Unit 8: Urinary catheterization and specimen collection Flashcards
What is fluid regulated by?
- Kidneys
- Mechanisms involving plasma proteins, hormones, nervous system, heart, and blood vessels
What is the point of fluid balance?
The whole point of the body maintaining fluid balance is to make sure that there is enough blood circulating to bring oxygen and nutrients to the tissues, and to remove waste products from the cells.
Which spaces is extracellular fluid found in?
The intravascular space is inside the blood vessels, and this includes plasma
The interstitial space is in between the body cells
The transcellular space, which is in the epithelial-lined spaces. This includes cerebrospinal fluid, fluid in the GI tract, intraocular fluid, and fluid in the pleural and pericardial spaces (between the parietal and visceral linings). (Break down what the terms mean)
What is the role of the kidneys in fluid balance maintenance?
The kidneys are the main regulators of water balance, as well as sodium balance (since the balance of fluid in the body is completely linked to the balance of electrolytes). The kidneys filter about 180L of plasma each day, and produces urine at a rate of at least 30mL/hr (normally). Urine production largely depends on blood flow to the kidneys.
Which plasma protein is the most important for water maintenance?
Albumin
Several other mechanisms are involved in fluid balance, what are they?
- Nervous system
- Heart
- Blood vessels
Hypovolemia
Excessive loss of ECF and electrolytes, resulting in low circulating blood volume (burns, hemorrhage, shock, sepsis, vasodilation)
Dehydration
deficit of water only, where water intake is less than water loss (excessive sweating, GI losses, ↓ water access).
Hypervolemia
too much ECF fluid, especially in intravascular space (renal or heart failure, liver cirrhosis, too much IV fluid).
Third spacing
movement of fluid into body compartments that aren’t usually involved in the fluid exchange between ICF & ECF (ascites in abdominal cavity).
S & S and treatment of Hypovolemia
S & S: - dizziness - decreased BP - tachycardia - weak pulses Treatment: - IV fluid - Blood volume
S & S and treatment of Dehydration
S & S: - thirst - decreased appetite - weakness - headache - dizziness - tachycardia - incoherent speech - dry mucous membranes - weight loss - decreased urine output - concentrated urine - decreased BP Treatment: Water replacement through... - oral intake - IV fluids.
Hypervolemia
S & S:
- Increased BP
- edema
- tachypnea
- SOB
- weight gain
- jugular vein distension
- Wet breath sounds
How is a significant change demonstrated?
Noted by comparing 24-hour totals over several days
Normal characteristics of urine
- Amount: ≥30mL/hr
- Colour: straw, amber
- Clarity: transparent/clear
- Odour: faint aroma
- pH: 6 (normal range 4.5-8)
- Specific gravity: 1.015-1.025
- No protein, glucose, or
ketones - None or few RBC, WBC,
bacteria, yeast
What is water made of?
96% water and 4% solutes. Organic solutes it contains… (urea is the main one). Inorganic solutes it contains… (sodium chloride is most abundant)
Factors affecting voiding
- Development: Normal urine output ranges are lower for infants and children than adults.
- Meds: Diuretic (antihistamines, antidepressants, anticholinergics) and opioids/narcotics.
- Nutrition/fluid intake
- Prep for surgery or diagnostic test
- Muscle tone, the more muscle, the more water
- Psychosocial factors: hearing water run, being asked if you must pee, lack of privacy, anxiety
- Pathological conditions
Altered urinary function
Neurogenic Bladder
- Impaired neurological function
- Impaired bladder fullness sensation
- Lack of urinary sphincter control
- Possible results:
\+ Incontinence
\+ Loss of micturition
reflex
\+ Reflex voidingTypes of incontinence and definitions
- Functional:unpredictable and involuntary loss of urine, yet the patient has an intact urinary and nervous system; what it looks like is the patient may have the urge to void, but isn’t able to reach the bathroom in time, or they may have cognitive deficits or dementia and have forgotten what to do.
- Overflow:when a patient can’t fully empty their bladder all the way, so the small amount of urine left over in the bladder leaks out. The patient may or may not sense that the bladder is full.
- Reflex: involuntary loss of urine when the bladder reaches a certain fullness/stretch.
- Stress: sudden, involuntary loss of small amounts of urine (<50mL) that happens with a sudden increase of intra-abdominal pressure. Often happens with sneezing, laughing, coughing, lifting, jumping, etc; can be caused by weak pelvic floor muscles, damage to the bladder neck, obesity, or some medications.
- Urge: strong sense of urgency to void followed by involuntary loss of urine. May happen after removing a urinary catheter or if the patient has a UTI, stroke, Parkinson’s disease, Alzheimer’s, MS, etc. Also called an overactive bladder.
- Total: involuntary, continuous, and unpredictable urine loss from a nondistended bladder. Could also be incontinence that simply doesn’t fit into the other categories. Often with neurological impairment or malformation of the urinary tract.
- Mixed: the patient experiences symptoms of more than one type of urinary incontinence, such as a combination of stress plus urge incontinence.
Urinary tract calculi
AKA “kidney stones”; r/t dehydration, alkaline or acidic urine, urinary stasis, UTIs, genetics, gout, hyperparathyroidism, diet, immobility
Prostate enlargement
r/t benign prostatic hyperplasia (BPH); prostate compresses or blocks urethra; S&S - decrease in flow - difficulty initiating voids - intermittency, dribbling
Urinary catheterization
Introducing a tube through the urethra into the bladder
Sterile procedure
Risks: UTIs, urethral trauma
Types:
- Indwelling (Foley)
catheter
- Intermittent (straight)
catheter
Needs physician’s orderIndwelling or Foley catheter
is inserted into the bladder, and stays in place until the nurse takes it out.
Intermittent catheterization
involves inserting a straight, single-use catheter tube into the bladder, holding it there while the bladder empties, then removing the catheter right away after the bladder has drained. Has one single lumen; only allow for temporary bladder emptying, then removal.
Coude tip
Has a firmer, curved tip; used when a regular, straight-tipped catheter cannot be inserted because of stricture or blockage in the urethra (ie/enlarged prostate); can be on an intermittent OR indwelling catheter.
2-way catheter
double-lumen catheters are a type of indwelling catheter. They have two lumens inside the one tube; one to drain the urine, and one to inflate the balloon that keeps the catheter inside the bladder.
3-way catheter
3-way or triple-lumen caths are another type of indwelling cath. They have three lumens instead of two; the extra lumen is for irrigation fluid to be able to flow into the bladder at the same time as urine is draining out (this is continuous irrigation). These are often used for patients after they have had TURP surgery because of BPH, since it helps flush out blood and blood clots from the bladder.
Indications for urinary catheterization
- Relieve urinary retention
- Close monitoring of urinary output in highly acute situations
- Diagnostic tests
- Provide irrigation
- Instill medications
Catheterization guidelines: Assessment
- Fluid status (I&O, weight, serum electrolytes, S&S of fluid volume deficit or excess)
- Pattern of voiding
- Need for catheterization
- Feelings & level of knowledge about catheterization
- LOC, developmental level, ability to cooperate, & mobility
- Bladder fullness: palpate over symphysis pubis or use bladder scanner
- Review hx
- Inspect perineum
Catheterization guidelines: Implementation
- Provide privacy
- Use smallest appropriate catheter
- Maintain aseptic technique
- Remove as soon as appropriate
- Ensure unobstructed urine flow through catheter, tubing, and drainage bag
- Keep the drainage bag below bladder level at all times
- Secure catheters to prevent movement and pulling
- Perform peri care OD and after soiling
Catheter irrigation
- To maintain patency of indwelling catheters
- Continuous or intermittent
- Sterile procedure
- Per physician’s orders
- Monitor fluid instilled and fluid/urine expelled (assess for retention)
- After irrigating, the output should be greater than the amount of fluid you instilled
Urinalysis
to test for kidney or metabolic function, nutrition, systemic diseases.
Routine U/A measures urine pH, protein and glucose levels, ketones, specific gravity, WBC count, and presence of bacteria and/or blood.
C & S
to test for presence of bacteria (culture) and determine the most effective antibiotic treatment (sensitivity); sample should be sterile
Timed urine specimen
for kidney function and urine composition; over 2 to 72 hours; levels of the elements measured fluctuate throughout the day.
Analyze things like amino acids, creatinine, hormones, glucose, and adrenocorticosteroids in the urine
Fecal occults blood testing
Used to screen for blood in stool, possibly due to: - Colorectal or gastric cancer - Bleeding GI ulcers - Localized gastric or intestinal irritation
False positive may happen if patient is taking iron supplements or has eaten red meat in the past 3 days.
False negative may happen if patient is taking vitamin C
Lower UTI
Bladder and urethra
Upper UTI
Kidneys and ureters
Size of catheter needed for older adults
16 or 14 fr
Purpose for bladder irrigation
- Continuously flush and drain bladder
- Dislodge blockage in indwelling catheter
- To instill medication into bladder
Long-term
More than 30 days
Short-term
A few weeks, less than 30 days
