Comprehensive Notes on Urinary Issues and Catheterization

Treatment Options for Urinary Incontinence

  • Behavioral Techniques:

    • Pelvic Floor Muscle Training Exercises (PFMT):

      • Also known as Kegel exercises.

      • Strengthen pelvic floor and sphincter muscles.

      • Can be done alone or with biofeedback.

    • Biofeedback:

      • Measuring devices help patients become aware of pelvic floor muscle contractions.

    • Electrical Stimulation:

      • Electrodes stimulate nearby muscles to contract; placed in the vagina or rectum.

    • Scheduled Voiding:

      • Also known as Timed voiding, Prompted voiding, or Bladder training.

      • Patient tracks voiding and leaking to plan voiding times with increasing intervals.

      • Bladder Training:

        • Involves biofeedback and muscle training.

        • Uses distraction and relaxation techniques to control urgency.

      • Prompting from caregiver:

        • Reminding and encouraging bladder control between voiding, especially for those with impaired cognitive function.

  • Weight Loss:

    • Obesity increases intra-abdominal pressure and pelvic floor weakness, so weight loss can improve incontinence.

  • Pharmacologic Treatment:

    • Medications target different issues:

      • Some inhibit bladder contractions.

      • Some relax muscles.

      • Some tighten muscles at the bladder neck and urethra.

    • Collagen injections:

      • Injected around the urethra to add bulk and help close the urethral opening.

  • Mechanical Treatment:

    • Pessaries:

      • A stiff ring inserted into the vagina to reposition the urethra.

      • Can be placed by the patient or a nurse.

    • External Barriers:

      • Adhere to the urethral opening to stop leakage; small foam pad placed over the urethral opening.

      • Seals against the body and is removed before voiding.

    • Urethral Insert:

      • A plug-like device that fits into the urethra; removed to void and then replaced.

    • Surgical Intervention:

      • Used as a last resort; the type of surgery depends on the cause of incontinence.

Self-Intermittent Catheterization (ISC)

  • ISC reduces complications from incomplete bladder emptying and voiding dysfunction, serving as an alternative to indwelling catheterization.

  • Learning ISC can be challenging, embarrassing, and fear-inducing, requiring lifestyle adjustments and coping mechanisms.

  • Qualitative study on lived experiences of ISC users:

    • 25 adults from five countries using ISC for at least 1 year and at least two different ISC products.

    • Semistructured telephone interviews were conducted.

    • Nine main themes emerged:

      • Initial fear

      • Urinary tract infection

      • Pain/discomfort

      • Independence

      • Choice

      • Community

      • Life quality

      • Resilience

      • Acceptance

    • Initial resistance to ISC is common and practical challenges must be overcome.

    • ISC is perceived as a burden by some, but not all, users.

    • Clinicians should learn factors that enhance or hinder successful adaptation to ISC and develop interventions based on these insights.

  • Relevance to Nursing Practice:

    • Nurses play a role in assisting patients with management of ISC.

    • Nurses are in strategic positions to plan interventions to help address the challenges patients face and to facilitate ISC to assist patients.

QSEN Evidence-Based Practice (EBP) & Patient Intermittent Self-Catheterization

  • Urinary catheterization can cause adverse effects, including catheter-associated infections.

  • Nurses should ensure individualized care plans based on patient values, clinical expertise, evidence, and best-practice guidelines.

  • Patient Education for Intermittent Self-Catheterization:

    • Explain the reason for self-catheterization and related health issues.

    • Explain the benefits: reducing postvoid residual volumes, reduced UTI risk compared to indwelling catheters, improved quality of life.

    • Explain potential complications (bleeding, UTI risk) and what to do if they occur.

    • Ensure privacy and dignity.

    • Discuss frequency of intermittent catheterization and how to incorporate it into the patient's daily routine.

    • Explain urinary tract anatomy, hygiene, and catheter preparation.

    • Demonstrate how to open, hold, and use the catheter.

    • Explain and demonstrate the catheterization process, and observe a return demonstration by the patient.

    • Explore how to obtain supplies, and assist with informed choice of a catheter that suits the patient and their lifestyle.

    • Provide information in an appropriate format (written materials, video) and language.

    • Allow adequate time for questions.

    • Provide information about how to recognize a UTI and other signs/symptoms to report.

    • Aids are available for patients with poor eyesight, reduced mobility, and/or reduced manual dexterity.

Peritoneal Dialysis

  • Continuous Ambulatory Peritoneal Dialysis (CAPD):

    • Performed manually using small bags of dialysate (dialysis solution), 7 days a week with four to five exchanges of new solution each day.

  • Automated Peritoneal Dialysis (APD):

    • Performed with the assistance of a machine overnight, while the patient sleeps.

    • The exchange of dialysis solution is cycled by the machine, 7 days a week, for 8 to 10 hours a night.

  • Patients need strong support to succeed; patient teaching is important.

  • Education should include family members or others identified by the patient, when appropriate.

  • Patients must take an active role in their therapy, managing much of their own care.

  • Patient education is essential for self-management.

  • Teaching should start as soon as possible before treatment, to allow adequate time to absorb information.

  • Patients are taught to perform peritoneal dialysis, manage exit-site care, take medication, monitor for complications, and follow dietary and fluid restrictions.

  • Refer patients to support groups or organizations like the National Kidney Foundation.

Caring for a Hemodialysis Access – Guidelines for Nursing Care

  • Perform hand hygiene and put on PPE, if indicated.

  • Put on gloves, if indicated.

  • Identify the patient.

  • Close the curtains and door, if possible. Explain the procedure to the patient.

  • Question the patient about muscle weakness, cramping, temperature changes, and abnormal sensations.

  • Inspect the area over the access site for skin color, muscle strength, and range of motion.

  • Palpate over the access site for a thrill or vibration. Palpate pulses above and below the site. Palpate skin temperature along and around the extremity. Check capillary refill. Remove gloves and perform hand hygiene.

  • Auscultate over the access site with the bell of the stethoscope, listening for a bruit or vibration.

  • Do not measure blood pressure, perform a venipuncture, or start an IV on the access arm.
    Remove PPE, if used. Perform hand hygiene.

Indwelling Catheters

  • Use smallest effective catheter size to promote drainage.

  • Adhere to evidence-based practice guidelines and facility policy to remove the catheter as early as possible.

  • Change indwelling catheters only when necessary, based on clinical symptoms like encrustations, obstruction, leakage, bleeding, and CAUTIs.

  • Patients needing long-term indwelling catheters need education on fluid intake, bowel management, hygiene, and self-monitoring for adverse events.

Patient Education for Indwelling Catheters

  • Teach patients how the system functions and how to care for the catheter and drainage system.

  • Teaching points include keeping the tubing free of kinks, maintaining a constant downward flow of urine, maintaining adequate fluid intake, and reporting any unusual symptoms.

  • Different urinary drainage systems are available; nurses should understand the options to support informed patient choices.

  • Closed drainage systems include:

    • A large, 2-L drainage bag.

    • A smaller leg bag that can be secured to the leg (not considered a closed system because it needs regular opening for drainage and connection to an overnight drainage bag).

    • A catheter valve.