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Nursing

Urinary Elimination

QuestionAnswer
Assessment of Urine I&O. Characteristics: volume, color, clarity, odor. Urine testing: specimen collection.
Factors affecting Urination Fluid intake, loss of body fluid, nutrition, body position, psychological factors, cognition, obstruction of urine flow, infection, meds, hypotension, neurologic injury, decreased muscle tone, pregnancy, surgery, urinary diversion
Altered Urinary Function Dysuria (painful), polyuria, oliguria (decreased), urgency, frequency, nocturia, hematuria (blood), pyuria (pus), urinary retention, enuresis, urinary incontinence (stress, urge, reflex, functional, total- no control), urinary diversion
Urinalysis Common urine test. Check for color, clarity, pH, specific gravity, protein, glucose, ketones, blood, WBC
Specific Gravity Urine Test Measures the concentration of solutes. 1.010-1.025. If dehydrated S.G. increases, if overhydrated S.G. decreases.
Culture and Sensitivity Urine test for infection. Midstream. Catheter collection.
24 hour Urine Collection Accurately measures kidney excretion. Discard first void. Collect ALL urine produced for 24hrs. Avoid contamination with stool. Keep collection container on ice or refrigerator. At the end of 24 hr period have client empty bladder. Mark time for 2nd void
Why is 24 hour urine test ordered? Could indicate autoimmune diseases, diabetes, heart failure, kidney damage
Urine collection techniques Clean catch or midstream. Catheter catheter. Straight catheter.
BUN Blood uria Nitrogen. Measures urea nitrogen in blood. Byproduct of liver metabolism. Normal range 5-20 mg/dL. If above normal, kidneys not functioning well.
Creatinine More sensitive than BUN. Byproduct of breakdown of skeletal muscle tissue. Normal range: Female 0.5-1.0 mg/dL. Male 0.6-1.3 mg/dL
BUS Bladder Ultrasound.
Radiologic Tests KUB: xray of ureter & pelvis. IVP: Intravenous pylogram. Inject contrast dye into pts IV. Take xrays to identify obstruction. Increase fluid intake post op.
Cystoscopy Scope inserted through urethra up to bladder.
Urodynamic Studies Monitors how blood stores & eliminates urine
Nursing Diagnosis Urinary incontinence, risk for infections, toileting: self-care deficit, impaired urinary elimination, urinary retention, disturbed body image, pain, impaired skin integrity, impaired urinary elimination
Indication for Catheterization Incontinence, urinary retention, accurate assessment of output, surgery, trauma
Straight Catheter Temporary. Used to drain catheter than remove. Inserted through the urethra. Used to check post void residual or to obtain sterile urine specimen.
Retention/Foley take out within 72 hrs of insertion. Do not inflate balloon before insertion. Left in place to drain urine over a period of time.
Suprapubic Long term. Trauma, cancer, surgery to bladder. Comes out through skin right above pelvic bone. Advantages: decreased infection rate, increased comfort.
Condom/Texas For men. Sits on outside of penis. Cleanse penis with soap and water. Risk for skin break down. Leave one to two inches at the tip of penis. Advantages: low risk for UTI. Disadvantage: potential for decreased circulation.
Nursing considerations for Urinary Catheterization Prepare client: Explain procedure. Position client. Provide privacy. Drape appropriately. Provide for client comfort. Provide perineal care before procedure.
Catheterization Procedure Wash hands Select size & type of catheter Collect necessary equipment Identify & assess the client Set up equipment Set up sterile field Sterile glove Open cleansing solution Open lubricant Attach pre-filled syringe of sterile water to catheter
Which hand is used to expose meatus during catheter procedure? Non-dominant hand. Retract foreskin on males. Separate labia on females.
Catheterization Procedure cont Clean meatus using sterile hand & swab. Use swab only once. With Sterile hand insert the catheter into the meatus until urine appears. After urine return, insert catheter two more inches. Inflate balloon. Attach bag to bed. Clean client.
Documentation of catheterization Date & time. Type & size. If a specimen was obtained & sent to lab. Amount of urine drained. Description of urine. Client's response.
How to swab a male for catheterization Circular motion from the meatus outward
How to swab a female for catheterization One side, front to back, other side front to back, ending with one swab down over the meatus
Things to remember Empty foley bag at least every 8 hours. Maintain closed sterile system. Tape or secure catheter to prevent pulling.
Things to remember cont Clean perineum & catheter daily with soap & water. Place client on I&O. Encourage client to increase fluid intake unless contraindicated. Keep foley bag below level of bladder. Hang foley bag on bed frame, not on side rail, not laying on floor.
Irrigating a catheter Used to cleanse the lumen of the catheter. Promotes Patency of the tube.
Irrigating a bladder Removes mucous, blood clots, and other tissue from the bladders. Introduces medication into the bladder.
Created by: senmark