Chapter 34 - Urinary Elimination

Question 1

What is the average urinary output for an adult?

Answer 1

2200 to 2700 mL in 24 hours

Question 2

An hourly output of less than ___mL/hr for 2 hours identifies need for further evaluation.

Answer 2

30mL/hr

Question 3

When should you measure I&O?

Answer 3

When there is an actual or anticipated change in fluid balance

Question 4

What do serum electrolyte measurement tell us?

Answer 4

about alterations in fluid balance

Question 5

You should use the ___________ catheter possible

Answer 5

smallest

Question 6

You should __________ the catheter as soon as possible

Answer 6

remove

Question 7

Patients taking what medication should have access to a toilet or urinal close by?

Answer 7

diuretics

Question 8

What extra measures are necessary when dealing with bodily wastes of patients receiving hazardous oncology drugs?

Answer 8

-double chemotherapy gloves
-protective chemotherapy gown
-eye/face protection
-respiratory protection

Question 9

Insertion of a urinary catheter requires what?

Answer 9

a doctors order

Question 10

What does CAUTI stand for?

Answer 10

catheter associated urinary tract infection

Question 11

How long is short term catheterization?

Answer 11

less than or equal to 2 weeks

Question 12

How long is long term catheterization?

Answer 12

more than 14 days

Question 13

What is intermittent urinary catheterization?

Answer 13

insertion of a flexible single-use catheter used for retention or specimen collection

Question 14

What is the difference between intermittent catheter and indwelling catheter?

Answer 14

indwelling uses an inflated balloon

Question 15

Intermittent catheter = ________ lumen

Answer 15

single

Question 16

What are the two lumens of indwelling catheters used for?

Answer 16

1. urinary drainage
2. balloon inflation

Question 17

What is the third lumen (if needed) for?

Answer 17

irrigation solution

Question 18

What is an ideal urine output after catheterization?

Answer 18

30mL/hr

Question 19

What is the most common catheter size for adults?

Answer 19

14Fr to 16Fr

Question 20

What is the most common catheter size for older adults?

Answer 20

12Fr to 14Fr

Question 21

Larger catheter sizes increase the risk of…

Answer 21

urethral trauma

Question 22

How should a female patient be positioned for catheter placement?

Answer 22

dorsal recumbent position (on back with knees flexed) or laying on side (Sims) with upper leg flexed at the knee

Question 23

How do you position a male patient for catheterization?

Answer 23

supine with legs extended and thighs abducted

Question 24

Is it recommended to pretest a balloon?

Answer 24

no

Question 25

Closure of the labia during the procedure means...

Answer 25

the area is contaminated and needs cleaning to proceed

Question 26

What order do you clean the labial folds?

Answer 26

far, near, over centre of urethral meatus

Question 27

How far do you insert a catheter in a female patient?

Answer 27

-5 to 7.5cm or until urine flows -stop if straight catheter, or continue another 2.5 to 5cm for indwelling catheter

Question 28

Should you use force to insert a catheter?

Answer 28

no.

Question 29

Why should you ask patient to bear down as if needing to void when inserting catheter?

Answer 29

relaxes external sphincter

Question 30

How far do you advance a catheter into a male patient?

Answer 30

-17 to 22.5cm or until urine flows out -stop with straight catheter, advance indwelling until bifurcation

Question 31

What do you document after inserting a urinary catheter?

Answer 31

-reason for catheterization -type and size of catheter -amount of fluid used to inflate balloon -specimen collection -characteristics and amount of urine -patient response and learning

Question 32

What should you teach patients and family about catheters?

Answer 32

-monitor for UTI symptoms -how to prevent UTI -signs of skin irritation -how to empty (if necessary)

Question 33

What lubricant should be used for pediatric catheterization?

Answer 33

containing 2% lidocaine

Question 34

What should be recorded after a catheter removal?

Answer 34

I&O 24-48 hours after removal

Question 35

What urine output indicates return of voluntary bladder function?

Answer 35

at least 150mL with each void no more than 6-8 hrs post removal

Question 36

How do you allow balloon fluid to drain during catheter removal?

Answer 36

gravity

Question 37

What do you record after removing a catheter?

Answer 37

-when it was removed -teaching related to increasing fluid intake, S&S of UTI -time, amount, characteristics of first void -intake and voiding times -patient symptoms during and after catheter removal

Question 38

How much fluid should one drink with a catheter?

Answer 38

at least 2200mL of fluid per day

Question 39

What does PVR?

Answer 39

postvoid residual

Question 40

How long after voiding do you measure PVR?

Answer 40

postvoid residual

Question 41

What is a concerning PVR measurement?

Answer 41

2+ measurements greater than 100mL

Question 42

What do you record after irrigating a catheter?

Answer 42

-method -amount and type of solution -amount returned as drainage -characteristics of output

Question 43

Never use ______ to secure a condom catheter

Answer 43

tape

Question 44

When are suprapubic catheters used?

Answer 44

when there is a blockage of the urethra or when long-term urethral catheter interferes with sexual functioning

Question 45

What is a symptom of UTI in older adults that may not be obvious at first?

Answer 45

change in mental status that may be confused as delirium

Question 46

What are the two things involved in catheter maintenance?

Answer 46

1. cleaning 2. monitoring for UTI symptoms

Question 47

When should the drainage bag be emptied?

Answer 47

when 1/2 full

Question 48

What should you do if a patient is unable to void 6-8 hours after catheter removal?

Answer 48

-assess for bladder distension -perform bladder scan -notify provider

Question 49

What is the purpose of catheter irrigation?

Answer 49

to keep the bladder clear and free of blood clots or sediment

Question 50

What is continuous bladder irrigation (CBI)?

Answer 50

continuous infusion of a sterile solution into the bladder using a three-way irrigation closed system

Question 51

Does catheter irrigation require an order?

Answer 51

yes!

Question 52

With CBI the amount of fluid draining from the bladder should be (more/less) than the fluid inserted

Answer 52

more than

Question 53

What does closed continuous irrigation involve?

Answer 53

-use of an IV drop system, aseptic technique

Question 54

What does closed intermittent irrigation involve?

Answer 54

-use of a sterile syringe, aseptic technique

Question 55

How much space should be between the tip of the penis and the end of the condom catheter?

Answer 55

2.5 to 5cm

Question 56

What should you document after applying a condom/hydrocolloid catheter?

Answer 56

-which device you applied -condition of penis, skin, scrotum -urinary output -voiding pattern -patient response

Question 57

What is important to be aware of with condom catheters?

Answer 57

skin breakdown

Question 58

Condom catheters are not recommended with ___________ obstruction

Answer 58

prostatic

Question 59

What is a risk of patients who can't feel pain and have a condom catheter?

Answer 59

possible pressure injury

Question 60

Where is a suprapubic catheter inserted?

Answer 60

through a small incision in the abdominal wall

Question 61

What do you record after cleaning a suprapubic catheter?

Answer 61

-condition of insertion site -type of dressing change -patients comfort