6.3 Urinary Elimination Flashcards
Urination
- Also called voiding or micturition
- Consists of Kidneys, Ureters, Bladder, and Urethra
- Most people void 3-4 times a day
- More frequent urine can mean infection or laxity in pelvic muscle
- Retention can be due to blockage from prostate enlargement for men or pelvic musculature prolapse for women, bladder cancer, and medication.
Urinary Incontinence Types
Overflow - Overdistension and overflow of bladder
Functional - Factors outside of urinary tract
Reflex - Emptying bladder without sensation of need to void
Total - Continuous, unpredictable loss of urine
Stress - Involuntary loss of urine related to increased pressure in abdomen from sneezing, laughing or coughing
Urinary Incontinence Types
Transient - Appears suddenly and lasts 6 months or less
Mixed - Urine loss from 2 or more types of incontinence
Factors affecting Micturition (urination)
Children - (2-5) Toilet Training and Enuresis (involuntary)
Elderly - Decreased muscle tone and strength, nocturia (wake up at night with need to urinate), medications increasing urine production
Food/Fluid Intake - Dehydration/food causing urine production
Factors Affecting Micturition (cont)
Psychological - Stress from not having privacy (bedpan) or voiding in unfamiliar place
Pathological - Acute Kidney Injury (AKI), UTI, Urinary Calculi (stones), Chronic Kidney Disease (CKD), Hypertension, Diabetes mellitus.
- Medications
- Congenital urinary tract abnormalities (present at birth)
Caring for patients with UTI
- Sexually active women more at risk for UTI
(Bacteria likely to flow from vagina to urethra) - Urinating after sex helps flush bacteria
- Spermicidal jelly can change protective bacterial flora in vagina.
- Post Menopausal women have urinary stasis, decreased vaginal flora, and pelvic floor musculature laxity.
Caring for Patients with UTI
- People with catheters are at risk of bacteria entering up tube.
- CAUTI is most common Hospital Acquired Infection
- Diabetes Mellitus more at risk
- Men with enlarged prostates are at risk
Medication affect on Urine
Anticoagulants - Hematuria (blood in urine) resulting in pink/red color
Diuretics - Prevents reabsorption of water and certain electrolytes causing lighter urine color
Cholinergic Medication - Stimulates contractions of detrusor muscle, producing urination
Medication affect on Urine
Analgesics/Tranquilizers - Suppress CNS, diminished neural reflex
Phenazopyridine (pyridium) - OTC pain reliever that causes orange or red color of urine
B-Complex Vitamins - Changes urine to blue/green
Levodopa (L-Dopa) - Changes urine brown or black
Kidney Assessment of Urinary Function
- Palpation of kidneys preformed by advanced health care practitioner as part of a more detailed assessment
Urinary Bladderm
- Palpate and Percuss or use bedside scanner
Urethral Orifice
- Inspect signs of infection, discharge or color
Skin
- Inspect color, texture, turgor and excretion of wastes
Urine
Assess color, odor, clarity, sediment (matter that settles at the bottom)
Measuring Urine Output
- Void into bedpan, urinal, or specimen container
- Urometers attached to catheters are the most accurate way to assess urine output
- Wear gloves and pour urine into measuring device such as calibrated container to measure urine output.
- Read at eye level on a flat surface
Normal Urine
- Pale yellow, straw, or amber in color
- Clear and translucent without exudate, pus, or sediment
- Free of malodorous odor
- Ammonia odor means bacterial action
- Minimum of 30mL an hour
Urinalysis
- Collected in Cup and Measured with Dipstick
- Measures Infection/Dehydration
- Menstrual flow can alter results as blood is a component
- Process/refrigerate specimen within an hour of collection
Urine Cultures
- Collected in sterile container to grow bacteria and determine pathogen
- If there is pain when urinating (sensitivity) antibiotics are placed in petri dish to determine which ones kill the pathogen
24 hour urine
- Used to diagnose kidney disease by evaluating creatine and protein
Clean-Catch/Midstream Specimens
- Used for urinalysis or sterile specimens
- Collected in sterile specimen
- Wipe urinary meatus first
(front to back females) (tip of penis for men) - Clean further, urinate into toilet first then begin collection of specimen
Clean-Catch/Midstream Specimen
Step 1 - Hand Hygiene
Step 2 - Get 3 cleaning wipes
Step 3 - Open and set wipes on paper towel
Step 4 - Wipe downward and use wipe only once
Step 5 - Keep labia spread during urination
Step 6 - Open cup (do not touch rim or inside)
Wipe 1 - Spread labia with 2 fingers and wipe downward urethra
Wipe 2 - Wipe downward from urethra
Wipe 3 - Wipe downward from urethra
Urinate while still holding labia open until cup is half full.
Sterile Specimens from catheter
- Collected directly into a cup using intermittent (red cap) catheter. Collected from a port
Urine Specimen from Urinary Diversion (Urostomy)
- Clean urine specimen drained from urinary bag
- Insert catheter 2-3 cm into stoma
- If no catheter clean stoma and allow it to drain into a cup
24 Hour Urine Specimen
- Discard first void and then collect into special container that is refrigerator.
Specimen from Infants and Children
- Collection bag adhered to skin surrounding perineum or penis
- Port at bottom of the bag can aspirate contents in the bag
Patient Goals
- Produce sufficient quantity of urine to maintain fluid, electrolyte, and acid-base balance
- Empty bladder completely at regular intervals without discomfort
- Provide care for urinary diversion and know when to notify physician
- Develop plan to modify factors contributing to current or future urinary problems
- Correct unhealthy urinary factors
Promoting Normal Urination
- Develop schedule based on patients normal void habits
- Allow patient to have comfortable position and privacy
(Males - Upright Position) - Provide perineal hygiene
- Promote fluid intake (8-10 ounces) to flush bacteria
- Strengthen pelvic floor improves control of urination and incontinence
(Kegel exercises,
Assisting with Toilet
- Assist in walking, keeping balance, cleaning, and flushing
Bedside Commode
- Used when patient can get out of bed but not walk to bathroom
- Document patient tolerance of activity and ability to use
- Record intake and output
- Document unusual urine/stool characteristics
- Alterations in patients skin
Bedpan
- Raise head of bed when possible to provide comfort. Used for when patients cannot move.
Assessments before using Bedpan
- Assess unusual elimination habits
- Determine why patient needs bedpan
- Access degree of limitation and ability to help with activity
- Assess health issues that contraindicate certain patient actions
- Check devices that can interfere with bedpan
- Assess characteristics of urine and patients skin
- Position bedpan to prevent muscle strain/discomfort, elevate head to 30-45 degrees, wear gloves
- For patients who are immobile you can roll them onto bedpan
Urinal
- Patient voids using urinal with assistance
- Patient maintains continence
- Patient demonstrates how to use urinal
- Patient maintains skin integrity
Catheters
- Inserting tube through urinary meatus into bladder
- Should be used with sterile technique
- Used to relieve urinary retention, obtain sterile specimen when patient cannot void, allow voiding of patient with prolonged immobilization, obtain accurate urinary output for critically ill patients
Intermittent Catheter
- Single lumen to empty bladder then removed
- “No Touch” kits to decrease infection
Indwelling Catheter (Foley Catheter)
- Double/Triple lumen catheter
- 1 lumen for emptying bladder
- 1 lumen leading to balloon with saline solution to stay in bladder after insertion
- 1 Lumen to irrigate bladder if necessary
French Diameters
- Refers to diameter of a catheter
Insertion of Urinary Catheter for Females
- Setup Sterile Field
- Insert 2-3 inches more after you see urine
- After in place, inflate balloon with sterile water
- Make sure bag is below urethra
- When removing, remove sterile water from balloon and pull catheter out
Insertion of Male Catheter
- Cleaning in and out in circular motion
- ## Insert catheter all the way to Y port (Longer urethra)
Suprapubic Catheter
- Surgically inserted through abdominal wall into bladder
- Used for long term drainage when there is a blockage of bladder not allowing catheter to be inserted into urethra.
- Care includes skin care around insertion site, care of drainage tube and drainage bag
External Urinary Sheath Catheter
- Condom Catheter
- Allow 1-2 inches between tip of penis and catheter.
- Vigilant skin care to avoid excoriation.
- Sheath should be removed daily to wash penis
- Inspect skin for urination
- Do not retract foreskin for non circumcised patients
External Female Catheter
Purewick - Non-invasive device for women that collects urine via suction in a container
- 40mmHg suction
Absorbent Products
- Pads, undergarments, diapers, can help mild incontinence.
- Be aware of skin breakdown if wet pad stays on too long
- Care needed if stool collects
Catheter Care
- Sterile technique and cleaning perineal area with soap and water during insertion
- Continued care to prevent CAUTI
- Clean ports with alcohol before using
- Urine drained into calibrated container to measure output
- Note color/clarity/odor of urine
- Redness/irritation (infection) report immediately
- Use appropriate PPE and make sure spout of catheter does not touch side of containers being drained into
- Secure catheter to leg with band or adhesive to prevent pulling
- Place drainage bag low on bed frame
- Drainage bag must be lower than patients bladder
Safety with Catheter
- Follow medical/surgical asepsis
- Identify risks of latex allergies (use non-latex catheter)
- Allergies to povidone-iodine (betadine). Provide alternatives such as chlorhexidine
Catheter irrigation/instillation
- Natural irrigation through increased fluid intake is preferred.
- Catheter irrigation used to rinse sediment, blood clots, or debris. Also used to infuse medications that act directly on bladder
- Routine intermittent irrigation of long term catheters are not recommended due to risk of infection
- Closed system irrigation via triple lumen catheter is suggested to prevent obstruction and maintain closed system.
Dialysis
- Remove fluid/waste from body in patient with kidney failure
Peritoneal Dialysis
- Catheter inserted through abdominal wall into peritoneal cavity to allow dialysate to be infused and drained.
- Exit care is important for patient care
- Dialysis catheter dressing is changed using aseptic techniques without trauma to site or patient.
- Dressing should be dry, clean and intact without signs of inflammation or infection
Hemodialysis Access
- Requires access to patients vascular system
- Insertion of catheter into vein or arteriovenous fistula/graft.
- Cared for in the same manner as central venous access device
