Impaired urinary elimination

Domain 3. Elimination and exchange
Class 1. Urinary function
Diagnostic Code: 00016
Nanda label: Impaired urinary elimination
Diagnostic focus: Elimination

Nursing diagnosis, impaired urinary elimination is defined as a patient’s difficulty in eliminating urine or their inability to completely empty their bladder. This condition may be caused by a wide range of factors, like incomplete bladder emptying, systemic causes, and mental or physical disability. This nursing diagnosis can be treated with several nursing interventions and therapeutic measures.

NANDA Nursing Diagnosis Definition

The NANDA-based definition of impaired urinary elimination consists of two components: activity and capacity. Activity refers to the ability to control urination and the pattern of elimination. Capacity reflects the ability to pass urine adequately, either through voluntary control, intermittent catheterization, self-monitoring, or indwelling catheterization.

Defining Characteristics

Subjective defining characteristics for impaired urinary elimination include:

• Complaints of decreased urinary output.
• Frequent episodes of localized urinary incontinence.
• Urine retention.
• Difficulty starting urination.
• Frequent trips to the bathroom even with no urination.

Objective defining characteristics may include the following:

• Inability or difficulty performing self-catheterization or intermittent catheterization.
• Weak or difficult stream of urine.
• Straining to void.
• A need for catheterization.
• Gross or gross odor in urine.

Related Factors

The related factors for this nursing diagnosis include:

• Congenital or acquired lower urinary tract abnormalities.
• Altered sensation due to neurological impairment.
• Diseases or conditions interfering with urination (i.e. diabetes, spinal cord injuries).
• Interference with normal urine flow (i.e. prostatic hypertrophy).
• Psychological factors.
• Medications with diuretic effects.
• Obstruction caused by foreign bodies.
• Fluid and electrolyte imbalances.
• Anatomic abnormalities from surgery, trauma, or infection.

At Risk Populations

Patients who are at a greater risk for developing impaired urinary elimination are those with congenital, neurogenic, psychological, or severe chronic illnesses. Other populations that may have an increased risk of developing this diagnosis due to their anatomical structure, environment, or other social circumstances include: the elderly, pregnant women, and the physically disabled.

Associated Conditions

Some associated conditions that may lead to or be associated with impaired urinary elimination are: pregnancy, urinary tract infection, benign prostatic hyperplasia, neurogenic bladder, and diabetes mellitus.

Suggestions of Use

When providing care, nurses should consider assessing the patient's understanding and ability to communicate regarding the nursing diagnosis of impaired urinary elimination. Nurses should also assess psychological factors and any environmental factors which may be impacting the patient's elimination. Additionally, nurses should monitor the patient's voiding pattern, the pattern of incontinence and the presence or absence of pain or discomfort.

Suggested Alternative NANDA Nursing Diagnodis

Suggested alternatives for this diagnosis are risk for urinary retention, risk for impaired skin integrity related to urinary incontinence, and risk for infection related to indwelling catheter.

Usage Tips

When diagnosing this condition, the nurse should take the time to review the medical history, laboratory values, and patient records to thoroughly assess the patient’s risk. A physical examination should also be performed in order to assess changes in bladder function, urine color, and visually detect any obstructions that could be creating disturbances in the patient’s urinary flow.

NOC Outcomes

The NOC Outcomes applicable to this diagnosis are Urine Elimination, Urinary Continence, Knowledge: Disease Process and Knowledge: Treatment Regimen.

• Urine Elimination: Urine elimination is the production and elimination of urine in appropriate volumes and at appropriate rates. This outcome evaluates patient’s ability to produce and eliminate urine in adequate amounts.
• Urinary Continence: Urinary continence is the ability to maintain control of the bladder and/or bowels over time during a regular urinary cycle. This outcome evaluates patient’s ability to remain continent for an established period of time.
• Knowledge: Disease Process: This outcome evaluates the patient’s ability to identify, understand, and explain the disease process of their condition.
• Knowledge: Treatment Regimen: This outcome evaluates the patient’s ability to adhere to and understand the importance of a prescribed treatment regimen.

Evaluation Objectives and Criteria

The objectives of evaluation are to determine the effectiveness of interventions or treatments, the patient’s level of understanding and knowledge of their condition, and to assess the outcomes of previous interventions. Criteria typically used in evaluating these objectives include measuring urine output and/or assessing the effectiveness of interventions.

NIC Interventions

NIC Interventions that may be beneficial in treating impaired urinary elimination include: Catheterization Management, Urine Screening and Specimen Collection, Incontinence Care or Management, Bladder Retraining and Medication Management.

• Catheterization Management: This intervention is aimed at teaching the patient about catheterization management, including how and when to perform catheter insertion and removal, and providing information on bladder hygiene.
• Urine Screening and Specimen Collection: A health care practitioner may order urine tests to evaluate the patient’s urine concentration and to diagnose suspected urinary tract infections.
• Incontinence Care or Management: This intervention includes educating the patient on proper use of absorbent products, pelvic floor exercises, bowel and bladder retraining, lifestyle modifications and assistance with toileting.
• Bladder Retraining: This intervention involves setting a timetable for the consumption of fluids and scheduled toileting at intervals determined by the doctor or healthcare practitioner.
• Medication Management: This intervention is designed to teach the patient about medications prescribed to treat this condition and their side effects.

Nursing Activities

Nursing activities for impaired urinary elimination include assessing for urine retention, assessing for bladder compliance, evaluating blood, urine, and/or other laboratory tests, patient education, and providing coordinate patient care. Additionally, the nurse should assess the patient’s response to changes in position, anxiety, or medication effects.

Conclusion

Impaired urinary elimination is a common nursing diagnosis that can affect patients of all ages and populations. It has many causes, such as congenital or acquired urinary tract abnormalities, mental or physical disabilities, neurological impairments, fluid and electrolyte imbalances, and medications with diuretic effects. The assessment of patients with impaired urinary elimination is crucial in helping to accurately diagnose the condition and selecting the appropriate treatment plan. When assessing a patient with this condition, the nurse should consider not only the physical aspects but also the psychological and environmental factors. Numerous nursing interventions are available for use in managing and treating this condition, but individualized nursing plans should always be implemented in order to best meet the patient's needs.

FAQs

• What is impaired urinary elimination? Impaired urinary elimination is a nursing diagnosis defined as a patient’s difficulty in eliminating urine or their inability to completely empty their bladder. This condition may be caused by a wide range of factors, like incomplete bladder emptying, systemic causes, and mental or physical disability.
• What populations are at risk of developing impaired urinary elimination? Patients who are at a greater risk for developing impaired urinary elimination are those with congenital, neurogenic, psychological, or severe chronic illnesses. Other populations that may have an increased risk of developing this diagnosis include the elderly, pregnant women, and the physically disabled.
• Which associated conditions may lead to or be associated with impaired urinary elimination? Some associated conditions that may lead to or be associated with impaired urinary elimination are: pregnancy, urinary tract infection, benign prostatic hyperplasia, neurogenic bladder, and diabetes mellitus.
• What are some suggested interventions for impaired urinary elimination? Suggested interventions for this diagnosis include catheterization management, urine screening and specimen collection, incontinence care or management, bladder retraining and medication management.
• What criteria should be used to evaluate this diagnosis? Criteria typically used in evaluating this diagnosis include measuring urine output and/or assessing the effectiveness of interventions.