Understanding Urinary Elimination: Key Concepts and
School
Harvard University**We aren't endorsed by this school
Course
NURS 1
Subject
Nursing
Date
Dec 12, 2024
Pages
10
Uploaded by CommodorePorpoise3520
NF2 Module 5Urinary Elimination
Organs of the urinary system (renal system)-KidneysoRemove waste from the blood to form urine-UretersoTransport urine from the kidneys to the bladder-BladderoReservoir for urine until the urge to urinate develops-UrethraoUrine travels from the bladder and exits through the urethral meatusUrine – waste product of the renal systemWhat is it?Characteristics? – clear, pale yellow to yellowish wasteWhat’s normal/abnormal? – cloudy, red to brown colorsColour=pale straw to amberOdour= ammonia likeClarity = transparentAmount = Min 30mL/hrTerminology-MicturationoUrination; act of passing urine voluntarily through the urethra-OliguriaoDiminished capacity to form and pass urine-AnuriaoCessation of urine production-PolyuriaoExcretion of an abnormally large volume of urine-DysuriaoPainful or difficult urination-HematuriaoAbnormal presence of blood in the urine-NocturiaoUrination at night-CystitisoInflammation of the urinary bladder characterized by pain, urgency, andfrequencyofurination
It is means inflammation of bladder ia means abnormalolig means very littlean means missingpoly means a lotdys means difficulthemat means presence of bloodNoct means nightCyst means bladderUrinary retentionWhat is it?What causes urinary retention?-An accumulation of urine in the bladder due to bladder’s inability to empty.oOverflow incontinence may occur (urethral sphincter is unable to hold back urine due to built-up pressure).oBladder could be firm and distended upon assessment. In severe cases, the bladder may hold as much as 2-3L of urine.-What are some factors that can affect a person’s ability tourinate?Illness; malfunction of an organ that affects the urinary system-How do you know your patient is retaining urine?Inflation of the abdomen-Complications of urinary retention?Bladder may burst if urine is not emptied in the bladderCatheterization: What is it?-Introducing a narrow tube through the urethra and into the bladder to allow a continuous flow of urine intro a drainage receptacleHow might we explain this procedure to a patient?Catheterization: Indications-Collect sterile urine specimen-Intermittent or continuous bladder drainage and/or irrigationAn intervention to manage•Incontinence •Surgery•Persistent residual urine volume after voiding•Feeling of discomfort (patient's subjective feeling of fullness, symptoms secondary to a UTI, etc.)Super pubic catheter – surgeons create a pathway through the pubic area and a catheter is placed inside the bladder
Catheterization: TypesStraight, Intermittent,“in & out”•Insertion followed by immediate removal•Single lumen catheter•No balloonIndications?NocturiaIndwelling, continuous, Foley•Balloon to secure in situ•Double or triple-lumen catheterIndications?Coudetip catheter•Type of indwelling catheter•Curved and rigid tip for ease of passing enlarged prostate•Easier to control/stiff•Less traumatic insertionIndications?Catheter materials and sizes (Check for allergies)1. Catheter Materials•Latex, silicone, teflon, plastic2. Catheter Size (lumen size)•Determined by size of patient's urethral canal•Presence of clots/debris•French (Fr) systemoChild→8 Fr to 10 FroAdults→14 Fr to 16 FroUrological procedure→20 Fr to 24 Fr3. Balloon Size (how much to instill?)•From 3mL (peds) to 30mL prostatectomies)•Commonly 5mL in adults for optimal drainage*Check packaging for manufacturer's recommendation of volume to instill*
Closed drainage systemsoWhat is a closed drainage system?-Another port for draining-Clamp it the tube firstoConsider position of the bag-No opening-Drainage tube in the bag-Open it to drain the bagoHow can you maintain asepsis?oWhen would a urometer drainage system be required?oWhat might the Luer lock port beused for?Catheterization: Assessments*Physician order is required to insert a catheter*Indications for the procedure•Consider any pathological condition that may impair the passage of the catheter (i.e., enlargedprostate)Allergies – allergic to latex?Gather data from your head-to-toe assessment•Intake and output•time of lastvoid•assess output forcolour,odour, consistency, amount(COCA)•Palpate bladder for distension, pain, etc.•Bladder scan to determine the amount of urine retained or post-void residual•May need a doctor’s order to use•Skin integrity at the perineum•redness, edema, ecchymosis, drainage, approximation (REEDA)•provide peri-care before (and after) the procedure•Subjective data from patient•feeling offullness,frequency,painful voiding, etc.Mobility/physical limitations which might impede procedure andpost-careConsider cultural, gender, age, and mental capacity•determinecathetersize, approach, teaching, and post-careCatheter Associated Urinary Tract Infections (CA-UTIs)Nursing interventions and evaluation:•Promote infection prevention (teaching and assessments)•Ensure unobstructedurine flow (bag below the height of the bladder)•Encourage hydration
•Proper peri-careAseptic catheter insertion techniques•75% of nosocomial UTIs are CA-UTIsRoutine Catheter Care is to promote bladder health- page 1198.Catheterization: Adverse outcomes•Leakage due to obstruction or bladder spasms•Obstructions (kinks/loops in tubing)•Bleeding•Chronic renal inflammation•Urethral erosion, strictures•Bladder spasms•Encrustations•Kidney stones•Prostatitis, Orchitis•UTI/UrosepsisTo catheterize or not to catheterizeGuideline for Prevention of Catheter-Associated Urinary Tract Infections (CA-UTIs; CDC, 2019)Best Practice Guidelines:•Risk/benefit must be weighed for each patient•Must be indicated for initiation•Must be indicated for continuing use•Must be assessed and reassessedCatheterization: Documentation•Date and time•Relevant data from your assessment•The indication for the procedure•Type and size of Foley inserted (# Fr.) and balloon (size/inflated volume) (so the next nurse will know how much fluid will they remove from the catheter)•Patientteaching provided•Ifspecimen obtained•Assessment of the drainage (COCA)•Patient reaction, adverse outcomesDiscussion1.What are the symptoms of an UTI?Burning sensationHematuriaFrequent urination feverFoul odorUrine color may differ from normal CystitisWBC in urineSediments in urineDysuria
Urinary retentionurgency2.Why are UTIs the leading cause of hospital acquiredinfections?Unsterile techniques for urinary cathetersInterventionsImmobility issuesPoor hygiene3.What patient teaching should take place?Drink of a lot of waterMaintain good hygieneDo not hold your peeComplete your medicationsPatient teaching are:•Hygiene•Fluids•Positioning•ReportingIndwelling catheter removal (Clean technique)Do pericare after*Need physician order to remove catheter*•Clean technique, wear clean gloves•Short-term dysuria is normal, especially if the catheter was in situ for several days or weeks•The patient may experience urinary frequency or retention until the bladder regains full tone•Assess urinary system function•Document first void after removal, time and amount of voiding during the next 24 hoursBody is very relax when catheter is in Couple of days: spasms or may mimic symptoms of UTI (burning feeling in the urethra)
Bladder irrigationPurposeoMaintain catheter patencyoMedication administrationoIndications?Intermittent – two lumens; bladder irrigation kitFlush it, clamp it, and drain ml according to the doctor’s orderContinuous – three lumens; set up like an iv bagIrrigate bladder – flushing to see if there is n0o blood clot after surgeryPrior to bladder irrigation1.Assess client•History of catheter changes (frequency, bypassing, blocking, spasms)•Ensure no kinks, clothing restricting, etc.•Bag below level of bladder•Intake and output•Pain assessment (OPQRSTUV)•Last bowel movement (can impede bladder emptying)•Presence of debris/film in tubing•Activity and mobility2.Investigate cause of catheter blockage•Mucosal occlusion•Encrustation - primary reason for blockageBacteria build-up >> Biofilm in catheter and tubing >> encrustation of catheterMaintenance solutions•Normal saline•Washdebris from catheter through mechanicalaction•Will not dissolve encrustation (crystalline material)•Acetic Acid•Evidence that mineral deposits can be dissolved withacetic acid but not preventative measureIntermittent bladder irrigation:Opensystem•Urine collection bag has no portson drainage bag therefore must disconnect drainage bag (openthe system) to instill fluid•MUST maintain sterility
•Catheter tip - bulb or piston syringe•Greater risk of infectionAlcohol swabs – can make the cap sterile after irrigation; 30 seconds to cleanIntermittent bladder irrigation:Closedsystem•Urine collection bag has a portin place•Collection bag is clamped prior to initiating irrigateBE SURE TO UNCLAMP when finished•Continuous infusion of a sterile solution into the bladder•Use a 3-way irrigation closed system with a triple-lumen catheterOne lumen is used to drain urine; another is used to inflate thecatheter balloon; the final lumen carries the irrigation solution•Usually indicated in patients with complications such as gross hematuriaor after a urological surgeryBladder irrigation: Documentation•Assessment of patient prior, during, and post irrigation•Type of irrigation performed and irrigate solution used (as per physician order)•Amount instilled & amount returned as drainage•Character of the drainage (COCA)•Any indicators of issues during irrigation:•Inability to instill, presence of clots or sudden bleeding•Changes to drainage•Retaining solution•Pain/bladder distention•Bladder spasms•Bypassing