Organs of urinary elimination
Kidneys |
removes wastes from the blood in form of urine |
Ureters |
Transports urine from the kidneys to the bladder |
Bladder |
reservoir for urine until the urge to urinate develops |
Urethra |
Urine travells. |
Differences: Female urethra is shorter than male's so more prone to UTIs
Factors effecting urination
Disease conditions |
neurogenic bladder, renal failure, etc |
Medications and medicla procedures |
diuretics, fluids via IV, antidiuretics, anticholinergics, |
Socioeconomic factors |
Nervous bladder, SRO Hotels, no water, etc |
Psychological factors |
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Fluid balance |
Nocturia, polyuria, oliguria, anuria, diuresis, fever |
Changes with aging
Prostate enlargement: starst at 40's to 80's. Urinary frequency and possible retention. |
Child bearing/hormonal changes/menopause: causes urinary difficulty such as decreased muscle tone, urinary urgency and stress incontinence. |
Elderly tend to drink less. |
Urinary incontinence is not a normal part of aging |
Decreased estrogen during & after menopause. increased risk of UTIs because urethral mucosa becomes thinner. |
Common Urinary Problems
Urinary retension |
bladder is unable to partially or completely empty. |
socioeconomic, neurogenic bladder |
Urinary tract infections (UTIs) |
nosocomial, bacteriuria, urosepsis |
hygiene, holding in, dehydration |
Urinary incontinence |
loss of control over voiding |
lots of patients have colonozed bladders, but not considered a UTI.
Containment Devices
absorbent day pads |
Briefs |
Condom Catheters |
Foley catheters |
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SPC Subra Pubic Catherizations |
Catheterizations
Sterilization is extremely important to not introduce pathogens into the urethra. |
Type A: straight. single us only |
Type B: Indwelling Foley. Has a little balloon filled with sterile water or saline. Has a split section for a syringe and urinary elimination. |
Potential sites for infection
insertion point
where the tub attaches to the catheter
where the tube attaches to bag
when too close to the ground
bag too full
drainage point
SPC caths
CARE - SPC |
CARE Urinary cath |
inspect stoma daily |
handwashing |
cleanse stoma |
perineal care daily and prn |
roll cath between fingers daily |
urine drains freely into bag |
cath bad below bladder,/ not touching floor |
bag not above bladder/ not close to ground |
cath secure, prevent pulling on skin. |
avoid tube kink |
drain when 1/2 - 2/3 full. |
maintain aspepsis when emptying bag |
change spic, bag, tubing per facility/physician orders |
wipe port with alcohol wipes prior to reconnecting when converting to alternate system. |
document & care plan. |
- no longer take samples from cath bag. most residential patients will be colonized.
- mid-stream is how to take a sample.
policy states that cath has to be removed and sample taken from new cath. do we need a CNS for this patient?
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Normal characteristics of urin
Volume: >30mls per hour (intke/output) | 1200-1500mLs per 24hrs. Void 4/5x/day |
Sterile |
colour: pale straw to amber, depends on concentration |
clarity: transparent |
pH 4.5-8.0 |
Specific gravity 1.010-2.025 |
No glucose, ketones or blood |
odour: mild ammonia in nature |
Colors caused by medications
Dark yellow: vit b12 |
Orange: sulphas; pyridium; warfarin |
pink/red: ex-lax; dilantin |
green/blue: amitriptyline; methylene blue |
brown/black: iron;levodopa; nitrofurantoin; metronidazole |
Specimen collection
urinalysis (u/a): ph, presence of protein, glucose, ketones, blood, specific gravity SG |
Clean voided or midstream, sterile colelction cup |
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Urine culture: may need 72hrs to determine bacterial growth. |
clean coided or midstream, sterile collection cup. |
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time collections- 12/24hrs: no urine or toilet tissue contamination |
clean receptacle, stored until collection finished. |
Asssiting urination
promote bladder emptying and relaxation |
bladder re-training, bladder diary, voiding regular intervals, 5-7x/day |
strengthening pelciv floor muscles (kegels) |
precent infection, avoid indwelling caths. |
encourage activity/mobolity -> reduces pressur ulcers and possible need for indwelling cath. |
drug therapy |
Kegels
squeeze pelvic muscles slowly increasing intensity over 8 seconds |
hold for 8 sec |
relax slowly over 8 sec |
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bladder scanner: see what kind of catheter is right for the patient. helps determine for full bladder and post-void residuals. PVR (post void residual). |
Catheter assessment
asses meatus for swelling, redness, or discharge |
patient, bed soaker pad, fram attached |
no kinks |
approx vol in drainage bag. bag not touching floor. |
to drain bag place cylinder on floor and drain into without touching the cylinder. |
assess urin color, smell, and texture when draining, close bag properly. |
note volume. dispose urine according to policy. |
condom cath
condom |
externally, less invasive, |
not too tight, not too loose |
check id band, allergies? latex. |
get supplies ready |
wash up client. pericare. |
cleanest to dirtiest. |
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