Elimination Flashcards
Inability to empty the bladder partially or completely
Urinary Retention
Incontinence caused by medial conditions that are treatable and reversible i.e. mobility impairment, inflammation/infection
Transient incontinence
Loss of continence because of causes outside the urinary tract such as functional deficits related to altered mobility, cognitive impairment or functional barriers
Functional incontinence
Involuntary loss of urine caused by an overdistended bladder often related to bladder outlet obstruction or poor bladder emptying
Overflow urinary incontinence
Involuntary leakage of small volumes of urine associated with increased intra-abdominal pressure i.e. with coughing, laughing
Stress urinary incontinence
Involuntary passage of urine caused by involuntary contractions of the bladder associated with a strong urge to void that causes leakage of urine
Urge incontinence
Involuntary loss of urine occurring at predictable intervals when bladder reaches specific volumes, related to spinal cord damage between C1 and S2
Reflex urinary incontinence
Delay in start of urinary stream when voiding
Hesitancy
What is the normal colour of urine?
Normal urine ranges in color from a pale straw to amber, depending on its concentration.
Urine is usually more concentrated in the morning or with fluid volume deficits. As the patient drinks more fluids, urine becomes less concentrated, and the color lightens.
What is a common cause of dark amber urine?
High concentration of bilirubin (urobilinogen) in patients with liver disease
What is a common cause of cloudy urine?
Presence of bacteria and white blood cells
Normal pH of urine
4.6 to 8.0
Is it normal to have protein in urine?
Protein is normally not present in urine, and is a sensitive indicator of kidney function.
What could be a cause of proteinuria?
Damage to glomerular membrane, allowing filtration of large molecules such as proteins
True or False: Glucose is normally not present in urine.
True. Glucose in urine may indicate poorly controlled diabetes
True or False: it is normal for some patients to have ketones in the urine.
False. Ketones are end-products of fat metabolism, which is usually an indicator of poorly controlled diabetes type 1.
What is the normal urine specific gravity?
1.005 to 1.030
What would cause presence of RBCs in urine?
Damaged glomeruli or tubules from trauma and renal disease
Helping patients assume the normal position for voiding promotes bladder emptying. What is the most natural position for:
Males
Females
Males: standing
Females: squatting
An exercise the can improve pelvic muscles strength and promote bladder emptying.
Kegel exercises
One-time catheterisation is also called:
Intermittent catheterisation
A catheter that remains in place over a period of time:
Indwelling catheter
Between single, double or triple-lumen catheters, which type used for intermittent/straight catheterisation?
Single lumen catheter
Between single, double or triple-lumen catheters, which type used for indwelling catheterisation?
Double lumen: one lumen is for urinary drainage, 2nd lumen is used to inflate the balloon that keeps the catheter in place
Between single, double or triple-lumen catheters, which type used for continuous bladder irrigation?
Triple lumen
What are the functions of each of the 3 lumens in CBI?
Drainage of urine, balloon inflation, delivery of irrigation fluid into bladder
What size catheter would you use for inserting a short-term indwelling catheter for an adult?
Fr 14 to 16
What size catheter would you use for inserting an indwelling catheter for an adult with hematuria or clots?
Fr 20 to 24 – higher number, smaller diameter
How much fluid is normally required to inflate the balloon of an adult catheter?
10 ml
When long-term catheterisation is required, how frequently will the catheter need to be changed?
Every 4 to 6 weeks
If a catheter appears to be blocked, which of the following is the preferred management:
Irrigation/flushing with sterile solution or changing the catheter immediately?
Irrigation poses risk of causing UTI. In general, if a catheter becomes occluded, it is best to CHANGE it rather than risk flushing debris into the bladder.
Irrigation can be used in specific situations such as after surgery, when there is high risk for catheter occlusion from blood clots.
What is an important nursing intervention after catheter removal?
Monitor patient’s voiding for at least 24 to 48 hours using a bladder diary.
Give at leas 3 measures to prevent catheter-associated urinary tract infection? HINT: CLEAN URINE
Clean: routine perineal hygiene
Catheter size: smallest possible
Low: keep drainage bag below level of bladder
Early removal: catheters should be removed as soon as possible
Aseptic: maintain sterile, closed urinary drainage system, do not let spigot of bag touch drainage receptacle
No obstruction: check for kinks or bends, observe for clots which may block tubing
What is an important assessment to make before application of a condom catheter?
Assess for latex allergy
What are the ideal positions for female catheterisation?
Dorsal recumbent
Side-lying position with upper leg flexed at knee and hip
What is the ideal position for male catheterisation?
Supine with legs extended and thighs slight abducted to aid in the visualisation of the penis
Why is it important to lubricate the catheter prior to insertion?
Lubrication minimises trauma to the urethra and discomfort during catheter insertion
How much of the catheter would you lubricate for a male and female catheterisation?
Male catheter 5-7 inches
Female 1-2 inches
What instruction to the patient would help visualise the urinary meatus and promote relaxation of the external urinary sphincter
Asking the patient to bear down gently
How far would you advance the catheter in a female patient?
2-3 inches or until urine flows out of the catheter, and then insert another 1-2 inches
How far would you advance the catheter INITIALLY in a male patient?
7-9 inches or until urine flows
Once urine flows during male catheterisation, what action will ensure that the balloon part is not in the prostatic urethra?
Advancing the catheter to the bifurcation of drainage and balloon port
Flow of urine indicates that tip of catheter is in bladder or urethra but the balloon part of the indwelling catheter may not necessarily be in bladder yet. Further advancement to bifurcation ensures that balloon part is not still in the prostatic urethra.
What 5 actions would a nurse take if patient reports sudden pain during balloon inflation?
If patient reports sudden pain or when resistance is felt during inflation, the nurse should:
- Stop the inflation
- Allow the fluid from the balloon to flow back into the syringe
- Advance catheter further – balloon may have been inflating in the urethra
- Reinflate the balloon
- If pain continues, notify health care provider
Why is it important to anchor the catheter properly?
Anchoring catheter reduces traction on the urethra and reduces urethral injury
What can be used to detect the chemical properties of urine such as presence of glucose, ketones, protein or blood not normally present in the urine when more detailed laboratory testing is not available?
Chemostrip
What is the most common type of timed urine specimen for quantitative analysis?
24-hour urine collection
Why is it important to perform perineal care prior to urine collection?
Prevents contamination of specimen, which is the most frequent reason for inaccurate results.
What is the best way to perform perineal care for circumcised males?
Clean meatus from centre to outside using a circular motion. This should be done 3 times using three different towelettes or sponges.
To effectively clean the meatus of an uncircumcised male and prevent stricture of the penis, the nurse must perform which step?
Have uncircumcised male retract foreskin, and return foreskin when done to prevent stricture.
What is the best way to perform perineal care for females?
Clean from front (above urethral orifice) to back (toward anus), holding labia apart; clean 3x using fresh swab each time.
How much urine should be collected for a mid-stream clean catch?
90 to 120 ml
How long will you need to clamp the catheter before collecting specimen from a catheter?
10 to 15 minutes
True or False. You cannot collect a specimen from the catheter bag.
True. Urine in drainage bag is not considered sterile.
How much specimen will you collect from a patient’s catheter for:
a. Culture
b. Routine urinalysis
Culture – 3 ml
Routine urinalysis - 20 ml
A urine specimen needs to be sent to the laboratory within _____ minutes.
20 minutes
What measure can be done to facilitate the collection of timed urine specimen?
Have the patient drink two to four glasses of water 30 minutes before times of collection
How do you prevent decomposition of urine while 24-hour collection is taking place?
Keep specimen bottle in specimen refrigerator or container of ice in bathroom
