Urinary Elimination Care Skills

Question 1

Micturition

Answer 1

The process of emptying the bladder

Normal adult voiding:
1500-1600ml/day OR 30ml/hr

Desire to urinate when:
250-300ml in adult
50-100ml in child

Question 2

Kidney

Answer 2

Empties urine into bladder intermittently

Question 3

Micturition Process

Answer 3

1. Stretch receptors in bladder
2. Impulses sent to spinal cord
3. Signals travel to pontine micturition centre in brainstem
4. Signals sent back down resulting in relaxation of internal sphincter and contract of detrusor muscle
5. Conscious relaxation of external urethral sphincter

Question 4

Factors influencing urinary elimination

Answer 4

• physiological (anxiety, stress)
• sociocultural (squatting v sitting)
• fluid balance (oral intake, caffeine, alcohol
• surgical/diagnostic (general anaesthetic)
• pathological conditions
• medications (diuretics)
• environment (comfort)

Question 5

Promote Urinary Elimination

Answer 5

a. promote fluid intake: 1500-2000ml daily
b. void q 3-4 hours
c. encourage BM
d. avoid substances that irritate bladder (caffeine, alcohol, greasy or spicy good, tobacco)
e. stimulate voiding reflex
f. complete bladder emptying
g. prevent infection (perineal hygiene)

Question 6

Urinary Assessment

Answer 6

a. Health history (voiding patterns, changes, risk factors that affect voiding)
b. Physical assessment
- fluid balance (skin condition, diaphoresis, mucous membrane)
- abdominal assessment (including kidney)
- perineum assessment
c. Urine assessment
- characteristics (colour, odour, clarity)
- intake and output
- urine testing and specimen collection

Question 7

Intake includes

Answer 7

IV fluids, dietary fluids, blood products

Question 8

Output includes

Answer 8

Urine, diarrhea, emesis, diaphoresis, drainage

Question 9

Output can be measured by..

Answer 9

a. graduated cylinder
b. urometer
c. urine hat

Question 10

Incontinence

Answer 10

Involuntary loss of urine

Question 11

Urgency

Answer 11

Sudden and compelling urge to void that cannot be postponed

Question 12

Dysuria

Answer 12

painful or difficult urination

Question 13

Frequency

Answer 13

voiding more than 8 times in a 24 hour period

Question 14

Hesitancy

Answer 14

difficult initiating urination

Question 15

Polyuria

Answer 15

large increased amount of urine

Question 16

Oliguria

Answer 16

decreased amount of urine

- less than 400ml in 24 hours

Question 17

Nocturia

Answer 17

getting up at night to void

Question 18

Dribbling

Answer 18

Leakage despite voluntary control

Question 19

Hematuria

Answer 19

presence of blood in urine

Question 20

Elevated post-void residual urine

Answer 20

urine retained in bladder

50ml remaining is normal but more than 100ml is not

Question 21

Urinary Incontinence

Answer 21

a. can be transient
b. urgency
c. stress incontinence (laughing, sneezing, coughing)
d. mixed (features of stress and urgency)
e. chronic retention (bladder unable to empty completely)
- enlarged prostate, fecal impaction, spinal cord injuries
f. multifactorial

Question 22

Urinary retention

Answer 22

Marked accumulation of urine in the bladder as a result of inability to empty bladder

Question 23

Urinary tract infection

Answer 23

Infection of lower urinary tract leading to cystitis, urethritis and prostatitis

Risk factors:

• sexual activity
• pregnancy
• low levels of vaginal estrogen
• incomplete bladder emptying
• decreased immunity

Symptoms:

• dysuria
• fever
• frequency, urgency
• hematuria
• nausea, vomiting
• urine concentrated and cloudy (foul smell)

Question 24

Urinary diversions

Answer 24

bypass bladder and urethra (permanent or temporary)

a. ureterostomy
ureters to abdominal surface
b. ileal loop
ureters attach to segment of ileum
c. nephrostomy
drainage tube directly into renal pelvis

Question 25

Signs and symptoms of Urinary Retention

Answer 25

• feelings of pressure and discomfort
• restlessness, diaphoresis
• distended bladder
• dull over supra-pubic area
• absence of urine output
• small frequency voiding or dribbling

Question 26

Complication of urinary retention

Answer 26

Prolonged retention can lead to:

• stagnation/stasis (alkaline, hospitable to bacteria)
• greater risk of UTI
• kidney infection

Question 27

Bladder scanner

Answer 27

ultrasound technology using high-frequency sound waves to detect urine volume in bladder

Question 28

Managing urinary retention

Answer 28

a. treat the cause
- change medications
- prostate surgery
b. intermittent catheter

Question 29

Urinary catheterization

Answer 29

Introduction of a catheter through the urethra into the urinary bladder

a. Intermittent
- insert for 5-10 mins or just long enough to empty the bladder

b. indwelling
- retained for longer using small balloon that keeps catheter in place

Question 30

Urinary catheterization lengths

Answer 30

Peds: 8-10 French
Vagina: 10-12 French (5-7.5 cm)
Penis: 12-16 French (22 cm)

*clean urethra meatus with chlorhexidine

Question 31

Intermittent catheterization

Answer 31

Inserted for 5-10 mins or just long enough to empty bladder

Indications:

• bladder distention
• sterile urine specimen
• assess post void residual
• urethral strictures
• management for patients with SCI, neuromuscular degeneration, incompetent bladder

Question 32

Indwelling catheterization

Answer 32

Retained for longer using small balloon that keeps catheter in place

Indications:
(short term)
- surgical procedures
- continuous measurement
- bladder irrigation
- prolonged immobilization due to trauma
- acute retention/obstruction
- end of life
(long term)
- chronic retention
- pressure injury
- intractable incontinence

Question 33

Urinary catheter types

Answer 33

a. straight catheter (intermittent)
b. indwelling retention catheter (one for drainage, one for balloon inflation)
c. triple lumen catheter (one for drainage, balloon, and irrigation
* Closed bladder irrigation
d. coude catheter (curved tip, helpful for enlarged prostate)
e. suprapubic catheterization
- surgically placed through abdo wall above symphysis pubis
- urethral trauma
f. condom catheter (elastic tape)
- change q1day
- nocturia

Question 34

Catheter Care

Answer 34

a. perineal care (BID, post BM, prn)
- soap and water, dirty to clean
b. catheter care (TID, post BM)
- urethral meatus followed by catheter
c. promote fluid intake
d. collection devices
- never raise higher than bladder
- don’t clip on bed rail or drag on floor

Question 35

CAUTI prevention

Answer 35

• hand hygiene
• strict aseptic technique
• maintain closed system
• prevent pooling of urine in tubing
• avoid kinks
• don’t let bag drag on floor
• empty bag at least q8hr (or half full)
• remove asap

Question 36

Preventing UTI

Answer 36

a. promote good personal hygiene
b. showers not baths
c. daily intake of 1500-200ml
d. practice frequent voiding every 2-4 hr

Question 37

Urine Testing (Specimen collection)

Answer 37

a. routine (routine and microscopic)
b. midstream urine specimen (c and s)
c. catheter specimen (c and s)
d. timed specimen (collection over given time)
e. urine dip (chemical reagent strips)

Question 38

Renal Replacement

Answer 38

Dialysis

• cleaning blood, renal failure that can no longer be treated with medication or diet modification alone
  a. peritoneal dialysis (indirect using osmosis and diffusion)
  b. hemodialysis (machine using semi-permeable filtering membrane)

Kidney transplant