When performing a nursing assessment of a patient with a suspected disorder of the urinary system, it is important to question the patient about urinary output and changes in voiding patterns.
a. Urinary Output.
(1) During the act of micturition (urination), the bladder contracts and urine is expelled from the body through the urethra. The average urine output for a normal adult is considered to be about 1500 to 2000 ml/24 hours. This, of course, will vary with fluid intake and other fluid losses (as discussed in Section I).
(2) Polyuria is the passage of a large volume of urine in a given periodtime. Polyuria is seen with diabetes. It may also occur with excessive fluid intake.
(3) Oliguria is the passage of a small amount of urine in a given period otime. This is generally considered to be 100-500 ml/24 hours. Oliguria may indicate renal failure, shock, dehydration, or a fluid and electrolyte imbalance.
(4) Anuria is the absence of urine. Passage of less than 50 ml/24 hours is considered to be anuria. This condition indicates a serious renal dysfunction and requires emergency medical intervention.
b. Changes in Voiding Patterns. When interviewing the patient, ask about changes in their normal voiding pattern. Identification of signs and symptoms is a valuable tool in diagnosis of the condition. The following symptoms are significant ashould be recorded in the nursing assessment.
(1) Frequency. Voiding that occurs more often than usual (in comparison to the patient’s regular pattern).
(2) Urgency . A strong desire (or urge) to urinate.
(3) Hesitancy . Unusual difficulty or delay in initiating voiding.
(4) Incontinence. Involuntary loss of urine.
(5) Stress incontinence. Intermittent leakage of urine is caused by sudden strain.
(6) Nocturia. Excessive urination at night.
(7) Enuresis. Involuntary voiding during sleep. Bedwetting is considered abnormal after the age of three.
(8) Dysuria . Painful or difficult urination.
(9) Hematuria. The presence of blood in the urine.
(10) Retention. Accumulation of urine within the bladder caused by the inability to urinate.