CBI

Question 1

How often should you assess the abdm/bladder of a pt with a CBI?

Answer 1

Every 1-2 hours, if bleeding assess more often

Question 2

When dealing with CBIs, what does the acronym BAD stand for?

Answer 2

• B = Bag - CBI – ensure it is 0.9% NaCl hanging and not Glycine
• A = Abdomen - palpate for distention. Note and chart size and softness of abdomen
• D = Drainage - Asses colour of urine in tubing

Question 3

T or F:

For CBIs, the goal is to be able to see your fingers through the tubing.

Answer 3

T

Question 4

For a pt with a CBI, what position should their bed be in? Explain

Answer 4

As high as possible (with the rails up) to ensure good gravity drainage

Question 5

T or F:

CBI is to be hung more than 1 meter above the bladder.

Answer 5

F, it should be NO more than 1 meter above the bladder

Question 6

How often should you empty catheter bag? Why?

Answer 6

Every 4 hours, if urine backs up into the bladder it could cause perforation

Question 7

What size syringe should be used for irrigating catheters?

Answer 7

60cc with catheter tip

Question 8

What should you always do before withdrawing contents from then bladder during hand irrigation?

Answer 8

Always instill 60mls of NS to provide a cushion, this helps prevent damage to the bladder, then instill another 60 and draw up 60

Question 9

Bladder Spasms may present as:

4

Answer 9

• An urge to void
• Urge to have a bowel movement
• Lower abdominal pressure
• Penile burning/urethral discomfort

Question 10

How might the nurse detect bladder spasms?

Answer 10

The nurse may observe:

• Fluid bypassing around the catheter
• Spasms felt as pulsing in the drainage tubing

Question 11

What are the treatments for bladder spasms?

Answer 11

• Irrigation
• B&O suppository to relax the bladder wall
• Xylocaine jelly for the urethral meatus as per
  physician’s order
• Analgesic as per physician’s order
• Toileting

Question 12

Before hand irrigating a pt with Transurethral Resection of Bladder Tumor (TURBT) what should you always do?

Answer 12

Check with the Urologist due to the risk of bladder perforation

Question 13

Common risk factor for urosepsis:

Answer 13

• Urinary tract surgery
• Untreated urinary tract infection
• Indwelling catheters
• Immunosuppression therapy and chemotherapy

Question 14

What are some signs and symptoms of urosepsis?

Answer 14

• Unexplained chill
• Altered mental status
• Fever (Rigors) followed by ↓ BP
• ↑Pulse
• Hyperventilation
• Cellular metabolism becomes anaerobic and lactic
  acidosis develops

Question 15

Tx of urosepsis:

Answer 15

• Anticipate urine and blood cultures
• IV antibiotics
• Bolus of IV fluids
• Frequent vital signs

Question 16

What is TUR Syndrome

Answer 16

The absorption of excessive irrigation fluid by venous complexes in the prostate during resection

Question 17

Signs and symptoms of TUR?

there are a lot, know at least 5

Answer 17

• Hyponatremia
• Confusion
• Hypervolemia
• Hemolysis
• Acute renal failure
• Visual disturbances (flashing lights that can lead to
  temporary blindness with Glycine 1.5%)
• Agitation
• Acute delirium (due to cerebral edema)
• Bradycardia
• Tachypnea
• Emesis

Question 18

What are risk factors of TUR Syndrome?

know 4

Answer 18

• Surgery time longer than 60 minutes
• Perforation of the prostate capsule
• Large prostate size >100g
• Excessive height of irrigation bags ie: irrigation bags
  should never be higher than 1m (3feet) above
  patient’s abdomen
• The amount of irrigation used during surgery should
  not exceed 10 bags of Glycine 1.5%