336). Fracture pans are used:
See Delegation Guidelines: Bedpans, p. 336.
See Promoting Safety and Comfort: Bedpans, p. 336.
Urinals
Men use urinals to void (Fig. 22-7). Plastic urinals have caps and hook-type handles. The urinal hooks to the bed rail within the man’s reach. He stands to use the urinal if possible. Or he sits on the side of the bed or lies in bed to use it. Some men need support when standing. You may have to place and hold the urinal for some men.
GIVING THE URINAL
Quality of life
Remember to:
Pre-procedure
Procedure
7 Give him the urinal if he is in bed. Remind him to tilt the bottom down to prevent spills.
a Help him sit on the side of the bed.
b Put non-skid footwear on him.
c Help him stand. Provide support if he is unsteady.
9 Position the urinal if necessary. Position his penis in the urinal if he cannot do so.
10 Place the signal light within reach. Ask him to signal when done or when he needs help.
12 Remove the gloves. Practice hand hygiene.
13 Leave the room, and close the door.
14 Return when he signals for you. Or check on him every 5 minutes. Knock before entering.
15 Practice hand hygiene. Put on gloves.
16 Close the cap on the urinal. Take it to the bathroom.
17 Note the color, amount, and clarity of urine.
18 Empty the urinal into the toilet and flush.
19 Rinse the urinal with cold water. Pour rinse into the toilet and flush.
20 Clean the urinal with a disinfectant.
21 Return the urinal to its proper place.
22 Remove soiled gloves. Practice hand hygiene, and put on clean gloves.
Post-procedure
After voiding, the urinal cap is closed. This prevents urine spills. Remind men to hang urinals on bed rails and to use the signal light after using them. Remind them not to place urinals on overbed tables and bedside stands. The overbed table is used for eating and as a work surface. Bedside stands are used for supplies. These surfaces must not be contaminated with urine.
Some beds may not have bed rails. Follow center policy for where to place urinals.
See Focus on Communication: Urinals
See Delegation Guidelines: Urinals.
See Promoting Safety and Comfort: Urinals.
Commodes
A commode is a chair or wheelchair with an opening for a container (Fig. 22-8). Persons unable to walk to the bathroom often use commodes. The commode allows a normal position for elimination. The commode arms and back provide support and help prevent falls.
HELPING THE PERSON TO THE COMMODE
