Urinary System
Key Points
- The urinary system filters blood, forms urine, regulates fluid and pH balance, and supports blood-pressure control.
- Typical adult urine output is about 1 to 2 L/day; sustained output below 500 mL/day is high risk.
- Common chronic issues include incontinence, UTI, stones, retention, and chronic kidney failure.
Pathophysiology
Renal filtration removes metabolic waste and maintains internal fluid-electrolyte balance. Urine formed in kidneys travels through ureters to bladder storage, then exits via urethra when neurologic and muscular coordination permits voiding.
Disruption in filtration, storage, or outlet function can cause retention, incontinence, infection, and systemic complications. Advanced renal impairment can progress to edema, electrolyte instability, arrhythmia risk, and life-threatening toxin accumulation.
Classification
- Filtration dysfunction: Acute/chronic kidney impairment with reduced waste clearance.
- Storage/voiding dysfunction: Incontinence and retention due to neurologic, muscular, or outlet causes.
- Infectious/inflammatory dysfunction: UTI progression risks including confusion and systemic illness.
- Obstructive dysfunction: Stones or prostatic enlargement impairing urine flow.
Nursing Assessment
NCLEX Focus
Priority assessment asks which urinary findings are early warning signs for infection, obstruction, or renal decline.
- Monitor urine amount, color, odor, clarity, and voiding frequency changes.
- Observe for dysuria, urgency, low-volume frequent voiding, hematuria, or sediment.
- Identify signs of retention or obstruction (hesitancy, incomplete emptying, suprapubic fullness).
- Report sudden confusion in older adults as potential urinary infection cue.
Nursing Interventions
- Implement scheduled toileting and prompted voiding to reduce incontinence episodes.
- Encourage fluids when appropriate and support mobility to improve urinary health.
- Provide front-to-back perineal hygiene and skin-protection routines.
- Follow renal-diet/fluid-restriction guidance when chronic kidney disease is present.
Retention and Infection Escalation Risk
Untreated retention or UTI can rapidly worsen into systemic instability and requires prompt reporting.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | UTI-treatment context | Monitor symptom response and report persistent fever, pain, or confusion. |
| diuretics | Fluid-management context | Track output trends and report dehydration or hypotension signs. |
Clinical Judgment Application
Clinical Scenario
A resident with urinary incontinence develops burning voids, foul/cloudy urine, and sudden increased confusion.
Recognize Cues: Typical UTI symptom cluster with acute cognitive change. Analyze Cues: Infection is likely progressing and may compromise overall safety. Prioritize Hypotheses: Immediate priority is rapid nurse evaluation and escalation. Generate Solutions: Report findings, reinforce hygiene/toileting support, and monitor hydration/voiding trends. Take Action: Implement supportive care while awaiting treatment orders. Evaluate Outcomes: Symptoms improve and confusion resolves with appropriate intervention.
Related Concepts
- urinary-tract-infections - Common infection pathway requiring early recognition.
- acute-kidney-injury - Reduced urine output can indicate urgent renal compromise.
- incontinence-management - Scheduled care and skin protection reduce complications.
- hydration-management - Hydration status strongly influences urinary findings.
- endocrine-system - Diabetes increases urinary-system infection and renal-damage risk.
Self-Check
- Which urinary findings suggest infection versus retention?
- Why is sudden confusion in older adults a high-priority urinary assessment clue?
- Which interventions best reduce incontinence-related skin breakdown risk?