Urinary Elimination
Mark Sumalinog
Effects of Aging on Urinary System
• urinary frequency (decrease ability to expand and
reduces storage capacity)
• nocturia; voiding improves after a recumbent position
(improve kidney circulation)
• long acting diuretics like thiazides (when administered in
the morning) can also cause nocturia
• inefficient neurologic control of bladder muscles can
promote retention of large volumes of urine
Effects of Aging on Urinary System
• In women, most common cause or urinary retention is a
fecal impaction
• in men, prostatic hypertrophy
• sx: urinary frequency, straining, dribbling, palpable
bladder, and the sensation that the bladder is not fully
emptied
• retention can lead to UTI
Effects of Aging in Urinary System
• filtration efficiency of the kidneys decreases with age,
affecting the body's ability to eliminate drugs
• check for adverse drug reactions resulting from
accumulation of toxic levels of drugs
• higher blood urea nitrogen causes lethargy,
confusion, headache, drowsiness
• decreased tubular function leads to problems in
concentration of urine (specific gravity: 1.024; younger
1.032)
Effects of Aging in Urinary System
• decreased reabsorption from the filtrate makes a
proteinuria of 1.0 usually of no diagnostic significance in
older adults
• increased renal threshold for glucose is a serious
concern, because older adults can be hyperglycemic
without evidence of glycosuria (false negative results in
diabetic urine testing)
Effects of Aging in Urinary System
• incontinence is not a normal occurrence with
advanced age; however age related changes increases
the risk
• incontinence reflects a physical or mental disorder
therefore thorough evaluation is needed
• stress incontinence (women with multiple pregnancies
and those who postpone voiding after they sense the
urge)
Urinary System Health Promotion
• good fluid intake
• vitamin C for acidic urine to fight infection such as
cranberries, prunes, plums, eggs, cheese, fish and grains
• catheterization increases the risk (should be avoided, if
possible)
• activity can eliminate urinary stasis
• frequent toileting can prevent retention
• void in upright position
• massaging the bladder area
Urinary System Health Promotion
• rocking back and forth
• running water
• soaking hands in warm water
• trips and activities should be planned to allow bathroom
breaks
• Nocturia can predispose them to accidents- nightlights
should be provided; remove clutter to avoid falls
• reduce fluid intake before bedtime
Urinary System Health Promotion
• complete history and examination
– set a comfortable tone and display sensitivity during the
assessment to facilitate good data collection
Urinary incontinence
• Bothersome for older adults that requires skillful nursing
attention
• Present in 8% to 46% of older people in the community
• Present in 50% institutionalized elderly
• Present in 90% of those in nursing homes and with
dementia
• Present in 30% of those hospitalized
• More prevalent in women than in men
Urinary incontinence
• Transient incontinence- acute and reversible and can be
caused by infections, delirium, medications, excessive
urine production, fecal impaction, mood disorders and
inability to reach commode
• Established incontinence- chronic and persistent with
either an abrupt or gradual onset
Types of Established Incontinence
• Stress incontinence- weak supporting pelvic muscles;
when pressure is placed on the pelvic floor (laughing,
sneezing, or coughing), urine is involuntary lost
• Urgency Incontinence- caused by urinary tract infection,
enlargement of prostate, diverticulitis, or pelvic or bladder
tumors; irritation or bladder spasm causes a sudden
elimination of urine
Types of Established Incontinence
• Overflow incontinence- associated with bladder neck
obstructions and medications (anticholinergics,
adrenergics, CCB); bladder muscle fail to contract or
periurethral muscles do not relax, leading to excessive
accumulation of urine in the bladder
• Neurogenic incontinence- cerebral cortex lesions, multiple
sclerosis, and other disturbances along the neural
pathway; inability to sense the urge to void
Types of Established Incontinence
• Functional Incontinence- caused by dementia, disabilities
that prevent independent toileting, sedation, inaccessible
bathroom, medications that impair cognition, inability to
reach a bathroom
• Mixed incontinence- combination of these factors
Nursing Intervention
• It is not normal part of aging
• Discussing this can be embarrassing
• Questioning every routine assessment is essential
• Identify the cause and determine appropriate treatment
measures through the process of nursing assessment
BLADDER CANCER
• Increases with age; 90% are 55 years old and above
• More men than in women
• Risk factors: Chronic irritation to bladder, exposure to dyes and
cigarette smoking
• Sx: frequency, urgency and dysuria, painless hematuria (primary
sign and characterizes cancer of the bladder)
• Dx: cytoscopic examination
• TTT: surgery, radiation, immunotherapy, and chemotherapy
• Metastasis: pelvic or back pain
RENAL CALCULI
• Middle-aged adults
• Older adults, results from immobility, infection, changes in
pH of the urine, chronic diarrhea, dehydration, excessive
elimination of uric acid, and hypercalcemia
• Sx: pain, hematuria, symptoms of UTI, GI upset may also
occur
• TTT: standard diagnostic and treatment measures, ample
fluids, prompt treatment to UTI
General Nursing Consideration
• Nurses need sensitivity in dealing with patient with urinary
problems
• May raise fears and anxieties
• Realistic explanation and committed effort to correcting this
disorder are vital
• Importance of discretion and dignity in managing problems
• Do not check to see if patient’s pants are wet in front of others, sit
in a bedside commode in a hallway, observe catheterization
without patient’s permission, or scold the patient when wets the
bed
• Promote positive self concept by reducing embarrassment
