Skills: ATI: Urinary Elimination
Questions and Correct Answers
Urinary Elimination
✓✓~ is a precise system of filtration, reabsorption, and excretion. These processes help fluid and
electrolyte balance while filtering and excreting water soluble wastes.
Primary organs involved in urinary elimination
✓✓~ Kidneys; with nephrons performing most of the functions of filtration and elimination. Most
adults produce between 1,500 and 2,000 mL of urine per day.
Once urine is filtered it:
✓✓~ passes through ureters into the bladder (storage reservoir for urine). Once urine collects in
the bladder (150-200mL) it sends a signal to the brain to indicate the need to urinate. Person then
relaxes internal and external sphincters located at bottom of the bladder and the urethra. Urine
passes from the bladder through uretha where it exits the body.
Factors that affect urinary elimination
✓✓~ surgery, immobility, medications, and therapeutic diets.
Urinary diversions
✓✓~ temporary or permanent. A stoma for the drainage of urine.
Created for patients who have bladder cancer, radiation injury to the bladder, or
chronic urinary infections may require a diversion to drain urine from a diseased or
dysfunctional bladder.
,Two types of urinary diversions
✓✓~ Continent urinary reservoir and Orthotopic Neobladder
Continent Urinary Reservoir
✓✓~ It is created from a distal portion of the ileum and proximal portion of the colon. The ureters
are embedded in the reservoir. The reservoir is situated under the abdominal wall and has a
narrow ilieal segment brought out through the abdominal wall to form a small stoma. The ileocecal
valve creates a one way valve in the pouch through which a catheter is inserted to empty the urine
from the pouch. Patients must be able to catheterize the pouch 4-6x a day for the rest of their
lives.
Orthotopic Neobladder
✓✓~ Uses an ileal pouch to replace the bladder. Anatomically the pouch is in the same place as
the bladder was before removal. This allows patients to void normally.
Nephrostomy
✓✓~ When patients need urinary drainage directly from one or both kidneys. In this case a tube is
placed directly into the renal pelvis to the abdominal surface.
Ureterostomy
✓✓~ One or both ureters to the abdominal surface
What are the roles of a nurse when caring for a client with urinary diversions?
✓✓~ Refer the client to an ostomy nurse
Train the client on management of urinary diversions.
, Refer the client to ostomy associations for further support
Refer to client to United Ostomy Associations of America.
Factors affecting normal Urinary Elimination:
Age
✓✓~ -full bladder control by 4-5 yrs of age
-enlargement of prostate after 40 yrs of age leads to urinary frequency, hesitancy,
retention, incontinence, and UTI's
-childbirth and gravity weaken pelvic floor, putting patients at risk for the prolapse of
bladder, leading to stress incontinence, which patients can manage with pelvic floor
(kegel) exercises.
Factors affecting normal Urinary Elimination:
Older adult patients
✓✓~ -fewer nephrons
-loss of muscle tone of bladder (frequency occurs)
-inefficient emptying of the bladder (residual urine increases risk of UTI's)
-increase in nocturia (waking up to pee at night)
Factors affecting normal Urinary Elimination:
Pregancy
Questions and Correct Answers
Urinary Elimination
✓✓~ is a precise system of filtration, reabsorption, and excretion. These processes help fluid and
electrolyte balance while filtering and excreting water soluble wastes.
Primary organs involved in urinary elimination
✓✓~ Kidneys; with nephrons performing most of the functions of filtration and elimination. Most
adults produce between 1,500 and 2,000 mL of urine per day.
Once urine is filtered it:
✓✓~ passes through ureters into the bladder (storage reservoir for urine). Once urine collects in
the bladder (150-200mL) it sends a signal to the brain to indicate the need to urinate. Person then
relaxes internal and external sphincters located at bottom of the bladder and the urethra. Urine
passes from the bladder through uretha where it exits the body.
Factors that affect urinary elimination
✓✓~ surgery, immobility, medications, and therapeutic diets.
Urinary diversions
✓✓~ temporary or permanent. A stoma for the drainage of urine.
Created for patients who have bladder cancer, radiation injury to the bladder, or
chronic urinary infections may require a diversion to drain urine from a diseased or
dysfunctional bladder.
,Two types of urinary diversions
✓✓~ Continent urinary reservoir and Orthotopic Neobladder
Continent Urinary Reservoir
✓✓~ It is created from a distal portion of the ileum and proximal portion of the colon. The ureters
are embedded in the reservoir. The reservoir is situated under the abdominal wall and has a
narrow ilieal segment brought out through the abdominal wall to form a small stoma. The ileocecal
valve creates a one way valve in the pouch through which a catheter is inserted to empty the urine
from the pouch. Patients must be able to catheterize the pouch 4-6x a day for the rest of their
lives.
Orthotopic Neobladder
✓✓~ Uses an ileal pouch to replace the bladder. Anatomically the pouch is in the same place as
the bladder was before removal. This allows patients to void normally.
Nephrostomy
✓✓~ When patients need urinary drainage directly from one or both kidneys. In this case a tube is
placed directly into the renal pelvis to the abdominal surface.
Ureterostomy
✓✓~ One or both ureters to the abdominal surface
What are the roles of a nurse when caring for a client with urinary diversions?
✓✓~ Refer the client to an ostomy nurse
Train the client on management of urinary diversions.
, Refer the client to ostomy associations for further support
Refer to client to United Ostomy Associations of America.
Factors affecting normal Urinary Elimination:
Age
✓✓~ -full bladder control by 4-5 yrs of age
-enlargement of prostate after 40 yrs of age leads to urinary frequency, hesitancy,
retention, incontinence, and UTI's
-childbirth and gravity weaken pelvic floor, putting patients at risk for the prolapse of
bladder, leading to stress incontinence, which patients can manage with pelvic floor
(kegel) exercises.
Factors affecting normal Urinary Elimination:
Older adult patients
✓✓~ -fewer nephrons
-loss of muscle tone of bladder (frequency occurs)
-inefficient emptying of the bladder (residual urine increases risk of UTI's)
-increase in nocturia (waking up to pee at night)
Factors affecting normal Urinary Elimination:
Pregancy
