Unit 5

Elimination and Understanding Urinary Catheterization

Foley Catheter

  • Definition: A Foley catheter is an indwelling catheter placed through the urethra into the bladder to continuously drain urine.
  • Components:
    • Balloon filled with saline to keep catheter in place.
    • Drainage port connected to a sterile closed drainage system.
    • Various catheter types such as ostomy pouches.

Indications for Urinary Catheterization

  • Post-operative Drainage: Used in urologic and other surgeries.
  • Accurate Urinary Drainage: Essential in critically ill patients.
  • Neurogenic Bladder Dysfunction: Facilitates urine drainage in patients with neurological deficits.
  • Suprapubic Catheterization:
    • Inserted through a suprapubic incision into the bladder.
    • Can be temporary or permanent.
  • Advantages of Suprapubic Catheters:
    • More comfortable for the patient.
    • Reduced risk of hospital-acquired urinary tract infections (CAUTI).

CAUTI (Catheter-Associated Urinary Tract Infections)

  • Symptoms:
    • 49.9% chance in medical-surgical settings.
    • Presentation includes cloudy and malodorous urine, hematuria, fever, chills, anorexia, malaise, back or flank pain.

Types of Urinary Diversions

  • Indications for Surgical Diversion: Typically performed after cystectomy.
  • Types of Diversions:
    • Ileal Conduit:
    • Urine is directed through a loop of ileum led through the abdominal wall to create a stoma.
    • Orthotopic Neobladder: Constructed from segments of intestine to restore bladder function.
    • Indiana Pouch: Reservoir created from a portion of the intestine.

Nursing Management of Stomas

  • Stoma Assessment:
    • Healthy stoma: Pink or red in color.
    • Compromised: Purple, brown, or black indicating vascular compromise.
  • Appliance Selection:
    • Choose appropriate stoma appliance (1-2 pieces) that is disposable or reusable.
  • Skin Care:
    • Inspect for irritation, rashes, redness, or infection.
  • Fluid Intake: Encourage increased fluid intake to maintain hydration.

Benign Prostatic Hyperplasia (BPH)

  • Definition: Non-cancerous enlargement of the prostate which may obstruct the bladder neck or urethra causing urinary retention.
  • Symptoms:
    • Increased urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased urinary stream, dribbling.
  • Risk Factors