Week 9 - Urinary Elimination Care Flashcards
Micturition
Process of emptying the bladder
Volume of normal adult voiding
1500-1600mL/day
Q3-4 hours
Sign of renal dysfunction
Voiding less than 30mL/hr
Factors Influencing Urinary Elimination (7)
Medication Environment Psychological factors Sociocultural factors Fluid balance Surgical procedures/ diagnostic examinations Pathological conditions
Process of Micturition (5)
- Stretch receptors in bladder
- Impulses sent to spinal cord
- Signals travel to pontine micturition centre in brainstem
- Signals sent back down resulting in relaxation of internal sphincter & contraction of detrusor muscle
- Conscious relaxation of external urethral sphincter
When might we initiate monitoring of ins and outs? (7)
- suspected urinary retention
- after surgery
- pts with renal/kidney issues
- CHF pts
- pts on diuretics
- pts with diarrhea and emesis
- pts with a lot of drainage
Measuring output with: Graduated Cylinder
Emptying urine bag for a very accurate measurement
Measuring output with: urometer
Helps us measure without having to transfer from the urine bag (attached to urine bag)
Measuring output with: urine hat
Attaches to the toilet and pt voids right into the hat
Urinals
Used for collection and measurement
There are types for people with penises and for vaginas
Incontinence
Symptom of urinary alteration
Involuntary loss of urine
NOT a normal part of aging
Dysuria
Symptom of urinary alteration
pain or difficulty urinating
“Frequency”
Urinating more than 8x per day
Symptom of urinary alteration
Dribbling
Symptom of urinary alteration
Leakage of urine despite voluntary control
Hesitancy
Symptom of urinary alteration
Difficulty initiating urination
Polyuria
Symptom of urinary alteration
Large volume while voiding
Oliguria
Symptom of urinary alteration
Diminished volume while voiding
Nocturia
Symptom of urinary alteration
Waking up to pee
Hematuria
Symptom of urinary alteration
Blood in urine
Elevated post-void residual urine
Symptom of urinary alteration
Urine that remains in bladder after client has voided
More than 100ml remaining in bladder is abnormal
Can contribute to incontinence and bacterial infection
Strategies for Promoting Continence (7)
- Lifestyle modification
- Pelvic floor muscle exercises (aka Kegel exercises)
- Bladder training
- Habit retraining and prompted voiding
- Intermittent catheterization
- Medications
- Maintaining skin integrity
Causes of urinary retention
Under active detrusor muscle
Urethral obstruction
Causes of acute urinary retention (4)
- Surgical or childbirth trauma
- Medication side effects
- Fecal impaction
- Surgery/anesthesia
Causes of chronic urinary retention (4)
- Enlarged prostate
- Pelvic organ prolapse
- Urethral stricture
- Alterations in motor and sensory innervation of the bladder
Signs and symptoms of Urinary Retention (6)
- Feelings of pressure & discomfort
- Restlessness, diaphoresis
- Distended bladder
- Dullness over suprapubic area
- Absence of urine output (acute)
- Small frequent voiding or dribbling
Pathology of prolonged retention
- Prolonged retention
- Stagnation/Stasis of urine
- Greater Risk of UTI
- Kidney Infections
Bladder Scanner
Ultrasound technology using high-frequency sound waves to detect urine volume in bladder
Intermittent (straight/in-and-out) Urinary Catheter
Inserted for ~5-10 minutes or just long enough to empty the bladder.
Performed by nurse or patient
Clean procedure.
Indwelling (foley/retention) Urinary Catheter
Retained for longer using small balloon that keeps catheter in the bladder.
Sterile procedure
“French”
Unit to measure a catheter.
Larger the French the wider the lumen.
When to use intermittent catheterization (5)
- Bladder distension
- Sterile urine specimen
- Assess post-void residual
- Urethral strictures
- Management for patients with SCI, neuromuscular degeneration, incompetent bladder
When to use SHORT TERM indwelling catheterization (6)
- Some surgical procedures
- Continuous measurement
- Bladder irrigation
- Prolonged immobilization d/t trauma
- Acute retention/obstruction
- End-of-life (only if required)
When to use LONG TERM indwelling catheterization (3)
- Chronic retention
- Pressure injury or wounds
- Intractable incontinence
How far to advance a urinary catheter?
Vaginas: 5-7.5”
Penises: 22cm (slightly longer than client’s anatomy)
Considerations for urine collection bag
Hang below level of pt bladder to prevent backflow
Catheter care - perineal care
At least BID, post BM and prn
Soap and water, clean to dirty
Catheter care
- Per policy, usually TID and post BM
- Urethral meatus followed by
catheter (10cms)
Promote fluid intake to flush bladder
Potential sites for introduction of infection in a urinary catheter (5)
- insertion site
- junction of where bag connects to catheter
- junction where tube meets bag
- bag itself (reservoir)
- spigot
Preventing Catheter-Associated Urinary Tract Infection (CAUTI) (8)
- Hand hygiene
- Strict aseptic technique
- Maintain closed system
- Prevent pooling of urine in tubing
- Avoid kinks in catheter tubing
- Don’t let bag drag on floor
- Empty drainage bag at least q8h (or ½ full)
- Remove catheter as soon as clinically possible!!
Closed bladder irrigation
Triple-lumen catheter required
Used for pts post-genitourinary surgery to remove clots
Allows for intermittent irrigations or continuous irrigation (CBI)
Suprapubic Catheterization
Surgically placed through the abdominal wall above the symphysis pubis and into the urinary bladder
Usually sutured into place
Tends to reduce the incidence of infection
Used for pts urethral trauma, gyne procedures, or pts at home
Condom Catheter
Used for urinary incontinence and nocturia (penis only)
Little risk of infection, BUT skin breakdown is a concern
MUST use the tape provided in the kit, because it stretches as the penis changes size
Urinary Tract Infections (UTIs)
Infection of lower urinary tract leading to cystitis, urethritis and prostatitis
Easy to treat but can spread to blood or kidneys
Occur more in vaginas – shorter urethra and proximity of rectum to urethral meatus
Risk factors for UTIs (9)
Sexual activity Pregnancy Low levels of vaginal estrogen Obstruction of urinary tract Incomplete bladder emptying Abnormal anatomy Older age Antibiotics Decreased immunity
Signs and symptoms of UTI (9)
Dysuria Fever Chills Nausea Vomiting Frequency Urgency Hematuria Urine concentrated and cloudy (possibly foul smelling)
Prevention of UTIs (4)
- good hygiene
- showers not baths
- daily intake of 1500-2000ml
- frequent voiding q2-4
Routine/routine and microscopic urine specimen for urinalysis (R and M)
Checks for: Urine pH, protein, glucose, ketones, blood, urine-specific gravity (urine concentration)
Micro: WBC, bacteria, casts (produced by the kidney, indicative of renal dysfunction)
Collected via normal urination in specimen cup or from urinary catheter or diversion bag
Culture and Sensitivity test (C and S)
Culture: bacterial growth
Sensitivity: which antibiotic is most effective
Can be collected by midstream or catheter
Midstream urine specimen/clean-catch specimen/clean-voided specimen (C and S)
Used to avoid contamination of urine sample
Sterile Urine Specimen
Collected from tube port of closed drainage system
Timed Urine Specimens
Collected over a defined period of time (i.e., numerous voids)
Must document when the collection time-frame begins and ends
Urinary diversions
Used to bypass the bladder and the urethra, urine needs to exit via another route
Indications:
- bladder cancer
- bladder trauma
- radiation injury
- fistula
- chronic cystitis
Ureterostomey
Urinary diversion
bringing the end of one or both ureters to the abdominal surface
Nephrostomy
Urinary diversion
tube placed directly into the renal pelvis to provide urinary drainage
Ileal loop or conduit
Urinary diversion
Ureters are attached to a segment of the ileum, used to drain urine externally
Indication for dialysis
- Renal failure that can no longer be treated with medication or diet modification alone
- Worsening of the uremic syndrome in end-stage renal disease
- Severe fluid or electrolyte imbalances that cannot be controlled
Peritoneal dialysis
Indirect using osmosis and diffusion
Hemodialysis
Machine using semi-permeable filtering membrane (akin to an artificial kidney)
Transient urinary incontinence
Urine loss resulting from causes outside of or affecting the urinary system
Resolved when causes are treated
Delirium, intake of fluids, stool impaction, atrophic vaginitis, psychological problems, pharmaceuticals, excess urine output, abnormal lab values, restricted mobility (DISAPPEAR)
Urge urinary incontinence
Urine loss associated with or immediately preceded by a sudden and urgent need to void that cannot be postponed.
- Overactive bladder syndrome.
- Common in pts with CNS disorders
Stress urinary incontinence
Urine loss resulting from increased intra-abdominal pressure (coughing, sneezing, laughing, lifting)
Mixed urinary incontinence
Urine loss that has features of both stress and urgent incontinence
Functional urinary incontinence
Urine loss due to inability to reach the toilet in time
Pts with cognitive, physical, or mobility impairments
Urinary incontinence associated with Chronic Retention
Involuntary loss of urine when the bladder does not completely empty with a high residual urine volume or a palpable nonpainful bladder remaining after voiding
Pts with prostate enlargement, spinal lesions, neurological conditions
Multifactorial urinary incontinence
Urine loss due to multiple interacting factors both inside and outside of the urinary tact
(medications, age-related changes, environmental factors, etc.)
