Recording-2025-02-20T17_37_15.276Z

Hearing and Catheter Care

• Frequency of Hearing Checks: Perform hearing checks every eight hours and adjust for the patient's unit.

• Catheter Care:

  • Should be performed regularly (specific frequency should be defined).

  • Cleaning Method:

    • Clean the catheter starting from the patient and then move outward.

    • Always clean away from the patient to prevent dragging bacteria towards them.

  • Importance of Cleanliness:

    • Bacteria are present on every device in the hospital, including catheters.

    • Bacteria can move approximately one inch per hour, emphasizing the need for strict cleanliness protocols.

Urinary Catheter Management

• Foley Catheter:

  • Keeps urine in the bladder with a balloon and connects to a drainage bag.

  • Be cautious with the drainage bag to avoid contamination (e.g., not letting it touch the floor).

• Urine Specimen Collection:

  • Urine specimens should be collected properly to avoid contamination.

  • Ideal method to avoid bacteria from the bag:

    • Use the sterile port on the catheter to collect urine directly, clamping the catheter just above the port to ensure a clean sample.

    • Collect around 10 milliliters to test for infections.

  • Cloudy urine post-catheterization indicates potential infection; sample collection should follow sterile techniques.

  • Use of specimen cup is beneficial for freshly inserted catheters.

Kidney Physiology and Pharmacology

• Proximal Convoluted Tubule:

  • Major site for reabsorption of water, ions, and organic nutrients.

• Loop of Henle:

  • Reabsorbs 20-25% of sodium; water follows sodium during this process.

• Distal Convoluted Tubule:

  • Responsible for the reabsorption of the remaining 5-10% of sodium, regulated by aldosterone. Aldosterone increases sodium retention, affecting fluid levels.

Medications Impacting Kidney Function

• Carbonic Anhydrase Inhibitors (CAIs):

  • Derived from sulfonamide antibiotics; note contraindications for those with sulfa allergies (e.g., Diamox).

  • Can decrease sodium and potassium levels.

• Loop Diuretics:

  • Act on the loop of Henle; cause significant potassium loss.

  • Patients may require potassium supplements while on loop diuretics.

• Osmotic Diuretics:

  • Operate through osmosis; e.g., mannitol draws fluids from tissues into the bloodstream, increasing urine production.

  • Should be administered via IV infusion; monitor for crystallization in the bag before administration. Infusions must be checked for clarity.

• Potassium-Sparing Diuretics:

  • Increase potassium levels; patient teaching regarding potassium-rich foods is essential.

Patient Education and Monitoring

• Educate patients about potential drug interactions that increase the risk of toxicity (e.g., digoxin).

• Monitor weight; 2-3 pounds gain in one day suggests fluid retention, especially in patients with kidney problems.