After completing the chapter, you will be able to accomplish the following:

1. Assist with the use of a bedpan.
2. Assist with use of a urinal.
3. Assist with use of a bedside commode.
4. Assess bladder volume using an ultrasound bladder scanner.
5. Apply an external urinary sheath (external urine collection device male genitalia).
6. Apply an external urine collection system (female genitalia).
7. Catheterize the urinary bladder of a patient with female genitalia.
8. Catheterize the urinary bladder of a patient with male genitalia.
9. Remove an indwelling urinary catheter.
10. Administer continuous closed bladder irrigation.
11. Empty and change a stoma appliance on a urinary diversion.
12. Care for a suprapubic urinary catheter.
13. Care for a peritoneal dialysis catheter.
14. Care for hemodialysis access.

• Assessment
• Clinical Decision Making/Clinical Judgment
• Elimination
• Functional Ability
• Infection
• Safety

• arteriovenous fistula
• arteriovenous graft
• bruit
• external urinary sheath
• external urine collection device
• fenestrated
• hemodialysis
• ileal conduit
• indwelling urethral catheter
• intermittent urethral catheters (straight catheters)
• peritoneal dialysis
• peritonitis
• sediment
• stoma
• suprapubic urinary catheter
• symphysis pubis
• thrill
• urinary sheath

Urine is excreted from the kidneys via the ureters to the bladder, where it is stored and eliminated via the urethra. Elimination from the urinary tract helps to rid the body of waste products and materials that exceed bodily needs. Numerous factors affect the amount and quality of urine produced by the body and the manner in which it is excreted. Some patients experience urinary elimination problems affecting fluid and electrolyte balance, hydration, skin integrity, comfort, and self-concept. Many health problems, medications, and health care interventions can affect urinary elimination. Nurses play an important role in preventing and managing urinary elimination problems.

This chapter covers skills that the nurse may use to promote urinary elimination. An assessment of the urinary system is required as part of providing interventions outlined in many of these skills. Refer to Fundamentals Review 12-1 for a review of the male and female genitourinary tracts. Fundamentals Review 12-2 summarizes factors that may affect urinary elimination.

1. Assess the patency of the external urinary sheath. Lack of adhesion of the sheath on the penis or resistance to gravity flow of urine would allow urine to leak around the sheath. You should assess for the presence of these conditions, as well as the condition of the patient's skin. Take care to fasten the external urinary sheath securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in the area. In addition, the tip of the tubing should be kept 1 to 2 inches (2.5 to 5 cm) beyond the tip of the penis to prevent irritation to the sensitive glans area. Maintaining free urinary drainage is another nursing priority. Institute measures to prevent the tubing from becoming kinked and urine from backing up in the tubing. Urine can lead to excoriation of the glans, as well as separation of the sheath from the skin, so position the tubing that collects the urine from the external urinary sheath so that it draws urine away from the penis.Always use a measuring or sizing guide supplied by the manufacturer to ensure the correct size of sheath is applied. Skin barriers, such as 3M or Skin-Prep, can be applied to the penis to protect penile skin from irritation and changes in integrity. In addition, nursing care of a patient with an external urinary sheath includes vigilant skin care to prevent excoriation. This includes removing the external urinary sheath daily, washing the penis with skin cleanser and water and drying carefully, and inspecting the skin for irritation. In hot and humid weather, more frequent changing may be required. Always follow the manufacturer's instructions for applying the external urinary sheath because there are several variations.
2. Discuss and confirm the continued need for bedrest with the health care team, if appropriate. Begin by assessing what the patient understands about the reason they are required to use the bedpan for elimination. Based on this information, reinforce the rationale for the use of the bedpan. Promote comfort and normalcy as much as possible, while respecting the patient's privacy. Determine if a regular bedpan or a fracture pan would be most appropriate for Ms. Halligan. Also be sure to provide skin care and perineal hygiene after bedpan use and maintain a professional manner.
3. Obtain additional assessment data regarding the catheter site. Assessment data should include the presence of erythema, drainage, bleeding, tenderness, swelling, skin irritation or breakdown, or leakage. These signs could indicate exit-site or tunnel infection. In addition, inquire about any tenderness, pain, and guarding of the abdomen, as well as nausea, vomiting, and fever, which could indicate peritonitis. Assess the patient's knowledge about measures to care for the exit site. Remind Mr. Wimmer that exit-site and catheter care includes avoiding baths and public pools; the importance of good handwashing before self-care; and that he should be maintaining a dressing over the site.Because he is experiencing site redness and tenderness, which could indicate an infection, instruct Mr. Wimmer to contact his health care provider for an appointment to have his catheter and exit site evaluated.