Week 10 - GI and GU Health Flashcards
Review of the GI System
Mouth: Begins the process of digestion by mechanically breaking down food & mixing it with saliva
Esophagus: Transports food from mouth to stomach
Stomach: Secretes acid & enzymes to break down food into a semi-liquid form called chyme
Small Intestine: Composed of the duodenum, jejunum, & ileu - primary site for nutrient absorption
Large Intestine: Absorbs water & electrolytes, forming & storing feces
Rectum & Anus: Control excretion of feces from body
Factors Affecting Bowel Elimination
- Age
- Diet
- Fluid Intake
- Physical Activity
- Psychological Factors
- Personal Habits
- Positioning during defecation
- Pain
- Surgery/Anesthesia
- Medications
Assessment of the GI System: Subjective Data
- Pattern
- Characteristics
- Medications
- Cognitive capacity
- Bowel diversion
- Changes in appetite
- Diet & fluid intake
- Prior medical history
- Emotional state
- Mobility/Exercise
- Pain or discomfort
- Social history
Objective Data: What do we look for?
1) Inspection
2)Auscultation
3) Palpation
What is an Ostomy?
- Surgical creation of an opening (stoma) for intestinal
contents - Stoma may be permanent or temporary
- Ileostomy:
→ Ileum brought through the abdominal wall
→ Used for Ulcerative Colitis, Crohn’s disease
Colostomy:
→ Colon (large intestine) brought through the abdominal wall
→ Used for bowel obstruction, trauma, perforated
diverticulum, cancer
Types of Ostomies
1) End Stoma
2) Loop Stoma
3) Double-barrelled Stoma
What is an End Stoma?
- Proximal end of divided bowel brought out as a
single stoma - Distal portion may be
removed or oversewn - Potential for reanastomosis &
stoma closure (takedown) if distal bowel remains intact
What is a Loop Stoma?
- Loop of bowel brought to the
surface, opened anteriorly - One stoma with proximal & distal openings
- Usually temporary
What is a Double-Barrelled Stoma?
- Both proximal & distal ends brought through the abdominal wall
- Proximal stoma functions, distal stoma is a mucous
fistula - Usually temporary
Comparison of Colostomies & Ileostomies
Transverse
Stool Consistency
→ Semiliquid to semi formed
Sigmoid
Stool Consistency
→ Formed
Ilesostomy
Stool Consistency
→ very very liquidy (bec it has not passed through the whole GI tract)
Pre-op Care for Client with an Ostomy
Review Information:
→ Ensure patient and family understand surgery, stoma type, and care
Enterostomal Therapy (ET) Nurse
→ Assess patient’s ability to perform self-care
Comprehensive Assessment:
→ Physical, psychological, social, cultural, & educational
components
Stoma Site Marking:
→ ET nurse marks site before surgery
→ Proper placement crucial for rehabilitation
Bowel Preparation
→ May include osmotic lavages & preop IV antibiotics
Post-op Care for Client with an Ostomy
Assess for Post-op Complications
→ Pain
→ Bleeding (hypovolemic shock)
→ Fluid & electrolyte imbalances (fluid deficit/hypovolemic shock)
→ Decreased mobility
Assess Stoma & Stool
→ Assess stoma q 4h X 72 hours for colour (dusky purple = ischemia; black/brown = necrosis)
→ Stoma should pink or red
→ Some bleeding, edema normal size over time
→ Drainage may be absent for 24-48 hours, then dark green,
brown & identifiable as stool
→ Ileostomy: High-volume output (1200-1800 mL/day) initially, increased odour
→ Psychosocial- teaching re diet, ostomy management
Client Teaching and Support
Adaptation to Ostomy
→ Gradual process,
psychological support
needed
→ Concerns: Body image,
sexual activity, lifestyle
changes
→ Encourage gradual
involvement in self-care
→ Refer to ostomy support
groups
Resumption of Activities
→ Gradual resumption within
2-3 weeks
→ Avoid heavy lifting, physical
exertion, sports for 6-8 weeks
Sexual Function
→Discuss potential impact on
sexual function
→ Pelvic surgery, radiation,
chemotherapy can affect
function
→Psychological impact &
body image concerns
→ Encourage open
communication & coping
strategies
Ostomy Care
Stomal Protrusion:
→ Protrusion of 1 cm (colostomy) or 2 cm (ileostomy) makes care easier
to attach appliance
→ Flat stoma can cause skin integrity issues
Stomal Function:
→ Frequent function, stool is very irritating to skin
→ Pouch must be worn at all times for most ostomies
Pouch Management:
→ Open-ended, drainable pouch emptied when one-third full
→ Change pouch every 4-7 days unless leakage occurs
→ Transparent pouch initially, opaque pouches for home use
→ Clean stoma & skin with warm water
→ Usual output _______________________________
→ Drink at least 1.5 to 2 L of fluid daily
→ ___________fluid intake during hot weather, excessive perspiration, or diarrhea to replace losses and prevent dehydration
→Encourage well-balanced diet
→ Identify foods to reduce diarrhea, gas, or obstruction (with ileostomy)
→ Identify foods to reduce constipation and gas (with colostom
Complications of Ostomies
→ Irritant contact dermatitis (ICD), due to contact of drainage with the skin
→ Often from pouch leakage or improper fitting of the pouching system
→ Characterized by redness; loss of epidermal tissue; pain; & open, moist areas
→ Untreated or improperly treated ICD increases the likelihood of more
leakage, followed by more irritation
→ Treatment: barrier cream/paste, properly fitting appliance
→ Other: changes in stoma appearance or function
Other Complications of Ostomies
- Blockage- some food hard to digest. Ensure adequate hydration
- Electrolyte imbalance, dehydration if ostomy bypasses large intestine
- Hernia- abdominal wall around stoma weakens
- Narrowing of stoma- passage of stool is more difficult
- Prolapse- bowel pushes itself out through a stoma
Risks and Manifestations of Colorectal Cancer
Risk Factors:
→ High red/processed meat diet, obesity, inactivity, alcohol, smoking, low fruit/vegetable intake
→ Genetic conditions, family history
Clinical Manifestations:
→ Nonspecific, don’t appear until advanced disease
→ Rectal bleeding, alternating constipation & diarrhea, abdominal
cramps, gas, bloating
→ Change in stool caliber (narrow stool)
→ Loss of appetite, weight loss, lethargy, incomplete evacuation
Diagnostic Studies and Goals of Colorectal Cancer
Diagnostic Studies:
→ History & physical examination
→ Digital rectal examination
→ Screening: Fecal Occult Blood Test (FOBT), Fecal Immunochemical Test
(FIT)
→ Colonoscopy: Diagnosis & biopsy
Goals:
→ Appropriate treatment (tumour removal, adjunctive therapy)
→ Normal bowel elimination patterns
→ Quality of life appropriate to disease prognosis
→ Relief of pain
→ Feelings of comfort & well-being
Nursing Care for Colorectal Cancer
Health Promotion (prevention):
→ Screening recommendations: FOBT or FIT every 2 years for ages 50-
74
→ High-risk patients: Begin screening before age 50
Acute Intervention:
→ Preoperative & postoperative care for colon resection & ostomy
creation
→ Management of abdominal & perineal wounds & stoma
→ Addressing psychosocial/body image concerns
Evaluation:
→ QoL, pain relief, stable bowel elimination pattern
Nausea & Vomiting
Nausea:
Vomiting:
Mechanism
→ Coordinated activities of several structures
→ Involves closure of glottis, contraction of the diaphragm, and abdominal muscles
→ Nausea and vomiting often occur together and are treated as 1 condition
- Vomiting center in the brainstem coordinates emesis
- Can be a protective mechanism to rid the body of irritants
- Autonomic nervous system is activated during vomiting
- Sympathetic: Tachycardia, tachypnea, diaphoresis
- Parasympathetic: Relaxation of lower esophageal sphincter, increased gastric motility, salivation
Nausea & Vomiting: Manifestations and Assessment
Clinical Manifestations:
→ Nausea is subjective
→ Nausea/vomiting associated with loss of appetite, dehydration, electrolyte
imbalances, metabolic alkalosis/acidosis, weight loss
→ Risk of pulmonary aspiration in vulnerable patients
Interprofessional Care Goals
→ Determine & treat underlying cause
→ Provide symptomatic relief
Assessment:
→ History of vomiting episodes, precipitating factors, description of vomitus (emesis)
→ Differentiate between vomiting, regurgitation, projectile vomiting
→ Identify presence of fecal odor, bile, partially digested food, & blood in vomitus
Medication Therapy
Choice of Medications:
→ Depends on the cause
→ Administer with caution, as antiemetics may mask underlying disease
Mechanism:
→ Act on CNS & block neurochemicals triggering nausea & vomiting
Pharmacological Interventions for Nausea and Vomiting
1) Dimenhydrinate (Gravol)
2) Metoclopramide (Maxeran)
3) Ondansetron (Zofran)
Dimenhydrinate (Gravol)
Therapeutic Class: Antiemetic
Pharmacy Class: Anticholinergic, antihistamine
Action:
→ works by affecting the vomiting center in the brain to prevent & relieve nausea & vomiting
Common doses:
→ Adults typically take 50-100 mg every 4-6 hours as needed
Routes:
→ Oral (tablets, liquid), rectal (suppositories), & injectable (IM, IV)
Side effects:
→ Drowsiness, dizziness, dry mouth, blurred vision, & constipation
Nursing considerations:
→ Monitor for drowsiness & dizziness
→ advise patients to avoid
driving or operating heavy machinery
→ ensure they stay hydrated
Metoclopramide (Maxeran)
Therapeutic Class: Antiemetic
Pharmacy Class: Dopamine Receptor Antagonist
Action:
→ increases the motility of the upper GI tract, helping food move through the stomach more quickly & reducing nausea
Common doses: Adults usually take 10-20 mg orally or IV before chemotherapy or
surgery
Routes: Oral (tablets, liquid), & injectable (IM, IV).
Side effects:
→ Drowsiness, fatigue, restlessness, & potential movement disorders
Nursing considerations:
→ Monitor for signs of movement disorders
→ advise patients to
avoid alcohol
→ assess for drowsiness & dizziness
Ondansetron (Zofran)
Therapeutic Class: Antiemetic
Pharmacy Class: Serotonin Receptor Antagonist
Action:
→ blocks serotonin receptors in the brain & gut, which helps prevent nausea &
vomiting
Common doses: Adults typically take 8 mg orally or IV before chemotherapy or
surgery, & then every 8 hours as needed
Routes: Oral (tablets, disintegrating tablets, liquid), & injectable (IV, IM)
Side effects:
→ Headache, constipation, dizziness, & potential QT interval prolongation
Nursing considerations:
→ Monitor for signs of QT prolongation
→ assess for headache &
constipation
→ ensure proper hydration
Nursing
Interventions for Nausea and Vomiting
Goals
→ Minimize nausea & vomiting
→ Maintain normal electrolyte levels & hydration
→ Restore normal fluid balance & nutrient intake
Nursing Management:
Non-pharmacological methods
→ Monitor for dehydration, electrolyte imbalances
→ Provide physical & emotional support
Nutritional Therapy:
→ IV fluids with electrolytes & glucose for severe
vomiting
→ NG tube & suction to decompress the stomach
→ Gradual reintroduction of oral nourishment
Evaluation of Interventions for Nausea and Vomiting???
Expected Outcomes of Treatment
The patient will:
→ be comfortable with minimal or no nausea and vomiting
→ maintain body weight
→ electrolytes will be within normal range
→ maintain adequate intake of fluids and nutrients
→ maintain normal urone volume
Diarrhea
- Frequent passage of loose, watery stools
- Symptom, not a disease
Etiology:
→ Decreased fluid absorption
→ Increased fluid secretion
→ Motility disturbances
→ Combination of factors
Infectious Causes:
→ Viruses (e.g., rotavirus, norovirus)
→ Bacteria (e.g., Salmonella, Clostridioides (aka clostridium difficile)
→ Parasites (e.g., Giardiasis lamblia)
Clinical Manifestations & Diagnostic Studies of Diarrhea
Clinical Manifestations:
→ Acute vs. chronic diarrhea (> 2 weeks, returns more than 2-4 weeks after initial episode)
→ Symptoms: Explosive watery diarrhea, tenesmus, cramping, perianal
irritation
→ Systemic symptoms: Fever, nausea, vomiting, malaise
→ Severe cases: Dehydration, electrolyte imbalances, malabsorption,
malnutrition
Diagnostic Studies:
→ Thorough history & physical examination
→ Stool tests: Blood, mucus, WBCs, ova, parasites
→ Stool cultures (to identify infectious organisms)
→ Endoscopy & radiographic studies
Treatment Goals of Diarrhea
Treatment Goals
→ Replace fluids & electrolytes
→ Decrease stool frequency & volume
Mild Diarrhea
→ Oral solutions with glucose & electrolytes (e.g., Pedialyte)
Severe Diarrhea
→ Parenteral fluids, electrolytes, vitamins, & nutrition
Pharmacological Agents
Protect mucous membranes
→ Absorb irritants
→ Inhibit GI motility
→ Decrease intestinal secretions
→ ** Avoid antidiarrheals in infectious diarrhea **
Pharmacological Interventions for Diarrhea
1) Loperamide (Imodium)
Therapeutic Class: Antidiarrheal
Action:
→ acts directly on the intestinal muscles to decrease GI peristalsis; reduced
volume & increased bulk of stool & prevents loss of electrolytes
Common doses: Adults take 4 mg orally after the first loose stool, then 2 mg after
each subsequent loose stool
Routes: Oral (tablets, tablets, liquid),
Side effects:
→ Constipation, dizziness, drowsiness, nausea, & stomach cramps
Nursing considerations:
→ Monitor for signs of constipation & abdominal distension
→ assess bowel function & fluid balance
C. Difficile Infections
Clostridium difficile:
→ Causes diarrhea & colitis
→ Present in normal flora & hospital environments
→ Risk factors: Prolonged antibiotic therapy, chemotherapy, advanced age
Symptoms:
→ Watery diarrhea, fever, loss of appetite, nausea, abdominal pain
Diagnosis & Treatment:
→ Laboratory confirmation from stool sample
→ First-line therapy: Metronidazole (Flagyl)
→ Alternatives: Vancomycin, Fidaxomicin
Nursing Assessment and Goals for C.Diff
Nursing Assessment
→ Thorough history & physical examination
→ Assess stool pattern, duration, frequency, character, consistency
→ Medication, travel, dietary history
Goals
→ Prevent transmission of infection
→ Cease diarrhea, resume normal bowel patterns
→ Maintain fluid, electrolyte, & acid-base balance
→ Prevent perianal skin breakdown
Infection Control for C.Diff
→ Contact isolation precautions
→ Environmental cleaning with hospital-grade disinfectant
→ Wash hands with soap & water*
Constipation
- Decrease in bowel movement frequency
- Hard, difficult-to-pass stools
- Decrease in stool volume
- Retention of feces in the rectum
- May be accompanied by nausea, abdominal distention, bloating
- May be acute or chronic
Causes of Constipation
- insufficient dietary fiber
- inadequate fluid intake
- medications
- lack of exercise
- sociocultural and environmental factors
Complications of Constipation
- Diverticulosis
- Fecal impaction & colonic perforation
- Anal fissures & rectal mucosal ulcers
- Hemorrhoids (straining)
- Complications of Valsalva manoeuvre
Diagnostic Studies & Management for Constipation
Diagnostic Studies:
→ History & physical examination
→ Abdominal radiographs, barium enema, colonoscopy, sigmoidoscopy
Management:
→ Diet therapy: Increase fiber & fluids (min 30 g fiber, 1.5-2L/day)
→ Exercise
→ Cautious use of laxatives
→ Step wise approach from bulk-forming fibre to stimulants
→ Enemas for immediate relief
Medications to Treat Constipation
Bulk-forming medications (ex. Metamucil)
→ Absorb water which increases bulk, stimulating peristalsis
Stool softeners & lubricants (ex. Docusate sodium [Colace])
→ Lubricate intestinal tract & soften feces, making it easier to pass
Saline & Osmotic Solutions (ex. Fleet enema, lactulose, PegLyte)
→ Cause retention of fluid in intestinal lumen
Stimulants (ex. Senna [Senokot], Bisacodyl [Dulcolax])
→ Increase peristalsis by irritating colon wall & stimulating enteric
nerves
Nursing Management of Constipation
Planning Goals:
→ Increase dietary fiber & fluid intake
→ Achieve passage of soft, formed stools
→ Prevent complications (e.g., bleeding hemorrhoids)
Nursing Assessment:
→ Obtain subjective & objective data
Nursing Implementation:
→ Teach importance of dietary measures
→ Maintain high-fiber diet, increased fluid intake (3000 mL/day), regular exercise
→ Establish regular meal & defecation patterns
→ Proper positioning during defecation
Fecal Incontinence
Fecal Incontinence
→ Involuntary passage of stool
Pathophysiology
→ Motor or sensory disorders (dementia, stroke, spinal cord injury, radiation)
→ Secondary to fecal impaction
→ Functional incontinence (physical or mobility impairment affecting toileting)
Diagnostic Studies:
→ Health history & physical examination
→ Rectal examination, flexible sigmoidoscopy
Nursing Interventions for Fecal Incontinence
- Address underlying cause
- Antidiarrheal agents – if
incontinence is related to noninfectious diarrhea - Manual disimpaction, lubricants, cleansing enemas – if incontinence
is from fecal impaction - High-fiber diet, increased fluid intake – to prevent recurrence
- Assess bowel habits & symptoms
- Implement bowel training
programs - Administer medications as needed
- Maintain skin integrity
- Use fecal containment devices, incontinence briefs
- Educate patient on proper perianal care
Review of the GU System
Kidneys: Filter blood to remove
waste products & excess fluids, forming urine
Ureters: Transport urine from the kidneys to the bladder
Bladder: Stores urine until it is
excreted
Urethra: Transports urine from the bladder out of the body
Reproductive Organs: Include the testes & penis in males, & the ovaries, fallopian tubes, uterus, & vagina in females
Common GU Issues
- Urinary Tract Infections (UTIs)
- Urinary Incontinence
- Urinary Retention
- Benign Prostatic Hyperplasia (BPH)
- Kidney Stones
- Sexually Transmitted Infections (STIs)
- Acute Kidney Injury
- Chronic Kidney Disease
Urinary Tract Infections
- Most common bacterial infection in women
- High prevalence in older adults
Causes:
→ Bacterial infection most common
→ E. coli is the primary pathogen
Classification:
→ Upper UTI: Involves renal parenchyma, renal pelvis, ureters – systemic manifestations
→ Lower UTI: Involves bladder & urethra
→ Location of the UTI/inflammation
→ Initial vs. recurrent infections
Etiology & Pathophysiology of UTIs
Sterility of Urinary Tract:
→ Normally sterile above the urethra
→ Defence mechanisms
against UTIs: Complete
bladder emptying, antibacterial properties of
bladder mucosa & urine
Pathogens
→ Introduced via ascending route from urethra
→ Common pathogens: Gram-negative bacilli (e.g., E.
coli), Grampositive organisms (e.g., streptococci, enterococci)
Predisposing Factors
→ Urological instrumentation
(e.g., catheterization)
→ Sexual intercourse
→ Health care– associated
infections (e.g., indwelling
urinary catheters)
Routes of Infection:
→ Ascending route most common
→ Hematogenous route (rare): Bloodborne bacteria invade urinary tract
Clinical Manifestations of UTIs
Lower Urinary Tract Symptoms (LUTS):
→ Dysuria, frequency, urgency, pain on urination
→ Suprapubic discomfort or pressure
→ Hematuria or cloudy urine
Upper Urinary Tract Symptoms:
→ LUTS listed above & flank pain, chills, fever
→ Indicates pyelonephritis
Older Adults:
→ Nonlocalized abdominal discomfort
→ Cognitive impairment or delirium
→ Less likely to have fever
Diagnostic Studies for UTIs
Dipstick Urinalysis:
→ Initial test
→ Identifies nitrites (indicating bacteriuria), WBCs, leukocyte esterase
Urine Culture:
→ Indicated for complicated or recurrent UTIs or when UTI unresponsive to ABX
→ Preferred method: Voided midstream clean-catch sample
→ Alternative methods: Catheterization, suprapubic needle aspiration
→ Sensitivity Testing
Imaging Studies:
→ IVP or abdominal CT scan for suspected obstruction
Nursing Interventions for UTI’s
Planning Goals:
→ Relief from symptoms
→ Prevention of upper urinary tract involvement
→ Prevention of recurrence
Nursing Assessment:
→ Obtain subjective & objective data
→ Identify symptoms & risk factors
Health Promotion VS. Acute Intervention for UTI
Health Promotion
→ Recognize individuals at risk
→ Educate on preventive measures: regular bladder & bowel emptying, proper perineal hygiene, adequate
fluid intake (33ml/kg/day)
→ Avoid unnecessary catheterization & advocate for early removal of indwelling catheters
→ Perform hand hygiene & use aseptic technique
Acute Intervention:
→ Collect urine samples
→ Ensure adequate fluid intake
→ Avoid bladder irritants: alcohol, caffeine, citrus juices, chocolate
→ Apply heat to relieve discomfort
→ Educate on medication adherence & full course of antibiotics (usually 1-3-
or 3-5-day course)
→ Monitor for changes in urine & symptoms
Urinary Incontinence Incontinence
- Uncontrolled loss of urine
- More common in women & older adults
- UI is NOT a natural consequence of aging
- Transient (acute) UI
- Caused by confusion, depression, infection, medications, restricted mobility, stool impaction
Established (chronic) UI
1) Stress incontinence:
sudden increase in intrabdominal pressure
→ pelvic muscle concerns
2) Urge incontinence: sudden involuntary urination with little warning
→ overactive bladder secondary to CNS and bladder disorders
3) Overflow incontinence: pressure from overfull bladder causes leakage
→ outlet obstruction
4) Functional incontinence: due to mobility/environmental factors
Urinary Retention
- Inability to empty the bladder
- May be associated with dribbling (overflow UI)
- Acute: Total inability to pass urine (medical emergency)
- Chronic: Incomplete bladder emptying despite urination
→ Post-void residuals may be 150-200 mL or more
Causes:
→ Bladder outlet obstruction (eg. enlarged prostate)
→ Deficient detrusor contraction strength (eg. neurological disorders, DM, overdistension)
Diagnosis of Incontinence & Retention
Evaluation of Incontinence & Retention
→ Focused history, physical assessment, bladder log or voiding record
→ Assess onset of UI, provoking factors, associated conditions
Physical Examination
→ General health, mobility, dexterity, cognitive function
→ Pelvic examination: Inspect perineal skin, evaluate pelvic muscle strength
Diagnostic Tests
→ Urinalysis: Identify contributing factors (e.g., infection, diabetes) for transient UI or retention
→ Postvoid residual volume: Measure after urination using a bladder scan or intermittent
catheterization
Treatment of Incontinence & Retention
- 80% of incontinence can be cured or significantly improved
- Pelvic Muscle Training
→ Kegel exercises for stress, urge, or mixed UI - Bladder Training & Prompted Toileting
- Anti-incontinence devices
→ Intravaginal support devices (pessaries) - Containment devices
→ Condom catheters, absorbent products - Antimuscarinic (antispasmodic) medications for urge UI
- Surgical therapy if needed
Nursing Management of Urinary Incontinence
Conservative Management of UI symptoms
→ Hydration, reduce caffeine & alcohol, smoking cessation
→ Manage constipation: Fluid intake, dietary fiber, exercise, stool softeners
→ Improving continence can help prevent falls & skin breakdown
Habit Training & Prompted Toileting:
→ Habit training: Use voiding diary to establish voiding frequency & create voiding schedule
→ Prompted toileting: Regular reminders for patients with cognitive impairment
Product Information:
→ Use products designed to contain urine
→ Incontinence pads, briefs, pad–pant systems
Nursing Management for Urinary Incontinence Continued…
Scheduled Toileting & Double Voiding
→ Effective for urinary retention with moderate postvoid residual volumes
→ Crede manoeuvre: Manual pressure on lower abdomen to facilitate bladder emptying
Intermittent Catheterization
→ Reduces risk of UTI & urethral irritation compared to in-dwelling catheters
In-Dwelling Catheter
→ Used when urethral obstruction makes intermittent catheterization unfeasible
Medication Therapy
→ Tamsulosin (Flomax): Relax smooth muscle of bladder neck & urethra
→ Finasteride (Proscar): Reduces prostate size, useful for BPH-related hematuria
Surgical Therapy
→ Treatment of prostatic enlargement
Urinary Catheterization
Indications for Catheterization
→ Accurate measurement of urinary output in critically ill patient
→ Facilitation of surgical repair
→ Measurement of residual urine if bladder scanner not available
→ Relief of urinary retention
→ Urine contamination of stage 3 or 4 pressure injury
→ Sterile urine specimens in complicated infections
→ Instillation of medications into bladder
Indications that are NOT Valid
→ Routine urine specimen collection
→ Convenience of staff or family
Risks
→ High risk of health care–associated infections & major cause of UTIs
Urethral Catheterization:
Catheter Types:
→ Vary in materials, tip shape, & lumen size
→ Sized according to the French scale (12-14F for women, 14- 16F for men) – larger # = larger diameter
Urethral Catheterization:
→ Most common route: through external meatus into the bladder
→ Use sterile, closed drainage system
→ Maintain unobstructed downhill flow
→ Regular perineal care with soap & water
→ Avoid routine catheter irrigation. If irrigation is needed, use a triple-lumen catheter with an irrigation port
→ Common complication CAUTI
Types of Catheters
1) Ureteral Catheters
→ Inserted through ureters into renal pelvis
→ Used post-surgery to splint the ureters & prevent obstruction by edema
2) Suprapubic Catheters
→ Catheter placed through a small incision in the abdominal wall
→ Care similar to urethral catheter
→ Temporary: Bladder, prostate, urethral surgery
→ Long-term: Select patients (e.g., tetraplegia)
Intermittent Catheterization
Purpose:
→ Gold standard for urinary retention
→ Used for neurogenic bladder, bladder outlet obstruction, post-surgery
→ Reduced complications compared to indwelling catheter
Technique:
→ Insert urethral catheter every 3 to 5 hours
→ Remove catheter after bladder is emptied
Nursing Care for Catheters
Goal: Prevent infection, maintain skin integrity
Interventions:
→ Manage fluid intake & track fluid balance
→ Use sterile technique to insert catheter & advocate for catheter removal when it
is no longer indicated
→ Check the catheter & drainage system regularly for signs of blockage, leakage, or
infection
→ Perform routine perineal care & clean the catheter insertion site
→ Educate patients & their families on proper catheter care
→ Maintain a closed drainage system to minimize the risk of infection (bag always lower than bladder to prevent backflow)
