UNIT 8 BUILDING CLINICAL COMPETENCE Responses to Altered...

UNIT 8 BUILDING CLINICAL COMPETENCEResponses to Altered Urinary EliminationFUNCTIONAL HEALTH PATTERN: Elimination

Think about clients with altered urinary elimination for whom you have cared in your clinicalexperiences.

■ What were the clients’ major medical diagnoses (e.g., urinary tract infection, kidneystones, bladder cancer, acute glomerulonephritis, acute or chronic renal failure)?

■ What manifestations did each of these clients have? Was the appearance or odor of theirurine affected? Did the clients complain of pain or discomfort? Were other body systemsaffected by their primary diagnosis (e.g., neurologic or cardiovascular)? How were theirmanifestations similar or different?

■ How did the clients’ urinary tract problems interfere with their elimination status? Howmany times did they urinate during the day and at night? Was their ability to controlurination and completely empty their bladder affected?

■ Did these clients have difficulty talking about urination or the effects of their condition onsocial interactions? What measures did you use to assist the clients in openly expressingtheir concerns?

The Elimination Pattern describes the client’s patterns of excretory function, including urinaryand bowel elimination and perspiration. Urinary system disorders disrupt the eliminationpattern because they affect urine production and elimination.

The urinary system is responsible for regulating body fluids, filtering metabolic wastesfrom the bloodstream, reabsorbing needed substances and water back into the bloodstreamfrom the filtrate, and eliminating metabolic wastes and water as urine. Any alteration in thestructure and function of the urinary system can potentially affect the whole body, leading tomanifestations such as:

■ Hematuria (inflamed or infected urinary tract tissue � local release of inflammatorymediators � vasodilation and increased capillary permeability � escape of WBCs andRBCs into tissue, filtrate, and urine; tumor growth and tissue invasion � blood vesseldamage and growth of new, fragile vessels into tumor � vessel rupture and bleeding intourine)

■ Proteinuria (inflammation � increased glomerular capillary permeability � proteinsescape from the bloodstream across the capillary membrane into the filtrate � presenceof protein in the urine)

■ Pyuria (breakdown of local defense mechanisms in urinary tract mucosa � bacteriainvade mucosa and multiply � activation of immune responses and formation ofimmune complexes � phagocytosis of immune complexes by neutrophils andmacrophages � pus formation)

Priority nursing diagnoses within the Elimination Pattern that may be appropriate for clients withurinary disorders include:

■ Impaired Urinary Elimination as evidenced by frequency, urgency, hesitancy, dysuria, andnocturia

■ Urge Urinary Incontinence as evidenced by frequency, urgency, loss of urine beforereaching toilet, and voiding in small or large amounts

■ Urinary Retention as evidenced by sensation of bladder fullness, dribbling urine, dysuria,and bladder distention

■ Stress Urinary Incontinence as evidenced by dribbling urine with increased abdominalpressure, urinary urgency, and urinary frequency.

Two nursing diagnoses from other functional health patterns often are of high priority for theclient with urinary elimination disorders. The first nursing diagnosis is important because of theclient’s need to actively manage many urinary elimination disorders. Physiologic responses tothe second problem can interfere with urinary elimination:

■ Ineffective Health Maintenance (Health Perception-Health Management)■ Acute Pain (Cognitive-Perceptual)

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