NUR212B: Urinary Elimination

The bladder normally contains urine under very little pressure. As the volume of urine increases, the pressure increases only slightly. The bladder wall is able to adapt to this pressure because of the muscle tissue in the bladder. (Taylor 1267)

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URETHRAL ORIFICE Inspect the urethral orifice for any signs of inflammation, discharge, or foul odor. In females, the urethral meatus is a slit-like opening below the clitoris and above the vaginal orifice. (Taylor 1272)

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Observe the lower abdominal wall, noting any swelling, and palpate this area for tenderness. Note the smoothness and roundness of the bladder. Measure the height of the edge of the bladder above the symphysis pubis.

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p1273: Characteristics of Urine

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Click the video in "Renal Function" p1265

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In contrast, the female urethra is about 1 1/2″ to 2 1/2″ (3.7 to 6.2 cm) long. The external, or voluntary, sphincter is located in the middle of the urethra. No portion of the female urethra is external to the body, as in the male, although the muscle at the meatus is usually called the external sphincter.

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In select patients, monitor the pH and specific gravity of the urine (which is a measure of the density of urine compared with the density of water) and check the urine for abnormal constituents such as protein, blood, glucose, ketone bodies, and bacteria (Taylor 1272)

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Acute failure is a sudden decline in kidney function, and may be caused by conditions such as severe ____, _____ shock, ____, and _____ obstruction. (Taylor 1269)

Acute renal failure is a sudden decline in kidney function, and may be caused by conditions such as severe dehydration, anaphylactic shock, pyelonephritis, and ureteral obstruction.

______ disease is the end result of irreparable damage to the kidneys, developing slowly over many years. Chronic ______ is caused by conditions such as diabetes, hypertension, and glomer-ulonephritis

Chronic kidney disease is the end result of irreparable damage to the kidneys, developing slowly over many years. Chronic renal failure is caused by conditions such as diabetes, hypertension, and glomer-ulonephritis

High blood glucose levels, such as with diabetes mellitus, may lead to an ______ in urine output secondary.

High blood glucose levels, such as with diabetes mellitus, may lead to an increase in urine output secondary to an osmotic diuretic effect.

Other people have habits of infrequent voiding. For example, some people go 8 to 12 waking hours or longer without urinating. A habitual _____ or a decrease in the sensation of thirst associated with aging may be one reason.

Other people have habits of infrequent voiding. For example, some people go 8 to 12 waking hours or longer without urinating. A habitual LOW FLUID INTAKE or a decrease in the sensation of THIRST associated with aging may be one reason.

A ____ involves the surgical creation of an alternate route for excretion of urine and is discussed later in the chapter. (Taylor 1271)

Patients with URINARY DIVERSIONS may have established individualized personal care routines. A URINARY DIVERSION involves the surgical creation of an alternate route for excretion of urine and is discussed later in the chapter.

People with indwelling urinary catheters lose bladder tone because the bladder muscle is not being stretched by the bladder filling with urine.

People with indwelling urinary catheters lose bladder tone because the bladder muscle is not being stretched by the bladder filling with urine.

_______, a urinary tract analgesic, can cause orange or orange-red urine.

Phenazopyridine (Pyridium), a urinary tract analgesic, can cause orange or orange-red urine.

Place female patients in the _______ position with the inner labia retracted for good visualization of the meatus. In males, the meatus is at the ______ of the penis. If the male patient is uncircumcised, retract the foreskin to visualize the meatus.

Place female patients in the DORSAL RECUMBENT position with the inner labia retracted for good visualization of the meatus or orifice. In males, the meatus/orifice is at the tip of the penis. If the male patient is uncircumcised, retract the foreskin to visualize the meatus.

_______: Protein in the urine; indication of kidney disease _______: Pus in the urine; urine appears cloudy

Proteinuria: Protein in the urine; indication of kidney disease Pyuria: Pus in the urine; urine appears cloudy

_____ is a condition in which the kidneys fail to remove metabolic end products from the blood and are unable to regulate fluid, electrolyte, and pH balance.

Renal failure is a condition in which the kidneys fail to remove metabolic end products from the blood and are unable to regulate fluid, electrolyte, and pH balance.

Results are most accurate when the patient is in the ______ position during the scanning. Skill 36-1 outlines the procedure for assessing bladder volume using an ultrasound bladder scanner

Results are most accurate when the patient is in the SUPINE position during the scanning (bedside scanner) Skill 36-1 outlines the procedure for assessing bladder volume using an ultrasound bladder scanner

SKIN INTEGRITY AND HYDRATION Assess the integrity of the skin in the perineal area (private area). Problems with incontinence may result in severe _____ or abrasion of the epidermis. (Taylor 1272)

SKIN INTEGRITY AND HYDRATION Problems with incontinence may result in severe EXCORIATION or abrasion of the epidermis.

The reason for this is believed to be ______ of urine in the bladder, which serves as a good medium for bacterial growth. Newly occurring infrequent voiding can also indicate a decreased production of urine caused by a kidney or circulatory disorder.

STAGNATION of urine in the bladder causing bacterial growth

_____ and _____ may diminish awareness of the need to void. People who view themselves as old, powerless, and neglected may cease to value voluntary control over urination and simply find toileting too much bother no matter what the setting. Incontinence may be the result.

Sedatives and tranquilizers may diminish awareness of the need to void.

Psychological Variables

Some people who experience STRESS void SMALLER amounts of urine at more W intervals. Stress can also interfere with the ability to relax the perineal muscles and the external urethral sphincter. When this happens, the person may feel an urge to void, but emptying the bladder completely becomes difficult or impossible.

Stretch receptors in the bladder are stimulated as the urine collects. The person feels a desire to void, usually when the bladder fills to about ___ to ____ mL in an adult.. (Taylor 1268)

Stretch receptors in the bladder are stimulated as the urine collects. The person feels a desire to void, usually when the bladder fills to about 150 to 250 mL in an adult..

Strong psychological factors, such as marked _____, may also result in involuntary urination. Alternately, in certain conditions, it may be difficult for a person to relax the restraining muscles sufficiently to void, such as when a shy or embarrassed person needs to give a urine specimen.

Strong psychological factors, such as marked FEAR, may also result in involuntary urination.

________: Stoppage of urine production; normally, the adult kidneys produce urine continuously at the rate of 60 to 120 mL/h

Suppression: Stoppage of urine production; normally, the adult kidneys produce urine continuously at the rate of 60 to 120 mL/h

The _____'s function is to transport urine from the bladder to the exterior of the body. The anatomy of the _____ differs in males and females. The _____ (male/female) urethra functions in the excretory system and the reproductive system. (Taylor 1267)

The URETER's function is to transport urine from the bladder to the exterior of the body. The anatomy of the URETER differs in males and females. The MALE (male/female) urethra functions in the excretory system and the reproductive system. (Taylor 1267)

The _______ or ___-complex vitamins can turn urine green or blue-green.

The antidepressant amitriptyline (Elavil) or B-complex vitamins can turn urine green or blue-green.

The bedside scanner method is noninvasive and painless. A bladder scan can be performed at the bedside, poses no risk for infection, and is a safer alternative to catheterization to determine bladder urine _____.

The bedside scanner method is noninvasive and painless. A bladder scan can be performed at the bedside, poses no risk for infection, and is a safer alternative to catheterization to determine bladder urine VOLUME.

The kidneys filter and excrete _____ constituents that are not needed and retain those that are. Despite varying kinds and amounts of food and fluids ingested, body fluids remain relatively stable if the kidneys are functioning properly.

The kidneys filter and excrete BLOOD constituents that are not needed and retain those that are. Despite varying kinds and amounts of food and fluids ingested, "body fluids remain relatively stable" if the kidneys are functioning properly.

‍♀️The measurement of fluid intake and output is described further in Chapter 39. ____ are required when handling urine to prevent exposure to pathogenic microorganisms or blood that may be present in the urine. ______ also are worn whenever there is a concern of urine splashing.

The measurement of fluid intake and output is described further in Chapter 39. GLOVES are required when handling urine to prevent exposure to pathogenic microorganisms or blood that may be present in the urine. GOGGLES also are worn whenever there is a concern of urine splashing.

The muscles of the perineum and the external sphincter relax, the muscle of the abdominal wall _____ slightly, the diaphragm lowers, and urination occurs.

The muscles of the perineum and the external sphincter relax, the muscle of the abdominal wall CONTRACTS slightly, the diaphragm lowers, and urination occurs.

The nephrons maintain and regulate ______ through the mechanisms of selective reabsorption and secretion of water, electrolytes, and other substances.

The nephrons maintain and regulate fluid balance through the mechanisms of selective reabsorption and secretion of water, electrolytes, and other substances.

The voluntary control of urination develops as the higher nerve centers develop after infancy. Until that time, voiding is purely a reflex action. People whose bladders are no longer controlled by the brain because of injury or disease also void by reflex only. This is called ______ bladder.

The voluntary control of urination develops as the higher nerve centers develop after infancy. Until that time, voiding is purely a reflex action. People whose bladders are no longer controlled by the brain because of injury or disease also void by reflex only. This is called autonomic bladder.

These impulses cause the detrusor muscle to _____ and the internal sphincter to ____, retaining urine in the bladder.

These impulses cause the detrusor muscle to relax and the internal sphincter to constrict, retaining urine in the bladder.

These three layers are called the _____ muscle. At the base of the bladder, the middle circular layer of muscle tissue forms the internal, or involuntary, _____, which guards the opening between the urinary bladder and the urethra. The ______ conveys urine from the bladder to the exterior of the body.

These three layers are called the DETRUSOR muscle. At the base of the bladder, the middle circular layer of muscle tissue forms the internal, or involuntary, sphincter, which guards the opening between the urinary bladder and the urethra. The urethra conveys urine from the bladder to the exterior of the body.

💀When a patient (or caregiver) reports a problem with voiding, explore its duration, severity, and precipitating factors. Also, note the patient's perception of the problem and the adequacy of the patient's self-care behaviors.

When a patient (or caregiver) reports a problem with voiding, explore its duration, severity, and precipitating factors. Also, note the patient's perception of the problem and the adequacy of the patient's self-care behaviors.

Nursing History In the nursing history, question the patient (or caregiver) about usual voiding habits and any current or past voiding difficulties. With infants, assess the number of wet diapers per day that the infant produces. Newborns should have ___ to ___ wet diapers per day.

With infants, assess the number of wet diapers per day that the infant produces. Newborns should have 6 to 8 wet diapers per day.

With young CHILDREN, assess whether the child has achieved _____ during both day and nighttime. Be sure to indicate on the nursing history and care plan the words that the child uses to indicate the need to void.

With young children, assess whether the child has achieved bladder control during both day and nighttime. Be sure to indicate on the nursing history and care plan the words that the child uses to indicate the need to void.

Some analgesics and TRANQUILIZERS suppress the central nervous system, interfering with urination by diminishing the effectiveness of the neural reflex. (Taylor 1270)

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3. Correlation of these findings with the results of diagnostic tests and procedures for examining the urine and the urinary tract

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THE NURSING PROCESS FOR URINARY ELIMINATION>>>>>>>>>>>>> (Taylor 1270)

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______: Presence of sugar in the urine ______: Awakening at night to urinate

Glycosuria: Presence of sugar in the urine Nocturia: Awakening at night to urinate

It is about 5 1/2″ to 6 1/4″ (13.7 to 16.2 cm) long and consists of three parts: the prostatic, the membranous, and the cavernous portions (Fig. 36-3). The external urethral sphincter consists of striated muscle and is located just beyond the prostatic portion of the urethra. The external sphincter is under voluntary control.

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The act of urination is normally painless. The voluntary control of voiding is limited to initiating, restraining, and interrupting the act. Restraint of voiding is thought to occur subconsciously when the volume of urine in the bladder is small. If voiding is delayed, however, the bladder continues to fill. Discomfort may then be felt when undue distention occurs, and the urgency to void becomes paramount. (Taylor 1268)

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Effects of Aging Physiologic changes that accompany normal aging may affect urination in older adults. These changes include the following: (Taylor 1269)

1. The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night). 2. Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination. (Cont)

Assessing A comprehensive nursing assessment of the functioning of a patient's urinary system includes the following: 1. Collection of data about the patient's voiding patterns, habits, and difficulties and a history of current or past urinary problems

2. Physical examination of the bladder, if indicated, and urethral meatus; assessment of skin integrity and hydration; and examination of the urine

FACTORS AFFECTING URINATION Infants are born without voluntary control of urination and with little ability to concentrate urine. An infant's urine is usually very light in color and without odor. At about ____ weeks of age, the infant's nephrons are able to control reabsorption of fluids in the tubules and effectively concentrate urine. (Taylor 1268)

6 weeks

(Cont on Effects of Aging) 3 Decreased bladder contractility may lead to urine retention and stasis, which increases the likelihood of urinary tract infection. 4. Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time.

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A fold of membrane in the bladder closes the entrance to the ureters so that urine is not forced up the ureters to the kidneys when pressure exists in the bladder. (Figure 36-1 shows the male and female urinary systems and the position of the kidneys and ureters in the abdomen.)

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ANATOMY + PHYSIOLOGY

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Color A freshly voided specimen is pale yellow, straw-colored, or amber, depending on its concentration. (Basically light yellow to very light orange) (Taylor 1273)

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Measuring Urine Output in Patients Who Are Continent. Patients who have self-control over urination are continent. The procedure for measuring the urine output of a patient who is continent and voiding is as follows: 1. Ask the patient to void into a bedpan, urinal, or specimen hat, either in bed or in the bathroom. Urinary devices used to collect or measure urine are shown in Figure 36-5 . 2. Pour the urine from the collection device into the appropriate measuring device provided by the agency. The devices are calibrated in milliliters. Collection devices may be calibrated for measurement, eliminating the need for an additional measuring device. 3. Place the calibrated container on a flat surface, such as a shelf, for an accurate reading. Reading at eye level, note the amount of urine voided and record it in the patient's electronic record. Record the total amount voided during each shift. The total for the 24-hour period is usually calculated by the electronic record computer software. Alternately, the information may be recorded in a paper form at the bedside. Figure 36-6 shows a paper form used for recording urine output. 4. Discard the urine in the toilet unless a specimen is required. If a specimen is required, pour the urine into an appropriate specimen container. (Taylor 1272)

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Older children and adults control urination voluntarily. They seldom wake to void at night because their kidneys are able to concentrate urine and produce less urine at night as a result of decreased RENAL BLOOD flow.

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Pathologic Conditions

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Reread page 1271: Focused Assessment Guide 36-1 in purple ***

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The measurement of fluid intake and output may be delegated to unlicensed personnel. However, the nurse is responsible for ensuring that staff members understand the required procedures, and the nurse must validate the accuracy of the measurements.

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This makes it possible for urine to continue to enter the bladder from the ureters against low pressure. When the pressure becomes sufficient to stimulate nerves in the bladder wall (stretch receptors), the person feels a desire to empty the bladder.

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Special Assessment Techniques In addition to the nursing history and physical examination, the nurse gathers data about urinary elimination through the following assessment measures: measuring urine output, collecting urine specimens, performing point of care urine testing, and assisting with diagnostic procedures. These are discussed in the following sections.

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When the body is dehydrated, the kidneys reabsorb fluid. The urine produced is more concentrated and is decreased in amount. Conversely, with fluid overload, the kidneys excrete a large quantity of dilute urine. (Taylor 1269)

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MEASURING URINE OUTPUT Measuring the patient's fluid intake and output is an important nursing responsibility. Accuracy of the total fluid intake and output from all sources aids in identifying potential alterations in fluid balance and is essential for planning the patient's nursing and medical care. (Taylor 1272)

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Food and Fluid Intake When the body is functioning well, the kidneys help the body maintain a careful balance of fluid intake and output, which should be about equal.

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A bedside _____ is another way to assess the bladder. These portable bladder ultrasound devices create an image of the patient's bladder and calculate urine volume present in the bladder. (Taylor 1271)

A BEDSIDE SCANNER is another way to assess the bladder. These portable bladder ultrasound devices create an image of the patient's bladder and calculate urine volume present in the bladder.

Abuse of ANALGESICS (painkillers), such as ____ or _____, can cause _____; some antibiotics, such as gentamicin, can be nephrotoxic.

Abuse of ANALGESICS, such as aspirin or ibuprofen (Advil), can cause nephrotoxicity; some antibiotics, such as gentamicin, can be nephrotoxic.

Abuse of _____, such as aspirin or ibuprofen (Advil), can cause nephrotoxicity; some antibiotics, such as gentamicin, can be nephrotoxic.

Abuse of ANALGESICS, such as aspirin or ibuprofen (Advil), can cause nephrotoxicity; some antibiotics, such as gentamicin, can be nephrotoxic.

_____ produces a diuretic effect by inhibiting the release of antidiuretic hormone, increasing urine production. Foods high in water may increase urine production.

ALCOHOL increase urine production

Certain drugs cause urine to change color, including the following: ______ may cause hematuria (blood in the urine), leading to a pink or red color. _____ can lighten the color of urine to pale yellow. (Taylor 1270)

ANTICOAGULANTS may cause hematuria (blood in the urine), leading to a pink or red color. DIURETICS can lighten the color of urine to pale yellow.

Other pathologic conditions, such as CONGESTIVE heart failure, may lead to fluid _____ and decreased urine output.

Fluid retention (CONGESTIVE heart failure)

_____: 24-hour urine output is less than 50 mL; synonyms are complete kidney shutdown or renal failure ______: Painful or difficult urination Frequency: Increased incidence of voiding (Taylor 1270)

Anuria: 24-hour urine output is less than 50 mL; synonyms are complete kidney shutdown or renal failure Dysuria: Painful or difficult urination Frequency: Increased incidence of voiding (Taylor 1270)

As a child grows, the bladder gradually enlarges, with an increase in capacity. Most children develop urinary control between the ages of ____ and ____ years. Daytime control precedes nighttime control, and ____ generally develop control earlier than ____. (Girls/Boys)

As a child grows, the bladder gradually enlarges, with an increase in capacity. Most children develop urinary control between the ages of 2 and 5 years. Daytime control precedes nighttime control, and GIRLS generally develop control earlier than boys

💀Assess the procedures and equipment used by patients to make sure they follow accepted guidelines and do not predispose themselves to infection or other risk. Record in both the history and the nursing plan of care any special routine, equipment, or supplies the patient uses for urinary elimination.

Assess the procedures and equipment used by patients to make sure they follow accepted guidelines and do not predispose themselves to infection or other risk. Record in both the history and the nursing plan of care any special routine, equipment, or supplies the patient uses for urinary elimination.

Diuretics, which commonly are used in the treatment of ______ and other disorders, prevent the reabsorption of water and certain electrolytes in the tubules.

Diuretics, which commonly are used in the treatment of hypertension and other disorders, prevent the reabsorption of water and certain electrolytes in the tubules.

___ and _____ (sweating/profuse perspiration) result in body fluid conservation by the kidneys. Urine production is decreased, and the urine is highly concentrated.

Fever and diaphoresis (profuse perspiration) result in body fluid conservation by the kidneys. Urine production is decreased, and the urine is highly concentrated.

Medications prescribed for other health problems in the older adult may interfere with bladder function. For example, ____ cause increased urine production, resulting in the need for increased urination and possibly urge incontinence (the involuntary loss of urine that occurs soon after feeling an urgent need to void). (Taylor 1269)

DIURETICS cause urinary incontinence in elderly

Depending on their strength, diuretics cause moderate to severe _____ in production and excretion of dilute urine. (Decreases/Increases) ______ medications stimulate contraction of the detrusor muscle and produce urination.

Depending on their strength, diuretics cause moderate to severe increases in production and excretion of dilute urine. CHOLINERGIC medications stimulate contraction of the detrusor muscle and produce urination.

Diseases that reduce physical activity or lead to generalized weakness, such as _____, _____'s disease, and _____ disease, may interfere with TOILETING. Cognitive deficits and certain psychiatric problems can interfere with a person's ability or desire to control urination voluntarily.

Diseases that reduce physical activity or lead to generalized weakness, such as arthritis, Parkinson's disease, and degenerative joint disease, may interfere with toileting. Cognitive deficits and certain psychiatric problems can interfere with a person's ability or desire to control urination voluntarily.

BLADDER Assessment of the bladder may be indicated when patients experience difficulty voiding or other alterations in elimination. The bladder is normally positioned below the symphysis pubis and cannot be palpated or percussed when ______. (Taylor 1271)

EMPTY

Each nephron consists of a complicated system of arterioles, capillaries, and tubules. Nephrons remove the end products of metabolism, such as urea, creatinine, and uric acid from the blood plasma and form ____.

Each nephron consists of a complicated system of arterioles, capillaries, and tubules. Nephrons remove the end products of metabolism, such as urea, creatinine, and uric acid from the blood plasma and form URINE.

Factors associated with urinary retention include _____, an _____, or vaginal _____.

Factors associated with urinary retention include medications, an enlarged prostate, or vaginal prolapse.

Kidneys and Ureters The kidneys are located on either side of the vertebral column behind the ______, in the ____ abdominal cavity. One of the more significant functions of the kidneys is to help maintain the composition and volume of body fluids. About once every ____ minutes, the body's total blood volume passes through the kidneys for waste removal. (Taylor 1265)

Kidneys and Ureters The kidneys are located on either side of the vertebral column behind the peritoneum, in the upper abdominal cavity. One of the more significant functions of the kidneys is to help maintain the composition and volume of body fluids. About once every 30 minutes, the body's total blood volume passes through the kidneys for waste removal. (Taylor 1265)

When the bladder is distended, it rises above the symphysis pubis and may reach to just below the umbilicus (Fig. 36-4). Before palpating the bladder, always ask when the patient ______.

Last voided

_____, an antiparkinson drug, and injectable _____ compounds can lead to brown or black urine.

Levodopa (L-dopa), an antiparkinson drug, and injectable iron compounds can lead to brown or black urine.

Once formed, urine from the nephrons empties into the pelvis of each kidney. From each kidney, urine is transported by rhythmic _____ through the ureters to the urinary bladder. The _____ enter the bladder obliquely.

Once formed, urine from the nephrons empties into the pelvis of each kidney. From each kidney, urine is transported by rhythmic PERISTALSIS through the ureters to the urinary bladder. The URERTERS enter the bladder obliquely.

Other causes of decreased muscle tone include _____, muscle atrophy due to decreased ______ levels as seen with menopause, and damage to muscles from trauma.

Other causes of decreased muscle tone include childbearing, muscle atrophy due to decreased estrogen levels as seen with menopause, and damage to muscles from trauma.

Medications Medications have numerous effects on urine production and elimination. Of gravest concern are the many prescription and nonprescription drugs known to be _______ it capable of causing kidney damage.

Medications have numerous effects on urine production and elimination. Of gravest concern are the many prescription and nonprescription drugs known to be nephrotoxic (capable of causing kidney damage).

Occasional daytime incontinence of urine in a child is usually not a cause for concern. Continued incontinence of urine past the age of toilet training is termed _____. ______ (nighttime bedwetting) usually subsides by ____ years of age

Occasional daytime incontinence of urine in a child is usually not a cause for concern. Continued incontinence of urine past the age of toilet training is termed enuresis. Nocturnal enuresis (nighttime bedwetting) usually subsides by 6 years of age

______: Scanty or greatly diminished amount of urine voided in a given time; 24-hour urine output is less than 400 mL ______: Excessive output of urine (diuresis)

Oliguria: Scanty or greatly diminished amount of urine voided in a given time; 24-hour urine output is less than 400 mL Polyuria: Excessive output of urine (diuresis)

The ______ system carries motor impulses to the bladder and inhibitory impulses to the internal sphincter. These impulses cause the detrusor muscle to CONTRACT and the sphincter to RELAX. The urinary bladder is shown in Figure 36-2. (Taylor 1267)

The parasympathetic system carries motor impulses to the bladder and inhibitory impulses to the internal sphincter. These impulses cause the detrusor muscle to contract and the sphincter to relax. The urinary bladder is shown in Figure 36-2.

Physical Assessment The physical assessment of urinary functioning includes an examination of the _____, if indicated, urethral ____, _____, and urine.(Taylor 1271)

The physical assessment of urinary functioning includes an examination of the urinary bladder, if indicated, urethral meatus, skin, and urine.

The pressure within the bladder is many times greater during urination than it is during the time the bladder is filling. When urination is initiated, the detrusor muscle _____, the internal sphincter _____, and urine enters the posterior urethra.

The pressure within the bladder is many times greater during urination than it is during the time the bladder is filling. When urination is initiated, the detrusor muscle CONTRACTS, the internal sphincter RELAXES, and urine enters the posterior urethra.

Act of Urination The process of emptying the bladder is known as urination, ______, or voiding. The nerve centers for urination are situated in the brain and the spinal cord. Urinating, or voiding, is largely an involuntary reflex act, but its control can be learned. (Taylor 1267)

The process of emptying the bladder is known as urination, micturition, or voiding. The nerve centers for urination are situated in the brain and the spinal cord. Urinating, or voiding, is largely an involuntary reflex act, but its control can be learned.

The urinary bladder muscle is innervated by the ______ nervous system. The ______ system carries inhibitory impulses to the bladder and motor impulses to the internal sphincter.

The urinary bladder muscle is innervated by the AUTONOMIC nervous system. The sympathetic system carries inhibitory impulses to the bladder and motor impulses to the internal sphincter.

Toilet Training Voluntary control of the urethral sphincters occurs between ____ and ____ months of age. However, many other factors are required to achieve conscious control of bladder function. Toilet training usually begins at about ____ to ____ years of age. Toilet training should not begin until the child is able to: Hold urine for ___ hours Recognize the feeling of bladder fullness Communicate the need to void and control urination until seated on the toilet (Taylor 1268)

Toilet Training Voluntary control of the urethral sphincters occurs between 18 and 24 months of age. However, many other factors are required to achieve conscious control of bladder function. Toilet training usually begins at about 2 to 3 years of age. Toilet training should not begin until the child is able to: Hold urine for 2 hours Recognize the feeling of bladder fullness Communicate the need to void and control urination until seated on the toilet (Taylor 1268)

_____ occurs when urine is produced normally but is not excreted completely from the bladder.

URINARY retention occurs when urine is produced normally but is not excreted completely from the bladder.

The inaccessibility of toilet facilities owing to travel, work circumstances, or illness, as well as limitations in mobility, can also lead to INFREQUENT urination. People who habitually urinate infrequently develop more _______ and kidney disorders than those who urinate at least every 3 to 4 hours.

UTIs (urinary tract infections)

______: Strong desire to void _______: Involuntary loss of urine

Urgency: Strong desire to void Urinary incontinence: Involuntary loss of urine

Bladder The ______ is a smooth muscle sac that serves as a temporary reservoir for urine. It is composed of three layers of muscle tissue: the inner longitudinal layer, the middle circular layer, and the outer longitudinal layer.

Urinary bladder

Sometimes, increased abdominal pressure—such as occurs during coughing and sneezing—forces an involuntary escape of urine. This is a particular problem for some women because the urethra is shorter. Any involuntary loss of urine that causes such a problem is referred to as ______. Urinary incontinence is discussed in detail later in the chapter.

Urinary incontinence

Urine is _____ than normal when it is scanty and concentrated. Urine is _____ than normal when it is excessive and diluted.

Urine is DARKER than normal when it is scanty and concentrated. Urine is LIGHTER than normal when it is excessive and diluted.

Urine, the waste product excreted by the kidneys, contains organic, inorganic, and liquid wastes. The _____ is the basic structural and functional unit of the kidneys. There are about 1 million _____ in each kidney.

Urine, the waste product excreted by the kidneys, contains organic, inorganic, and liquid wastes. The nephron is the basic structural and functional unit of the kidneys. There are about 1 million nephrons in each kidney.