Introduction to Nursing Care: Altered Urinary Elimination
Altered urinary elimination occurs as a result of many different
physiological or pathological causes. Physiological causes can include aging
or compensation for extreme fluid status changes (e.g., dehydration).
Pathological conditions that affect urinary elimination can include diabetes
mellitus, uncontrolled hypertension, infection, or cancer. Structural
obstruction can occur with kidney stones, trauma, or post-surgery
complications. As a nurse, looking for cues such as the underlying causes
and assessment findings will help to manage clients who have altered
urinary elimination.
All the listed conditions can cause altered urinary elimination. While some
are more obvious (benign prostatic hypertrophy, pyelonephritis, and
chronic kidney disease), others are not as simple. Coronary artery
disease can lead to myocardial infarction. Since the kidney demands 20%
of oxygenated blood for the body, reduced cardiac output can cause kidney
damage, leading to altered urinary elimination. Strep throat, specifically,
Group A beta-hemolytic streptococcus (GABS), if untreated, can lead to
post-streptococcal glomerulonephritis and kidney inflammation, leading to
kidney failure.
The glomerular filtration rate measures the ability of the kidneys to filter
via glomerulus. BUN measures the amount of nitrogen that comes from
urea and the kidneys' ability to excrete nitrogenous wastes. Creatinine is
measured by the ability of the kidneys to eliminate creatinine from the body.
Hemoglobin measures the amount of hemoglobin present in the blood. The
anion gap measures the difference between the positively and negatively
charged electrolytes.
,The functions of the urinary system
are filtration, reabsorption, and excretion.
Perfusion is one of the functions of the cardiovascular system, while
ventilation is one of the functions of the respiratory system.
Altered Urinary Elimination
The urinary system is vital in filtering and excreting what’s not needed by
the body. Filtration is measured by glomerular filtration rate (GFR). The
kidneys can reabsorb fluids and electrolytes when needed to maintain
homeostasis. The kidneys can prevent additional health issues by excreting
waste, excess fluids, and unneeded electrolytes.
Kidneys do so much more than filter waste by creating urine. They control
blood pressure, regulate acid-base balance, make erythropoietin, activate
Vitamin D, and assist with the regulation of bone breakdown and
absorption. Therefore, when a client has altered urinary elimination, they
can have hypertension and hypotension, metabolic acidosis, severe
electrolyte imbalances, anemia, and calcium-phosphorus imbalances. The
kidneys require over 20% of the total cardiac output to maintain an
adequate blood flow of 1200 ml/minute.
The glomerulus filters anything that goes through the kidneys. The normal
glomerular filtration rate is 125 ml/minute. The tubules are responsible for
the reabsorption and excretion of the waste products. Urine is then sent
through the ureters to the bladder, which has a capacity of 600 to
1,000 ml.
When the kidneys fail, it is caused by:
prolonged reduced blood flow through the kidney—when this
occurs, the client becomes oliguric or anuric (little/no urine)
destruction of the filtration system (glomerulus)—when this occurs,
urine still comes out, but electrolytes and toxins collect
ureteral blockage—when this occurs, urine does not come out but
continues to collect and cause back pressure in the urinary system,
leading to hydronephrosis and kidney ischemia
, The most therapeutic response is to let the client talk more about their
concerns.
The other statements are non-therapeutic.
Clients who have altered urinary elimination due to kidney failure can
develop metabolic acidosis. Kidneys produce bicarbonate, and therefore,
if kidneys are not functioning well, production of bicarbonate will drop. The
kidneys are also responsible for excreting hydrogen ions. If they do not
work properly, acids accumulate in the body.
Rarely can a client have metabolic alkalosis, but this is usually because of a
combination of severe dehydration with kidney failure. Respiratory alkalosis
and acidosis are caused by ventilation and perfusion problems.
Nursing Assessment
Altered urinary elimination can be caused by medical or surgical
complications. It is also common to have inherited kidney disease, or a
family history suggesting a predisposition to urinary abnormalities. There
are social components including frequent urinary tract or sexually
transmitted infections that could put the client at higher risk of urinary
problems. Working in environments that may cause high levels of
dehydration combined with the intake of carbonated concentrated fluids can
lead to kidney stone formation. Finally, some medications can put additional
stress on the urinary system as well. Here are some common assessment
cues to consider:
History Nursing Assessment
Past Trauma, infection, obstruction (kidney stones), uncontrolled
Medical hypertension, diabetes mellitus, cancer, multiple sclerosis,
History streptococcal infection
Past Any surgery can predispose the client to develop renal
Surgical insufficiency.
History
Altered urinary elimination occurs as a result of many different
physiological or pathological causes. Physiological causes can include aging
or compensation for extreme fluid status changes (e.g., dehydration).
Pathological conditions that affect urinary elimination can include diabetes
mellitus, uncontrolled hypertension, infection, or cancer. Structural
obstruction can occur with kidney stones, trauma, or post-surgery
complications. As a nurse, looking for cues such as the underlying causes
and assessment findings will help to manage clients who have altered
urinary elimination.
All the listed conditions can cause altered urinary elimination. While some
are more obvious (benign prostatic hypertrophy, pyelonephritis, and
chronic kidney disease), others are not as simple. Coronary artery
disease can lead to myocardial infarction. Since the kidney demands 20%
of oxygenated blood for the body, reduced cardiac output can cause kidney
damage, leading to altered urinary elimination. Strep throat, specifically,
Group A beta-hemolytic streptococcus (GABS), if untreated, can lead to
post-streptococcal glomerulonephritis and kidney inflammation, leading to
kidney failure.
The glomerular filtration rate measures the ability of the kidneys to filter
via glomerulus. BUN measures the amount of nitrogen that comes from
urea and the kidneys' ability to excrete nitrogenous wastes. Creatinine is
measured by the ability of the kidneys to eliminate creatinine from the body.
Hemoglobin measures the amount of hemoglobin present in the blood. The
anion gap measures the difference between the positively and negatively
charged electrolytes.
,The functions of the urinary system
are filtration, reabsorption, and excretion.
Perfusion is one of the functions of the cardiovascular system, while
ventilation is one of the functions of the respiratory system.
Altered Urinary Elimination
The urinary system is vital in filtering and excreting what’s not needed by
the body. Filtration is measured by glomerular filtration rate (GFR). The
kidneys can reabsorb fluids and electrolytes when needed to maintain
homeostasis. The kidneys can prevent additional health issues by excreting
waste, excess fluids, and unneeded electrolytes.
Kidneys do so much more than filter waste by creating urine. They control
blood pressure, regulate acid-base balance, make erythropoietin, activate
Vitamin D, and assist with the regulation of bone breakdown and
absorption. Therefore, when a client has altered urinary elimination, they
can have hypertension and hypotension, metabolic acidosis, severe
electrolyte imbalances, anemia, and calcium-phosphorus imbalances. The
kidneys require over 20% of the total cardiac output to maintain an
adequate blood flow of 1200 ml/minute.
The glomerulus filters anything that goes through the kidneys. The normal
glomerular filtration rate is 125 ml/minute. The tubules are responsible for
the reabsorption and excretion of the waste products. Urine is then sent
through the ureters to the bladder, which has a capacity of 600 to
1,000 ml.
When the kidneys fail, it is caused by:
prolonged reduced blood flow through the kidney—when this
occurs, the client becomes oliguric or anuric (little/no urine)
destruction of the filtration system (glomerulus)—when this occurs,
urine still comes out, but electrolytes and toxins collect
ureteral blockage—when this occurs, urine does not come out but
continues to collect and cause back pressure in the urinary system,
leading to hydronephrosis and kidney ischemia
, The most therapeutic response is to let the client talk more about their
concerns.
The other statements are non-therapeutic.
Clients who have altered urinary elimination due to kidney failure can
develop metabolic acidosis. Kidneys produce bicarbonate, and therefore,
if kidneys are not functioning well, production of bicarbonate will drop. The
kidneys are also responsible for excreting hydrogen ions. If they do not
work properly, acids accumulate in the body.
Rarely can a client have metabolic alkalosis, but this is usually because of a
combination of severe dehydration with kidney failure. Respiratory alkalosis
and acidosis are caused by ventilation and perfusion problems.
Nursing Assessment
Altered urinary elimination can be caused by medical or surgical
complications. It is also common to have inherited kidney disease, or a
family history suggesting a predisposition to urinary abnormalities. There
are social components including frequent urinary tract or sexually
transmitted infections that could put the client at higher risk of urinary
problems. Working in environments that may cause high levels of
dehydration combined with the intake of carbonated concentrated fluids can
lead to kidney stone formation. Finally, some medications can put additional
stress on the urinary system as well. Here are some common assessment
cues to consider:
History Nursing Assessment
Past Trauma, infection, obstruction (kidney stones), uncontrolled
Medical hypertension, diabetes mellitus, cancer, multiple sclerosis,
History streptococcal infection
Past Any surgery can predispose the client to develop renal
Surgical insufficiency.
History
