Ch 46: Urinary Elimination

Skin breakdown interventions (incontinence)

-keep skin clean/dry -assess for manifestation of breakdown -Apply protective barrier creams -Implement a bladder-retraining program

Possible reasons for nocturia

-prostate problems -overactive bladder (caffeine/alcohol/artificial sweeteners) -Excessive fluid intake -Diuretics -HTN meds -UTI

11. Which clinical manifestation can a nurse expect when a postoperative client experiences stress associated with surgery? 1. Decreased urinary output 2. Low specific gravity 3. Reflex incontinence 4. Urinary hesitancy

1 During surgery, because of the effects of the general adaptation syndrome, the posterior pituitary secretes antidiuretic hormone (ADH) that promotes water reabsorption in the kidney tubules. Also, the anterior pituitary secretes adrenocorticotropic hormone that stimulates the adrenal cortex to secrete aldosterone, which reabsorbs sodium and thus water.

19. Which information about a client is communicated when a nurse documents that the client has polyuria? 1. Excreting excessive amounts of urine 2. Experiencing pain on urination 3. Retaining urine in the bladder 4. Passing blood in the urine

1 Polyuria is an excessive output of urine. This is associated with problems such as diabetes mellitus, diabetes insipidus, the acute (diuresis) phase after a burn injury, and reduced levels of ADH.

8. A nurse is caring for a group of clients with a variety of urinary problems. Which physical response identified by the nurse should cause the most concern? 1. Anuria 2. Dysuria 3. Diuresis 4. Enuresis

1 The inability to produce urine (anuria) is a life-threatening situation. If the cause is not corrected, the client will need dialysis to correct fluid and electrolyte imbalances and rid the body of the waste products of metabolism.

7. A client reports burning on urination. Which question should the nurse ask to best obtain information about the client's dysuria? 1. "Can you tell me about the problems you are having with urination?" 2. "How would you describe your experience with incontinence?" 3. "What are your usual bowel habits?" 4. "What color is your urine?"

1 This open-ended question encourages the client to talk about the problem from a personal perspective. Follow-up questions can be more specific.

6. What should the nurse teach a young woman with a history of urinary tract infections (UTIs) about UTI prevention? (Select all that apply.) 1. Maintain regular bowel elimination. 2. Limit water intake to 1 to 2 glasses a day. 3. Wear cotton underwear. 4. Cleanse the perineum from front to back. 5. Practice pelvic muscle exercise (Kegel) daily.

1, 3, 4

1. A patient is scheduled to have an intravenous pyelogram (IVP) the next morning. Which nursing measures should be implemented before the test? (Select all that apply.) 1. Ask the patient about any allergies and reactions. 2. Instruct the patient that a full bladder is required for the test. 3. Instruct the patient to save all urine in a special container. 4. Ensure that informed consent has been obtained. 5. Instruct the patient that facial flushing can occur when the contrast media is given.

1, 4, 5

36. Which should the nurse implement to facilitate bladder continence for a male client who is cognitively impaired? Select all that apply. 1. _____ Offer toileting reminders every 2 hours. 2. _____ Apply a condom catheter in the morning. 3. _____ Provide clothing that is easy to manipulate. 4. _____ Encourage avoidance of fluids between meals. 5. _____ Explain the need to call for help with toileting every 4 hours

1-A cognitively impaired person may not be able to receive, interpret, or respond to cues for voiding. Reminding the person to void every 2 hours results in emptying of the bladder, which may limit episodes of incontinence 3-Cognitively impaired individuals may have problems handling clothing, particularly when attempting to respond to the urge to void. Clothing that is easy to manipulate, such as articles with elastic waistbands and zippers, will facilitate undressing and dressing to void.

10 common risk factors for incontinence

1-Female sex 2-History of multiple pregnancies and vaginal births, aging, chronic urinary retention, urinary bladder spasm, renal disease, chronic bladder infection (cystitis) 3-Neurologic disorders: Parkinson's disease, cerebrovascular accident, spinal cord injury, multiple sclerosis 4-Medication therapy: Diuretics, opioids, anticholinergics, calcium channel blockers, sedative/hypnotics, adrenergic antagonists 5-Obesity 6-Confusion, dementia, immobility, depression 7-Physiological changes of aging 8-Decreased estrogen levels and decreased pelvic-muscle tone 9-Immobility, chronic degenerative diseases, dementia, diabetes mellitus, cerebrovascular accident 10-Urinary incontinence increasing the risk for falls, fractures, pressure injuries, and depression

17. A confused client is incontinent of urine and stool and smears the stool on the bed linens and bed rails. Which should be the initial client goal? 1. The client will be clean and dry continuously. 2. The client will become continent within a week. 3. The client will stop soiling the environment immediately. 4. The client will call for the bedpan whenever the urge to eliminate occurs.

1. A client's basic physical needs should be given first priority. As soon as a client is incontinent of either urine or stool, the client should receive perineal care. Remaining "continuously" clean and dry meets the criterion of a time frame when writing a goal.

16. A client has urinary incontinence. Which is the best nursing intervention for this client? 1. Providing skin care immediately after soiling 2. Using a deodorant soap when providing skin care 3. Drying the area well after providing perineal care 4. Dusting the perineal area with a light film of cornstarch

1. As soon as possible after an incontinence episode, the client should receive thorough perineal care with soap and water, and the area should be dried well. This action removes urea from the skin, which can contribute to skin breakdown.

30. A nurse is caring for a client with a condom catheter. Which of the following is important to implement? Select all that apply. 1. _____ Avoiding kinks in the collection tubing 2. _____ Providing perineal care at least once a day 3. _____ Confirming that the adhesive band is not too tight 4. _____ Leaving 1 inch between the glans penis and drainage tubing 5. _____ Ensuring that the foreskin is over the glans penis before the catheter is applied

1. Avoiding kinks in the tubing is essential so that urine flows unimpeded to the urine collection bag. 2. Perineal hygiene should be performed at least once a day, after a bowel movement, and whenever the catheter is changed or replaced. 3. The anchoring device (e.g., adhesive band, elastic strip, or inflatable ring) must be snug enough to prevent the condom from falling off but not so tight that it interferes with blood circulation to the penis. 4. Placing the condom over and beyond the glans penis and leaving 1 inch between the glans penis and drainage tubing prevents pressure against the glans penis that could cause excoriation and skin trauma. 5. The foreskin should be over the glans penis. If the foreskin is left in the retracted position, it can constrict the penis, resulting in edema and tissue

10. There is no urine when a catheter is inserted 3 inches into a female's urethra. What should the nurse do next? 1. Remove the catheter and start all over with a new kit and catheter. 2. Leave the catheter there and start over with a new catheter. 3. Pull the catheter back and reinsert at a different angle. 4. Ask the patient to bear down and insert the catheter farther.

2

5. An ambulatory elderly woman with dementia is incontinent of urine. She has poor short-term memory and has not been seen toileting independently. What is the best nursing intervention for this patient? 1. Recommend that she be evaluated for an overactive bladder (OAB) medication. 2. Establish a toileting schedule. 3. Recommend that she be evaluated for an indwelling catheter. 4. Start a bladder-retraining program.

2

2. A nurse must measure the intake and output (I&O) of a client who has a urinary retention catheter. Which equipment is most appropriate to use to measure urine output from a urinary retention catheter accurately? 1. Urinal 2. Graduate 3. Large syringe 4. Urine collection bag

2 A graduate is a collection container with volume markings (usually at 25-mL increments) that promote accurate measurements of urine volume.

3. A client's urine is cloudy, is amber, and has an unpleasant odor. Which problem may this information indicate that requires the nurse to make a focused assessment? 1. Urinary retention 2. Urinary tract infection 3. Ketone bodies in the urine 4. High urinary calcium level

2 A graduate is a collection container with volume markings (usually at 25-mL increments) that promote accurate measurements of urine volume.

21. Which clinical manifestation identified by the nurse commonly is associated with excessive production of antidiuretic hormone (ADH)? 1. Diuresis 2. Oliguria 3. Retention 4. Incontinence

2 ADH increases the reabsorption of water by the kidney tubules, thus decreasing the amount of urine formed. Oliguria is diminished urinary output relative to intake (less than 400 mL in 24 hours).

10. A nurse is caring for two clients. One client has reflex incontinence and the other has total incontinence. Which characteristic is common to both reflex incontinence and total incontinence? 1. Small loss of urine after an increase in intra-abdominal pressure 2. Loss of urine without awareness of bladder fullness 3. Retention of urine with intermittent urine overflow 4. Strong, sudden desire to pass urine

2 Involuntary voiding and a lack of awareness of bladder distention are related directly to both reflex incontinence and total incontinence. Reflex incontinence is the predictable, involuntary loss of urine with no sensation of urgency, the need to void, or bladder fullness. Total incontinence is the continuous unpredictable loss of urine without distention or awareness of bladder fullness.

18. A client has a urinary retention catheter. Which is most important when the nurse cares for this client? 1. Applying an antimicrobial agent to the urinary meatus 2 times a day 2. Ensuring that the catheter remains connected to the collection bag 3. Wearing sterile gloves when accessing the specimen port 4. Increasing fluid intake to 3,000 mL a day

2 Maintaining the connection of the catheter to the collection bag prevents the introduction of microorganisms that can cause infection. A urinary retention catheter is a closed system that should remain closed.

6. A nurse reviews the results of a client's urinalysis. Which constituent found in urine indicates the presence of an abnormality that should be reported to the primary health-care provider? 1. Electrolytes 2. Protein 3. Water 4. Urea

2 The presence of protein in the urine indicates that the glomeruli have become too permeable, which occurs with kidney disease. Most plasma proteins are too large to move out of the glomeruli, and the small proteins that enter the filtrate are reabsorbed by pinocytosis.

4. A postoperative patient with a three-way indwelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurse's initial intervention(s)? (Select all that apply.) 1. Increase the rate of the CBI. 2. Assess the patency of the drainage system. 3. Measure urine output. 4. Assess vital signs. 5. Administer ordered pain medication.

2, 3

8. Which nursing interventions should a nurse implement when removing an indwelling urinary catheter in an adult patient? (Select all that apply.) 1. Attach a 3-mL syringe to the inflation port. 2. Allow the balloon to drain into the syringe by gravity. 3. Initiate a voiding record/bladder diary. 4. Pull the catheter quickly. 5. Clamp the catheter before removal.

2, 3

34. Which should a nurse teach the client to avoid that will help prevent urinary diuresis? Select all that apply. 1. _____ Narcotics 2. _____ Caffeine 3. _____ Activity 4. _____ Alcohol 5. _____ Protein

2. Drinks with caffeine (e.g., coffee, tea, and some carbonated beverages) promote the secretion and excretion of increased amounts of urine. This may be related to the inhibition of phosphodiesterases or antagonism of adenosine receptors (or both). Antagonism of adenosine receptors inhibits proximal tubular reabsorption, resulting in an increased urine output. 4. Drinks with caffeine (e.g., coffee, tea, and some carbonated beverages) promote the secretion and excretion of increased amounts of urine. This may be related to the inhibition of phosphodiesterases or antagonism of adenosine receptors (or both). Antagonism of adenosine receptors inhibits proximal tubular reabsorption, resulting in an increased urine output.

2. What is a critical step when inserting an indwelling catheter into a male patient? 1. Slowly inflate the catheter balloon with sterile saline. 2. Secure the catheter drainage tubing to the bedsheets. 3. Advance the catheter to the bifurcation of the drainage and balloon ports. 4. Advance the catheter until urine flows, then insert ¼ inch more.

3

3. Which instruction should the nurse give the assistive personnel (AP) concerning a patient who has had an indwelling urinary catheter removed that day? 1. Limit oral fluid intake to avoid possible urinary incontinence. 2. Expect patient complaints of suprapubic fullness and discomfort. 3. Report the time and amount of first voiding. 4. Instruct patient to stay in bed and use a urinal or bedpan.

3

4. A nurse is caring for a debilitated female client with nocturia. Which nursing intervention is the priority when planning to meet this client's needs? 1. Encouraging the use of bladder training exercises 2. Providing assistance with toileting every 4 hours 3. Positioning a bedside commode near the bed 4. Teaching the avoidance of fluids after 5 p.m.

3 A graduate is a collection container with volume markings (usually at 25-mL increments) that promote accurate measurements of urine volume.

23. A client is admitted to the emergency department because of hypertension and oliguria. For which additional clinical manifestation associated with this cluster of information should the nurse assess the client? 1. Thirst 2. Retention 3. Weight gain 4. Urinary hesitancy

3 Oliguria is the inability to produce more than 400 to 500 mL of urine daily. Expected daily urinary output is 1,000 to 3,000 mL, depending on the volume of fluid intake. If urine is not being produced in the presence of an average daily intake of 2,500 mL of fluid, then fluid will be retained and reflected in a gain in weight. One liter of fluid weighs 2.2 pounds. Excess fluid contributes to an increase in circulating blood volume, causing hypertension

12. Which assessment is not related to monitoring both urine and stool? 1. Constituents 2. Urgency 3. Shape 4. Color

3 Only stool can be assessed regarding shape. Stool usually is tubular in shape. Urine is a liquid that assumes the shape of the container in which it is collected.

1. A nurse identifies that the client has overflow incontinence. Which factor contributes to this clinical manifestation? 1. Coughing 2. Mobility deficits 3. Prostate enlargement 4. Urinary tract infection

3 Rationale: An enlarged prostate compresses the urethra and interferes with the outflow of urine, resulting in urinary retention. With urinary retention, the pressure within the bladder builds until the external urethral sphincter temporarily opens to allow a small volume (25 to 60 mL) of urine to escape (overflow incontinence).

9. A nurse is performing a physical assessment on a newly admitted client who is experiencing urinary incontinence. Which problem identified by the nurse is often associated with this problem? 1. Chronic pain 2. Reduced fluid intake 3. Disturbed self-esteem 4. Insufficient knowledge

3 The inability to produce urine (anuria) is a life-threatening situation. If the cause is not corrected, the client will need dialysis to correct fluid and electrolyte imbalances and rid the body of the waste products of metabolism.

40. A nurse must obtain a urine specimen for a culture and sensitivity test from a client who has an indwelling urinary catheter. Place the following steps in the order in which they should be performed. 1. Wash your hands and don clean gloves. 2. Remove the clamp from the drainage tubing. 3. Drain the urine in the tubing into the drainage bag. 4. Clamp the drainage tubing below the specimen port for 15 to 30 minutes. 5. Swab the specimen port with an antiseptic and aspirate urine via a sterile syringe. 6. Transfer the urine to a sterile specimen cup and discard the syringe into a sharps container.

3, 4, 1, 5, 6, 2

27. A nurse is inserting an indwelling urinary catheter into a male client. The nurse feels firm resistance while inserting the urinary catheter through the penis. What should the nurse do? 1. Lower the penis until it is parallel to the length of the body. 2. Inflate the balloon of the catheter with 10 mL of normal saline. 3. Stop the procedure and notify the health-care provider about the resistance. 4. Use a twisting motion and firmly advance the catheter 2 inches farther into the penis.

3. Resistance indicates that there may be a blockage in the urethra (e.g., enlarged prostate, tumor). The procedure should be discontinued when firm resistance is felt, to prevent trauma to the urinary system. The event should be documented in the client's clinical record and the primary health-care

26. An older adult with an indwelling urinary catheter is receiving 75 mL of 0.9% sodium chloride hourly. The client has had several hospital admissions in the last year for dehydration. The nurse is concerned about the client's renal function. What is the best intervention by the nurse to assess this client's renal functioning? 1. Inspect the client's dependent areas for signs of edema. 2. Calculate the client's intake and output every shift. 3. Monitor the client's urine output hourly. 4. Obtain the client's weight daily.

3. The kidneys should produce more than 30 mL/hour. The client has an indwelling urinary catheter that facilitates the assessment of urine output hourly. Clients without an indwelling urinary catheter should void a minimum of 240 mL of urine in 8 hours.

37. When the nurse is planning nursing care, which factor in the client's history places the client at risk for stress incontinence? Select all that apply. 1. _____ Lumbar spinal cord injury 2. _____ Urinary obstruction 3. _____ Six vaginal births 4. _____ Menopause 5. _____ Obesity

3. Stress incontinence is an immediate, involuntary loss of urine during an increase in intra-abdominal pressure. It is associated with weak pelvic muscles and structural supports resulting from multiple pregnancies, age-related degenerative changes, and overdistention between voiding. 4. Older women experience a weakening of the muscles surrounding the urinary and reproductive systems because of decreasing levels of estrogen associated with menopause. 5. The relationship of obesity and stress incontinence is theorized to be that excess weight increases abdominal pressure. This, in turn, increases bladder pressure and mobility of the urethra. In addition, obesity may lead to chronic strain, stretching, and weakening of the nerves and muscles of the pelvic area.

20. A client is experiencing bladder irritability. Which fluid should the nurse teach the client to include in the diet? 1. Beer 2. Coffee 3. Orange juice 4. Cranberry juice

4 Cranberries have no constituents that irritate the bladder. In addition, they produce a more acidic environment that is less conducive to the growth of microorganisms and prevents bacteria from adhering to the mucous membranes of the urinary tract, thus promoting bacterial excretion

15. Which is an effective nursing intervention to prevent urinary tract infections? 1. Teach female clients to wipe from the back to the front after urinating. 2. Advise clients to report burning on urination to health-care providers. 3. Instruct clients to use bath powder to absorb perineal perspiration. 4. Encourage clients to drink several quarts of fluid daily.

4 Drinking a minimum of 2,000 mL of fluid a day produces adequately dilute urine, washes out solutes, and flushes microorganisms from the distal urethra and urinary meatus.

25. A primary health-care provider discusses the need for a cystoscopy with a client. Which is most important for the nurse to do when caring for this client before the cystoscopy? 1. Monitor the client's I&O. 2. Assess the client's urine routinely. 3. Encourage the client to increase the intake of oral fluids. 4. Have the client sign an informed consent form before the procedure.

4 During a cystoscopy, a fiberoptic instrument is inserted through the urethra and into the bladder. It is an invasive procedure that requires the client's written permission. The primary health-care provider's discussion with the client includes the purpose of the procedure, its risks and benefits, and alternatives.

14. A client tells the nurse, "I have to urinate as soon as I get the urge to go." For which contributing factor to urinary urgency should the nurse implement a focused assessment? 1. Anesthesia 2. Dehydration 3. Full bladder 4. Urinary tract infection

4 Feeling the need to void immediately (urgency) occurs most often when the urinary bladder is irritated. In the adult, the usual bladder capacity is 400 to 600 mL of urine, although the desire to urinate can be sensed when it contains as little as 150 to 200 mL. As the volume increases, the bladder wall stretches, sending sensory messages to the sacral spinal cord, and parasympathetic impulses stimulate the detrusor muscle to contract rhythmically. Bladder contractions precipitate nerve impulses that travel up the spinal cord to the pons and cerebral cortex, where the person experiences a conscious need to void.

13. A nurse is assessing the urinary status of a client. Which sign indicates that additional nursing assessments are necessary? 1. Aromatic odor 2. Pale yellow urine 3. Output of 50 mL hourly 4. Specific gravity of 1.035

4 Specific gravity is the measure of the concentration of dissolved solids in the urine. The expected range is 1.001 to 1.029. A specific gravity of 1.035 indicates concentrated urine.

24. A nurse must obtain a clean-catch urine specimen from one client and a urine specimen via a straight catheterization from another. Which intervention is not performed for both when obtaining these specimens? 1. Cleanse around the urinary meatus with antiseptic swabs. 2. Send the specimen to the laboratory immediately. 3. Use a sterile cup to collect the specimen. 4. Wear sterile gloves during the procedure.

4 Sterile gloves must be worn when obtaining a urine specimen via a catheter. The nurse's hands touch the client and catheter tubing, which must remain sterile. Clean, rather than sterile, gloves are worn when obtaining a clean-catch urine specimen. Urine flowing out of the client is collected midstream into a sterile specimen cup.

22. A nurse must obtain a urine specimen from a client. Which nursing intervention is the greatest help to most people who need to void for a urine test? 1. Exerting manual pressure on the abdomen 2. Encouraging a backward rocking motion 3. Running water in the sink 4. Providing for privacy

4 Tending to bodily functions is a personal, private activity in the North American culture. Providing privacy supports client dignity and generally promotes voiding.

28. When a nurse assesses a client, which clinical manifestations support the presence of urinary retention? Select all that apply. 1. _____ Nocturia 2. _____ Hematuria 3. _____ Bladder contractions 4. _____ Suprapubic distention 5. _____ Frequent small voidings

4. The bladder lies in the pelvic cavity behind the symphysis pubis. When it fills with urine (600 mL), the bladder extends above the symphysis pubis, and when greatly distended (2,000 to 3,000 mL), it can reach to the umbilicus. 5. With urinary retention, the bladder fills with urine, causing distention. Eventually, the external urethral sphincter temporarily opens to allow a small volume of urine to pass out of the bladder (overflow incontinence, retention with overflow).

32. A nurse is caring for a female client on bedrest who has a urinary retention catheter. Which should the nurse do? Select all that apply. 1. _____ Position the tubing through the side rail of the bed. 2. _____ Ensure the tubing is positioned under the leg. 3. _____ Label the tubing with the date of insertion. 4. _____ Irrigate the tubing to ensure its patency. 5. _____ Secure the tubing to the client's leg.

5 Securing the tubing to the client's leg prevents tension on the urinary meatus.

7. Place the following steps for insertion of an indwelling catheter in a female patient in appropriate order. 1. Insert and advance catheter. 2. Lubricate catheter. 3. Inflate catheter balloon. 4. Cleanse urethral meatus with antiseptic solution. 5. Drape patient with the sterile square and fenestrated drapes. 6. When urine appears, advance another 2.5 to 5 cm. 7. Prepare sterile field and supplies. 8. Gently pull catheter until resistance is felt. 9. Attach drainage tubing.

5, 7, 2, 4, 1, 6, 3, 8, 9

33. A primary health-care provider prescribes a bladder ultrasound scan to be performed after a client voids to determine the amount of residual urine. The nurse explains the test to the client. Place the following steps in the order that they should be performed by the nurse. 1. Clean the client's abdomen to remove the gel and clean the scan head with isopropyl alcohol. 2. Put 5 mL of conducting gel on the client's symphysis pubis and place the scan head on the gel. 3. Aim the scan head toward the client's coccyx and press the scan head button. 4. Drape the client, exposing only the lower abdomen and suprapubic area. 5. Obtain the bladder volume and repeat the measurement several times. 6. Place the client in the supine position.

6, 4, 2, 3, 5, 1

A client has an indwelling cath and need to urinate. Which of the following actions should the nurse take? A. Check to see whether the cath is patent B. Reassure pt that it is not possible for them to urinate C. Recath the bladder with a large-gauge cath D. Collect a urine specimen for analysis.

A

A nurse is caring for client who is collecting 24hr urine. Which of the following actions should the nurse take? A. Discard the first voiding B. Keep urine in a single container at room temp C. Dispose of the last voiding D. Ask the client to urinate into the toilet, stop midstream, and finish urinating into the specimen container.

A

A nurse is preparing to start bladder-retraining program for pt who is incontinent. Which of the following actions should they task? (SATA) A. Restrict the clients intake of fluids during the daytime B. Have the client record urination times C. Gradually increase the urination intervals D. Remind the client to hold urine until the next scheduled urination time E. Provide a sterile container for urine.

B, C, D

A nurse is teaching with stress incontinence- which instructions should they include? (SATA) A. Limit daily fluid intake B. Decrease or avoid caffeine C. take calcium supplements D. Avoid drinking alcohol E. Use the Cred. Maneuver

B, D

transient incontinence

Reversible incontinence due to inflammation or irritation (UTI), temporary cognitive impairment, disease process (hyperglycemia), medications (diuretics, anticholinergics, sedatives

overflow incontinence

Urinary retention from bladder overdistention and frequent loss of small amounts of urine due to obstruction of the urinary outlet or an impaired detrusor muscle. Can occur as a result of a neurologic disorder (spinal cord injury, or multiple sclerosis), and can lead to a neurogenic (flaccid) bladder. Can also occur with an enlarged prostate

Factors that increase risk of UTIs A. Frequent sex B. Lowering of testosterone levels C. Wiping from front to back to clean perineum D. Location of the urethra closer to anus E. Frequent catherization

A, D, E

bladder retraining program

- Schedule times to urinate - Hold urine until scheduled time -Gradually increase intervals working toward 4hr intervals

Nursing care interventions for urinary elimination

-Establish a toileting schedule -Monitor and increase fluid intake during the daytime, and decrease fluid intake prior to bed -Remove or control barriers to toileting -Provide incontinence garments -Apply an external or condom cath for males -Avoid the use of indwelling urinary caths -Provide incontinence care

CAUTI manifestations

-Frequency, urgency, nocturia, flank pain, hematuria, cloudy, foul-smelling urine, and fever. -Older adults: new onset increased confusion, recent falls, new onset incontinence, anorexia, fever, tachycardia, hypotension

Client education on urinary elimination

-Regular BM's -Try to empty bladder completely with each void -Keep incontinence diary -Kegels -Perform bladder compression techniques (Crede, Val saliva, double voiding, splinting) to help manage reflex incontinence. -Avoid caffeine and alcohol (irritation/increase urge ) -Adverse effects of meds -Strengthen pelvic floor (stress incontinence)

CAUTI nursing interventions

-Use aseptic technique when inserting catheters. -Prevent obstruction and backflow of urine through catheter, drainage tubing, and drainage bag. -Provide perineal hygiene routinely and after soiling. -Assess ongoing need for indwelling urinary catheter daily

CAUTI Risk Factors

-Use of indwelling catheters -Increased dwell time of indwelling urinary catheter -Opening the closed urinary drainage system -Routine changes of indwelling urinary catheter -Irrigation of the indwelling catheter

5. A primary health-care provider prescribes a urine specimen for culture and sensitivity via a straight catheter for a client. Which should the nurse do when collecting this urine specimen? 1. Use a sterile specimen container. 2. Collect urine from the catheter port. 3. Inflate the balloon with sterile water. 4. Have the client void before collecting the specimen.

1 A culture attempts to identify the microorganisms present in the urine, and a sensitivity study identifies the antibiotics that are effective against the isolated microorganisms. A sterile specimen container is used to prevent contamination of the specimen by microorganisms outside the body.

9. Which nursing intervention decreases the risk for catheter-associated urinary tract infection (CAUTI)? 1. Cleansing the urinary meatus 3 to 4 times daily with antiseptic solution 2. Hanging the urinary drainage bag below the level of the bladder 3 Emptying the urinary drainage bag daily 4. Irrigating the urinary catheter with sterile water

2

urge incontinence

Inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle with increased bladder pressure. Can occur due to bladder irritation from a UTI or an overactive bladder

reflex incontinence

Involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction. Can occur due to impaired central nervous system (stroke, multiple sclerosis, or spinal cord lesions

stress incontinence

Loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting. Can occur in females due to weak pelvic floor muscles following childbirth or menopause, and in males due to alterations in the urethra following a prostatectomy

functional incontinence

Loss of urine due to factors that interfere with responding to the need to urinate (cognitive, mobility, and environmental barriers