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Summary NURA 303 Urinary and Bowel Elimination Study Guide-2
- Course
- NURA303
- Institution
- Mercer University
This is a comprehensive and study guide on Urinary and Bowel Elimination for NURA 303. *Essential Study Material!!
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NURA 303 Fundamentals of Nursing CareUrinary Elimination; Bowel Elimination Learning Guide
Urinary Elimination
Review Anatomy and Physiology related to Urination
Kidneys Ureters Bladder (Detrusor muscle) Urethra – internal (smooth muscle;
involuntary; right below bladder) and external (membranous; skeletal
muscle; voluntary; further down) ** men also have prostatic urethra; they
have longer urethra, so risk of infection is lower than for women
Act of Urination (Micturition, Voiding) = emptying the bladder
Urinating is largely involuntary reflex act, but control can be learned
When urination is initiated, detrusor muscle(bladder) contracts, the internal sphincter relaxes and urine enters posterior
urethra. Muscles of perineum and external sphincter relax, muscle of abdominal wall contracts slightly, diaphragm lowers
and urination occurs.
Factors Affecting Urination
Developmental considerations
Children toilet training (18-24 months old); voluntary control of urethral sphincter
Cannot begin until able to Hold urine for 2 hours; recognize the feeling of a full bladder; communicate
the need to void and control urination until seated on toilet
Enuresis – bed wetting when continence should be present; not seen as problem until 6 y.o.
Effects of aging include
Diminished ability of kidneys to concentrate urine may result in nocturia (peeing at night)
Decreased bladder muscle tone may reduce capacity of bladder to hold urine, which may lead to more
frequency in urination
Decreased bladder contractibility may lead to urine retention and stasis ( UTI’s)
Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness
interferes w/ voluntary control and ability to reach toilet
Medications may interfere as well = ie, diuretics
Food and fluid intake
i. If body is dehydrated, kidneys reabsorb fluid urine is more concentrated (darker) and decreased volume
ii. Fluid overload, kidneys excrete large amount of diluted urine
Alcohol and caffeine = increase urination (diuretics)
High in sodium foods = decreased in urine formation and pee
Psychological variables
For some, this is very personal and may make anxious if they need help
Stress may void less more frequently; or become unable to void bladder completely
Activity and muscle tone
Optimal urine production and elimination promoted by activity
Immobility decrease bladder and sphincter tone AND poor urinary control and urinary stasis
Indwelling catheters loosen bladder tone
Other considerations childbearing; muscle atrophy DT decreased estrogen (menopause); damage to
muscles from trauma
Pathologic conditions affecting urination
, NURA 303 Fundamentals of Nursing Care
Urinary Elimination; Bowel Elimination Learning Guide
o Congenital urinary tract abnormalities o Hypertension
o Polycystic kidney disease o Diabetes mellitus
o Urinary tract infection (UTI) o Gout
o Urinary calculi (kidney stones) o Connective tissue disorders (arthritis, Parkinson’s)
Medications (Which ones increase urination? decrease urination?)
o Diuretics – promote excretion of urine
o Cholinergic medications – drugs contract the bladder allowing complete emptying; produce same effects
as parasympathetic nervous system
o Nephrotoxic (medications capable of causing kidney damage) – can happen with abuse of analgesics and
some antibiotics cause this
o Analgesics and tranquilizers – may diminish awareness of need to void
o Medications that affect color of urine (what color of urine would the nurse educate the patient to expect
if he or she were on these medications?)
Anticoagulants (i.e., warfarin, heparin) – PINK OR RED
Diuretics (i.e. furosemide, diazide, hydrochlorothiazide, bumetadine) – PALE YELLOW
Pyridium, Phenazopyridine (UT analgesic) – ORANGE TO ORANGE/RED
Amitriptyline (antidepressant) or B-complex vit’s– BLUE TO BLUE/GREEN
Levodopa (for Parkinson’s) or injectable iron – BROWN OR BLACK
Using the Nursing Process
Assessment
i. What would you ask the patient in obtaining information about urination and urinary patterns?
Usual patterns of urinary elimination (frequency during day? Night?)
Recent changes in urinary elimination (frequency? Force of stream? Pain? Leak urine?)
Aids to elimination
Present or past occurrence of voiding difficulties (urgency? Pain? Difficulty starting? Incontinence?... past
problems? Infections?)
Presence of urinary diversion?
ii. Urine characteristics – assess color (pale-yellow to amber), odor (aromatic), turbidity (clear or
transluscent), presence of sediment, pH (5-6; range 4.5 – 8), specific gravity (1.015 – 1.025), Abnormal
constituents of urine include protein, blood, pus, albumin, glucose, ketone bodies, casts, gross bacteria,
and bile.
iii. Use of a bladder scanner – helpful in seeing pt’s bladder and calculating volume of urine present
iv. Measuring Urine Output – How would you measure urine output in a patient who is …
Continent pt voids in bedpan, or hat; gloves; pour urine from collection device to measuring
device if need be; place container on flat surface and read at eye-level; document amount; total
24-hour doc required; discard urine in toilet
Incontinent use of scheduled toileting can assist in collection; weigh the wet pad and subtract
dry pad weight to get total output (1g = 1 mL)
indwelling catheter? gloves; measuring device beneath urine collection bag; drainage spout
above (not touching) collection and open clamp; re-clamp when compete, wipe spout with
alcohol pad; measure as previously discussed
How would you collect the following urine specimens?
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