Impaired Urinary Elimination, Impaired Urinary Elimination Nursing Assessment, Impaired Urinary Elimination Interventions, and Impaired Urinary Elimination Nursing Care Plans

This guide is on impaired urinary elimination, impaired urinary elimination nursing assessment, impaired urinary elimination interventions, and impaired urinary elimination nursing care plans. It can be used to create impaired urinary elimination nursing care plans for educational purposes.

Impaired Urinary Elimination, Impaired Urinary Elimination Nursing Assessment, Impaired Urinary Elimination Interventions, and Impaired Urinary Elimination Nursing Care Plans

Impaired Urinary Elimination

Pacemaker for the bladder helps control incontinence

Impaired Urinary Elimination is a NANDA diagnosis that refers to any disturbance to the urine elimination. It is commonly used to create a nursing care plan for patients with genito-urinary disorders, such as urinary tract infections or UTIs, and renal diseases, such as acute kidney injury and chronic renal failure.

The goal of nursing care for a patient with an impaired urinary elimination is for him/her to urinate without bladder distention, urine retention, pain or discomfort.

Factors Related to Impaired Urinary Elimination

The factors that may contribute to having an impaired urinary elimination include:

  • Obstruction of the bladder outlet
  • Bladder atony – poor tone of the bladder muscles
  • Decreased bladder capacity
  • Diminished bladder cues
  • Multiple injuries
  • Disruption in bladder innervation
  • Congenital GU problems such as epispadias, hypospadias, or having a small bladder
  • Environmental barriers
  • Sensory-motor impairment
  • Incompetent bladder

Signs and Symptoms of Impaired Urinary Elimination

  • Bladder distention
  • Enuresis (urinary incontinence) loss of bladder control
  • Increased frequency and urgency to urinate
  • Nocturia – voiding at night
  • Dribbling
  • Hesitancy
  • Dysuria – difficulty to urinate that can be uncomfortable or painful
  • Retention of urine – large residual volumes of urine as detected in bladder scans

Goals and Outcomes

The following are the common goals and expected outcomes for impaired urinary elimination:

  • Patient demonstrates behaviors and techniques to prevent retention/urinary infection.
  • Patient identifies the cause of incontinence.
  • Patient maintains balanced I&O with clear, odor-free urine, free of bladder distension/urinary leakage.
  • Patient provides rationale for treatment.
  • Patient verbalizes understanding of the condition.

Impaired Urinary Elimination Nursing Assessment

Nursing Diagnosis, Care Plan, and Interventions for Impaired Urinary  Elimination- A Student's Guide

Focus assessment is necessary in order for the nurse to determine whether incontinence is transient, in response to an acute condition, or established in response to various chronic neural or genitourinary conditions.

Assessment Rationales
Assess voiding pattern (frequency and amount). Compare urine output with fluid intake. Note specific gravity. Identifies characteristics of bladder function (effectiveness of bladder emptying, renal function, and fluid balance). Note: Urinary complications are a major cause of mortality.
Palpate for bladder distension and observe for overflow. Bladder dysfunction is variable but may include loss of bladder contraction and inability to relax urinary sphincter, resulting in urine retention and reflux incontinence. Note: Bladder distension can precipitate autonomic dysreflexia.
Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of urinary stream. Palpate bladder after voiding. This provides information about degree of interference with elimination or may indicate bladder infection. Fullness over bladder following void is indicative of inadequate emptying or retention and requires intervention.
Review drug regimen, including prescribed, over-the-counter (OTC), and street. A number of medications such as some antispasmodics, antidepressants, and narcotic analgesics; OTC medications with anticholinergic or alpha agonist properties; or recreational drugs such as cannabis may interfere with bladder emptying.
Assess the availability of toileting facilities. Patients may need a bedside commode if mobility limitations interfere with getting to the bathroom.
Assess the patient’s usual pattern of urination and occurrence of incontinence. Many patients are incontinent only in the early morning when the bladder has stored a large urine volume during sleep.
Common Assessment Findings
  • Urgency
Strong desire to void my be caused by inflammations or infections in the bladder or urethra
  • Dysuria
Painful or difficult voiding
  • Frequency
Voiding that occurs more than usual when compared with the person’s regular pattern or the generally accepted norm of voiding once every 3 to 6 hours
  • Hesitancy
Undue delay and difficulty in initiating voiding
  • Polyuria
A large volume of urine or output voided at any given time
  • Oliguria
A small volume of urine or output between 100 to 500 mL/24 hr
  • Anuria
Lack of urine production
  • Nocturia
Excessive urination at night interrupting sleep
  • Hematuria
RBCs in the urine

Impaired Urinary Elimination Interventions

Basics of Nursing Practices and Interventions | Faculty of Medicine,  Masaryk University

The following are the therapeutic nursing interventions for impairment in urinary elimination:

Interventions Rationales
Begin bladder retraining per protocol when appropriate (fluids between certain hours, digital stimulation of trigger area, contraction of abdominal muscles, Credé’s maneuver). Timing and type of bladder program depend on type of injury (upper or lower neuron involvement). Note: Credé’s maneuver should be used with caution because it may precipitate autonomic dysreflexia.
Encourage adequate fluid intake (2–4 L per day), avoiding caffeine and use of aspartame, and limiting intake during late evening and at bedtime. Recommend use of cranberry juice/vitamin C. Sufficient hydration promotes urinary output and aids in preventing infection. Note: When patient is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of drug, reducing risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., Nutrasweet), may cause bladder irritation leading to bladder dysfunction.
Observe for cloudy or bloody urine, foul odor. Dipstick urine as indicated. Signs of urinary tract or kidney infection that can potentiate sepsis. Multistrip dipsticks can provide a quick determination of pH, nitrite, and leukocyte esterase suggesting presence of infection.
Promote continued mobility. This decreases risk of developing UTI.
Cleanse perineal area and keep dry. Provide catheter care as appropriate. Proper perineal hygiene decreases risk of skin irritation or breakdown and development of ascending infection.
Recommend good hand washing and proper perineal care. Handwashing and perineal care reduce skin irritation and risk of ascending infection.
Refer to urinary continence specialist as indicated. Collaboration with specialists is helpful for developing individual plan of care to meet patient’s specific needs using the latest techniques, continence products.
Administer medications as indicated:
Oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M), flavoxate hydrochloride (Urispas), tolterodine (Detrol). These drugs reduce bladder spasticity and associated symptoms of frequency, urgency, incontinence, nocturia.
Catheterize as indicated. Catheterization may be necessary as a treatment and for evaluation if patient is unable to empty bladder or retains urine.
Teach self-catheterization and instruct in use and care of indwelling catheter. This method helps patient maintain autonomy and encourages self-care. Indwelling catheter may be required, depending on patient’s abilities and degree of urinary problem.
Obtain periodic urinalysis and urine culture and sensitivity as indicated. These tests monitor renal status. Colony count over 100,000 indicates presence of infection requiring treatment.
Administer anti-infective agents as necessary:
Nitrofurantoin macrocrystals. (Macrodantin); co-trimoxazole (Bactrim, Septra); ciprofloxacin (Cipro); norfloxacin (Noroxin). Bacteriostatic agents inhibit bacterial growth and destroy susceptible bacteria. Prompt treatment of infection is necessary to prevent serious complications of sepsis/shock.
Urinary Catheterization:
Monitor BUN, creatinine, white blood cell (WBC) count. These reflect renal function and identify complications.
Keep bladder deflated by means of indwelling catheter initially. Begin intermittent catheterization program when appropriate. Indwelling catheter is used during acute phase for prevention of urinary retention and for monitoring output. Intermittent catheterization may be implemented to reduce complications usually associated with long-term use of indwelling catheters. A suprapubic catheter may also be inserted for long-term management.
Measure residual urine via postvoid catheterization or ultrasound. Measuring residual urine via postvoid catheterization or ultrasound is helpful in detecting presence of urinary retention and effectiveness of bladder training program. Note: Use of ultrasound is noninvasive, reducing risk of colonization of bladder.
Refer for further evaluation for bladder and bowel stimulation. Clinical research is being conducted on the technology of electronic bladder control. The implantable device sends electrical signals to the spinal nerves that control the bladder and bowel. Early results look promising.
More interventions:
Teach Kegel exercises. These exercises improve pelvic floor muscle tone and urethrovesical junction sphincter tone.
Educate patient about the importance of limiting intake of alcohol and caffeine. These chemicals are known to be bladder irritants. They can increase detrusor overactivity.

Impaired Urinary Elimination Nursing Care Plans

Nursing Care Plan 1

Urethritis

Nursing Diagnosis: Impaired Urinary Elimination related to urethritis as evidenced by dysuria and urinary frequency

Desired Outcome: The patient will be able to achieve normal pattern of urinary elimination.

Interventions Rationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern prior to the manifestations/ symptoms of benign prostatic hyperplasia/ hypertrophy. To establish baseline data on urinary elimination pattern.
Administer the prescribed antibiotic for urethritis. The choice of antibiotic is based on the result of the urine culture and sensitivity test. The usual course of antibiotics for urethritis runs for 7 to 10 days. To treat the underlying infection
Palpate the bladder and observe for bladder distention. To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours. To facilitate flushing of bacteria from the bladder and avoid urine accumulation.
Teach the patient some lifestyle changes related to the prevention of urethritis. Including:proper perineal hygieneadequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting Wiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Adequate oral hydration results to more urine production leading to flushing of bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee. To aid in the recovery of the patient.

Nursing Care Plan 2

Benign Prostatic Hypertrophy/ Hyperplasia (BPH)

Nursing Diagnosis: Impaired Urinary Elimination secondary to mechanical obstruction due to enlarged prostrate, as evidenced by dysuria and urinary frequency

Desired Outcome: The patient will be able to achieve better pattern of urinary elimination as evidenced by post-void residuals of less than 50 mL without any dribbling.

Interventions Rationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern (i.e. prior to urethritis). To establish baseline data on urinary elimination pattern.
Administer the prescribed medication for BPH. To treat the underlying cause of impaired urinary elimination, which is the mechanical obstruction of urine flow due to the enlargement of prostate.
Palpate the bladder and observe for bladder distention. To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours. To facilitate avoid urine accumulation and alleviate bladder distention.
Insert an indwelling catheter as required. To help evacuate urine from the bladder. Catheterization might be uncomfortable for a BPH patient, but it is effective to relieve pain and discomfort due to an overly distended bladder.
Educate the patient about sitz bath. Sitz bath has been proven effective to relax urinary muscles and reduce edema if there is any. It also promotes comfort and pain relief due to the enlarged prostate.
Teach the patient some lifestyle changes related to impaired urinary elimination, including:proper perineal hygieneadequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting Wiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Adequate oral hydration results to more urine production leading to flushing of bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing materials or are tight-fitting may add to the discomfort of the patient.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee. To aid in the recovery of the patient.

Nursing Care Plan 3

Urolithiasis (Stones in the Urinary Tract)

Nursing Diagnosis: Impaired Urinary Elimination related to formation of stones in the urinary tract as evidenced by pain when voiding, dysuria, distended bladder, and urinary frequency

Desired Outcome: The patient will be able to achieve better pattern of urinary elimination as evidenced by painless urinary elimination, improving bladder muscle tone, and normal urinary frequency.

Interventions Rationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern (i.e., prior to urolithiasis). To establish baseline data on urinary elimination pattern.
Administer alpha-blockers as prescribed. Currently, there is no medication to directly treat urolithiasis. However, alpha blockers may be administered to relax the muscles of the ureter. This will enable the small renal stones (renal calculi) to pass and be eliminated from the body.
Palpate the bladder and observe for bladder distention. Use a portable bladder scanner as needed. To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours. To facilitate flushing of the renal calculi from the bladder and avoid urine accumulation.
Insert an indwelling catheter as required. To help evacuate urine, stones, and other debris from the bladder.
Strain every urine voided and document the characteristic of the renal stones and urine. The characteristics of the renal stones (e.g., size) and urine provide crucial information in the further treatments that are needed by the patient.
Teach the patient some lifestyle changes related to the prevention of more renal stones. These include:adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), drink fruit juices, particularly cranberry juice Adequate oral hydration results to more urine production leading to flushing of debris, small renal stones, and bacteria from the bladder once the urine is eliminated.     Fruit juices help acidify urine.
Collect blood samples for renal function tests. To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee. To aid in the recovery of the patient.

Nursing Care Plan 4

Renal Failure

Impaired Urinary Elimination related glomerular malfunction to secondary to renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, and eGFR levels), oliguria or anuria, and urinary retention

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

Interventions Rationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern prior to having symptoms of renal injury. To establish baseline data on urinary elimination pattern.
Weigh the patient daily. Commence strict Input and Output monitoring. Note the characteristics of the urine. To assess the fluid volume status of the patient. To check for signs of worsening renal function and perfusion.
Palpate the bladder and observe for bladder distention. Use a bladder scan as needed. To check for bladder distention and bladder retention.
Teach the patient some lifestyle changes including proper perineal hygiene, adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting. To promote wellness and prevent urinary tract infection (UTI). Acute renal failure is a major risk factor for UTIs due to reduced immunity and related metabolic disorders. Wiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.
Collect blood samples for renal function tests. To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee. To aid in the recovery of the patient.

Nursing Care Plan 5

Guillain-Barre Syndrome

Nursing Diagnosis: Impaired Urinary Elimination related to neuromuscular impairment secondary to Guillan-Barre Syndrome as evidenced by distended bladder, paralysis, and urinary retention

Desired Outcome: The patient will be able to achieve better pattern of urinary elimination as evidenced by painless urinary elimination, improving bladder muscle tone, and post-void residuals of less than 50 mL.

Interventions Rationales
Assess the patient’s current pattern of elimination. Assess the effect of paralysis to the patient’s elimination. To establish baseline data on urinary elimination pattern.
Palpate the bladder and observe for bladder distention. Use a portable bladder scanner as needed. To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours. To facilitate emptying the bladder and avoid urine retention and bladder distention.
Insert an indwelling catheter as required. To help evacuate urine and debris from the bladder.
Commence an input and output chart. To monitor the patient’s input and output, which give important data on the patient’s kidney function.
Teach the patient to have an adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), Adequate oral hydration results to more urine production leading to flushing of debris, small renal stones, and bacteria from the bladder once the urine is eliminated.
Collect blood samples for renal function tests. To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee. To aid in the recovery of the patient.

Impaired Urinary Elimination, Impaired Urinary Elimination Nursing Assessment, Impaired Urinary Elimination Interventions, and Impaired Urinary Elimination Nursing Care Plans

 

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