1. Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
NURSING SKILLS
URINARY ELIMINATION
Lecturer: Mark Fredderick R. Abejo RN MAN
_____________________________________________
Urinary Catheterization
Purposes:
 To relieve bladder distention or to provide gradual decompression of a distended bladder
 To instill medication into the bladder
 To irrigate the bladder
 To measure hourly urine output accurately
 To collect urine specimen
 To measure residual urine Residual Urine, is the amount of urine retained in the bladder after
forceful voiding
 To maintain continence among incontinent clients
 To prevent urine from contracting an incision after perineal surgery
 To promote healing of the genito-urinary structures postoperatively
Equipment:
Catheter insertion kits: A, indwelling; B, straight.
A B

2. Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
Assessment appropriate position:
Determine the most appropriate method of Male: Supine, legs
catheterization based on the purpose and any abducted and extended
criteria specified in the order such as total Female: Dorsal
amount of urine to be removed or size of recumbent
catheter to be used: Don sterile gloves
Inflate the balloon of
Straight Catheter catheter with air to
- use for a spot urine specimen check that it is intact
- amount of residual urine is being measured then deflate.
- temporary decompression / emptying of the Locate the urinary
bladder is required. meatus properly:
Male: at the tip of the
Indwelling/Retention Catheter glans penis
- if the bladder must remain empty or continuous Female: between the
urine measurement and collection is needed clitoris and vaginal
orifice
Determine if the client is able to cooperate and
hold still during the procedure and if the client
can be positioned supine with head relatively
flat.
Determine when the client last voided or was
last catheterized.
Percuss the bladder to check for fullness or
distention
Steps / Procedure Rationale
Verify doctor’s
order
Identify and inform
the client and
explain, why it is To allay anxiety
necessary and how
he/she can cooperate
Provide privacy To prevent feeling of
embarrassment
Wash hands and
observe appropriate To prevent ascending
infection control UTI
procedures
Perform routine To minimize
perineal care before microorganism at the
the procedure external genitals
Use appropriate size
of catheter To prevent trauma to
Male: Fr 16-18 the mucous membrane
Female: Fr 12-14
Have adequate To visualize urethral
lighting meatus properly
Place the client in

3. Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
Cleanse urinary meatus with antiseptic solution the penis at 90 degree urethra and facilitate
Note: The nondominant hand is considered angle or insertion
contaminated once it touches the client skin. perpendicular to the
body
Male: For indwelling or
- Use your nondominant hand retention catheter,
to grasp the penis just below Lifting the penis inflate the balloon
the glans. firmly and with 5 – 10 ml. of
- Hold the penis firmly upright prevents PNSS
upright with slight tension possible erection
- Pick up a cleansing ball with and helps Placement of indwelling / retention catheter and
the forceps and wipe from the strengthen the inflated balloon
center of the meatus in urethra
circular motion
Note:
The foreskin must not be
allowed to return over the
cleanse meatus nor the penis
be dropped
Female: Female Male
- Use your nondominant hand
to spread the labia
- Pick up a cleansing ball with
the forceps in your dominant
hand and wipe one side of the
labia in an anteroposterior
direction. Gently pull on the
- When cleansing the urinary catheter. If resistance
meatus, move the swab is felt, the catheter
downward balloon is properly
Lubricate catheter inflated in the
with water soluble bladder.
lubricant before To prevent friction and Anchor catheter
insertion prevent trauma properly:
Male: 6 – 7 inches
Female: 1 – 2 inches Male: laterally or To prevent penoscrotal
Insert catheter gently upward over the lower pressure
in rotating motion. abdomen / upper thigh
Instruct the client to
take slow deep Female: inner aspect of
breaths to relax the thigh
sphincter or strain as Attach drainage bag
if attempting to void to the bed frame,
to opens urinary ensuring that tubing
meatus should fall below the
Length of catheter top of the bag.
insertion: Keep client
Male: 6 – 9 inches comfortable
Female: 3 -4 inches Do after-care
During insertion of Do relevant
catheter in male, hold To straighten the documentation

4. Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
 Elevate urine receptacle at the level of
symphysis pubis to slow down expulsion of
urine.
 Do not remove more than 1000 ml of urine at
a time
Nursing Interventions for Client with
Indwelling/Retention Catheter
Practice asepsis. Proper handwashing should
be done before and after manipulating the
device. To prevent infection
Increase fluid intake. To enhance excretion of
microorganism and body wastes
Acidify urine ( diet: meat,fish.eggs and
cereals) Acidic urine inhibits proliferation of
microorganism.
Maintained closed drainage system. Do not
detach catheter from the connecting tubing,
unnecessarily.
Meticulous perineal care. To prevent
ascending UTI
Note: Ensure patency of urinary catheter. Avoid
If the purpose of catheterization is to kinks. Irrigate with sterile PNSS as ordered.
relieve bladder distention, practice GRADUAL
DECOMPRESSION, to prevent shock, Ensure that gravity drainage of urine is
hemorrhage or bladder atony. maintained. Hold the urinary drainage bag
below the level of bladder when ambulating
Gradual Decompression may be done by the Monitor I & O
following actions:
Change urinary catheter, tubing and bag when
 Empty the bladder slowly by pinching the sediments accumulates, if leakage is present or
catheter to reduce the size of the lumen. if a strong odor is evident.

5. STI Global City College of Nursing / QMMC Surgery Ward Exposure 5
Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
Removal of Indwelling / Retention Catheter
Check doctor’s order
Wash hands. Remove the tape that secured the catheter to the client’s body
Don clean disposable gloves. Handwashing and gloving prevent transfer of microorganism
Insert hub of the syringe into balloon inflation port and draw out all the liquid. The balloon must be
completely deflated to prevent trauma to the urethra as the catheter is remove.
Instruct the client to inhale and then pinch and remove the catheter slowly and carefully as the clients
exhales. Breathing provides distraction and exhalation prevents tightening of abdominal and perineal
muscles as the catheter is withdraw. Pinching catheter prevents urine from dribbling onto the bed linens.
After removal of catheter, allow the urine to drain into collection bag. Measure and record the amount of
urine remaining in the collection bag.
Assess client’s perineum and meatus for any signs of redness or irritation.
Assist client to do perineal care and dry genitals. To ensure client comfort.
Discard contaminated equipment and articles in appropriate containers. To prevent contamination of the
environment.
Make relevant document
NOTE:
 Voiding should be expected within 6 – 8 hours from the time of removal of catheter. Some dribbling of
urine may be experienced.
 Continue to assess I & O
 If the client has not voided in 8 hours, assess for urinary retention
 If the client has difficulty establishing voluntary control of voiding, notify the physician. It may be
necessary to reinsert the catheter or to perform in and out ( intermittent ) catheterization

6. STI Global City College of Nursing / QMMC Surgery Ward Exposure 6
Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
Urinary Elimination
Characteristics of Normal and Abnormal Urine
Characteristics Normal Abnormal Nursing Considerations
Amount in 24 1, 200 – 1,500 ml Under 1,200 ml Urinary output normally is approx. equal to fluid
hours ( 30 ml/hr) A large amount over intake.
intake Output of less than 30 ml/hr may indicate
decrease blood flow to the kidneys and should be
immediately reported
Color, clarity Straw, Amber Dark Amber Concentrated urine is darker in color
(Clear ) Cloudy Dilute urine may appear almost clear or very pale
Dark Orange yellow.
Red/Dark Brown RBC in urine (hematuria) may be evident as pink,
Mucous plugs, bright red or rusty brown urine
viscid,thick WBC, bacteria,pus or contaminants such as
prostatic fluid, sperm or vaginal discharge may
cause cloudy urine.
Note:
Some drugs may alter urine color
Rifampicin – bright orange red
Laxative – red
Chloroquine – rusty yellow
Phenazopyridine – orange brown
Odor Faint Aromatic Offensive Some food (eg asparagus) cause a musty odor
Infected urine can have a fetid odor.
Urine high in glucose has a sweet odor
Sterility No Microorganism Urine specimen may contaminate by bacteria
Microorganism Present from perineum during collection.
pH 4.5 – 8 Over 8 Freshly voided urine is normally somewhat
Under 4.5 acidic.
Alkaline urine may indicate a state of alkalosis,
UTI or diet high in fruits and vegetables.
More acidic urine (low pH) is found in
starvation,diarrhea or with diet high in CHON
Specific Gravity 1.010 – 1.025 Over 1.025 Concentrated urine has a higher specific gravity.
Under 1.010 Diluted urine has a lower specific gravity
Glucose Absent Present Glucose in the urine indicates high blood glucose
level (>180 mg/dl) and may be indicative of
undiagnosed or uncontrolled DM
Protein Absent Present Protein in the urine (proteinuria) may be
indicative of PIH in pregnant women
Ketones Absent Present Ketones, the end product of the breakdown of
fatty acids, are not normally present in the urine.
They may be present in the urine of the clients
who have uncontrolled DM or excessively ingest
aspirin
Pus Absent Present Pus in urine may indicative of UTI and other
STD’s
Blood Absent Present Blood may be present in the urine of the clients
who have UTI, kidney disease or bleeding from
the urinary tract.

7. STI Global City College of Nursing / QMMC Surgery Ward Exposure 7
Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
Alteration on Urinary Elimination
Problem Definition Selected Associated Factors
Polyuria ( diuresis) Production of excessive amount of urine - Fluids containing caffeine or alcohol
(> 100ml/hr or >2500 ml/day) - Prescribed diuretics
- Hx of DM. Diabetes Insipidus / K.Dse
Oliguria Production of decreased amount of urine - Decrease fluid intake , dehydration
(<30ml/hr or <500ml/day) - Hypotension, shock or kidney dse.
Anuria Absence of production of urine by the - Decrease fluid intake , dehydration
kidneys such as 0-10 ml/hr - Hypotension, shock or kidney dse.
Urinary Frequency Voiding in frequent interval - Pregnacy
- Increase fluid intake , UTI
Nocturia Increased urination at night - Pregnacy
- Increase fluid intake , UTI
Urinary Urgency The strong feeling that the person wants to - Presence of physiologic stress
void. - UTI
Dysuria Voiding that is either painful or difficult - UTI, Infection and Trauma
Hesitancy Difficulty in initiating voiding - UTI, Infection and Trauma
Enuresis Bed wetting, repeated involuntary voiding - Family History, Home stresses
beyond 4-5 years of age - Difficult access to toilet facilities
Pollakuria Frequent, scanty urination
Urinary Incontenence
Total Incontenence A continuous and unpredictable loss of - Bladder inflammation
urine - UTI
Stress Incontenence Leakage of less than 50ml of urine as a - Kidney diseases
sudden increase in entra abdominal - Infections
pressure - Mobility impairment
Urge Incontenence Follows a sudden strong desire to urinate - Presence of physiologic stress
and leads to involuntary detrusor - Cognitive impairment
contraction. - Leakage when coughing, sneezing
Functional Involuntary unpredictable passage of urine and laughing
Incontenence
Reflex Incontinence Involuntary loss of urine occurring at
somewhat predictable intervals when
specific bladder volume is reached
Urinary Retention The accumulation of urine in the bladder - Recent anesthesia
with associated inability of the bladder to - Recent surgery
empty itself. - Presence of perineal sweeling
Note: - Medications prescribed
250-450 ml. of urine in the bladder triggers - Lack of privacy
micturition reflex - Difficult access to toilet facilities
Clinical Signs of Urinary Retention:
Discomfort in pubic area
Bladder distention
- smooth firm, ovoid mass at the supra
pubic area
- mass arising out of the pelvis
- dullness on percussion
Inability to void or frequent voiding of
small volumes
Increasing restlessness and feeling of
need to void
A disproportionately small amount of
output in relation to fluid intake

8. STI Global City College of Nursing / QMMC Surgery Ward Exposure 8
Lecture Notes on Urinary Elimination & Urinary Catheterization
Prepared By: Mark Fredderick R Abejo R.N MAN
Clinical Instructor
Nursing Interventions for Clients with Urinary Incontenence
 Bladder Retraining Program. Determine the client’s voiding pattern or establish a regular voiding time.
 Lengthen the intervals of voiding once the client’s voiding can be controlled.
 Regulate fluid intake
 Avoid large amounts of fruit juices and carbonated beverages.
 Avoid stimulants at bedtime
 Schedule diuretics in the morning.
 Adequate fluid intake in the morning.
 Kegel’s Exercise ( alternating tension and relaxation of the pubococcygeal muscles )
Nursing Interventions to Induce Voiding/Urination
 Provide privacy
 Provide fluids to drink
 Assist the patient in the anatomical position of voiding
 Serve clean, warm and dry bedpan (female) or urinal (male)
 Allow the client to listen to the sound of running water
 Dangle fingers in warm water
 Pour warm water over the perineum
 Promote relaxation
 Provide adequate time for voiding
 Perform Crede’s Maneuver as ordered ( this is done by applying pressure on the suprapubic area)
 Administer cholinergics as ordered
 Last resort: URINARY CATHETERIZATION