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.