Nursing Care Plans for Impaired Urinary Elimination – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Impaired Urinary Elimination plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

The body is a complicated system of organs and systems that work together to produce nourishment for the organism’s survival. The urinary tract is one such organ that plays a vital role in this process. It removes excess water, electrolytes, acids, and other substances from your bloodstream, preventing them from being reabsorbed. If you have a problem with any part of this procedure, you may have problems with urine elimination (IUE).

Impaired urinary elimination can be unpleasant and inconvenient, and it can significantly influence one’s quality of life. Nurses can help patients understand what’s causing their symptoms and how to avoid or manage them.

Impaired Urinary Elimination

Impaired urinary elimination is the inability to remove body wastes from the kidneys in urine. Impaired urinary elimination can be caused by a physical anomaly, a sensory impairment, or a side effect of an illness or disease. Bladder distention, painful urination, and a complete loss of bladder control are all possible symptoms. Treatment options range from noninvasive bladder training to surgical procedures, depending on the cause.

Causes of Impaired Urinary Elimination

There are many possible causes for impaired urine production and excretion. Many of these can be divided into obstructive causes and non-obstructive.

Obstructive Causes

This is usually due to enlargement of the distal urethra and bladder or narrowing of the urethral lumen. These obstructions are considered partial if there is some flow through the obstacle without severe discomfort. Obstruction can result from benign prostatic hyperplasia (BPH), urinary tract infections (UTIs), urethral strictures, or bladder stones, as well as a pelvic mass.

Non Obstructive Causes

• Infection such as UTI or prostatitis
• Vaginal yeast infections (Candida)
• Autoimmune disorders like Lupus
• Dementia
• Diabetes mellitus type 1 or 2
• Parkinson’s disease
• Other factors such as fever, dehydration, or a lack of fluids can also contribute to an inability to urinate normally.

Signs and Symptoms of Impaired Urinary Elimination

Frequency or incontinence

Urgency to urinate

Pain during urination

Difficulty starting urination

Blood in the urine (hematuria)

Cloudy urine due to bacterial infection

Increased thirst

Unusual discharge from the reproductive organs (dysuria)

Factors Related to Impaired Urinary Elimination

The following are some of the factors that are closely related to impaired Urinary elimination:

• Bladder outlet obstruction
• Bladder atony
• Diminished bladder cues
• Decreased bladder capacity
• Disruption in bladder innervation
• Environmental barriers
• Multiple causalities
• Small bladder
• Sensory-motor impairment
• Incompetent bladder

Nursing Care Plans for Impaired Urinary Elimination

Goals and Outcomes

The following are the common goals and expected outcomes for impaired urinary elimination:

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1. Patient demonstrates behaviors and techniques to prevent retention/urinary infection.
2. Patient identifies the cause of incontinence.
3. Patient maintains balanced I&O with clear, odor-free urine, free of bladder distension/urinary leakage.
4. Patient provides a rationale for treatment.
5. Patient verbalizes understanding of the condition.

Nursing Care Plan 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 a normal pattern of urinary elimination.

Interventions	Rationales
Assess the patient’s current pattern of elimination and compare it with their normal pattern before 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 urine culture and sensitivity test result. 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 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	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 UTl-causing pathogens. Adequate oral hydration results in more urine production leading to flushing bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing or tight-fitting promote moisture formation. This encourages bacteria 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 2: Benign Prostatic Hypertrophy/ Hyperplasia (BPH)

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

Desired Outcome:

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

Interventions	Rationales
Assess the patient’s current pattern of elimination and compare it with their normal pattern (i.e., before 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 the 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 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 effectively relieves pain and discomfort due to an overly distended bladder.
Educate the patient about sitz bath.	Sitz bath has been proven effective in relaxing urinary muscles and reducing edema if 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 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	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 UTl-causing pathogens. Adequate oral hydration results in more urine production leading to flushing bacteria from the bladder once the urine is eliminated. Undergarments made of non-breathing materials or are tight-fitting may add to the patient’s discomfort.
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.

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Nursing Care Plan 3: Urolithiasis (Stones in the Urinary Tract)

Nursing Diagnosis: Impaired Urinary Elimination related to the 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 a better pattern of urinary elimination as evidenced by painless urinary elimination, improving bladder muscle tone, and normal urinary frequency.

Interventions	Rationales
Assess the patient’s current pattern of elimination and compare it with their 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 treat urolithiasis directly. 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 the renal calculi from the bladder and avoid urine accumulation.
Insert an indwelling catheter as required.	To help evacuate urine, stone, and other debris from the bladder.
Strain every urine voided and document the renal stone and urine characteristics.	The characteristic renal stones and urine provide crucial information in the further treatments that of the renal are needed by the patient.
Teach the patient some lifestyle changes related to preventing more renal stones. These include: adequate oral hydration(at least 2 liters of fluids per day, if not contraindicated), drink fruit juices, particularly cranberry.	Adequate oral hydration results in 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. juice
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 4: Renal Failure

Impaired Urinary Elimination related glomerular malfunction to secondary to renal failure as evidenced by an 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.

Interventions	Rationales
Assess the patient’s current pattern of elimination and compare it with their normal pattern prior to having	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 avoid undergarments that have non-breathing materials or are constricting/ tight-fitting.	To promote wellness and prevent 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 UTl-causing pathogens. Undergarments made of non ­ breathing materials or 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.

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Nursing Care Plan 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 a better pattern of urinary elimination as evidenced by painless urinary elimination, improving bladder muscle tone, and post-void residuals of less than 50 ml.

Interventions	Rationales
Assess the patient’s current pattern of elimination. Assess the effect of paralysis on the patient’s elimination	To establish baseline data on urinary elimination patterns.
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 in important data on the pat
Teach the patient some lifestyle changes, including proper perineal hygiene, adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated).	Adequate oral hydration results in 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.

Summary

The inability to completely empty the bladder is known as urinary retention. It is either acute or chronic in nature. Prostate enlargement and elderly individuals are the most typical causes of this illness in men. Managing the underlying reasons, resolving infections such as UTIs and prostatitis, and using non-steroidal anti-inflammatory medicines are all options for treatment (NSAIDs).

Related FAQs

1. What are interventions for impaired urinary elimination?

Nursing Interventions

Encourage adequate fluid intake (2–4 L per day), avoiding caffeine and use of aspartame, and limiting intake during late evening and at bedtime. Recommend use of cranberry juice/vitamin C. Sufficient hydration promotes urinary output and aids in preventing infection.

2. What are the priority nursing diagnosis related to urinary elimination?

A literature search combined with clinical observation and review of anatomy and physiology helped to identify five specific nursing diagnoses. They are: urinary retention, stress incontinence, urge incontinence, reflex incontinence, and uncontrolled incontinence.

3. Is impaired elimination a nursing diagnosis?

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.

4. What are some nursing interventions for elimination?

Common nursing interventions related to facilitating elimination include inserting and managing urinary catheters, obtaining urine specimens, caring for ostomies, providing patient education to promote healthy elimination, and preventing complications.

5. What is urinary elimination care?

Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required: In cases of acute urinary retention.

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