• Called Voiding or Micturition
• 60 mL/hour or 1500 - 2000 mL/day
• Five to six times/day
• Clear pale yellow
• Steady stream/Without pain
• Pungent but not foul odor

• Decline in filtration rate
• Loss of tone and elasticity in the bladder wall decreases its potention volume. Leads to
• Need to void more frequently (Nocturia/Frequency/Urgency)
• Inability of bladder to empty completely (Retention/UTI)
• Females: Childbearing may have weakened pelvic muscles (Leaking/Incontinence)
• Males: Enlarged prostate (Hesitancy/Dribbling)
• Drying of the urethra and vaginal mucosa as a result of decreased estrogen levels (UTI)
• Cognitive impairment or generalized clinical deterioration

• Personal
• Sociocultural
• Nutrition
• Hydration
• Immobility
• Medications
• Pathogical Conditions

• Urgency, Frequency, Burning
• Medical & Surgical Hitory/UTIs/Medications
• Usual Pattern
• Nocturia
• Incontinence (involuntary passage of urine)
• Hesitancy
• Color, Odor, Amount
• Pain
• Intake of fluids
• Caffeine intake
• Bowel Pattern
• Ability to get bathroom and manage clothing

• Inspection/Palpation
• Color
• Clarity
• Constituents
• Odor
• Bladder
• Kidneys
• Costovertebral Angle
• Perineum
• Measure
• Intake and Output
• Postvoid Residual

• Serum
• BUN (Blood Urea Nitrogen): 8-20 mg/dL
• Creatinine 0.5 - 1.1 mg/dL
• Urine
• Bedside Testing (dipstick)
• Routine Urinalysis (with Microscopic)
• Clean Catch Specimen
• Culture and Sensitivity
• 24 Hour Urine Collection
• Specific Gravity 1.001 - 1.035

• Toilet
• Bedside Commode
• Toilet receptacle ("hat")
• Bedpan/Fracture Pan
• Urinal
• Graduated Cylinder
• Catheter (indwelling or one-time)
• Specimen Bag with adhesive for infants

• Bladder Scan (bedside)
• Cytoscopy
• Intravenous Pyelogram
• Ultrasound
• X-ray (KUB - Kidney-Ureters-Bladder)

• Urinary Incontinence
• Urinary Retention
• Readiness for Enhanced Urinary Elimination

• Impaired urinary Elimination
• Urinary Incontinence (Functional, Reflex, Stress, Urge)
• Urinary Retention
• Risk for Infection (Urinary Tract)
• Risk for Ineffective Renal Perfusion

• Anxiety related to urinary urgency and recent episode of incontinence
• Distrubed Body Image r/t urinary ostomy or incontinence
• Social Isolation r/t frequent periods of incontinence
• Fall Risk r/t urgency (rushing to get to the bathroom)
• Risk for Impaired Skin Integrity r/t incontinence or poor hygiene

• Pain
• Immobility
• Fluid Volume Imbalance
• Knowledge Deficit
• Ineffective Self Health Management

• The patient expresses willingness to enhance urinary elimination
• Urine is straw colored with no odor
• Specific gravity is within normal limits
• The amount of output is within normal limits for age and other factors
• The patient positions him/herself for emptying of bladder
• Fluid intake is adequate for daily needs
• Patient voids every 2 hours and experiences no episodes of incontinence

• Assist patient in devising fluid management plan including
• Adequate fluid intake
• Limiting fluids proximal to bedtime
• Assist the patient in identifying and managing medications that affect urinary elimination
• Assist the patient in creating an environment conducive to continence
• Obtain assistive devices as needed (eg bedside commode, seat adapters, safety frames)
• Assist the patient in devising initial toileting schedule. Assist in revising as patient progresses
• Assist patient in identifying appropriate bladder training program
• Pelvic muscle training program (Kegels)
• Biofeedback
• Sheduled Voiding
• Encourage fuids to at least 2000 mL per day
• Increase client activity if sedentary

• Provide Privacy
• Assist with Positioning
• Facilitate Toilet Routines
• Promote Adequate Fluids and Nutrition
• Assist with Hygiene

• 31% of all nosocomial infection
• Usually caused by microorganisms from the colon that travel up the urinary tract
• Uretheritis, Cystitis, Pyelonephritis
• Risk Factors include: advanced age, kidney stones, enlarged prostate, femal, catheters, obesity, diabetes, constipation, poor personal hygiene, history of UTIs

• Frequency
• Urgency
• Foul-smelling urine
• Chills and Fever
• Back (Flank) Pain
• Burning with urination
• Suprapubic discomfort

• Costovertebral angle tenderness
• ↑WBCs and Bacteria
• Hematuria
• Sediment or Cloudy appearance
• Fever

• Nonlocalized abdominal discomfort rather than dysuria and suprapubic pain
• Cognitive impairment or generalized clinical deterioration
• Less likely to have a fever, maybe even slight decline in temperature

• Pain
• Immobility
• Knowledge Deficit
• Fluid Volume Deficit
• Self-Care Deficit
• Altered Mental Status
• Ineffective Health Maintenance

• Obtain urine sample, administer antibiotics and analgesics, fluids, As Ordered
• TEACH!
• Encourage fluids
• Urinate when you have the urge
• Wipe from front to back
• Wear cotton
• Avoid bubble baths
• Know signs and symptoms
• Urinate after intercourse
• Avoid diaphragms, spermicidal jelly

• Anti-infectives
• Bactrim/Septra, Bactrim DS (double strength)/Septra DS - (trimethropin/sulfamethoxazone (sulfa drug)), PO or IV
• Macrobid, Macrodantin (nitrofurantoin) - PO (specific to UTIs, severe pulmonary, GI effects)
• Antibiotics: First Generation Cephalosporins
• Keflex (cephalexin), PO
• Ancef (cefazolin); IM, IV
• Analgesic
• Pyridium (phenazopyridine), PO; (turns urine orange)
• Tylenol PO, supp

Urge incontinence (overactive bladder) - the involuntary loss of of larger amounts of urine accompanied by a strong urge to void

Stress incontinence - an involuntary loss of small amounts of urine with increased intra-abdominal pressure, such as exercise, laughing, sneezing, coughing, and lifting. Risk factors - pregnancy, childbirth, obesity

Overflow incontinence - the loss of urine in combination with a distended bladder

Functional incontinence - the untimely loss of urine when no urinary or neurological cause is involved. Occurs because of physical disability, immobility, pain, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet

Unconscious (reflex) incontinence - the loss of urine when the person does not realize the bladder is full and has no urge to void. Often caused by CNS disorders.

• Toileting q 2 hours
• Bedside commode and urinals
• Call Bell in Reach
• Gait and Strength Training
• Bladder Training
• Perineal Skin Care! Barrier Creams and Antifungals
• Teach Kegels (pelvic floor muscles exercises)
• Avoid urge to catheterize

• Accessibility of toilet/Consider a commode
• Keep a bladder diary
• Know the effect of medications on voiding patterns
• Weart attends/pads when going out
• For urge incontinence, teach distraction, deep breathing and relaxation to increase intervals between voidings
• Kegels, Kegels, Kegels
• Avoid caffeine, constipation, inactivity
• Promote weight loss and smoking sessation
• Pessary/Surgery

• Anticholinergenics/Antispasmotics
• Pro-Banthine
• Ditropan (oxybutynin), PO
• Detrol, Vesicare
• Barrier Creams: Calmoseptine
• (anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system)
• (side effects, anticholinergics - dry mouth, constipation, urinary retention)

• An inability to empty the bladder completely
• Causes are: obstruction, inflammation, neurologic, medications, loss of bladder tone, spinal anesthesia, opioid analgesics - pain/anxiety
• Treatments (medical): surgery, catheterization
• Medications
• Cholinergics: Urecholine (bethanechol), Neostigmine (prostigmin)
• For BPH (benign prostatic hypertrophy): Flomax, Proscar
• (side effects, cholinergics: bradycardia, salivation, bronchospasm)

• Place patient in normal position
• Inspect and palpate for distention
• Water
• Crede's Maneuver (gently massage the bladder)
• Measure post-void residual
• Bladder Scanner
• Intake and Output

• Patient voided 1500 mL of light yellow urine in 24 hours
• Patient used call bell and asked for assistance to toilet
• Patient return demonstrated proper hygiene post void
• Post void residual <150 mL
• Patient denies pain, burining, frequency, or urgency with urination
• Patient stated "I can now go 1 1/2 hours without needing to run to the toilet"
• Client stated: "When I feel the urge to go, I take slow, deep breaths until it passes"
• Patient stated: "I wear attends when I go to meet my friends for lunch"
• Patient discussed feelings about urinary ostomy
• Patient states "This time I felt like I emptied my bladder"

• Ureterostomy - one or both ureters to the abdominal surface
• Nephrostomy - a tube from the renal pelvis to the abdominal surface
• (risks associated with urinary diversions are primarily infection and permanent kidney damage which can occur from hydronephrosis (distention of the kidneys with urine, which results from obstruction of the ureter))

• Monitor Intake and Output
• Encourage fluids
• Keep bleow level of bed or below waist level to prevent reflux
• When not flowing - check for kinks first
• Keep system closed
• Meticulous peri/foley care
• Secure to leg to prevent pulling
• After removal check for voiding/amount