Urinary Elimination

Question 1

Indwelling Catheterization time length

Answer 1

May be short term (2 weeks or less) or long term (more than 1 month)

Question 2

INT catheterization

Answer 2

Is used to measure PVR when scanner not available or to manage chronic urinary retention

Question 3

3 catheter types

Answer 3

Straight tip: most commonly used. 16fr is the most common size

Coude tip: Typically used for men with an enlarged prostate

3-way Cath: used for continuous irrigation and medication administration

Question 4

Which allergy must you ask your patient about prior to catheterization?

Answer 4

Allergy to Betadine

Question 5

What can a nurse do if their patient is allergic to betadine? (according to Ms. Karvas)

Answer 5

Typically if someone says they are allergic to betadine it’s because they received it via IV in the past and had an adverse reaction to it. What you can do is contact pharmacy and ask for an antibacterial soap or alternative.

Question 6

What is a safe and non-invasive device/way to collect and contain urine?

Answer 6

Condom/External Catheters/Urine Collection devices

Question 7

Condom catheter care:(4)

Answer 7

-Change every 24 hours
(daily)
-Clean site
-Check tubing for patency
-Check skin for skin breakdown

Question 8

Does tape secure the condom catheter?

Answer 8

No

Question 9

External Catheter care: (4)

Answer 9

-Empty when 1/2 full
-Change when device turns white (24-48hrs)
-Assess tubing for kinks and free flow
-Assess skin for breakdown

Question 10

For both the condom and external catheters:

Answer 10

Allow for 1/2” away from penis to not allow tip to sit bathed in urine

Question 11

What is a non-invasive device for women with urinary incontinence?

Answer 11

A female external catheter (ex. PUREWICK)

Question 12

How often do you replace a female external catheter?

How often should you asses the skin for proper placement?

Answer 12

-Every 8-12hrs
-At least every 2 hrs

Question 13

When should you connect the female external catheter to suction?

What is the suction set at for a female external catheter?

Answer 13

-Before application
-40 (low continuous suction)

Question 14

Contraindications for female ext. Caths: (5)

(Anything that is a reason for a person to not receive a particular treatment or procedure because it may be harmful.)

Answer 14

-Pts that are agitated, combative, or uncooperative
-Frequent loose stools
-Skin breakdown or irritation
-Barrier cream (impedes suction)
-Latex allergy

Question 15

If catheter is misplaced during the application what should the nurse do?(female)

Answer 15

Do not remove, leave in as a landmark and start again with a new catheter.

Question 16

In females, once you see urine return what next?

Answer 16

Avance catheter another 2-3 inches before inflating balloon

Question 17

All 3 orifices of the vagina place the woman at a high risk of what?

Answer 17

UTI 2nd degree to E. coli

Question 18

The male urethra length varies to about:

Answer 18

8- 10”

Question 19

The female urethra length varies to about:

Answer 19

1.5-2”

Question 20

How far should you thread the catheter for men?

Answer 20

All the way to the bifurcation before inflating the balloon

Question 21

At what angle should you hold the penis upon application of catheter?

Answer 21

90 degrees

Question 22

If you meet resistance during the threading of the catheter you-

Answer 22

Could just be a spasm.
-So stop, wait, and proceed unless pain increases.

Question 23

How should you hang the urine bag? (2)

Answer 23

-below bladder
-coil tubing and attached to bed, but not the railing

Question 24

You begin the procedure with a women in the lithotomy position but the patients states “My back hurts, I don’t think I can hold this position any longer!”. What should the nurse do?

Answer 24

Reposition the patient in a side-lying position, with her upper leg flexed at the knee and hip.

Question 25

Should you be concerned if there is no urine in the bag after two hrs?(4)

Answer 25

Yes, you should:

-Check for Kinks
-Irrigate
-Increase fluids
-Assess Bladder fullness

Question 26

The nurse is inflating the balloon and the patient states “OWWWEEEEE! STAWP!”. The nurse should-

Answer 26

Withdraw fluid back into syringe, advance catheter further, then inflate the balloon again.

Question 27

To irrigate, the solution needed is:

Answer 27

A room temp, sterile solution to prevent cramping and discomfort.

Question 28

The nurse understands that closed syringe irrigation is typically needed when?

Answer 28

If there is an accumulation of mucous or a hematoma.

Question 29

What type of specialists can insert a coude catheter?

Answer 29

Enlarge prostates often require a special catheter called a ‘Coude Catheter’ placed by specially trained nurse or PCP. Urologists can also be called in for this as well

Question 30

The nurse treating a patient with a catheter has an uncircumcised penis. It is best practice for the nurse to do what prior to catherization and post perineal care?

Answer 30

-Retract the foreskin prior to insertion and during perineal cleaning care and fix it afterwards to avoid Paraphimosis.
-Always document it!

Question 31

D/C of indwelling catheter: (3)

Answer 31

-Perform peri care
-Remove all water from balloon (double check)
-Gently remove catheter

Question 32

Post removal of catheter:

Answer 32

-Monitor voiding (should void every 4-8hrs)
-1st void may be painful
-Increase fluids
-Monitor s/s of UTI, especially 2-3 days after removal

Question 33

If a patient who post removal of catheter spontaneously voids within 6 hrs but it is less than 200mL. The nurse should-

Answer 33

Perform bladder scan.
If PVR (post void residual) is greater than 200mL Initiate straight cath.

Question 34

If a patient who post removal of catheterization spontaneously voids within 6 hrs but is continent. The nurse should-

Answer 34

Perform bladder scan
If the PVR (post void residual) is greater than 200mL, Insert straight cath.

Question 35

If a patient who post removal of cath. has not voided within 6 hrs even after straight catheterization. The nurse should-

Answer 35

Notify HCP