Urinary Elimination Skills Flashcards
How should a standard bedpan be positioned?
Like a regular toilet seat–the buttocks are placed on the wide, rounded shelf, with the open end pointed towards the foot of the bed.
How should a fracture pan be positioned?
With the thing edge towards the head of the bed.
What is a fracture pan and when is it used?
Smaller and flatter than the ordinary bedpan. It is helpful for patients who cannot easily raise themselves onto the regular bedpan. Frequently used for patients with fractures to the femur or lower spine; very thin or elderly patients often find it easier/more comfortable than a regular bedpan
What assessments should be done prior to and during assisting a patient with a bedpan?
Prior:Determine why the patient needs to use a bedpan. Assess the patient for limitations and ability to assist with activity. Assess for activity limitations such as hip surgery or spinal injury. Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction or any other devices that could interfere.
During: assess characteristics of the urine and skin
What are the steps to assisting with the use of a bedpan?
1) Review chart for limitations in physical activity
2) Bring bedpan and other supplies to the bedside
3) perform hand hygeine and put on PPE if indicated
4) identify the patient
5) Provide privacy, discuss procedure with the patient and assess their ability to assist with the procedure as well as personal hygiene preferences
6) unless contraindicated, apply powder to the rim of the bedpan. Place bedpan and cover on chair next to bed. Put on gloves
7) Adjust bed to comfortable working height. Place the patient in a supine position, with the head of the bed elevated about 30 degrees unless contraindicated
8) Fold top linen back just enough to allow placement of the bedpan. If their is no waterproof pad on the bed, consider placing one under the patient’s buttocks before placing bedpan.
9) Ask the patient to bend the knees. have the patient lift his hips upward. Assist patient, if necessary, by placing your hand that is closest to the patient palm up, under the lower back, and assist with lifting. Slip the bedpan into place with other hand.
10) Ensure that the bedpan is in proper position
11) Raise head of the bed as near to sitting as tolerated, unless contraindicated. Cover the patient with bed linens
12) Place call bell and toilet tissue within easy reach. Place bed in the lowest position. Leave patient if it is safe to do so. Use side rails appropriately (for re-positioning)
13) Remove gloves and addition PPE, if used. Perform hand hygeine.
Why is powder applied to bedpan?
Helps to keep the bedpan from sticking to the patient’s skin and makes it easier to remove.
When is powder not applied to the bedpan
If the patient has respiratory problems, is allergic to powder or if a urine specimen is needed.
What are the steps for removing a bedpan?
1) Perform hand hygiene, put on gloves and additional PPE if indicated. Adjust bed to a working height. Have a receptacle handy for discarding tissue
2) Lower the head of the bed, to about 30 degrees. Remove bedpan in the same manner in which it was offered, being careful to hold it steady. Ask the patient to bed the knees and lift the buttocks up from the bedpan. Assist patient, if necessary, by placing your hand that is closest to the patient palm up, under the lower back, and assist with lifting. Place the bedpan on the bedside chair and cover it.
3) If the patient needs help with hygiene, wrap tissue around the hand several times, and wipe the patient clean, using one stroke from the pubic area towards the anal area. Discard tissue and use more until patient is clean. Place patient on his side and spread buttocks to clean anal area.
3) Do not put tissue in the bedpan if a specimen is required or if output is being recorded.
4) Return the patient to a comfortable position. Make sure the linens under the patient are dry. Remove gloves and ensure the patient is covered.
5) Raise side rail, lower bed height and adjust head of bed to a comfortable position. Reattach call bell
6) Offer patient supplies to wash and dry his or her hands, assisting as necessary
7) Put on clean gloves. Empty and clean the bedpan, measuring urine in graduated container as necessary. Discard trash receptacle with used toilet paper per facility policy
8) Remove additional PPE if used. Perform hand hygiene
What is different about assisting with the use of a bedpan when the patient has limited movement?
Instead of having the patient bend their legs and lift their bottom up, have them roll unto their sides (assisting as needed). Then hold the bedpan firmly against the patient’s buttocks, with the upper end under the patient’s buttocks towards the sacrum and down into the mattress. Keep one had against the bedpan, applying gentle pressure to keep it in place while you assist the patient to roll back unto the bedpan. To remove, lower the head of the bed, and hold the bedpan down while the patient rolls over unto their side. Remove bedpan and set aside while you clean the patient.
what words are used that refer to emptying the bladder?
Urination, micturition or voiding
autonomic bladder
a bladder that is no longer controlled by the brain due to injury or disease; voiding occurs by reflex only (involuntary)
enuresis
continued incontinence of urine past the age of toilet training
nocturia
urination during the night
nephrotoxic
capable of causing kidney damage
hematuria
blood in the urine
urinary diversion
a surgical creation of an alternate route for excretion of urine
anuria
24-hour urine output less than 50mL; synonymous with kidney shutdown/renal failure
dysuria
painful or difficult urination
glycouria
presence of sugar in the urine
oliguria
scanty or greatly diminished amount of urine voided in a given time. 24-hour urine output less than 400mL
polyuria
excessive output of urine (diuresis)
proteinuria
protein in the urine; indicates kidney disease
pyuria
pus in the urine; urine appears cloudy
Suppression (urinary elimination)
stoppage of urine production; normally the adult kidneys produce urine continuously at the rate of 60-120mL/hour
specific gravity (of urine)
measure of the density of urine compared with the density of water; the higher the number the more concentrated the urine is
transient incontinence
appears suddenly and lasts for 6 months or less
stress incontinence
involuntary loss of urine related to an increase in intra-abdominal pressure
urge incontinence
involuntary loss of urine that occurs soon after feeling an urgent need to void
mixed incontinence
urine loss with features of two or more types of incontinence
overflow incontinence
involuntary loss of urine associated with overdistention of the bladder
functional incontinence
urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory or disorientation
reflex incontinence
emptying of the bladder without the sensation of the need to void
total incontinence
continuous and unpredictable loss of urine, resulting from surgery, trauma or physical malformation
Postvoid residual (PVR)
the amount of urine remaining in the bladder immediately after voiding
bacteriuria
presence of bacteria in the urine
how do you select a catheter size?
Choose the smallest appropriately sized catheter. For adults this is usually 14F-16F size catheter with a 5 to 10 mL balloon. For infants and young children size 5F to 8F is appropriate. For older children size 8F to 12F is appropriate
What measures can be taken if there is not an immediate flow of urine when the catheter is insterted?
1) Have the patient take a deep breath which helps to relax the perineal and abdominal muscles.
2) Rotate the catheter slightly because a drainage hole may be resting against the bladder wall
3) Raise the head of the bed to increase pressure on the bladder area
4) Assess the patient’s intake to ensure adequate fluids have been ingested
5) Assess the catheter and drainage tubing for kinks and occlusion
What is a foley?
An indwelling urethral catheter; used when a catheter is to remain in place for continuous drainage; designed using an inflated balloon so that it does not slip out of the bladder
What is a straight cath?
An intermittent urethral catheter; used to drain the bladder for shorter periods (5-10 minutes)
What are factors that affect elimination?
Aging, Food and fluid intake, activity and muscle tone, medications, pathologic conditions, physcological variables, and developmental considerations,
Indications for use of an ultrasound bladder scanner
Urinary frequency, absent or decreased urine output, bladder distention, inability to void, establishing intermittent catheterization schedules
Care of a patient with an external condom catheter includes…
1) Providing vigilant skin care to prevent excoriation
2) Remove the condom catheter daily, washing the penis with soap and water and drying carefully
3) follow the manufacturer’s instructions for application
4) Fasten the condom securely to prevent leakage, yet not so tightly as to constrict blood flow
5) Keeping the tip of the tubing 1-2” beyond the tip of the penis
6) maintain free urinary drainage
Reasons for catheterization
Relieving urinary retention; obtaining a sterile urine specimen; obtaining a urine specimen when usual methods can’t be used; emptying bladder before, during or after surgery; monitoring critically ill patients
