skills lecture 5 Flashcards
sterile technique
also known as surgical asepsis, prevents contamination of an area
WHAT ARE THE STEPS OF APPLYING STERILE GLOVES
-open outer wrapper
-open inner glove package on work surface
-pick up glove at cuff and insert fingers while pulling gloveover hand
-pick up other glove inside cuff
-pull on both hands properly
LOWER UTIs
CYSTITIS
BLADDER AND URETHRA AFFECTED
SYMPTOMS OF LOWER UTI
Suprapubic tenderness
Urinary Issues:
Dysuria
Urgency
Frequency
Incontinence
Foul-smelling cloudy urine
UPPER UTI
Pyelonephritis
Kidneys affected along with bladder & urethra
If a lower UTI is not treated appropriately, bacteria will travel superior to kidneys
UPPER UTI SIGNS AND SYMPTOMS
Signs and symptoms
() Those of a Lower UTI
CVA Tenderness
Systemic Issues:
Fever
Chills
SYSTEMIC SYMPTOM OF UPPER UTI
FEVER
CHILLS
LOCALIZED SYMPTOMS OF UPPER UTI
CVA TENDERNESS
PREVENTIONS MEASURES OF UTI
ENCOURAGE FLUIDS
DONT HOLD URINE
PROPER PERI CARE
STRESS INCONTINENCE
Involuntary urine loss from increasing abdominal pressure
Urge Incontinence
-STRONG URGE AND UNABLE TO MAKE IT TO THE BATHROOM IN TIME
-Most common type of incontinence in older adults
Functional Incontinence
Incontinence due to inability to get to the bathroom;
- physical limitations,
-loss of memory (progressed dementia),
-disorientation
-DEPENDANT ON OTHERS
OVERFLOW INCONTINENCE
Involuntary loss of urine associated with bladder distention; may occur due to prostate enlargement
TOTAL INCONTINENCE
-Continuous LOSS OF URINE
-Unpredictable Loss of Urine
-Neurological impairement,
-surgery,
-trauma
WHAT DO NURSES NEED TO DO WHEN A RESIDENT IS INCONTINENT?
-Keep patient clean and dry
-Ask patient about needing to use bathroom
-Skin on buttocks and perineal area may become reddned and irritated, monitor for skin breakdown
-Assess for signs and symptoms of a UTI
the inability to empty the bladder completely during attempts to void
URINARY RENTENTION
ACUTE URINARY RETNETION CAN BE CAUSED BY WHAT
Anesthesia,
Medications,
Local Trauma to Urinary Structures
CHRONIC URINARY RETENTION CAN BE CAUSED BY WHAT
-Enlarged Prostate MALES ONLY
-Medications,
-Strictures,
-Tumors
Pattern of Urination WHEN ASSESSING PT
Frequency
Time of day
Amount
Focused Urinary Assessment Questions
Urinate more than usual?
Pain or burning upon urination?
Changes in color of urine? Any blood? Dark Tea-Like color? Cloudy? (Hematuria, Infection)
Difficulty starting or maintaining the stream of urine?
Changes in characteristics of urine? Peeing Less or More? (Polyuria, Oliguria)
Feel like the bladder is still full after you urinate?
Dribbling of urine occur after urinating?
Continent? Incontinent?
NOCTURIA
GOING TO THE BATHROOM AT NIGHT
DYSURIA
PAIN WITH URINATION
DARK URINE INDICATES WHAT?
DEHYDRATION
HEMATURIA
BLOOD IN THE URINE
POLYURIA
EXCESSIVE URINE PRODUCTION
OLIGURIA
SCANT URINE PRODUCTION
PHYSICAL ASSESSMENT OF URINARY TRACT ISSUES KIDNEY
PALPATE LOWER BACK FOR KIDNEY PAIN
CVA
PHYSICAL ASSESSMENT OF URINARY TRACT ISSUES BLADDER
PALPATE FOR BLADDER ON ABDOMIN FOR BLADDER DISTENTION
PHYSICAL ASSESSMENT OF URINARY TRACT ISSUES PERINEAL
LOOK AT SKIN
External genitalia and urethral meatus
CVA TENDERNESS TEST
Place flat palm over kidney
With the other hand, make a first and thumb your hand currently resting over the kidney
If patient reports pain or discomfort, CVA tenderness is present
Laboratory Tests to Assess Kidney Function
BUN - NORAML 10-20, CRITICAL >100 COULD BE ELEVATED IF CONSUMING A HIGH PROTEIN DIET , SPECIFIC TO KIDNEY
Creatinine - NORAML 0.6-1.2, CRITICAL >4. , SPECIFIC TO KIDNEY
eGFR - >60 NORMAL, SERUM TEST TESTED WITH THE BLOOD. BEST SERUM TEST TO DETERMINE KIDNEY FUNCTION
24 hour urine - NUMBER 1 WAY TO DETERMINE KIDNEY FUNCTION
Creatinine Clearance
BUN NORMAL CRITICAL
NORAML 10-20, CRITICAL >100 COULD BE ELEVATED IF CONSUMING A HIGH PROTEIN DIET
BEST SERUM TEST FOR KIDNEY FUNCTION
EGFR
NUMBER 1 WAY TO DETERMINE KIDNEY FUNCTION
24 HOUR URINE
CREATINE CLEARANCE - COLLECTED WITH THE URINE WITHIN 24 HOURS
CREATININE
NORMAL 0.6-1.2, CRITICAL >4. , SPECIFIC TO KIDNEY
WAYS TO COLLECT URINE FOR A UA
Midstream Collection
Straight catheterization
Indwelling catheter specimen
About 10 mL of urine collected
URINALYSIS
Common test, performed to assess urinary system, kidneys, systemic disease
URINE CULTURE AND SENSITIVITY
Usually collected with urinalysis
Ensure urine specimen collected before antibiotic given
Urine culture identifies organisms present; usually bacteria
Urine sensitivity test determines antibiotic that will destroy bacteria
24 HOUR URINE COLLECTION RULES
Start at 0800 (or per policy), discard the very first void
Save all urine for 24 hours, keeping it on ice
HOW TO COLLECT A MIDSTREAM URINE SAMPLE
Patient urinates in a sterile cup: midstream collection
Educate appropriately!
Instruct patient to clean perineal area with cleansing cloth
Clean front to back
Females: hold labia open entire time (while cleaning and during urination process)
Begin urine stream into toilet
Stop urine stream and place cup under urethral opening
Begin urine stream into cup (this is a midstream collection)
After cup is filled, continue urine stream into toilet
WHAT DO YOU NEED TO PUT ON THE CUP WHEN COLLECTING URINE SAMPLE
DATE
TIME
INITIALS
NORMAL URINE CHARACTERISTICS: AMOUNT
1,000 to 2,000 mL/24 Hours
Should be no less than 30-40 mL/hr is concerning, possible kidney injury
NORMAL URINE CHARACTERISTICS: COLOR
STRAW
AMBER
NORMAL URINE CHARACTERISTICS: CLARITY
CLEAR
NORMAL URINE CHARACTERISTICS: SPECIFIC GRAVITY
1.005 to 1.030
Lower = Dilute urine (more fluid than waste)
Higher = Concentrated (more waste than fluid)
NORMAL URINE CHARACTERISTICS: PH
4.5-8.0
NORMAL URINE CHARACTERISTICS: CONSTITUENTS
95% Water
Waste Products: Urea, Creatinine, Uric Acid
URANALYSIS TESTS YOU NEED TO KNOW
ph, specific gravity, protein, glucose, bilirubin, nitrite, leukocyte esterase, rbc, wbc
HOW DO WE ENCOURAGE PTS TO VOID
-PROPER POSITION
-ADEQUATE FLUID INTAKE
-WATER SOUNDS
-MAINTING ELIMINATION HABITS
HOW DO WE PROMOTE COMPLETE BLADDER EMPTYING?
PROVIDE PRIVACY
WHAT IS A URINARY CATHETER?
A pliable tube that is placed through the urethral open into the bladder to drain urine
Urinary catheters are always placed using sterile technique
Why would a health care provider insert an indwelling catheter?
Urinary obstruction
Urinary retention
Strict intake & output necessary
Coma
Surgery & Anesthesia
Urinary incontinence with skin breakdown/wounds
Why would a health care provider insert an intermittent catheter?
Urine sample necessary
Patient unable to provide clean-catch
Urine retention present, drain bladder and then attempt to see if patient can void on own
IF A RESIDENT HAS RED AREAS ON BUTTOCKS, GENITALS OR LEGS WHAT WOULD THE NURSE DO?
MAKE SURE THEY STAY CLEAN AND DRY TO AVOID SKIN BREAKDOWN
Catheter sizes
Measured in French
12 French, 14 French, 16 French, 18 French
Larger the number, the larger the diameter
The catheter sizing is located on the catheter tubing
TYPICAL SIZE OF INDWELLING CATH IS?
12 AND 14 FRENCH
HOW TO DOCUMENT CATH INSERTION
- CATH SIZE
-BALLOON FLUID AMOUNT
-STERILE TECHNIQUE USED - position
SIGNS OF INFECTION OF SUPRAPUBIC CATH
SWELLING
REDNESS
TENDERNESS
FEVER CHILLS
ODOR
DRAINAGE
INDWELLING CATH INSERTION
-OPEN STERILE KIT
-OPEN STERILE GLOVES
-PREPARE STERILE AREA
-MOVE KIT TO A WORK AREA (BETWEEN LEGS)
-RESTART STERILE PROCEDURE IF STERILE FIELD IS BROKEN
-MALE URETHRA CLEAN IN CIRCULAR MOTION
-FEMALE URETHRA CLEANING
-NON DOMINANT TO HOLD OPEN LABIA-NOW NOT STERILE
-WITH DOMINANT HAND YOU WILL INSERT CATH
- MAKE SURE CATH IS SECURE IN HAND
-INSERT CATH UNTIL YOU SEE URINE RETURN
-ADVANCE CATH ONE TO TWO MORE INCHES
-INFLATE BALLOON
- SECURE BAG TO LEG OR NONMOVABLE PART OF THE BED
-MAKE SURE THERE ARE NO KINKS IN THE TUBING
-WANT THERE TO BE SOME SLACK SO WE DONT CAUSE TUGGING
HOW FAR DO YOU NEED TO INSERT CATH FOR MALES?
7-8 INCHES
GO ALL THE WAY TO BIFORCATION?
HOW FAR DO YOU INSERT CATH FOR WOMEN?
2-3 INCHES
WHERE DO YOU PUT CATH BAG AFTER INSERTION
ON A NON MOVABLE PART OF THE BED LOWER THAN THE BLADDER
WHAT DO YOU DO AFTER CATH INSERTION?
DOCUMENT THE PROCEDURE
NOTE THE COLOR OF URINE AND PRESENCE OF URINE
CATH TROUBLE SHOOTING FOR WOMEN NO RETURN
-Leave the catheter in the vagina as a landmark
-May not have urine in bladder
-Leave catheter in place and perform bladder scan
CATH TROUBLE SHOOTING FOR MEN RESISTANCE
Hold in place for a moment to see if prostate & sphincter will relax and then attempt to advance catheter
If resistance occurs when inflating balloon, deflate balloon and insert catheter further
TROUBLE SHOOTING CATH FOR PAIN
If pain occurs when inflating balloon, stop, deflate balloon and insert catheter further
TROUBLE SHOOTING FOR CATH WITH BLEEDING
Bleeding may occur after insertion due to local trauma
Notify provider and document, continue to assess urine
TROUBLE SHOOTING FOR CATH WITH Leakage around catheter
Catheter diameter may not be large enough, insert larger catheter
TROUBLE SHOOTING FOR CATH WITH UNABLE TO INSERT IN URETHRA
Do not force, contact urology
how do you collect a urine sample from an indwelling cath
-collect sample from foley cath tubing
-cleanse hub of port prior to connecting syringe and collect sample
-may need to kink tubing distal to port to collect urine
-never collect from drainage bag
REMOVING INDWELLING CATH
- Hand hygiene, don gloves
- Release catheter from stabilization device
- Drain all urine from tubing and bag
- Bring bag to bed, place on disposable pad
- Secure catheter at urethra with non dominant hand
- Connect syringe to port to empty water from balloon
Ensure you empty all water from balloon
How do you know how much water is in the balloon? - Inform patient to take a deep breath in and out, slowly remove catheter
- Inspect tip to ensure it is intact
9.Provide perineal care - Discard all supplies
DOCUMENTATION FOR CATH REMOVAL
-HOW MUCH FLUID AND CHARACTERISTICS OF FLUID
-DOCUMENT CATH INTACT
-DOCUMENT YOU PROVIDED PERI CARE
**DOCUMENT IN THE ORDER YOU DID IT IN
HOW LONG AFTER REMOVAL SHOULD THEY VOID AND WHAT PROBLEMS CAN OCCUR AFTER REMOVAL
-4-6 HOURS TO VOID AFTER REMOVAL
-IF VOIDING IN SMALL AMOUNTS THEY COULD BE RETAINING URINE
PATIENT EDUCATION AFTER REMOVAL OF CATH
-fluid intake
-voiding after removal
-urine retention
-infection
Sterility is
the absence of viable life that has the potential to reproduce and spread dangerous and disease-causing germs and bacteria
if the object or area is touched by any object that is not sterile what is is considered?
contaminated
sterile technique also known as asepsis prevents contamination of what kind of areas?
-open wounds
-isolates and operative or procedural areas from unsterile environment
-maintains sterile field for surgery or procedural intervention
where is sterile technique most often used?
operating room
other than the operating room, when should sterile technique be used?
when performing any procedure that could introduce microbes into a patient
how will you know if sterile technique should be used?
there will be an order placed for sterile technique with the order for the procedure
If you break sterile technique what should you do?
start over
sterile sites include:
organs
central vascular system
bone or bone marrow
cerebrospinal fluid
pericardial fluid
peritoneal fluid
pleural fluid
joint fluid
what is not a sterile site?
passageways that are open to the outside
examples of sites that are not sterile
-nasal passage
-throat
-sputum
-esophagus/stomach
-rectum
-vagina
-skin
-local soft tissue infections
-abscesses
what organs require sterile technique
-heart
-brain
-gallbladder
-kidney
-pancreas
-ovary
-nodes
-spleen
-liver
medical asepsis is referred to what
clean technique
medical asepsis _______ the number of pathogens
reduces
surgical asepsis ________ all pathogens
eliminates
medical asepsis is used in administration of:
-medications
-enemas
-tube feedings
-daily hygiene
what is the number one way medical asepsis is used:
hand hygiene
surgical asepsis is also know as what
sterile technique
what is surgical asepsis/sterile technique used in?
-dressing changes
-catheterizations
-surgical procedures
principles of surgical asepsis
1.A sterile object remains sterile only when touched by another sterile object.This principle guides a nurse in placement of sterile objects and how to handle them.
2.Only sterile objects may be placed on a sterile field.
3.A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated.
4.The edges of a sterile field or container are considered to be contaminated.
sterile touching sterile remains _______
sterile
sterile touching cleans becomes ________
contaminated
sterile touching contaminated becomes ________
contaminated
sterile state is ________
questionable
what type of objects can be placed in the sterile field?
all items that are properly sterilized before use
where are sterile objects stored?
clean, dry storage area
if a package containing sterile items are punctured, wet, torn, or open they are considered what?
unsterile
is the outside of a sterile package considered sterile?
no
what position should you be in when your sterile field is prepared?
facing sterile field with hands above waist and below shoulders
never turn back to sterile field
what are ways you can break sterile with clothing?
a piece of clothing dangling over sterile field
how big is the border around the sterile field when placing a drape down that is considered contaminated?
1 inch
the edges of sterile containers become exposed to air after they are opened and then considered what?
contaminated
when performing sterile procedures you need a:
sterile work area
a sterile field is an area free of ________ and prepared to receive _______ items
microorganisms, sterile
what can you use to transfer sterile items to a sterile field?
sterile forceps
sterile gloves
what can you use to prepare a sterile field on?
inner surface of a sterile wrapper
sterile drape
dressing tray
when transferring items that are not in a sterile kit the sterile gloves you are wearing cannot what?
touch the wrappers of the sterile items you need to open
what should you do before opening a sterile kit?
wash hands
what is a nurses role in urinary elimination?
assess patients urinary tract functions and provide support for bladder emptying
urinary elimination can be compromised by what?
illness and conditions
organs of urinary elimination
kidneys
ureters
bladder
urethra
filtering blood through nephrons to make urine and many other functions
kidneys
transport urine from the kidneys to the bladder
ureters
reservoir for urine until the urge to urinate develops
bladder
where urine exits the body
urethra
kidney functions
-formation of urine
-Acid-base balance
-excretion or conservation of Water
-Electrolyte balance
-excrete bacterial Toxins, water-soluble drugs, and drug metabolites
-regulate Blood pressure via renin-angiotensin-aldosterone system (RAAS)
-production of Erythropoietin
-activation of vitamin D
kidney function acronym
a wet bed
cysto-
bladder
temporary storage of urine and its elimination
bladder
smooth muscle _______ during bladder filling and _______ with emptying
expands, contracts
what prevents reflux of urine from bladder traveling to ureter
sphincter
length of female urethra
2 - 3 inches
length of male urethra
7 to 8 inches
who is more prone to UTIs and why
females because the urethra is shorter
A patient with a long-standing history of diabetes mellitus is voicing concerns about kidney disease. The patient asks the nurse where urine is formed in the kidney. The nurse’s response is the:
A. bladder.
B. kidney.
C. nephron.
D. ureter.
c nephron
other than urinary organs what plays a big role in bladder function?
the brain
where is the micturition center?
sacral spinal cord
stretching of the bladder wall signals the what?
micturition center in the sacral spinal cord
the brain either responds or ignores impulse from the micturition center when the bladder fills making urination what?
voluntary control
when a person is read to void, the _______ ________ relaxes, the ________ _________ stimulates the _________ muscle to contract and the bladder empties
external sphincter
micturition reflex
detrusor
an accumulation of urine in the bladder due to the inability of the bladder to empty
urinary retention
what is the amount of urine a patient should void for urinary retention to not be a concern?
30 - 40 mL per hour
results from a catherization or procedure
urinary tract infection
involuntary leaking of urine
urinary incontinence
artificial route for urine is called what
urinary diversions
examples of urinary diversions
nephrostomy
urostomy
what is a urinary tract infection?
invasion of urinary tract by bacteria
causes of a uti
-stasis of urine in bladder
-contamination in perineal/urethral area
-instrumentation
-reflux of urine
-previous utis
why is it important to know a residents urinary history?
so you can know if they are having uti symptoms or if something is out of normal so we can catch it early
urinary tract infection nursing care
-monitor symptoms
-monitor intake and output
-pain control
-keep area clean
-encourage fluids
-teaching
what teaching do nurses need to do for uti?
medications- take all antibiotics
prevention - dont hold urine, proper pericare, encourage fluids
what symptoms can older adults have with uti?
-confusion
-decrease LOC
-agitation
-s/s delirium
involuntary urine loss from increasing abdominal pressure
stress incontinence
involuntary urine loss with abrupt/strong desire to void; unable to make it to the bathroom in time
urge incontinence
what is the most common type of incontinence in older adults?
urge incontinence
what is is the goal with urinary incontinence
to have no involuntary leakage
incontinence due to inability to get to the bathroom; physical limitations, loss of memory (progressed dementia), disorientation
function incontinence
when an individual is usually dependent on others what type of incontinence is it?
functional
involuntary loss of urine associated with bladder distention
overflow incontinence
incontinence that may occur due to prostate enlargement
overflow incontinence
continuous, unpredictable loss of urine
total incontinence
incontinence seen with neurological impairment, surgery or trauma
total incontinence
acute reasons for urinary retention
anesthesia
medications
local trauma to urinary structures
chronic reasons for urinary retention
-enlarged prostate
-medications
-strictures
-tumors
things to monitor/do with urinary retention
-monitor urine output
-palpate to identify bladder distention
-change positions, ambulate, turn on water to help them urinate
-perform bladder scan
how much urine should be in the bladder after urination?
less than 50mL
how much residual urine in the bladder after urination indicates the need for treatment?
150-200 mL
A health care provider may suspect that a patient is experiencing urinary retention when the patient has, select all that apply
A. large amounts of voided cloudy urine.
B. Pain and distension in the suprapubic region.
C. spasms and difficulty during urination.
D. small amounts of urine voided two to three times per hour.
B and D
things involved in an assessment of urinary elimination
-self care ability
-cultural considerations
-health literacy
-nursing history
-fluid overload
-dehydration
-pattern of urination
what should you assess with fluid overload?
-lung sounds
-edema
-daily weights
what should be assessed with dehydration?
-skin turgor
-oral mucosa
what should be assessed with pattern of urination?
frequency
time of day
amount
focused urinary assessment questions
-urinate more than usual?
-pain or burning upon urination
-changes in color of urine?
-difficulty starting or maintaining the stream of urine
-changes in the characteristics of urine?
-feel like the bladder is still full after you urinate
-dribbling of urine occur after urinating?
-continent or incontinent
if patient has costovertebral tenderness (cva tenderness) what could it indicate?
pyelonephritis
polycystic kidney disease
what is involved in a physical assessment of urinary elimination
-check for cva tenderness
-palpate bladder for tenderness and fullness, distention
-external genitalia and urethral meatus
-perineal skin
how to do a cva tenderness test
-place flat palm over the kidney
-with the other hand, make a fist and thumb your hand currently resting over the kidney
-if patient reports pain or discomfort cva tenderness is present
physical assessment of urine
-intake and output
-characteristics of urine
ways you can collect urine to measure intake and output
-hat
-urinal
-foley catheter drainage bag
how often should you empty a cath drainage bag?
at least every four hours
what type of patient will you have to measure strict fluid intake for and why?
kidney disease because they are on fluid restrictions typically
characteristics of urine include:
-color
-clarity
-odor
-amount
labs to assess kidney function
-bun
-creatinine
-egfr
-24 hour urine - creatinine clearance
lab tests for urinary system
-urinalysis
-urine culture and sensitivity
-24 hour urine
how can you collect a UA
-midstream collection
-straight cath
-indwelling cath
what volume of urine needs to be collecting for a ua
about 10mL
what is the best way for urine to be collected for a UA
any catheter
what must you ensure when collecting a urine culture and sensitivity?
that antibiotics have not already been given
what does a urine culture idenitify?
organisms present usually a bacteria
what does a sensitivity test determine?
the antibiotic that will destroy the bacteria
how do you do a 24 hour urine?
start at 0800, discard the very first void, save all urine for 24 hours and keep on ice
can you delegate a collection of a midstream urine sample?
yes
instructions for midstream urine sample
-clean perineal area with cleansing cloth provided
-instruct females to hold labia open entire time
-begin urine stream into toilet
-stop urine stream and place cup under urethral opening
-begin urine stream into cup
-after cup is filled continue urine stream into toilet
what info should nurse put on urine cup?
time
date
initials
when should you take a urine sample to the lab when you get it?
as soon as possible
normal urine amount
1,000 - 2,000 mL in 24 hours
normal urine color
straw or amber
normal urine clarity
clear
normal urine specific gravity
1.005 to 1.030
if specific gravity is less than 1.005 what does that indicate?
dilute urine - more fluid than waste
excessive fluid intake
diabetes mellitus
if specific gravity is higher than 1.030 what does it indicate?
concentrated urine - more waste than fluid
dehydration
SIADH
heart failure
what is the normal pH of urine
4.5 to 8.0
what is the normal constituents of urine
95% water
5% waste products
what waste products are in urine?
urea
creatinine
uric acid
what can cause brown urine
-fava beans
-antibiotics like metronidazole and nitrofurantoin
-over the counter laxatives
what can cause light brown urine
-kidney failure
-muscle breakdown from extreme exercise
what can cause orange urine
-vitamin c
-carotene from carrots
-antibiotics used for TB rifampicin
-liver disease
red/pink urine
-foods like beets and berries
-blood
blue/green urine
-food coloring
-vitamin b
-medications like amitriptyline, propofol, indomethacin
what does cloudy urine indicate
could be a sign of infection like a UTI
if pH of urine is greater than 8 what does it indicate?
-infection
-metabolic alkalosis
if urine pH is less than 4.5 what does it indicate?
metabolic acidosis
what is the normal level for protein in urine?
less than 20 mg/dL
what would persistent elevated protein in the urine indicate?
kidney disease
fever
dehydration
what is a normal glucose range for urine
negative
if a patient has an abnormal glucose level in urine what can this indicate
excessive glucose in blood
uncontrolled diabetes
what is a normal level for bilirubin in urine
negative
if a patient has an abnormal bilirubin level in urine what can this indicate
liver issues
what is a normal nitrite level in urine
negative
what does an abnormal nitrite level indicate
infection
what is a normal leukocyte esterase level in urine
negative
what does an abnormal leukocyte esterase level mean?
urine infection
what is the normal level for red blood cells in urine
less than 5/hpf
what does an abnormal level of red blood cells in the urine indicate
kidney stones
trauma
what is a normal level of white blood cells in the urine?
less than 5/hpf
what does an abnormal level of white blood cells in the urine indicate
infection
inflammation
if a patient has excessive amounts of white blood cells >15-20 it can indicate what?
pyelonephritis
ways to promote normal micturition
-maintaining elimination habits
-maintaining adequate fluid intake
-maintain appropriate body position while voiding if safe to do so
-encourage micturition with running water/sounds
urinary retention may be secondary to what?
body positioning
health promotion for urine elimination
-patient education
-promoting normal micturition
-promoting complete bladder emptying
-preventing infection
how will we help a patient prevent urinary infection at clinicals?
by providing perineal care with soap and water at least once per shift for patients who cannot self-perform
what is a urinary catheter
a pliable tube that is placed through the urethral opening into the bladder to drain urine
why would a healthcare provider insert an indwelling catheter?
-urinary obstruction
-urinary retention
-strict intake and output necessary
-coma
-surgery and anesthia
-urinary incontinence with skin breakdown/wounds
why would a healthcare provider insert an intermittent catheter?
-urine sample necessary
-urine retention present -drain bladder and then attempt to see if pt can void on own
why wouldnt a healthcare provider insert a catheter
if a patient is incontinent
examples of external caths
condom cath
female external cath
intermittent (straight) cath
temporary (in and out)
indwelling cath (foley)
longer duration goes in and stays in for a while
triple lumen cath
irrigation of the bladder
coude cath tip
a cath with a firm, bent tip
used on men
suprapubic cath
surgically inserted in the abdomen typically for cancer
how much fluid is typically inserted in a cath balloon
10mL
what are catheter sizes measured in?
french
WHAT IS A STRAIGHT CATH USED FOR
URINARY RETENTION
PATIENTS THAT CANT MAKE IT TO THE BATHROOM
URINE COLLECTING
WHEN A PATIENT HAS A SUPRAPUBIC CATH WHAT SHOULD YOU WATCH OUT FOR
INFECTION SYMPTOMS
REDNESS
TENDERNESS
DRAINAGE
ODOR
FEVER
CHILLS
IF A LONG-TERM CATH IS IN PLACE WHEN IS IT CHANGED OUT?
DEPENDS ON FACILITY
TYPICALLY ABOUT 4-6 WEEKS
STABILIZATION DEVICES ON A CATH
DEVICE THAT KEEPS THE EXTERNAL PIECE OF CATH TUBING AND DRAIN TUBING IN PLACE
-STATLOCK
-LEG BAG
There is a seal that connects the Foley catheter to the drainage tubing keeps it all in one piece
Do not separate the Foley catheter from its drainage tubing unless absolutely necessary what is this called?
closed drainage system
what does cauti stand for?
catheter associated urinary tract infections
will insurance pay for cauti (catheter associated urinary tract infection)?
no they will not reimburse facility for any infections related to cath
when inserting cath in penis what angle should you use to be able to see urine come out of bladder?
90 degree angle
how often should you do indwelling cath care and perineal care
perform per facility policy/orders at least once per shift
how to perform indwelling cath care and perineal care
-expose urethral meatus anc cath, secure with non-dominant hand
-utilize mild soap and water to clean urethral meatus and cath
-clean away from meatus and remove all traces of soap
-provide additional cleaning if area gets soiled, appears dirty, ect
cauti prevention measures:
-keep drainage tubing without any kinks or excessive coils to avoid urine backflow
-clean the cath tubing away from the meatus with soap and water
-keep drainage bag below the level of the bladder on a non-moveable part of the bed
-avoid touching the spigot to the receptacle when emptying the drainage bad
what must you measure when a catheter is in place?
intake and output
what can you use to measure urine from a cath
urometer
urinal
graduated cylinder
