Physiologic changes that accompany normal
aging may affect urination in the older adult.
b.Food and fluid: The kidneys should preserve a
careful balance of fluid intake and output.
Caffeine-containing beverages have a diuretic
effect and increase urine production. Alcohol
produces the same effect by inhibiting the
release of antidiuretic hormone. Foods high in
water may increase urine production. High-
sodium foods and beverages cause sodium and
water reabsorption and retention.
c. Psychological variables: Individuals experiencing
stress often find themselves voiding smaller
amounts of urine at more frequent intervals.
Stress can also interfere with the ability to relax
perineal muscles and the external urethral
sphincter.
d.Activity and muscle tone: Exercise increases
metabolism and optimal urine production and
elimination. With prolonged periods of immobil-
ity, decreased bladder and sphincter tone can
result in poor urinary control and urinary stasis.
e.Pathologic conditions: Certain renal or urologic
problems can affect both the quantity and qual-
ity of urine produced.
f. Medications: Medications have numerous effects
on urine production and elimination.
Nephrotoxic drugs are a serious concern. Abuse
of analgesics can result in nephrotoxicity.
Certain drugs cause urine to change color.- a.The child should be able to hold urine for 2
hours.
b.The child should recognize bladder fullness.
c. The child should be able to express the need to
void and control urination until reaching the
toilet. - a.Infants and young children: It is important to
assess whether the child has achieved bladder
control and whether a toileting schedule has
been established for the child. It is also
important to identify the words the child uses to
indicate the need to void.
b.Older adults: Decreased bladder tone may be a
problem. The nursing history should note how
the person handles these problems and the ade-
quacy of the solution.
c. Patients with limited or no bladder control or
urinary diversions: The procedures and
equipment used should be assessed to make sure
they follow accepted guidelines and are not pre-
disposing the person to infection or other risk. - a.Kidneys: The right kidney may at times be
palpated by the nurse by pushing down on the
diaphragm as the patient inhales. The left kidney
is palpated similarly. The contour and size of the
kidneys are noted, as are any tenderness or
lumps. A check for costovertebral tenderness
should be performed.
b.Bladder: The bladder cannot be assessed by the
nurse when it is empty. When it is distended, the
nurse observes the lower abdominal wall, noting
any swelling, and palpates the area for tenderness,
noting the smoothness and roundness of the
bladder.
c. Urethral orifice: This is inspected for any signs of
inflammation or discharge. Foul odors should be
noted.
d.Skin integrity and hydration: The skin should be
carefully assessed for color, texture, turgor, and
the excretion of wastes. The integrity of the skin
in the perineal area should also be assessed.
e.Urine: Each time a patient’s urine is handled, it
should be assessed for color, odor, clarity, and
the presence of sediment. Abnormalities should
be noted.
5.Urine is placed in a cylindrical container, and the
urinometer is inserted in a circular motion without
touching the bottom or side of the container. The
reading should be made at eye level at the bottom
of the meniscus formed by the urine. The density
of the urine supports the urinometer. If urine is
concentrated, the urinometer will be buoyed high;
if urine is dilute, the urinometer will be supported
low in the urine.
6.Sample answers:
a.The patient will produce urine output about
equal to fluid intake.
b.The patient will maintain fluid and electrolyte
balance.
c. The patient will report ease of voiding.
d.The patient will maintain skin integrity.- a.Schedule: Some patients report voiding on
demand in no apparent pattern; others have
inflexible patterns that have developed over the
years and become anxious if these are interrupted.
b.Privacy: Many adults and children cannot void in
the presence of another person; privacy should
be offered in the healthcare and home setting.
c. Position: Helping patients assume normal void-
ing positions may be all that is necessary to
resolve an inability to void.
d.Hygiene: Patients confined to bed will find it dif-
ficult to perform their usual genital hygiene. The
nurse should place these patients on a bedpan
and pour warm soapy water over the perineal
area, followed by clear water.
8.Sample answers:
a.To relieve urinary retention
b.To obtain a sterile specimen from a woman
c. To empty the bladder before, during, and after
surgery
9.Sample answers:
a.The patient will explain the cause for the urinary
diversion and the rationale for treatment.
b.The patient will demonstrate self-care behaviors
and manage the diversion effectively.
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