• age
• loss of body fluid
• fluid intake
• nutrition
• body position 
• psychological issues
• privacy, time, volunatry suppression 
• cognition
• obstruction of urine flow
• renal calculi, prostate enlargement, tumors, structual abnormalities
• infection 
• hypotension
• neurologic injury
• spinal cord injury, CVA, brain tumor
• decreased musle tone
• aging, multiple pregnancies, obesity
• pregnancy
• surgery
• anesthesia, edema, immobility
• medications
• urinary diversions 

• impaired neurological function interfering with normal urination mechanisms 
• person is unable to recognize bladder fullness and is unable to control urinary sphincter
• results
• bladder may become flaccid or spastic 
• flaccid ~ distended 
• spastic ~ frequent involuntary urination 

• normal voiding pattern and frequency
• appearance of urine and recent changes
• past or current problems of urination 
• does the patient have a urinary diversion? care?
• assessment of intake and output
• factors that could affect urinary elimination 

• considered personal, private activity that individuals may not feel comfortable sharing with other
• may feel embarrassed, so may not report all symptoms such as incontinence 
• implications
• develop trust during interview
• ask if it's okay if family members are present and included in the car/discussion 
• provide written materials in the patient's primary language

• inspection
• skin and mucosal membranes
• place patient in supine position
• look for bulging at the symphysis pubis
• urinary meatus during perineal hygiene
• palpation 
• palpate for tenderness and bladder distension 
• bladder ultrasound (scanner)
• estimates the total volume of urine in the bladder
• ultrasound gel to lower abdomen & place probe so outline of bladder fills screen

• intake and output
• normal kidneys ~ 60ml/hr (1500ml/day)
• color
• normal ~ pale, straw or amber colored
• abnormal ~ dark amber, dark orange, red, tea, brown
• hydration affects color
• concentrated urine ~ darker in color
• diluted urine ~ almost clear or very pale yellow 
• some foods and meds can affect urine color 
• clarity
• normal ~ transparent, no sediment
• abnormal ~ cloudy (pathology present) 
• blood or mucus
• odor
• ammonia in nature
• concentrated urine much stronger
• amount 
• each void/24 hour period

• color
• clarity
• pH (normal: 4.6-8)
• specific gravity (normal: 1.015-1.025)
• proteins (none)
• glucose (none) 
• RBC's (none) 
• ketones (none)

• measures acidity/alkalinity
• acidic - starvation, diarrhea, diet high in protein
• alkaline - UTI, diet high in fruits & vegetables

• elevated - (concentrated urint) dehydration 
• decreased - (diluted urine) over-hydration 

• glucose - could be indicative of diabetes
• ketone bodies - could be indicative of diabetes or starvation 
• blood - could be indicative of UTI, kidney disease, renal calculi
• protein - could be severe stress or renal disease 

• void into a specimen container
• need about 120 ml
• must be free of fecal material
• cap, label, and send to lab
• document 

• clean perineum or penis with soap and water, then with an antiseptic wipe
• have client start voiding
• place container into stream of urine 
• don't touch perineum or penis
• collect 30-60 ml
• cap specimen cup - clean outside with disinfectant if necessary 
• label and take to lab 
• document 

• collect all urine over a specific time period
• generally refrigerated or contain a preservative to prevent bacterial growth or decomposition 
• first void if discarded and timing begins
• record time and save all urine after
• at end of time, have client completely empty bladder and save this also
• take all urine to lab
• document 

• take specimen from a self sealing rubber catheter or one with a port
• do NOT take sample from the drainage bag (bacteria multiply)
• clamp tubing below site used to draw specimen (approx. 30 minutes)
• wipe area with disinfectant swab
• insert needle 35-45 degree angle
• aspirate amount of urine needed
• transfer urine to specimen container
• send to lab
• document

• adequate intake (6-8 glasses recommended) 
• up to toilet if possible
• privacy 
• warm water over perineum
• fingers in warm water
• as normal a routine as possible (up every 2-3 hours)
• adequate time
• strengthening pelvic floor muscles 
• promote comfort 
• bladder retraining 

patient education - preventing UTI's 

• avoid tight fitting pants (irritation to urethra and prevents ventilation of perineal area
• wear cotton underwear
• women need to wipe and clean from front to back
• shower rather than bathe (bacteria present in bathwater) 
• encourage to void at least every 4 hours 
• cranberry juice (acidifies pH of urine)
• urinating after sexual intercourse 

• single use
• withdrawn when urine drained

• remains in place
• balloon inflated to hold catheter in place in bladder
• urine drains into collection bag
• may need to be changed periodically 

• sizes
• children - #5-#10 Fr.
• women - #14-#16 Fr. 
• men - #16-#18 Fr.
• closed drainage system
• catheter, drainage tubing, collection bag
• reduces risk of microorganisms entering system & causing infection 
• safety guidlines
• follow principles of surgical and medical asepsis as indicated when performing catheterizations
• latex allergies
• betadine allergies 

• fluid intake up to 3000cc/day
• decreases the likelihood of urinary stasis and infection 
• encourage foods that acidify urine 
• may reduct UTI and calculus formation 
• perform routine perineal care
• only change catheter if necessary
• client teaching
• empty bag at least every 8 hours

• a flushing or "washing-out" with a specified solution 
• done to maintain or restore patency of the catheter
• need a doctors order - a dependent intervention 

• intermittent self-catheterization 
• performed by the client 
• client usually has some form of neurogenic bladder dysfunction (such as that caused by spinal cord injury) 
• alternatives to bladder catheterization 
• suprapubic catheter
• a catheter is surgically inserted through the intestinal wall into the bladder 
• sutured in place 
• external drainage devices 
• condom catheter