Impaired Urinary Elimination Nursing Diagnosis and Nursing Care Plan

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Impaired Urinary Elimination Nursing Care Plans Diagnosis and Interventions

Impaired Urinary Elimination NCLEX Review and Nursing Care Plans

Impaired Urinary Elimination is a NANDA diagnosis that refers to any disturbance to the urine elimination. It is commonly used to create a nursing care plan for patients with genito-urinary disorders, such as urinary tract infections or UTIs, and renal diseases, such as acute kidney injury and chronic renal failure.

The goal of nursing care for a patient with an impaired urinary elimination is for him/her to urinate without bladder distention, urine retention, pain or discomfort.

Factors Related to Impaired Urinary Elimination

The factors that may contribute to having an impaired urinary elimination include:

  • Obstruction of the bladder outlet
  • Bladder atony – poor tone of the bladder muscles
  • Decreased bladder capacity
  • Diminished bladder cues
  • Multiple injuries
  • Disruption in bladder innervation
  • Congenital GU problems such as epispadias, hypospadias, or having a small bladder
  • Environmental barriers
  • Sensory-motor impairment
  • Incompetent bladder

Signs and Symptoms of Impaired Urinary Elimination

  • Bladder distention
  • Enuresis (urinary incontinence) loss of bladder control
  • Increased frequency and urgency to urinate
  • Nocturia – voiding at night
  • Dribbling
  • Hesitancy
  • Dysuria – difficulty to urinate that can be uncomfortable or painful
  • Retention of urine – large residual volumes of urine as detected in bladder scans

Impaired Urinary Elimination Nursing Diagnosis

Nursing Care Plan for Impaired Urinary Elimination 1

Urethritis

Nursing Diagnosis: Impaired Urinary Elimination related to urethritis as evidenced by dysuria and urinary frequency

Desired Outcome: The patient will be able to achieve normal pattern of urinary elimination.

Nursing Interventions Impaired Urinary EliminationRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern prior to the manifestations/ symptoms of benign prostatic hyperplasia/ hypertrophy.To establish baseline data on urinary elimination pattern.
Administer the prescribed antibiotic for urethritis. The choice of antibiotic is based on the result of the urine culture and sensitivity test. The usual course of antibiotics for urethritis runs for 7 to 10 days.To treat the underlying infection
Palpate the bladder and observe for bladder distention.To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours.To facilitate flushing of bacteria from the bladder and avoid urine accumulation.
Teach the patient some lifestyle changes related to the prevention of urethritis. Including:proper perineal hygieneadequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fittingWiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Adequate oral hydration results to more urine production leading to flushing of bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.  
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee.To aid in the recovery of the patient.

Nursing Care Plan for Impaired Urinary Elimination 2

Benign Prostatic Hypertrophy/ Hyperplasia (BPH)

Nursing Diagnosis: Impaired Urinary Elimination secondary to mechanical obstruction due to enlarged prostrate, as evidenced by dysuria and urinary frequency

Desired Outcome: The patient will be able to achieve better pattern of urinary elimination as evidenced by post-void residuals of less than 50 mL without any dribbling.

Nursing Interventions Impaired Urinary EliminationRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern (i.e. prior to urethritis).To establish baseline data on urinary elimination pattern.
Administer the prescribed medication for BPH.To treat the underlying cause of impaired urinary elimination, which is the mechanical obstruction of urine flow due to the enlargement of prostate.
Palpate the bladder and observe for bladder distention.To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours.To facilitate avoid urine accumulation and alleviate bladder distention.
Insert an indwelling catheter as required.To help evacuate urine from the bladder. Catheterization might be uncomfortable for a BPH patient, but it is effective to relieve pain and discomfort due to an overly distended bladder.
Educate the patient about sitz bath.Sitz bath has been proven effective to relax urinary muscles and reduce edema if there is any. It also promotes comfort and pain relief due to the enlarged prostate.
Teach the patient some lifestyle changes related to impaired urinary elimination, including:proper perineal hygieneadequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fittingWiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Adequate oral hydration results to more urine production leading to flushing of bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing materials or are tight-fitting may add to the discomfort of the patient.  
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee.To aid in the recovery of the patient.

Nursing Care Plan for Impaired Urinary Elimination 3

Urolithiasis (Stones in the Urinary Tract)

Nursing Diagnosis: Impaired Urinary Elimination related to formation of stones in the urinary tract as evidenced by pain when voiding, dysuria, distended bladder, and urinary frequency

Desired Outcome: The patient will be able to achieve better pattern of urinary elimination as evidenced by painless urinary elimination, improving bladder muscle tone, and normal urinary frequency.

Nursing Interventions Impaired Urinary EliminationRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern (i.e., prior to urolithiasis).To establish baseline data on urinary elimination pattern.
Administer alpha-blockers as prescribed.Currently, there is no medication to directly treat urolithiasis. However, alpha blockers may be administered to relax the muscles of the ureter. This will enable the small renal stones (renal calculi) to pass and be eliminated from the body.
Palpate the bladder and observe for bladder distention. Use a portable bladder scanner as needed.To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours.To facilitate flushing of the renal calculi from the bladder and avoid urine accumulation.
Insert an indwelling catheter as required.To help evacuate urine, stones, and other debris from the bladder.
Strain every urine voided and document the characteristic of the renal stones and urine.The characteristics of the renal stones (e.g., size) and urine provide crucial information in the further treatments that are needed by the patient.
Teach the patient some lifestyle changes related to the prevention of more renal stones. These include:adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), drink fruit juices, particularly cranberry juiceAdequate oral hydration results to more urine production leading to flushing of debris, small renal stones, and bacteria from the bladder once the urine is eliminated.     Fruit juices help acidify urine.
Collect blood samples for renal function tests.To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee.To aid in the recovery of the patient.

Nursing Care Plan for Impaired Urinary Elimination 4

Renal Failure

Impaired Urinary Elimination related glomerular malfunction to secondary to renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, and eGFR levels), oliguria or anuria, and urinary retention

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

Nursing Interventions Impaired Urinary EliminationRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern prior to having symptoms of renal injury.To establish baseline data on urinary elimination pattern.
Weigh the patient daily. Commence strict Input and Output monitoring. Note the characteristics of the urine.To assess the fluid volume status of the patient. To check for signs of worsening renal function and perfusion.
Palpate the bladder and observe for bladder distention. Use a bladder scan as needed.To check for bladder distention and bladder retention.
Teach the patient some lifestyle changes including proper perineal hygiene, adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting.To promote wellness and prevent urinary tract infection (UTI). Acute renal failure is a major risk factor for UTIs due to reduced immunity and related metabolic disorders. Wiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.  
Collect blood samples for renal function tests.To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee.To aid in the recovery of the patient.

Nursing Care Plan for Impaired Urinary Elimination 5

Guillain-Barre Syndrome

Nursing Diagnosis: Impaired Urinary Elimination related to neuromuscular impairment secondary to Guillan-Barre Syndrome as evidenced by distended bladder, paralysis, and urinary retention

Desired Outcome: The patient will be able to achieve better pattern of urinary elimination as evidenced by painless urinary elimination, improving bladder muscle tone, and post-void residuals of less than 50 mL.

Nursing Interventions Impaired Urinary EliminationRationales
Assess the patient’s current pattern of elimination. Assess the effect of paralysis to the patient’s elimination.To establish baseline data on urinary elimination pattern.
Palpate the bladder and observe for bladder distention. Use a portable bladder scanner as needed.To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours.To facilitate emptying the bladder and avoid urine retention and bladder distention.
Insert an indwelling catheter as required.To help evacuate urine and debris from the bladder.
Commence an input and output chart.To monitor the patient’s input and output, which give important data on the patient’s kidney function.
Teach the patient to have an adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated),  Adequate oral hydration results to more urine production leading to flushing of debris, small renal stones, and bacteria from the bladder once the urine is eliminated.
Collect blood samples for renal function tests.To monitor the status of kidney function.
Encourage the patient to avoid or reduce the intake of urinary irritants such as colas, alcohol, tea, and coffee.To aid in the recovery of the patient.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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