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UNIT 8 BUILDING CLINICAL COMPETENCE
Responses to Altered Urinary Elimination
FUNCTIONAL HEALTH PATTERN: Elimination
Think about clients with altered urinary elimination for whom you have cared in your clinical
experiences.
■ What were the clients’ major medical diagnoses (e.g., urinary tract infection, kidney
stones, bladder cancer, acute glomerulonephritis, acute or chronic renal failure)?
■ What manifestations did each of these clients have? Was the appearance or odor of their
urine affected? Did the clients complain of pain or discomfort? Were other body systems
affected by their primary diagnosis (e.g., neurologic or cardiovascular)? How were their
manifestations similar or different?
■ How did the clients’ urinary tract problems interfere with their elimination status? How
many times did they urinate during the day and at night? Was their ability to control
urination and completely empty their bladder affected?
■ Did these clients have difficulty talking about urination or the effects of their condition on
social interactions? What measures did you use to assist the clients in openly expressing
their concerns?
The Elimination Pattern describes the client’s patterns of excretory function, including urinary
and bowel elimination and perspiration. Urinary system disorders disrupt the elimination
pattern because they affect urine production and elimination.
The urinary system is responsible for regulating body fluids, filtering metabolic wastes
from the bloodstream, reabsorbing needed substances and water back into the bloodstream
from the filtrate, and eliminating metabolic wastes and water as urine. Any alteration in the
structure and function of the urinary system can potentially affect the whole body, leading to
manifestations such as:
■ Hematuria (inflamed or infected urinary tract tissue local release of inflammatory
mediators vasodilation and increased capillary permeability escape of WBCs and
RBCs into tissue, filtrate, and urine; tumor growth and tissue invasion blood vessel
damage and growth of new, fragile vessels into tumor vessel rupture and bleeding into
urine)
■ Proteinuria (inflammation increased glomerular capillary permeability proteins
escape from the bloodstream across the capillary membrane into the filtrate presence
of protein in the urine)
■ Pyuria (breakdown of local defense mechanisms in urinary tract mucosa bacteria
invade mucosa and multiply activation of immune responses and formation of
immune complexes phagocytosis of immune complexes by neutrophils and
macrophages pus formation)
Priority nursing diagnoses within the Elimination Pattern that may be appropriate for clients with
urinary disorders include:
■ Impaired Urinary Elimination as evidenced by frequency, urgency, hesitancy, dysuria, and
nocturia
■ Urge Urinary Incontinence as evidenced by frequency, urgency, loss of urine before
reaching 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 abdominal
pressure, urinary urgency, and urinary frequency.
Two nursing diagnoses from other functional health patterns often are of high priority for the
client with urinary elimination disorders. The first nursing diagnosis is important because of the
client’s need to actively manage many urinary elimination disorders. Physiologic responses to
the second problem can interfere with urinary elimination:
■ Ineffective Health Maintenance (Health Perception-Health Management)
■ Acute Pain (Cognitive-Perceptual)