Chapter 22: Urinary Elimination

external catheter

A catheter placed on the outside of the body (male or female) and drains urine to a collection container.

straight catheter

A catheter that drains the bladder and then is removed

What should you remind mean to do after using their urinals?

Remind men to hang urinals on bed rails and to use the call light after using them. Remind them not to place urinals on over-bed tables and bedside. (some beds may not have bed rails. Follow center policy for where to place urinals.)

Where are drainage bags placed?

The bag hangs from the bed frame, chair, lower part of an intravenous (IV) pole, or wheelchair.

Some states and centers let nursing assistants insert and remove catheters. True or false?

True.

Incontinence may be temporary or permanent. True or false?

True. Incontinence can be temporary or permanent.

UTI

Urinary tract infection

What would happen if the drainage bag is high than the bladder?

Urine can flow back to the bladder. A UTI can occur.

reflex incontinence

Urine lost at predictable intervals where the bladder is full. The person does not feel the need to void.

urinary frequency

Voiding at frequent intervals

What is the drainage bag drained into for measurement?

graduate

Fracture pan

has a thin rim. It is only about 1/2-inch deep at one end.

Plastic urinals

have caps and hook-type handles.

Sometimes incontinence results from:

intestinal, rectal, and reproductive system surgeries, physical illness or medications.

Commode

is a chair or wheelchair with an opening for a container.

Who is at high risk of catheter-associated urinary tract infections?

persons with indwelling catheters

Clamped catheter

prevents urine from draining out of the bladder

How long does successful bladder retraining take?

several weeks.

Oliguria

(voiding less than 500 mL [milliliters] in 24 hourse)

Bedpans are used by:

- Persons who cannot be out of bed - Women for voiding and bowel movements - Men for bowel movements

The urinary system:

- Removes waste products from the blood - Maintains the body's water balance

The basic types of incontinence are:

- Stress - Urge - Over-flow - Functional - Reflex - Mixed incontinence - Transient

If a drainage system is disconnected accidentally:

- Tell the nurse at once - Do not touch the ends of the catheter or tubing - Practice hand hygiene and put on gloves - Wipe the end of the tube with an antiseptic wipe - Wipe the end of the catheter with another antiseptic wipe - Do not put the ends down - Do not touch the ends after you clean them - Connect the tubing to the catheter - Discard the wipes into a biohazard bag - Remove the gloves and practice hand hygiene

What affects the frequency of urination?

- The amount of fluid intake, habits, and available toilet facilities. - Activity, work, and illness

What things are needed to know about commodes?

- The commode allows a normal position for elimination. - The commode arms and back provide support and help prevent falls. - Some commodes are wheeled into bathrooms and placed over toilets; they are useful for person who need support when sitting. - The container is removed if the commode is used with the toilet. Wheels are locked after the commode is positioned over the toilet.

What are the different way men use urinals?

- The man stands if possible - Some sit on the side of the bed - The man may lie in bed - Some men need support when standing - You may have to place and hold the urinal for some

Persons with dementia may:

- Void in the wrong places - Remove incontinence products and throw them on the floor or in the toilet - Resist staff efforts to keep them clean and dry

How much space is there between the penis and the end of the catheter?

1-inch space.

How do you give the bedpan?

1.) position the person on one side. 2.) Place the bedpan firmly against the buttocks 3.) Push downward on the bedpan and toward the person * Or the person can raise the buttocks off the bed with help. The bedpan is slid under the person 4.) The person is positioned on the bedpan so the urethra and anus are directly over the opening.

stress incontinence

(Also called dribbling) When urine leaks during exercise and certain movements that cause pressure on the bladder. Urine loss is small (less than 50 mL).

indwelling catheter

(Foley catheter or retention catheter) A catheter left in the bladder, so urine drains constantly into a drainage bag.

What are some foods that affect urine color?

(Red-colored urine) - Red food dyes - Beets - Blackberries - Rhubarb (Bright yellow urine) - Carrots - Sweet potatoes Certain drugs cause urine color

Bladder restraining

(bladder rehabilitation) requires the person to resist or ignore a strong desire to urinate, postpone or delay voiding, and urinate following a schedule rather than the urge to void.

Condom catheters

(external catheters, Texas catheters, or urinary sheaths) a soft sheath that slides over the penis. Tubing connects the condom catheter and the drainage bag.

urination

(micturition or voiding) The process of emptying urine from the bladder.

Habit training

(scheduled voiding) Scheduled at regular times to match the person's voiding habits. This is usually every 3 to 4 hours while awake. The person does not delay or resist voiding. Timed voiding is based on the person's usual voiding patern.

Drainage systems

- A closed drainage system is used for indwelling catheters. - Nothing can enter the system from the catheter to the drainage bag. - Some people wear leg bags, which attach to the thigh or calf, when up - The drainage bag is always kept lower than the bladder to prevent urinary tract infections (UTIs)

What are the factors affecting urine production?

- Age - Disease - Amount and kinds of fluid ingested - Dietary salt - Body temperature and perspiration - Medications - Activity, work, and illness

When are drainage bags emptied and measured?

- At the end of every shift - When changing from a leg bag to a drainage bag - When changing from a drainage to a leg bag - When the bag is becoming full

Catheters are used:

- Before, during, and after surgery - For people too weak or disabled to use the bedpan, urinal, commode, or toilet - To protect wounds and pressure ulcers from contact with urine - To allow hourly urinary output measurements - As a last resort for incontinence - For diagnostic purposes - are used to collect sterile urine specimens

What are the four methods of bladder training?

- Bladder retraining (resist the urge, follow a schedule instead. - Prompted voiding (the person uses the toilet, commode, bedpan, or urinal at certain times. - Habit training/scheduled voiding (voiding is scheduled usually every 3 to 4 hours based on the person's normal voiding pattern. - Catheter clamping (catheter is clamped for increasing periods of time, increasing tolerance.)

Fracture pans are used:

- By persons with casts - By persons in traction - By persons with limited back motion - After spinal cord injury or surgery - After a hip fracture - After hip placement surgery

What is the color chart

- Dilute - Amber - Concentrated - Tea - Cranberry

To apply condom catheters:

- Follow the manufacturer's instructions - Thoroughly wash the penis with soap and water - Dry the penis before applying the catheter - Condom catheters are self-adhering or applied with elastic tape - Never use adhesive tape to secure catheters

Normal urine:

- Is pale yellow, staw-colored, or amber - Is clear with no particles - Has a faint odor

What are the different urinary elimination problems that must be reported?

- Oliguria - Polyuria - Urinary frequency -Hematuria -Dysuria

catheter

A tube used to drain or inject fluid through a body opening.

polyuria

Abnormally large amounts (poly) or urine (uria)

What should you do when urine looks or smells abnormal?

Ask the nurse to observe urine.

hematuria

Blood (hemat) in the urine (uria)

What does CMS requires for persons who are incontinent?

CMS requires appropriate treatmnent and services for person who are incontinent. The goals are to prevent UTIs and restore as much normal bladder function as possible.

CAUTI

Catheter-associated urinary tract infection

CMS

Centers for Medicare and Medicaid Services

When are condom catheters changed?

Condom catheters are changed daily after perineal care.

Where should you never place a drainage bag?

Do not hang the drainage bag on a bed rail. Otherwise when the bed rail is raised, the bag is higher than the bladder level.

Who inserts a catheter?

Doctor or nurse

What type of tape to you use for the condom catheters?

Elastic tape. IT expands when the penis changes size. This allows blood flow to the penis. It is applied in a spiral fashion to secure the condom catheter to the penis.

F

Fahrenheit

Urinary incontinence is a normal part of aging. True or false?

False. Although it occurs in some older person, it is not a normal part of aging.

nocturia

Frequent urination (uria) at night (noct)

ID

Identification

How does incontinence affect the person?

Incontinence is embarrassing and uncomfortable. Pride, dignity, and self-esteem are affected. Social isolation, loss of independence, and depression are common.

What is incontinence linked to?

Incontinence is linked to abuse, mistreatment, and neglect.

I&O

Intake and output

IV

Intravenous

When are leg bags changed?

Leg bags are changed to drainage bags when the person is in bed.

post void residual urine

Measure the amount of urine left in the bladder after the person voids.

Urinals

Men use urinals to void.

mL

Milliliter

dysuria

Painful or difficult (dys) urination (uria)

What time do people usually void?

People usualy void at bedtime, after sleep, and before meals. Some people voide every 2 to 3 hours.

What should you do when you open the closed drainage system?

Prevent microbes from entering the system

oliguria

Scant amount (olig) of urin (uria); less than 500 mL in 24 hours

overflow incontinence

Small amounts of urine leak from a full bladder. The person feels like the bladder is not empty. Person dribbles and has a weak urine stream.

What should you do if incontinence is a new problem?

Tell the nurse at once.

transient incontinence

Temporary or occasional incontinence that is reversed when the cause is treated

Where is the catheter cleaned daily?

The catheter is cleaned starting at the meatus. About 4 inches of the catheter are cleaned.

How do you secure a catheter for a man?

The catheter is secured to the mans abdomen with tape. Drainage tubing secured to bottom linens with a clamp.

mixed incontinence

The combination of stress incontinence and urge incontinence

Where must not the drainage back touch on the graduate?

The drain must not touch the inside of the graduate

How do you secure a catheter for a woman?

The drainage tube is coiled on the bed and secured to the bottom linens. The catheter is secured to the inner thigh with a tube holder. Drainage tubing is secured to bottom linens with tape.

How much does a healthy adult produce urine a day?

The healthy adult produces about 1500 mL (milliliters) of 3 pints of urine a day.

incontinence

The inability to control urination or defecation

What area of the sterile cap and catheter plug are you allowed to touch?

The inside of the cap is sterile. Touch only the end of the plug.

urinary incontinence

The involuntary loss or leakage of urine

urge incontinence

The loss of urine in response to a sudden urgent need to void; the person cannot get to a toilet in time

Urinary urgency

The need to void at once

functional incontinence

The person has bladder control but cannot use the toilet in time. (Urinary frequency, urinary urgency, and nighttime voiding are common.)

What does urination, micturition, and voiding mean?

The process of emptying urine from the bladder.

catheterization

The process of inserting a catheter

How is the fracture pan placed under the buttocks?

The smaller end is placed under the buttocks.

Where is the urinal usually placed after use?

The urinal hooks to the bed rail within the man's reach.

What does the balloon near the tip of the indwelling catheter do?

a balloon near the tip is inflated with sterile water after the catheter is inserts. It prevents the catheter from slipping of the bladder.

What person need bladder training?

after an indwelling catheter removal.

Why are older persons at risk for incontinence?

because of changes in the urinary tract, medical and surgical conditions, and drug therapy.

What does asparagus do to urine?

causes urine odor.

C

centigrade

What do persons often use when they are unable to walk to the bathroom?

commodes (some commodes are wheeled into and placed over toilets.

Where is the clamp applied directly to?

the clamp is applied directly to the catheter. Not the drainage tube.

Prompted voiding

the person is taught to recognize when the bladder is full, recognize the need to void, ask for help, and void when prompted.