INTERVENTIONS FOR URINARY ELIMNATION : Foundations 2 Test 3

History of Urinary Assessment

Changes in urination (color, frequency, amount)

Pain / Discomfort (during voiding, in the back/flank)

Previous history of urinary problems (UTI, Kstones, intcontinence)

Normal Urinary Output

30ml

Further investigation of abnormal urinary findings

Fluid intake

Fluid loss

Diet

Mobility

Anxiety

Cognitive Dysfunction

Neurologic Injury

Pregnancy

Infection

Urinary Obstruction

Medication history

stress incontinence

the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing

urge incontinence

state in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void

functional incontinence

the person has bladder control but cannot use the toilet in time

total incontinence

continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation

Lab Analysis of urine

Urinalysis

Specific Gravity

Culture and Sensitivity

24 Hour urine collection

Blood work for urine

BUN

Creatinine

Radiologic Urine Test

Bladder scan / ultrasound

Intravenous pyelogram

Cystoscopy

Urodynamic studies

Sterile Samples of urine

Clean Catch / mid stream

Catheterized sample

Are urine samples clean or sterile

Both

24 urine collection

Discard first void

Collect all urine produced for 24 hours

avoid stool contamination

Keep collection cold

At the end of the 24 hour period have client empty the bladder and add that void to the container before sending to lab

Indications for urinary catheter

- Retention

- prevent skin damage or wound contamination

- essential need for accurate output measurements (surgery/trauma/certain medical conditions)

- comfort at end of life

adult catheter size

14-18

Types of catheters

External

Straight

Indwelling

Suprapubic

Coude Catheter

Used for BPH

Nursing considerations for catheters

- explain the procedure steps and rationale for procedure

- provide privacy (doors and curtains)

- position PT (dorsal recumbent for females)

- perform routine perineal care prior to starting procedure

Start with the assumption that an object is

NOT sterile

Sterile items must always include

Intact and undamaged packaging

Expiration or use by date

Sterile

Opened but unused sterile items are

considered unsterile

Creating sterile field

Minimize air movement

Sanitize the work surface and allow for drying

Face the sterile field

Keep the sterile field above your waist

Sterile items must be kept in 1 inch margins on the field

Do not reach across sterile fields

Sterile to sterile

Clean to clean

Sterile objects can only touch sterile objects

Catheter Supplies

- Peri care supplies

- disposable under pad

- catheter tray

- extra sterile gloves

-securement device

- additional lighting

- waste basket

Steps for catheterization before touch PT

Verify order

Gather supplies

position and prepare PT

provide Peri care

Remove gloves and wash hands

Remove outer wrap from supplies

Set up sterile field

Don sterile gloves

Prepare all sterile equipment before touching PT

Steps for catheterization after touch PT

Expose meatus with one hand having one sterile and one non sterile hand

use each antiseptic swab once

insert catheter until urine appears in tube

Insert 2 more inches for indwelling

if met with resistance have PT relax

May use NS hand to hold catheter near the urethra while urine drains or while inflating the balloon

Secure indwelling to PT thigh

Attach bag to non-movable part of bed

Provide peri-care

Preventing Complications : skin irritation

- keep skin clean and dry

- barrier creams

- breathable under pads

Preventing Complications : Falls

- targeted toileting

- education

Preventing Complications : UTI

- minimize the use of indwelling

- use strict sterile technique for insertion

- secure indwelling catheters to prevent friction

- peri-care daily and after each episode of incontinence

- gently clean several inches of the tubing moving from the urethra outwards with a fresh wipe

- manage tube and bag

- empty drainage every 8 hours

Preventing Complications : Hematuria

-Minimize catheterization

-Use the smallest functional catheter

-Gentle insertion technique

-Secure indwelling catheters

-Secure drainage tubing to prevent pulling