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    Impaired Urinary Elimination

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    bby_hael17
    This document provides guidance for assessing impaired urinary elimination by gathering subjective and objective data. The subjective assessment focuses on symptoms, patterns, triggers, and lifestyle impacts. Key areas include control, voiding patterns, sensations, restrictions, and risk factors. The objective assessment examines urine characteristics, voiding patterns, muscle tone, reflexes, bladder capacity, and functional and cognitive abilities as they relate to urinary control. Both assessments aim to identify defining characteristics, related factors, and underlying causes of incontinence.

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    Impaired Urinary Elimination

    Uploaded by

    bby_hael17
    4K views5 pages
    This document provides guidance for assessing impaired urinary elimination by gathering subjective and objective data. The subjective assessment focuses on symptoms, patterns, triggers, and lifestyle impacts. Key areas include control, voiding patterns, sensations, restrictions, and risk factors. The objective assessment examines urine characteristics, voiding patterns, muscle tone, reflexes, bladder capacity, and functional and cognitive abilities as they relate to urinary control. Both assessments aim to identify defining characteristics, related factors, and underlying causes of incontinence.

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    This document provides guidance for assessing impaired urinary elimination by gathering subjective and objective data. The subjective assessment focuses on symptoms, patterns, triggers, and lifestyle impacts. Key areas include control, voiding patterns, sensations, restrictions, and risk factors. The objective assessment examines urine characteristics, voiding patterns, muscle tone, reflexes, bladder capacity, and functional and cognitive abilities as they relate to urinary control. Both assessments aim to identify defining characteristics, related factors, and underlying causes of incontinence.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    4K views5 pages

    Impaired Urinary Elimination

    Uploaded by

    bby_hael17
    This document provides guidance for assessing impaired urinary elimination by gathering subjective and objective data. The subjective assessment focuses on symptoms, patterns, triggers, and lifestyle impacts. Key areas include control, voiding patterns, sensations, restrictions, and risk factors. The objective assessment examines urine characteristics, voiding patterns, muscle tone, reflexes, bladder capacity, and functional and cognitive abilities as they relate to urinary control. Both assessments aim to identify defining characteristics, related factors, and underlying causes of incontinence.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 5

    Impaired Urinary Elimination

    Subjective Data
    ASSESS FOR DEFINING CHARACTERISTICS
    “Do you have a problem with controlling your urine (or going to the bathroom)?”
    History of Symptoms
    Lack of control Change in voiding pattern
    Pain or discomfort Urgency
    Dribbling Retention
    Burning Frequency
    Hesitancy
    Onset and Duration
    Description Relieved by what?
    Frequency Aggravated by what?
    Precipitated by what?
    Restrictions on Llifestyle
    Social Occupational
    Sexual Role responsibilities

    Adult Incontinence
    History of Continence
    Is degree of continence acceptable?
    History of “weak” bladder
    Age of attainment of continence
    Family history of incontinence
    Previous history of enuresis
    Onset and Duration (Day, Night, Just Certain Times)
    Factors that Increase Incidence:
    Coughing Standing
    Delay in getting to bathroom Leaving bathroom
    Laughing Turning in bed
    When excited Running
    Perception of Need to Void
    Present
    Absent
    Diminished
    Ability to Delay Urination After Urge
    Present (how long?)
    Absent
    Sensations Occurring Before or During Micturition
    Difficulty starting stream Lack of sensation to void
    Need to force urine out Painful straining (tenesmus)
    Difficulty stopping stream
    Relief After Voiding
    Complete
    Continued desire to void after bladder is emptied
    Use of Catheters, Diapers, Bed Pads

    Childhood Enuresis
    Onset and pattern (day, night)
    Toilet training history
    Family history of bed-wetting
    Response of others to child (parents, siblings, peers)

    ASSESS FOR RELATED FACTORS


    Physiologic Risk Factors
    Fluid intake pattern (type and amount, especially before bedtime)
    Dehydration (self-imposed, overuse of diuretics, caffeine, alcohol)
    Prostatic hypertrophy
    Bladder, vaginal infections
    Chronic illnesses (e.g., diabetes, alcoholism, Parkinson’s disease, Alzheimer’s disease,
    multiple sclerosis, cerebrovascular accident, vitamin B12 deficiency)
    Metabolic disturbances (e.g., hypokalemia, hypercalcemia)
    Fecal impaction/severe constipation
    Certain medications (diuretics, anticholinergics, antihistamines, sedatives, acetaminophen,
    amitriptyline, aspirin, barbiturates, chlorpropamide, clofibrate, fluphenazine, haloperidol,
    narcotics)
    Multiple or difficult deliveries
    Pelvic, bladder, or uterine surgery, disorders

    Functional Ability
    Perception of bladder cues
    Ability to reach toilet in time
    Walking, balance, manual dexterity

    Environmental Barriers
    Location of bathroom within 40 feet
    Stairs, narrow doorways
    Dim lighting
    Ability to locate bathroom in social settings

    Objective Data
    ASSESS FOR DEFINING CHARACTERISTICS
    Urination Stream
    Slow Drops
    Sprays Slow or hard to start
    Small Dribble
    Starts and stops

    Urine
    Color
    Yellow Straw color
    Yellow-brown Dark brown
    Amber Red-brown
    Green-brown Black
    Odor
    Faint Ammoniac
    Offensive Acetonic
    Appearance
    Clear
    Cloudy
    Reaction (Normal, pH 4.6–7.5, or Alkaline, > 7.5)
    Specific gravity
    Dilute (<1.003)
    Concentrated (>1.025)
    Normal (1.003–1.025)
    Negative or Positive for
    Glucose Red blood cells
    Bacteria Ketone
    Protein

    ASSESS FOR RELATED FACTORS


    Voiding and Fluid Intake Patterns
    Record for 2–4 days to establish a baseline
    What is daily fluid intake?
    When does incontinence occur?

    Muscle Tone
    Abdomen firm, or soft and pendulous?
    History of recent significant weight loss or gain?

    Reflexes
    Presence or absence of cauda equina reflexes
    Anal
    Bulbocavernosus
    Bladder
    Distention (palpable)
    Can it be emptied by external stimuli? (Credé’s method, gentle suprapubic tapping, or warm
    water over the perineum, Valsalva maneuver, pulling of pubic hair, anal stretch)
    Capacity (at least 400–500 mL)
    Residual urine
    None
    Present (in what amount?)

    Functional Ability
    Get in/out of chair
    Walk alone to bathroom
    Maintain balance
    Manipulate clothing

    Cognitive Ability
    Asks to go to bathroom
    Initiates toileting with reminders
    Aware of incontinence
    Expects to be incontinent

    Assess for Presence of


    Constipation Mobility disorders
    Depression Dehydration
    Fecal impaction Sensory disorders

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