Selected Nursing Skills Urinary Students-1

Selected Nursing for Urinary Related Disorders

Pre-Skill Procedures

  • Check doctor's orders for necessary actions.

  • Introduce yourself to the patient.

  • Identify the patient by checking their arm band and asking them to state their name.

Before Skill Execution

  • Explain the procedure clearly and the reasons behind it to the patient.

  • Assess and provide patient teaching throughout the procedure as required.

  • Assess the patient's condition prior to starting any procedure.

Equipment Setup

  • Assemble necessary equipment before starting.

  • Ensure privacy by closing the door and pulling curtains.

  • Adjust the patient's bed to a comfortable working height.

During Skill Execution

  • Encourage patient involvement in the process as much as possible.

  • Monitor the patient's tolerance and be vigilant for signs of discomfort and fatigue.

Post-Procedure Care

  • Assist the patient into a comfortable position after the procedure.

  • Raise bed side rails for safety.

  • Lower the bed to the lowest position for patient ease.

Monitoring Post-Procedure

  • Document patient's response and expected or unexpected outcomes post-procedure.

  • Provide patient teaching regarding aftercare and any signs to watch for.

  • Report any changes in the patient's condition to the healthcare team.

Important Reminders

  • STOP! THINK! OBSERVE! PROCEED!

Patient Support for Urinary Elimination

  • Patients may need urologic and psychological support from nursing staff.

Indications for Catheters

  • Catheters may be used for both treatment and diagnosis of urinary issues.

  • The procedure involves introducing a catheter through the meatus and urethra into the bladder.

Catheter Types and Use

  • Various types of catheters can be introduced into the bladder, ureter, or kidney depending on specific conditions.

  • Catheters are measured using the French system (Fr), with adult urethral catheters typically ranging from 14 to 24 Fr, and ureteral sizes averaging 4 to 6 Fr.

Indwelling Catheter Specifics

  • Indications for Use:

    • Short-term use typically indicates conditions like shock, heart failure, urinary obstruction, or wounds.

  • Complications:

    • Indwelling catheters can lead to Catheter Associated Urinary Tract Infection (CAUTI).

    • Risk of bacteria entering through the catheter outlet or traveling up the urethra.

  • Types of Indwelling Catheters:

    • Foley Catheter: Designed with an inflatable balloon near the tip to secure placement after insertion.

    • Coudé Catheter: Specifically designed for ease of insertion in patients with prostate enlargement.

    • Whistle-tip Catheter: Contains a slanted orifice to accommodate cases of blood in urine.

  • Specialized Catheters:

    • Malecot, Pezzer & Mushroom Catheters: Used for draining urine from the renal pelvis of the kidney.

    • Ureteral Catheter: Long and slender, used for direct insertion into the ureter.

    • Nephrostomy Tube: Thin plastic tube passed from the back through the skin to the kidney.

Bladder Irrigation Management

  • Components of irrigation include:

    • Irrigation bag, drip chamber, and clamping mechanisms for flow control.

Suprapubic Catheter Care

  • Important nursing considerations:

    • Keep the area clean and dry.

    • Change the dressing when new.

    • Secure the catheter to prevent tension and use a skin barrier for protection.

External Catheters

  • Condom or Texas Catheters: Used for male patients to minimize skin irritation due to incontinence.

Intermittent Catheterization

  • Indicated for patients with spinal cord injuries, assumes patient independence in performing procedures.

  • Teaching:

    • Recommended every 3 hours.

    • Hospital use involves single-use catheters, while at home patients may wash and reuse.

Catheter Care and Maintenance

  • Urinary tubing and collection bags should be changed as needed.

  • Regular checks on drainage tubing and bag integrity are essential.

Bladder Training Techniques

  • Aim to develop pelvic floor muscles to improve voluntary control over urination.

  • Clamping/unclamping routines can enhance bladder tone.

  • Kegel exercises for pelvic muscle strength are encouraged.

Stress Incontinence

  • Definition: Involuntary loss of less than 50 mL of urine associated with increased abdominal pressure caused by actions such as:

    • Laughing

    • Coughing

    • Sneezing

Functional Incontinence

  • Characterized by an inability to reach the toilet due to:

    • Environmental obstacles

    • Physical limitations

    • Cognitive issues like memory loss or disorientation.

Managing Incontinence

  • Solutions include urology consult, Kegel exercises, bladder training, the Credé maneuver, and disposable adult undergarments.

Discontinuing Catheter Use

  • An indwelling catheter can either be replaced with a new catheter or removed to allow for normal urination.

Urinary Tract Infection (UTI)

  • Epidemiology: More than 3 million cases annually in the U.S.; can resolve within days to weeks.

  • Main cause: Invasion of the urinary tract by pathogens, particularly Escherichia coli, making it the second most common bacterial infection and a leading hospital-acquired infection.

Risk Factors for UTI

  • Incomplete bladder emptying due to obstruction or inadequate voiding.

  • Perineal and urethral contamination, particularly from fecal soiling or sexual intercourse.

  • Instrumentation, such as Foley catheterization, increases infection odds.

  • Anatomical differences, especially in females, lead to higher UTI susceptibility.

  • Pregnancy and aging also play significant roles in UTI risk.

Therapeutic Measures for UTI Prevention

  • Increase fluid intake to facilitate flushing of bacteria.

  • Avoid irritants like caffeine and alcohol.

  • Encourage regular voiding and completion of prescribed medications.

  • Consumption of cranberry products has preventive benefits.

Urolithiasis (Kidney Stones)

  • Symptoms: Severe pain, primarily located in the abdomen or lower back.

Assessment for Urinary Retention

  • Use palpation and percussion to identify full bladders by dull sounds.

  • Bladder scans assist in determining catheter necessity, ensuring patients void prior.

Kidney Failure Causes

  • Various etiologies include kidney trauma, dehydration, medicinal toxicity, untreated diabetes, and hypertension.