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NSE211 > URINARY CATHETERIZATION > Flashcards

URINARY CATHETERIZATION Flashcards

1
Q

What is urinary retention?

A

accumulation of urine in the bladder, inability to empty

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2
Q

how is urinary retention caused

A

inability to respond to micturition reflex, underactive/contractile detrusor and urethral obstruction

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3
Q

what happens when there is an accumulation of urinary retention

A

may lead to urinary incontinence

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4
Q

chronic vs acute retention

A

chronic:
Men - enlarged prostate
women - pelvic organ prolapse
Acute:
- Absence of urine output
- discomfort, diaphoresis, pain over symphis pubis and restlessness

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5
Q

causes of UTI

A
  • STD
  • catheterization
  • e coli
  • prostate disease
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6
Q

urinary diversion

A

urinaryy diversion to external source

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7
Q

Transient incontinence

A

urine loss resulting from causes outside of or affecting urinary system, resolves when underlying causes are treated

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8
Q

urge incontinence

A

sudden urge and need to void that cannot be potponed: overactive bladder

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9
Q

stress incontinence

A

urine loss resulting from intra-abdominal pressure - coughing, sneezing, laughing

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10
Q

overflow

A

involuntary loss of urine when bladder does not completely empty

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11
Q

mixed

A

urine loss that has both stress and urge incontinence

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12
Q

functional

A

urine loss due to not being able to go to toilet

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13
Q

frequency

A

voiding more 8 times in 24 hours - increased intake of fluid, polyuria, OBS, incomplete emptying

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14
Q

dysuria

A

experiencing pain/burning sensation during urination - bladder inflammation, urethral trauma

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15
Q

polyuria

A

voiding large amounts of urine- excess fluid intake, nocturnal polyuria , post obstructive diuresis

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16
Q

hematuria

A

blood in urine - renal disease, infection of kidnet, bleeding disorders, UTI

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17
Q

oliguria

A

diminishedd urinary output relative to intake - dehydration, increased ADH

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18
Q

elevated postvoid residual urine

A

neurogenic bladder, prostate enlargement

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19
Q

diuresis

A

increased/excessive formation of urine

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20
Q

pneumaturia

A

bubbles in urine - fistula bet colon and bladder, UTI

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21
Q

anuria

A

failure of kidneys to produce urine

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22
Q

nocturia

A

prevalent and bothersome lower urinary tract defined as waking up from sleep

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23
Q

hesitancy

A

difficulting initiating urination

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24
Q

dribbling

A

leakage of urine despite voluntary control of urination

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25
Q

How a uti develops and what can occur with it

A
  • obstruction of urinary tract, incomplete bladder emptying and abnormal anatomy
  • occurs due to E.coli bacteria especially in women
  • UTI can spread to upper tract leading to the kindneys being damaged - pyleonephritis
  • then can move to bloodstream - bacteremia - leading to urosepsis
  • not all bacteria in urine causes infection
  • patients with lower UTI may experience dysuria and fever,chills, nausea may start to develop as it worsens
  • inflammation of bladder - cystitis - increases frequency and urgency and may cause incontinence, irritation of bladder results in heamturia
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26
Q

why do we use a condom catheter?

A

when a pt. experiences incontinece and is the second alternative to catheterization

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27
Q

Is there an infection in the bladder when a patient has cloudy, foul smelling urine, and change in color in the absence of symptoms?

A

does not indicate infection

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28
Q

duration for short term catheters (in days)

A

fewer than 14 days

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29
Q

duration for long term catheters (in days)

A

more than 14 days

30
Q

when to use short term catheters?

A
  • post op, when urine flow is obstructrd
  • prolonged immobilization due to trauma
  • instillations of medication into bladder
  • to collect a sterile specimen when patient is unable to provide on their own
  • end of life - if comfortable
31
Q

when to use long term catheters?

A
  • when pt. not suitable for surgical intervention
  • neurological disease is short term not feasible
  • stage 3/4 of sacral pressure injury
  • if alternate approaches have been tried but not succesful
32
Q

intermittent catheterization

A

single use, straight catheter introduced urethrally for 5-10 minutes, just long enough to drain the bladder. Straight catheter has a single lumen and small opening about 1.3cm ffrom the tip and the urine drains from the tip, through the lumen and into a receptacle
used - to assess residual urine after urination or as an alterative to long term indwelling catheterization

33
Q

indwelling/foley catheter

A

retained for linger periods by means of a small balloon.
there are 2 types:
1. 2 lumen - 1 lumen to drain urine and the other to inflate sterile water into balloon - most common
2. 3 lumen - 3rd lumen allows fro irrigation
- used for patients that are immobile or have spinal injury resulting in paralysis

34
Q

coude catheter

A

has a curved tip, typically used in men that have an enlarged prostate that partially obstructs the urethra

35
Q

suprapubic catheterization

A

surgical placement of catheter through the abdominal wall above the symphsis pubis and into the urinary bladder

36
Q

how to prevent infection in suprapubic catheters

A

adequate fluid intake will help risk of sedimentation or infection due to stagnation

37
Q

catheter size for different genders and ages

A

children - 8-10 french gauge (larger the gauge - larger the catheter)
female - 10 to 12 fr gauge
male - 12-16 fr gauge

38
Q

what kinda material are long term catheters made of and why

A

pure silicone or hydrophilic polymer coated catheters as they cause less encrustation at the urethral meatus and cause less friction and irritation to tissues

39
Q

what size fr gauge is used after prostatectomy

A

20-24 fr three lumen catheter to allow clot drainage and irrigation

40
Q

balloon sizes for different ages

A

3ml - children
10ml - adults
30ml - after prostatectomy to provide hemostasis of the prostatic bed

41
Q

urinary catheter removal

A
  • removed as soon as clinically appropriate - to prevent infection
  • prior to removal - pt.understands the need to void
  • should void with 4-6 hrs of catheter removal
42
Q

complication during removal

A

inability to remove catheter due to balloon
lumen is cut
inability to deflate balloon
inability to void after removal (complication)

43
Q

how to remove a catheter

A
  1. all the weird procedures, HH, intro, explain yada yada, order
  2. assess catheter site and note any abnormalities
  3. Place blue pad over clients thighs
  4. collect sample, if needed
  5. connect syringe and fully deflate balloon
  6. do not ever cut balloon lumen
  7. Slide cather out in one, gentle motion
  8. examine catheter to ensure it is intact and wrap in blue pad
  9. unhook collection bag, empty and measure output
  10. discard, clean, remove gloves, wash hands
  11. repostiion client
  12. teaching - unable to void after 4-6 hrs complication , burning
  13. document
44
Q

Purpose of a continuous bladder irrigation?

A

to flush bladder continuously or intermittently

45
Q

indication of a continuous bladder irrigation

A

post surgery for a prostate

46
Q

types of continuous bladder irrigation

A

open/closed irrigation either with a double/triple lumen catheter

47
Q

if a catheter becomes occluded by sediment and encrustation, what should be done?

A

should be changed to avoid flushingdebris containg bacteria into bladder

48
Q

thing to note prior to a contiuous irrigation

A

1.assess urine color and presence of sediment
2. determine type of catheter - 2 lumen (closed intermittent irrigation/instillation)/3 lumen (closed contiunous irrigation)
3. determine volume of urine present in drainage system before starting
4. assess pt lower abdomen for bladder distention - detect whether catheter is blocking urinary drainage
5. postion client in dorsal recumabant/supine - promotes pt.comforty and provides easy access to catheter

49
Q

closed intermittent irrigation - double lumen

A
  1. prepare a prescribed sterile solution in sterile graduated cup
  2. draw sterile solution into syringe using aseptic technique
    ** ensure irrigating fluid - remains sterile
  3. clamp in dwelling cather just distal to injection port and clean injection port with antiseptic swab. insert needless syringe tip through port, slowly inject fluid into cather and bladder reduces trauma to bladder wall
  4. withdraw syringe, remove clamp and allow solution to drain into drainage bag. If instillation ordered by prescriber, keep clamped to allow solution to remain in bladder for ordered time
50
Q

closed continuous irrigation with triple lumen

A
  1. using aseptic technique, insert tip of sterile irrigation tubing into bag of sterile irrigating solution
  2. Close clamp on tubing and hang bag of solution on IV pole
  3. open clamp and allow solution to flow through (prime) tubing, keeping end of tubing sterile. close clamp - removes air from tubing
  4. wipe off irrigation port of triple lumen catheter with antiseptic swab and then attatch to irrigation tubing (3rd lumen)
  5. be sure that drainage bag and tubinf are securely connected to drainage port of triple lumen catheter
  6. for intermittent flow - clamp tubing on drainage sysytem, open calmp for irrigation and allow prescribed fluid to enter bladder (100ml normal for adults). close irrigation clamp and then open drainage tubing clamp
  7. for continuous drainage - calaculate drip rate and adjust clamp on irrigation tubing accordingly. Be sure that clamp on drainage tubing is open and check volume of drainage bag (ensure drainage tubing is patent and avoid kinks)
  8. calculate fluid used to irrigate bladder and subtract from total output and this gives you the accurate urinary output
  9. assess characteristics of output: viscoscity, olour and presence of matter (sediment, clots, blood)

short vid link to understand all this better: https://www.youtube.com/watch?v=fOcK2nG95cY

51
Q

What do you do when the irrigation solution does not retuen or is not flowing at prescribed rate, possible occlusion of catheter?

A
  • examine tubing for kinks, clots or urine sediment
  • evaluate bladder distention
  • notify prescriber if irritant is retained, if pt. complains of pain, or if bladder is distented
52
Q

what do you do when you see bright red bleeding with irrigation?

A
  • assess for shock (check vitals, skin colour, and moisture)
  • closed intermittent - stop irrigation
  • closed continuous - leave flowing
  • notify prescriber
53
Q

what do you do when you see increased cloudiness of urine or fever

A
  • monitor fever
  • notify prescriber
  • obtain steril urine specimen if ordered
54
Q

what do you do when there is an increase in pain after irrigation?

A
  • evaluate bladder distention
  • examine if there are kinks, clots, sediments
  • notify prescriber
55
Q

how to calculate urine output after irrigation?

A

volume of fluid used for irrigation - total output

56
Q

Types of urinary diversions

A

incontinent and continent

57
Q

what is an incontinent diversion

A

ileal coduit (ileal loop) or colon conduit.
- pt. wears an ostomy appliance as there is no spinchter to control urine flow

58
Q

what is continenet diversion?

A

reservoir created in abdomen using part of bowel and a spinchter is created (needs to be catheterized) eg - kock pouch

59
Q

what is uretrostomy?

A

involves bringing the end of one or both ureters to abdominal surface and avoids the need for 2 collecting devices

60
Q

what is trasureteroureterostomy?

A

connects the ureters and brings one out through abdominal wall. A tube may be placed directly onto the renal pelvis to provide urinary drainage and is called a nephrostomy

61
Q

nursing consideration for diversion?

A
  • risk of skin breakdown at stoma site
  • assess pt urine output, amount and colour
  • assess for infection at site/systemic
  • assess pt acceptance of device - body image, sexuality
  • complication : if outflow becomes blocker, there may be permanent damage due to kidneys due to backflow pressure or could be infection and can travel to kindeys causing hydronephrosis
62
Q

why is a dialysis used?

A

when there is irreversible damge to glomeruli/ renal tubules and cause decline in kindey function and leads to end stage renal diseae

63
Q

types of dialysis

A

peritoneal and hemodialysis

vid to understand better: https://www.youtube.com/watch?v=SgBMoCArNak

64
Q

peritoneal dialysis

A
  • indirect method of cleaning the blood of waste products and excess fluid using osmosis and diffusion.
  • peritoneum fucntion as a semipermeable membane for the procedure
  • sterile electrolye is instilled into the peritoneal cavity by gravity via a surgically placed catheter
65
Q

what is hemodialysis

A

involves using a machine equipped with a semipermeable filtering membrane (artificial kidney) that removes accumulated wasted product and excess fluid from blood.
- Sterile electrolyte is pumped through one side of filter membrane (artficial kidney) while pt. blood passes through the other side

66
Q

how to collect a midstream (clean voided) urine specimen

A
  1. using surgical asepsis, open sterile kit is using one or prepare sterile supplies. apply sterile gloves after opening sterile cup, placing cap with sterile inside surface up, dont touch th inside of container/cap
  2. allow or assist pt, to independantly clean perineum and collect specimen

A. for a female pt.
- spread labia with thumb and forefinger of non dom hanf providing access to urethral meatus
- clean area with cotton ball/gauze and approved solution, moving front to back. Using a fresh swab each time, repeat motion 3 times

B. for a male pt.
- hold pt. penis with one hand or have the pt. hold his penis. Using circular motion and antiseptic swab/cotton ball with approves solution, clean end of penis, moving from ventre to outside
- in uncircumcised male, foreskin should be retracted before cleaning.

  1. after pr has initiated urine stream, pass specimen collection container into stream and collect 30-60 ml
  2. transport specimen to lab within 15-30 minutes or refrigerate
67
Q

why do we not collect urine in initial stream?

A

initial stream flushes out microorganisms that accumulate at the urethral meatus and prevents transfer specimen

68
Q

why do we need to refrigirate urine samples if it goes beyond 30 minutes to give to lab?

A

prevents the growth of bacteria

69
Q

if pt is menstruating, what do you do

A

you indicate this information to the lab

70
Q

charecteristics of urine (CCO)

A

Colour - bleeding from kidneys or ureters causes dark red urine, bleeding from bladder/urethra causes urine to be bright red
Clarity - with renal disease, urine may appear clouds or foamy due to high protein concentration or it could be a result of bacteria
Odour - the more concentrated the urine, the stronger the odour. Sweet/fruity odour occurs from acetone seen with diabetes mellitus or starvation

71
Q

NORMAL OR ABNORMAL:
a. hourl output of less than 30ml more than 2 hrs
b. 2000ml to 2500ml of urine daily
c. 800 -2000 ml of urine per day
d. change in urine volume

A

a. abnormal
b. abnormal
c. normal
d. abnormal - may indicate kiney disease or fluid alteration

NSE211 (6 decks)

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