unit 9

Fluid Intake and Output Monitoring

  • Essential for assessing fluid and electrolyte balance in patients.
  • Intake includes:
    • Oral liquids
    • Enteral feedings
    • Parenteral fluids (IV fluids, blood products, Total Parenteral Nutrition (TPN))
  • Output includes:
    • Urine
    • Diarrhea
    • Vomitus
    • Gastric (NG) suction
    • Drainage from surgical tubes or drains
  • Monitoring:
    • Conducted each shift to determine net fluid loss or gain.
    • Intake and output should be roughly equal over 24-hour periods.
    • Compare totals across several days.

Anatomy of the Urinary System

  • Key components include:
    • Kidneys: filters blood and produces urine.
    • Ureters: tubes that carry urine to the bladder.
    • Urinary Bladder: stores urine until excretion.
    • Urethra: conducts urine out of the body.
    • Sphincter Muscle: controls urination.

Normal Characteristics of Urine

  • Composition: 96% water, 4% solutes.
  • Organic Solutes:
    • Urea
    • Ammonia
    • Creatinine
    • Uric acid
  • Inorganic Solutes:
    • Sodium, chloride, sulfate, phosphorus, magnesium, potassium.
  • Characteristics:
    • Amount: ≥ 30 mL/hr.
    • Colour: Straw to amber.
    • Clarity: Should be transparent/clear.
    • Odour: Faint aroma.
    • pH: Typically at 6 (normal range: 4.5-8).
    • Specific gravity: Ranges from 1.015 to 1.025.
    • Normal findings: No protein, glucose or ketones; minimal RBCs, WBCs, bacteria, and yeast.

Altered Urinary Function

Types:
  • Neurogenic Bladder:
    • Impaired neurological function.
    • Symptoms: impaired fullness sensation, lack of sphincter control, potential incontinence.
  • **Types of Incontinence: **
    • Functional
    • Overflow
    • Reflex
    • Stress
    • Urge
    • Total
    • Mixed
  • Obstruction:
    • Conditions causing decreased urinary flow.
    • Examples include:
    • Urinary tract calculi (kidney stones)
    • Prostate enlargement (BPH)
    • Structural abnormalities (genetic or tumor-related).

Urinary Catheterization

Indications:
  • To relieve urinary retention
  • Close monitoring in acute situations
  • Diagnostic tests
  • Provide irrigation
  • Instill medications
Guidelines for Catheterization:
  1. Assessment of:
    • Fluid status (I&O, weight, serum electrolytes).
    • Pattern of voiding.
    • Need for catheterization.
    • Level of cooperation and mobility.
    • Bladder fullness (palpation or bladder scanner).
  2. **Procedure: **
    • Provide privacy.
    • Use smallest appropriate catheter.
    • Maintain aseptic technique.
    • Ensure unobstructed urine flow.
    • Keep the drainage bag below bladder level.
    • Secure catheter to prevent movement.
    • Perform peri care as needed.

Documentation of Procedures

  • Important to document:
    • Date and time of catheter insertion or care.
    • Fluid drained, appearance, and patient response.
    • Any complications or concerns.

Specimen Collection

Urine Specimens:
  • Types:
    • Urinalysis: Tests kidney or metabolic function, nutrition, systemic diseases.
    • Culture & Sensitivity: Identifies bacteria and determines effective antibiotic treatments.
    • Timed Urine Specimens: Assesses kidney function and urine composition over a specified time.
Additional Specimen Types:
  • Stool Cultures: Identify microorganisms causing infections.
  • Fecal Occult Blood Testing: Screens for blood in stool, which may indicate serious conditions like cancer or ulcers. False positives can occur with certain diets and medications.
  • Wound Cultures: Identify microorganisms in wounds; must be performed under sterile conditions.
Documenting Specimen Collection
  • Document all collection details including appearance, quantity, time, and patient condition to ensure accurate reporting and assessment.