Chapter 36: Urinary Elimination/CAUTI

Question 1

What is CAUTI?

Answer 1

catheter associated urinary tract infection

Question 2

What are the types of catheters used?

Answer 2

Straight catheters and indwelling

Question 3

What are the characteristics of normal urine?

Answer 3

pale yellow, straw colored, slightly aromatic, clear, acidic, specific gravity (1.015-1.025).

Question 4

What are some ORGANIC constituents in urine?

Answer 4

urea, uric acid, creatinine, hippuric acid, urican, urene pigments, and undetermined nitrogen.

Question 5

What are some INORGANIC constituents in urine?

Answer 5

ammonia, sodium, chloride, iron, phosphorus, sulfur, potassium, and calcium

Question 6

What effect does aging have on the urinary process?

Answer 6

decreased muscle tone, increased nocturia, increased frequency, decreased bladder contractibility, increased urinary retention, and increased UTIs,

Question 7

What is the normal urine output per hour: know the basic amount and the formula.

Answer 7

30mL/hour. 0.5ml/kg/hr is the actual formula

Question 8

What are two reasons that urinary output is low?

Answer 8

Either patient is not making urine OR the patient is unable to excrete urine.

Question 9

What amount of urine will produce the urge to void?

Answer 9

150-250mL of urine

Question 10

When should a straight catheterization be performed?

Answer 10

When the bladder is retaining more than 150mL of urine. These are used for short term emptying of the bladder.

Question 11

What are some appropriate reasons to catheterize a patient?

Answer 11

Appropriate reasons to catheterize include: acute urinary retention, bladder outlet obstruction, when there is a need for strict I/O, perioperative use for selected procedures, pts with sacral or perineal wounds in pts who are incontinent, prolonged immobilization, and end of life care/comfort.

Question 12

What are some Inappropriate reasons to catheterize a patient?

Answer 12

As a substitute for nursing care when a pt is incontinent, as a means of collecting urine when a pt can void independently, prolonged use after surgery.

Question 13

What are S/S of UTI

Answer 13

Burning or pain in lower abd, fever, bloody urine, burning during urination, increase in frequency. elderly patients may experience great confusion.

Question 14

How can CAUTI be prevented?

Answer 14

Use catheters only when necessary, remove as soon as possible, only properly trained personnel insert catheters using sterile technique, providing perineal care prior to insertion of catheter, and use of external urinary collection devices. Attach catheter to leg, keep bag lower than bladder, and empty regularly.

Question 15

How do you care for pts with an indwelling catheter to prevent CAUTI?

Answer 15

Wash hands before/after care, clean peri area daily, after BM, always wiping front to back. Use mild soap/water. Increase fluid intake, encourage pt. involvement, note color/characteristics of urine, report S/S of infection, limit time period of use, and encourage GHWT for patient.

Question 16

How does a nurse address incontinence in pts.?

Answer 16

Offer regular toileting, pelvic floor exercises, biofeedback, electrical stimulation, timed voiding, drug RX, Mech. Rx., use of absorbent pads, briefs, and adequate liquid intake.

Question 17

What are the different types of urinary incontinence?

Answer 17

Transient, stress, mixed, overflow, functional, reflex, and total

Question 18

What is transient incontinence?

Answer 18

A type of incontinence that appears suddenly and lasts up to 6mos.

Question 19

What is functional incontinence?

Answer 19

Urinary incontinence caused by an inability to reach the toilet on time due to environmental barriers, physical limitations, memory loss, or disorientation

Question 20

What is Stress incontinence?

Answer 20

Stress incontinence is incontinence caused by an involuntary loss of urine related to an increase in intra-abdominal pressure

Question 21

What is mixed incontinence?

Answer 21

Mixed incontinence is a type of incontinence in which there are 2+ types of incontinence occurring.

Question 22

What is overflow incontinence?

Answer 22

Overflow incontinence is an overflow of urine resulting from overdistention and overflow of the bladder.

Question 23

What is reflex incontinence?

Answer 23

Emptying of the bladder without the sensation to void

Question 24

What is total incontinence?

Answer 24

Continuous and unpredictable loss of urine due to trauma, surgery, physical malformation.

Question 25

What are some ways to promote normal urination?

Answer 25

Maintenance of normal voiding habits, promote fluid intake, strengthening of muscle tone, and assist with toileting. Promote adequate fluid intake.

Question 26

How do you determine if the patient is not making urine or is not able to excrete it?

Answer 26

Use of a bladder scanner will reveal the amount of urine in the bladder.

Question 27

What are some steps for developing the maintenance of normal voiding habits?

Answer 27

Develop a schedule, assist pt, when they express urge to void, allow for privacy, position to void comfortably, and assist with hygiene.

Question 28

Why would a pt have an indwelling catheter?

Answer 28

Trauma, long periods of immobilization, strict I/O, sacral, perineal wounds that need to heal.