Promoting Urinary Elimination, Promoting Bowel Elimination Flashcards
1
Q
What is the Coude Catheter?
A
variation of the Robinson catheter; curved and has a rounded or bulbous tip; easier to insert into the male urethra when the prostate is enlarged.
2
Q
What is the Triple-lumen Alock Catheter?
A
Triple-lumen Alock is a catheter that is used for bladder irrigation.
3
Q
What are the steps for applying an external male catheter?
A
- Follow specific directions on the package.
- Apply the double-sided elastic tape, if used, in a spiral fashion from the base of the penis downward.
- Hold the condom sheath at the tip of the penis and smoothly roll the sheath onto the penis, leaving 1 to 2 inches of space between the tip of the penis and the drainage tube of the condom sheath.
4
Q
What are urinary diversions?
A
- Urinary diversions are created to reroute urine due to bladder cancer or injury.
- Urinary diversions can be temporary or permanent
- Urinary diversions are either continent with controlled elimination of urine from the body or incontinent with urine draining continuously without control.
- Continent diversions have a reservoir in the abdomen that allows clients to control the elimination of urine.
5
Q
What is Ureterostomy (ileal conduit)?
A
An incontinent urinary diversion in which the surgeon attaches one or both ureters via a stoma to the surface of the abdominal wall
6
Q
What is a Nephrostomy?
A
An incontinent urinary diversion in which the surgeon attaches a tube from the renal pelvis via stoma to the surface of the abdominal wall
7
Q
What is a Kock Pouch?
A
A continent urinary diversion in which the surgeon forms a reservoir from the ileum. The pouch is emptied by clean straight catheterization every 2 to 3 hrs. initially, and every 5 to 6 hrs. once the pouch expands to capacity.
8
Q
What is a Neobladder?
A
A new bladder created by the surgeon using the ileum that attaches to the ureters and urethra. It allows the client to maintain continence; the client learns to void by straining the abdominal muscles.
9
Q
What are the necessary Nursing Interventions for urinary diversions?
A
- Consult wound ostomy continence nurse for assistance
- Monitor stoma and peristomal skin for indications of a breakdown
10
Q
What are the Nursing Actions for indwelling catheter care?
A
- Use soap and water at the insertion site.
- Cleanse the catheter at least three times a day and after defecation.
- Monitor the patency of the catheter.
- For reports of fullness in the bladder area, check for kinks in the tubing, and check for sediment in the tubing.
- Make sure the collection bag is at a level below the bladder to avoid reflux.
11
Q
What are the Nursing Actions to prevent catheter-associated urinary tract infections?
A
- Ensure that the patient takes in the adequate fluid to flush bacteria and sediment from the urinary system.
- Maintain a closed drainage system
- Accurately measure and record the urine output at least every 8 hours.
- Wash hands before and after working with a patient’s catheter. Wear clean, nonsterile gloves
- Empty the urine bag via the spout at the bottom, being careful not to contaminate the spout. Wipe the spout with a clean antiseptic swab before returning it to the storage sleeve. Use a separate collection container to empty the bag for each patient
- Observe the drainage tubing and amount of urine in the bag each time the patient is seen. Keep the drainage tubing above the level of entrance to the collection bag. Check to see that the patient is not lying on the catheter or tubing.
- Keep the drainage bag below the level of the bladder. Clamp the tubing before raising the bag above the level of the bladder when moving the patient to avoid urine backflow into the bladder.
- Provide perineal care at least twice daily. Cleanse the genitalia and perineum, and also cleanse 7 to 10 inches down the catheter with soap and rinse well or follow the agency’s policy for cleansing.
- Keep the catheter firmly attached to the leg or to the abdomen of the male to prevent pulling on the catheter at the meatus, which causes irritation.
- Cleanse the insertion site of the suprapubic catheter twice a day according to agency policy.
- Expect at least 30 mL/h urine output. Less than this is abnormal unless there is a known physiologic reason, such as chronic kidney disease. Check for kinked tubing, bladder distention, or a wet bed. If no reason is found, report the decreased flow to the primary care provider.
12
Q
What are the Nursing Interventions for meeting the needs of older adults?
A
- Monitor fluid intake closely. Older adult clients are less able to compensate for fluid lost due to diarrhea. Monitor older adults who have diarrhea for diarrhea-associated complications (electrolyte imbalances, dehydration, skin breakdown).
13
Q
What are the Nursing Interventions for toileting procedures?
A
- Encourage the client to set aside time to defecate. Sometimes, after a meal works best.
- If not contraindicated or restricted, encourage the client to drink plenty of fluids and to consume a diet high in fiber to prevent constipation.
- Wear gloves when addressing toileting needs.
- Provide privacy.
- Assist the client in a sitting position whether using a regular bedpan, commode, or toilet.
- If a patient feels too weak to ambulate to the bathroom, consider a bedside commode (better alternative than bedpan)
- For clients using a fracture pan, raise the head of the bed to 30°.
- If the client cannot lift their hips, roll the client onto one side, position the bedpan over the buttocks, and roll the client back onto the bedpan.
- Encourage the client to decrease stress when sitting or rising by using an elevated toilet seat or a footstool.
- Never leave a client lying flat on a regular bedpan.
- After the client voids (urinates), provide skin care to the perianal area.
14
Q
What are the Nursing Actions for obtaining a urine specimen from an indwelling catheter?
A
- The specimen is taken from the port on the catheter or connecting tubing using sterile technique. The specimen should not be taken from the drainage bag or the tube used to empty the bag.
- Clamp the tubing below the aspiration port with a clamp, or double it over and secure with a rubber band. Note the time. Leave it clamped for 15 to 30 minutes per agency policy. (Ensures there will be fresh urine near the port for the removal of the specimen.)
- Perform hand hygiene and don gloves. Scrub the aspiration port of the drainage tubing with an alcohol or antimicrobial swab. (Maintains asepsis and prevents contamination of catheters.)
- Insert a 25-gauge needle (or a needleless connector) attached to a 5-to 10-mL syringe into the aspiration port at a 30-to 45-degree angle. (Use of small-bore needle and angle decreases coring. Needleless connectors are safer, but some aspiration ports may require a needle. Ask for assistance before starting the procedure.)
- Aspirate 3mL of urine by gently pulling back on the plunger of the syringe. Remove the needle or connector from the port. Swab the aspiration port with the alcohol or antimicrobial pad. (Pulling hard on the plunger may collapse the catheter and prevent urine from flowing into the syringe.)
- Empty the syringe into the sterile specimen container without touching the inner surface of the container. Dispose of syringe in sharps container. Close and label the specimen container. Unclamp the catheter. (Keeps specimen sterile. Unclamping catheter allows free flow of urine again.)
- Ensure the specimen goes to the laboratory within 15 minutes, or refrigerate the specimen. (Changes can occur in urine that sits at room temperature for more than 15 minutes.)
- Remove gloves and perform hand hygiene. (Reduces transfer of microorganisms)
15
Q
What are the Nursing Actions for the removal of an indwelling catheter?
A
- Check the order in the patient’s medical record. (An order is required for this procedure.)
- Obtain a 10-mL syringe and an absorbent towel. (Water in the balloon must be withdrawn before removing the catheter. Some balloons may hold as much as 25 mL of water.)
- Perform hand hygiene, don gloves, and check the patient’s identity wristband while explaining the procedure. Warn the patient that there may be slight discomfort as the catheter is removed. (Correctly identifies the right patient; reduces fear of the unknown.)
- Place the absorbent towel on the mattress under the catheter and attach the syringe to the balloon port. Withdraw the water from the balloon until resistance is met. Never cut the catheter. (Protects the mattress; deflates the balloon. Cutting the catheter will sever access to the balloon. If the catheter does not come out, it will have to be surgically removed.)
- While holding the absorbent towel in your nondominant hand in front of the perineum, pinch off the catheter near the meatus and pull it steadily out onto the absorbent towel until the end is retrieved. It should slip out easily. Control the catheter by moving your hand steadily up the catheter as you gently withdraw it. (The catheter can flip or spill urine as it slips out of the urethra.)
- Inspect the catheter to make certain it is intact. If it is not, notify the primary care provider immediately. (Ensures a piece of the catheter is not left in the bladder.)
- Measure and record the output. Empty the urine into the toilet, and clean the measuring equipment. (Adds the urine drainage to the output for the shift. Reduces transfer of microorganisms.)
- Remove gloves, perform hand hygiene, and make the patient comfortable. Instruct the patient to drink extra fluid, and caution that there may be mild burning with the first few voidings. (Reduces transfer of microorganisms. Extra fluid helps to flush the bladder. Irritation of the mucosa in the urethra may cause burning with voiding.)
- The catheter and bag should be disposed of in a biohazard bag or container and not left in the trash can in the patient’s room.
- Document the time of removal and time limit for the next voiding. (Sets guideline so all nurses know when to check to see if the patient has voided.)
16
Q
What is the function of a Suprapubic Catheter?
A
- A Suprapubic Catheter is used for drainage post gynecologic and bladder surgery (inserted through the abdominal wall by a surgeon)
- A Suprapubic Catheter is for long term use with neurologic injury.
17
Q
What are the Risk Factors for urinary tract infections?
A
- In females, close proximity of the urethral meatus to the anus
- Frequent sexual intercourse
- Menopause: decreasing estrogen levels
- Uncircumcised clients
- Use of indwelling catheters
18
Q
What are the Manifestations of urinary tract infections?
A
- Urinary frequency
- Urgency
- Nocturia
- Flank pain
- Hematuria
- Cloudy urine
- Foul-smelling urine
- Fever
- In older adults, new onset of increased confusion, recent falls, new-onset incontinence, anorexia, fever, tachycardia, hypotension.
19
Q
What are the Nursing Actions to treat urinary tract infections?
A
- Cleanse female clients from front to back.
- Cleanse beneath the foreskin in males.
- Provide catheter care regularly.
20
Q
What are the different types of urinary incontinence?
A
- Stress
- Urge
- Overflow
- Reflex
- Functional
- Transient
21
Q
What is Stress incontinence?
A
- Stress incontinence is the loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting.
- Can occur in females due to weak pelvic floor muscles following childbirth or menopause, and in males due to alterations in the urethra following a prostatectomy
22
Q
What is Urge incontinence?
A
- Urge incontinence is the inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle with increased bladder pressure.
- Can occur due to bladder irritation from a UTI or an overactive bladder
23
Q
What is Overflow incontinence?
A
- Overflow incontinence is Urinary retention from bladder overdistention and frequent loss of small amounts of urine due to obstruction of the urinary outlet or an impaired detrusor muscle.
- Can occur as a result of a neurologic disorder (spinal cord injury, or multiple sclerosis), and can lead to a neurogenic (flaccid) bladder. Can also occur with an enlarged prostate
24
Q
What is Reflex incontinence?
A
- Reflex incontinence is the involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction.
- Can occur due to impaired central nervous system (stroke, multiple sclerosis, or spinal cord lesions)
25
Q
What is Functional incontinence?
A
- Functional incontinence is the loss of urine due to factors that interfere with responding to the need to urinate
- Barriers: cognitive, mobility, and environmental
26
Q
What is Transient incontinence?
A
- Transient incontinence is reversible incontinence.
- Can occur due to inflammation or irritation (UTI), temporary cognitive impairment, disease process (hyperglycemia), medications (diuretics, anticholinergics, sedatives)
