urinary elimination

Question 1

the need for urinary elimination

Answer 1

• Urination helps to rid the body of waste products and materials that exceed bodily needs (pg. 1342)
• Primary organs are the kidneys
• Helps to regulate electrolytes, blood volume and blood pressure

Question 2

across the lifespan

Answer 2

Normal adult bladder can hold up to two cups of urine or 16 oz (~475 ml) during the day and four cups or 32 oz of urine during the night (1 fl oz is about 30 mls)
* Children: Bladder capacity: 30 mL in newborn; increases to adult size by 1 year
* Infants should have at least 6 to 8 wet diapers daily (American Academy of Pediatrics)
* By age 3, most children urinate around a dozen times per day. Urinary frequency typically 4-6 times daily, on average.
* Average adult urinates about 7 times per day
* Depending on the amount of liquid, a healthy bladder can stretch anywhere between 5-15 cm.

Question 3

kidneys ureters

Answer 3

o Kidneys major function: maintain composition & volume
of body fluids (there about 1 million nephrons in each kidney)
o Ureters: Enter the bladder obliquely.

Question 4

bladder function

Answer 4

o Normal urine output: (Urine consists of about 95% water & 5% solid substances)
 Average adult person is about 0.5ml/kg/hr. About 30 to 40 ml per
hour. (typically 30 ml per hour is what you will see most)
 The expected urine output in the infant and child is 0.5 to 2 mL/kg/hr.

Question 5

urethra

Answer 5

o Transports urine from bladder to the exterior of the body

Question 6

female urethra

Answer 6

Female Urethra:
About 1.5-2.5
inches long

Question 7

male urethra

Answer 7

Male Urethra:
About 5.5-6.25
inches long

Question 8

kidneys and ureters

Answer 8

Maintain composition and volume of body fluids
Filter and excrete blood constituents not needed; retain
those that are needed
o Kidneys regulate blood volume & blood pressure
 Can lead to water retention or excretion
Excrete waste product (urine)
o The nephrons maintain and regulate fluid balance
through the mechanisms of selective reabsorption and
secretion of water, electrolytes, and other substances.
o Urine from the nephrons empties into the kidneys.
Kidney (children): large in relation to the stomach; prone to
injury

Question 9

bladder

Answer 9

Smooth muscle sac innervated by autonomic nervous
system (ANS)
Serves as a temporary reservoir for urine (stores it)
Composed of three layers of muscle tissue called
detrusor muscle
o The inner longitudinal layer, the middle circular layer,
and the outer longitudinal layer
Sphincter guards opening between urinary bladder
and urethra
Urethra conveys urine from bladder to exterior of
body
Bladder capacity: 30 mL in newborn; increases to
adult size by 1 year

Question 10

the act of urination

Answer 10

micturation

Question 11

the urinary bladder

Answer 11

The Urinary Bladder
* The first voided urine
of the day is usually
more concentrated than
other urine excreted
during the day
* Less fluid intake
* Newborns: urine is
usually light and without
odor
* Do you know why?

Question 12

newborns urine is light and w/o odor why?

Answer 12

because of immature kidneys and nephrons

Question 13

the urethra function in males and females

Answer 13

Conveys urine from the bladder
to the exterior
Male urethra functions in
excretory and reproductive
systems
No portion of female urethra is
external to the body
Urethra (children): shorter;
risk for bacteria into bladder
(UTI)

Question 14

act of urination

Answer 14

The voluntary control of urination develops as the higher nerve centers
develop after infancy.
o Until that time, voiding is purely a reflex action
o Voluntary control of the urethral sphincters occurs between 18-24 months
of age.
o Process of emptying the bladder
o Detrusor muscle contracts, internal sphincter relaxes, urine enters
posterior urethra
o Muscles of perineum and external sphincter relax
o Muscle of abdominal wall contracts slightly
o Diaphragm lowers, micturition occurs

Question 15

developmental considerations

Answer 15

Developmental considerations
o At ~6 weeks of age, the infants nephrons are able to control reabsorption of fluids in the tubules
and effectively concentrate urine.
Food and fluid intake: drink ~64 oz a day!
Psychological/cultural variables (Privacy)
o For some people, voiding is a personal and private act—something one does not talk about

Question 16

factors affecting urination

Answer 16

Activity and muscle tone
o Decreased bladder muscle tone with aging and think about childbirth!
o The diminished ability of the kidneys to concentrate urine may result in nocturia
Pathologic conditions
o Diseases associated with renal problems include congenital urinary tract abnormalities, polycystic kidney
disease, UTI, urinary calculi (kidney stones), hypertension, diabetes mellitus & gout,
Medications
o Diuretics (increase urinary output) Common diuretic: Furosemide (Lasix

Question 17

what should you monitor for renal disorders

Answer 17

Close monitoring of
serum blood counts
and electrolytes is a
critical component of
nursing care related to
renal disorders.

Question 18

hematuria

Answer 18

blood in the urine

Question 19

white blood cells in the urine

Answer 19

can indicate an infection

Question 20

pyuria

Answer 20

pus in the urine, indicative of a UTI

Question 21

bacterunia

Answer 21

bacteria in the urine

Question 22

ketonuria

Answer 22

ketones in the urine, sweet urine, Ketones in the urine is a sign
that your body is using fat for energy instead
of using glucose because not enough insulin
is available to use glucose for energy.
Ketones in the urine is more common in type
1 diabetes.

Question 23

proteinuria

Answer 23

Proteinuria. Kidney damage
(diabetes, high blood pressure)

Question 24

glucose in the urine

Answer 24

Glycosuria. Consuming excessive sugar can
raise your blood glucose past the level that your
kidneys can properly reabsorb

Question 25

Which term describes a condition in which 24-hour
urine output is less than 50 mL?

Answer 25

anuria

Question 26

dysuria

Answer 26

difficulty urinating.

Question 27

glycosuria

Answer 27

sweet urine, sugar in the urine

Question 28

children and the effects of urine

Answer 28

o Toilet training 2 to 3 years old, enuresis
o Must be able to hold urine for 2 hours and recognize the feeling of bladder fullness
o Nocturia (nighttime bedwetting) usually subsides by 6 years of age

Question 29

Diuretics cause increased urine production, resulting in
the need for increased urination and possibly urge
incontinence.

Answer 29

true
Answer: A. True
Rationale: Diuretics cause
increased urine production,
resulting in the need for increased
urination and possibly urge
incontinence.

Question 30

adult renal problems

Answer 30

Congenital urinary tract
abnormalities
Polycystic kidney disease
Urinary tract infection
Urinary calculi
Hypertension
Diabetes mellitus
Gout
Connective tissue disorders
BPH

Question 31

acquired disorders that result in decreased urine function

Answer 31

o Nephrotic syndrome
o Acute glomerulonephritis
o Hemolytic-uremic syndrome

Question 32

what is the function of diuretics

Answer 32

Diuretics: prevent reabsorption of water and certain
electrolytes in tubules
o Commonly used for hypertension and edema caused by heart failure
o Cause moderate to severe increase in production and excretion of dilute urine.
o Furosemide (Lasix)-most commonly loop diuretic used,
Hydrochlorothiazide

Question 33

function of cholinergic medications

Answer 33

Cholinergic medications: stimulate contraction of
detrusor muscle, producing urination
o Commonly used for myasthenia gravis, a disease that causes severe
muscle weakness.
o Bethanechol (Duvoid, Urecholine): Treats urinary retention

Question 34

analgesics and tranquilizers

Answer 34

Analgesics and tranquilizers: suppress CNS, diminish
effectiveness of neural reflex
o Hydrocodone, oxycodone and barbiturates

Question 35

what color do anticoagulants turn urine

Answer 35

red and pink

Question 36

what color do diuretics turn urine

Answer 36

pale yellow

Question 37

some urinary analgesics turn urine what color

Answer 37

dark orange

Question 38

some antidepressants or vitamins like vitamin B would turn urine what color

Answer 38

green or blue colors

Question 39

parkinsons drugs make urine what color

Answer 39

brown or black

Question 40

certain medications can make urine certain colors

Answer 40

Anticoagulants: red urine or blood in urine
Diuretics: pale yellow urine (furosemide)
Pyridium: orange to orange-red urine
The antidepressant amitriptyline or B-complex vitamins: green or
blue-green urine
Levodopa: brown or black urine

Question 41

characteristics of urine

Answer 41

Color- pale yellow, straw-colored or amber
Odor- Aromatic (usually does not smell very strong)
Ph- Normal Ph is 5-6, with a range of 4.5-8
Specific Gravity- Normal range 1.015-1.025

Question 42

normal urine output

Answer 42

Normal
Output: 24
hrs X 30
mls= 720
mls

Question 43

using the nursing process with urine

Answer 43

Assessing data about voiding patterns,
habits, past history of problems
Physical examination of the bladder, if
indicated, and urethral meatus; assessment
of skin integrity and hydration; and
examination of the urine
Correlation of these findings with results of
procedures and diagnostic tests
U/A (urine)
BUN (blood test: Blood Urea Nitogren) Measures protein
Creatinine clearance- how well are the kidneys working
C&S- infection (UTI)
KUB- Kidney, Ureter, Bladder x-ray

Question 44

assessing problems with voiding

Answer 44

Explore its duration, severity, and
precipitating factors.
Note the patient’s perception of
the problem.
Check the adequacy of the
patient’s self-care behaviors.
Children- Assess:
o Infant: Wet diapers (6-8 per day)
o Young child: assess whether the child has
achieved bladder control during both day
and nighttime.

Question 45

past medical history

Answer 45

o Maternal polyhydramnios (excessive fluid),
oligohydramnios (too little amniotic fluid), diabetes,
hypertension, or alcohol or cocaine ingestion

Question 46

neonatal history

Answer 46

Presence of a single umbilical artery, abdominal
mass, chromosome abnormality, or congenital
malformation

Question 47

family history

Answer 47

o Renal disease or uropathology, chronic UTIs, renal
calculi, or a history of parental enuresis

Question 48

assessment for gu disorders

Answer 48

 Burning on urination
 Changes in voiding patterns
 Foul-smelling urine
 Vaginal or urethral discharge
 Genital pain, irritation, or discomfort
 Blood in the urine
 Edema
 Masses in the groin, scrotum, or abdomen
 Flank or abdominal pain; cramps
 Nausea and/or vomiting
 Poor growth; weight gain
 Fever
 Infectious exposure and/or Trauma

Question 49

physical assessment of urinary functioning

Answer 49

Kidneys: Palpation of the kidneys is usually
performed by an advanced health care
practitioner as part of a more detailed
assessment.
Urinary bladder: Palpate and percuss the bladder
or use a bedside scanner.
Urethral orifice: Inspect for signs of infection,
discharge, color or odor.
Skin: Assess for color, texture, turgor, and
excretion of wastes.
Urine: Assess for color, odor, clarity, and
sediment.

Question 50

Tell whether the following statement is true
or false.
Normal fresh urine has an ammonia odor.

Answer 50

false

should have an arrommatic odor

Question 51

measuring urine intake and output

Answer 51

Ask the patient to void into a bedpan, urinal, or specimen container
in bed or bathroom.
Put on gloves. Pour urine into the appropriate measuring device.
Accuracy is important!
Place the calibrated container on a flat surface and read at eye level.
Note amount of urine voided and record on the appropriate form. (I&O’s)
Discard urine in the toilet unless specimen is needed. If a specimen
is required, pour the urine into an appropriate specimen container
Be sure to document in patients EMR
Measurement of fluid intake & outpatient can be delegated to an
unlicensed personnel (you are responsible for accuracy)

Question 52

urine specimens

Answer 52

Routine urinalysis (sterile urine not necessary)
o Measures specific gravity, glucose, RBC’s, sediment for casts
Clean-catch or midstream specimens
Sterile specimens from indwelling catheter
o Aspirate from the urine collection port
Urine specimen from a urinary diversion
24-hour urine specimen
o First void is discarded & then documentation starts
Specimens from infants and children
Point-or-care urine testing
Plastic disposable collection bags are available for collecting urine specimens from
infants and young children who have not achieved voluntary bladder control

Question 53

urinary functioning as the problem

Answer 53

Urinary functioning as the problem
o Incontinence
o Pattern alteration
o Urinary retention
 Urine not fully excreted
o Urinary hesitancy
 Decrease in the force of stream of urine
Urinary functioning as the etiology
o Anxiety
o Caregiver role strain
o Risk for infection