chapter 38 Urinary Elimination

The parent of a 5-year-old child tells the nurse that on two occasions their child has lost control of urination when they had to wait to go to the bathroom at school. What is the appropriate nursing response? "It would be appropriate to place your child in incontinence undergarments." "This is extremely abnormal. You will need to see your child's pediatrician." "Let's review the types of fluids that your child drinks in the morning." "I would only worry about this if you were raising a female child."

"Let's review the types of fluids that your child drinks in the morning." Bladder irritants such as caffeine can cause urge incontinence; it is appropriate to determine whether the child is consuming fluids that contain caffeine. The child's urge incontinence is not extremely abnormal, and this physiological response is not related to gender. It is too soon to refer the client to the health care provider without taking a history, and it is impractical to simply recommend incontinence undergarments.

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? clean-catch specimen random specimen 24-hour specimen intermittent specimen

24-hour specimen A 24-hour urine specimen is required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day. A clean-catch or midstream-voided specimen is used when a specimen relatively free from microorganisms is required. Random urine specimen collection is used when sterile urine is not required.

The nurse is teaching an older adult female client who must provide a urine specimen. Which is the proper method to instruct a female client to obtain a clean-catch urine specimen? Catch the urine in the cup after cleansing the perineum. Catch the urine while holding the labia apart, after allowing the first urine to flow into the toilet. Catch the urine while holding the labia apart, then cleanse each side of the labia with prepared aseptic swabs. Catch the urine while holding the labia apart, after cleansing. Fill the specimen cup.

Catch the urine while holding the labia apart, after allowing the first urine to flow into the toilet. The client should first perform hand hygiene, then separate the labia minora and cleanse the perineum with commercially prepared aseptic swabs, starting in front of the urethral meatus and moving the swab toward the rectum. The client should repeat this cleansing process three times with different cotton balls or swabs, then begin to urinate while continuing to hold the labia apart. Next, the client should allow the first urine to flow into the toilet, and then hold the specimen container under the urine stream and collect urine. Then, the client should remove the specimen container, release the hand from the labia, seal the container tightly, and finish voiding. The client then performs hand hygiene again.

A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take? Instruct on proper wiping technique Encourage fluids Monitor vital signs Contact the health care provider

Contact the health care provider The term pyuria refers to the presence of pus in the urine. The nurse should first contact the health care provider, as antibiotic therapy may be necessary. Encouraging fluids, instruction on wiping technique and monitoring vital signs will follow.

Three days after surgery for breast reconstruction, the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action(s)? Select all that apply. Contact the health care provider to ask for an order for catheter discontinuation. Perform, or allow client to perform, perineal hygiene at least once daily. Ensure that the drainage bag is above the level of the bladder at all times. Discontinue the catheter and report this to the health care provider. Delegate catheter discontinuation to the unlicensed assistive personnel (UAP).

Contact the health care provider to ask for an order for catheter discontinuation. Perform, or allow client to perform, perineal hygiene at least once daily. The nurse should advocate for catheter discontinuation to prevent a catheter-associated urinary tract infection (CAUTI), and still perform or encourage the client to perform daily perineal care. Discontinuation of the catheter should not take place until the nurse has received an order, and delegation should take place only if appropriate based on the unlicensed assistive personnel's (UAP's) qualification and the nurse's ongoing appropriate supervision. The drainage bag should never remain above the level of the bladder; it should be below the level of the bladder.

The UAP reports that a client on furosemide has voided 4000 mL in a 24-hour period. What is the appropriate nursing action? Increase IV fluids. Contact the health care provider to decrease furosemide. Administer an additional dose of furosemide. Document the finding as normal.

Contact the health care provider to decrease furosemide. Voiding over 3000 mL/day is considered abnormal. The client may benefit from a reduction in the amount of furosemide that is prescribed. Therefore, it is appropriate to contact the health care provider to decrease furosemide. Documenting the finding as normal, increasing IV fluids, and administering an additional dose of furosemide are not appropriate nursing actions.

A female client is diagnosed with recurrent urinary tract infections (UTIs) and the nurse is providing education about preventative methods. What information is important for the nurse to give to the client to prevent another UTI? Select all that apply. Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. Avoid clothing that is tight and restrictive on the lower half of the body. Dry the perineal area after urination or defecation from the back to the front. Take baths instead of showers. Wear underwear with a cotton crotch.

Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. Wear underwear with a cotton crotch. Avoid clothing that is tight and restrictive on the lower half of the body. Client education can help prevent UTI recurrence. Teaching the client about measures that promote health and decrease the severity and incidence of UTIs is a major nursing responsibility. The nurse should instruct the client to drink eight to ten 8-oz glasses (1,920 to 2,400 mL) of water daily, drink two 8-oz glasses (480 mL) of water before and after sexual intercourse, void immediately after sexual intercourse, wear underwear with a cotton crotch, and avoid clothing that is tight and restrictive on the lower half of the body. Instruction should include drying the perineal area after urination or defecation from the front to the back, or from the urethra toward the rectum, as well as taking showers instead of baths.

The nurse is performing a portable bladder ultrasound on a client who has palpable bladder distention. The scanner reveals little urine in the bladder. What should the nurse do next? Ensure proper positioning of the scanner head and rescan. Wipe off some of the ultrasound gel and rescan. Have the client drink 8 ounces of water every 15 minutes for 1 hour. Place the client on either side and rescan.

Ensure proper positioning of the scanner head and rescan. The scanner head should be repositioned, and the bladder should be rescanned before assuming that the bladder is truly empty. Additional ultrasound gel may need to be added for the scanner to work properly. If the bladder is truly distended, the client may become more uncomfortable from drinking additional water. The best position for bladder scanning is supine.

A nurse is caring for a client with an external condom catheter. Which guideline should be implemented when applying and caring for this type of catheter? Ensure the tip of the tubing is touching the tip of the client's penis. Fasten the condom securely enough to prevent leakage without constricting blood flow. Wipe the penis thoroughly with an alcohol swab and dry thoroughly before application. Remove the catheter every 8 hours, or more often in humid weather.

Fasten the condom securely enough to prevent leakage without constricting blood flow. Nursing care of a client with a condom catheter includes vigilant skin care to prevent excoriation. This includes removing the condom catheter daily, washing the penis with soap and water and drying carefully, and inspecting the skin for irritation. In hot and humid weather, more frequent changing may be required. In all cases, care must be taken to fasten the condom securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in the area. In addition, the tip of the tubing should be kept 1 to 2 in. (2.5 to 5 cm) beyond the tip of the penis to prevent irritation to the sensitive glans area.

What is an advantage of using an external condom catheter for a client who has frequent episodes of urinary incontinence? The client can apply it themself with minimal supervision. It can be left in place for a long period of time. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. A sterile urine specimen can be obtained from the drainage bag tubing.

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. The external condom catheter is not in the bladder. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters which are placed in the bladder. Because it is not sterile, a sterile urine specimen cannot be obtained. Often, the client does not place the external condom catheter by themself. The catheter is changed every day and the skin of the penis is assessed.

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include? Perform these exercises two times daily for a week. Relax muscles for at least 5 minutes between repetitions. Keep muscles contracted for at least 10 seconds. Loosen the internal muscles used to prevent or interrupt urination.

Keep muscles contracted for at least 10 seconds. Pelvic floor muscle exercises (Kegel exercises) should be performed by tightening the internal muscles used to prevent or interrupt urination for 10 seconds, followed by a period of 10 seconds of relaxation. The client should be instructed to perform this regimen 3 to 4 times daily for 2 weeks to 1 month.

Which statement should the nurse convey to the parent of a 3-year-old male child who has not achieved urinary continence? Daytime continence is usually not achieved by male children until age 5. Incontinence after the age of 3 years is not normal. Male children may take longer for daytime continence than female children. Male children may walk by 1 year and should be continent by 3 years.

Male children may take longer for daytime continence than female children. Children in North American cultures usually achieve daytime urinary continence by 3 years of age; male children may take longer than female children. Nighttime continence may not occur until 4 or 5 years of age.

A client with an emergently placed central venous catheter (CVC) is to have emergent hemodialysis. Upon assessment of the CVC the nurse visualizes redness, drainage, and odor to the area around the CVC. Palpation of the surrounding skin causes the client pain. Which intervention is the priority? Checking for blood return in the CVC Notifying the health care provider of the assessment findings Obtaining laboratory studies Placing the client as N.P.O. status

Notifying the health care provider of the assessment findings The assessment is indicative of hospital-acquired catheter infection associated with the CVC. The medical provider may request laboratory studies, but these cannot be obtained until a prescription is received. There is no indication to withhold oral food or fluids from the client at this time. Checking for blood return is not indicated and access to the CVC used for hemodialysis should not be attempted without a prescription to do so from the health care provider.

Which urinary care teaching will the nurse provide to a young adult female client? Refrain from douching unless ordered by a health care provider. Drink water more frequently in the morning and evening to facilitate hydration. If you do not feel like voiding, still strain to make sure the bladder is empty. Wipe from the back to the front.

Refrain from douching unless ordered by a health care provider. Douching is not recommended unless ordered by the health care provider. Female clients should be taught to wipe from the urinary area towards the rectum to decrease the risk for introducing pathogens into the urethra. Straining is not appropriate. Water should be consumed throughout the day, not just in the morning and evening.

A client who visits a health care facility for a routine assessment reports to the nurse being unable to control urinary elimination. This has resulted in the client soiling clothes and has led to a lot of embarrassment. Which nursing intervention will be appropriate to use with this client? Indwelling catheterization Fluid restriction Encouraging the client to stay close to home Regular toileting routine

Regular toileting routine The nurse should document the client's condition as urinary incontinence. A toileting routine and verbal reminders, external catheters for men, absorbent products, and excellent skin care and hygiene are appropriate interventions. Indwelling catheterization and fluid restriction can lead to urinary tract infection. Encouraging the client to stay home may be isolating.

The nurse is caring for a client who has been experiencing difficulty voiding in the 8 hours since giving birth vaginally. What information should be provided to the client? Catheterization is likely necessary for 5 to 7 days. A neurogenic bladder results from local anesthesia. The birth can cause perineal swelling. A urinary tract infection can result from the birth process.

The birth can cause perineal swelling. Trauma from vaginal birth causes swelling in the perineal area, which can obstruct the flow of urine and cause urinary retention during the early postpartum period. The effects of anesthesia do not constitute a neurogenic bladder. Catheterization may be necessary in the short term, but 5 to 7 days would normally be excessive and create a risk for infection. Birth does not normally cause a urinary tract infection, whose effects would not evident at this early stage postpartum.

A nurse is preparing a discharge teaching plan for a client being sent home with a peritoneal dialysis catheter in place. Which guideline should be included in the instructions? A dressing should always be worn over the site to avoid leaking. The client may bathe rather than shower, provided the site is covered with gauze. Sterile technique must be observed by the client in the home setting. The client should avoid wearing tight clothes or belts near the site.

The client should avoid wearing tight clothes or belts near the site. Clients should avoid baths and public pools as well as wearing tight clothes and belts around the exit site. Once the site is healed, some health care providers do not require clients to wear a dressing unless the site is leaking. Clean technique is sometimes allowed in the home.

The novice nurse is assessing the urinary bladder of a client with transient urinary incontinence. The nurse mentor would intervene if which action by the novice nurse is noted? The novice nurse asks the client when was the last time they voided before palpating the bladder. The novice nurse asks the client to urinate before palpating the bladder. The novice nurse measures the height of the edge of the bladder above the symphysis pubis. The novice nurse observes the lower abdominal wall for any swelling.

The novice nurse asks the client to urinate before palpating the bladder The urinary bladder cannot be palpated when empty, so the client should not urinate before the nurse palpates or percusses it. During data collection, the client should be asked—before the bladder is palpated—when the last voiding occurred. The height of the edge of the bladder should be measured above the symphysis pubis. The lower abdominal wall during an urinary bladder assessment is observed for any swelling.

A nurse who is right-handed is inserting a female client's indwelling urinary catheter. The nurse will use cotton balls and antiseptic solution to cleanse the client's meatus and perineum. Which of the nurse's actions is most appropriate? Insert the catheter with their left hand while supporting the client with their right hand. Use their left hand to spread the client's labia and keep them spread until the catheter is inserted. Perform hand hygiene between cleansing the client's labia and inserting the catheter. Grasp a cotton ball with forceps in their left hand and spread the client's labia with their right hand.

Use their left hand to spread the client's labia and keep them spread until the catheter is inserted. Using the thumb and one finger of the nondominant hand, the nurse should spread the client's labia and identify the meatus. The nurse should be prepared to maintain separation of labia with one hand until the catheter is inserted and urine is flowing well and continuously. The nurse does not let go of the labia to perform hand hygiene after cleansing. The catheter is inserted with the dominant hand.

A nurse is preparing to measure a client's urine output. Which interventions would be of highest priority? Wearing gloves when handling the urine Noting the color and clarity of the urine Measuring the urine container at eye level Using an appropriate measuring container

Wearing gloves when handling the urine All of these interventions would be important to ensure safety in handling the client's urine and obtaining an accurate output. However, safety with handling body fluids would be a priority for the nurse to decrease risk of exposure to pathogens or blood that may be in the client's urine.

The nurse is preparing a client for a cystoscopy procedure. Which intervention would be part of the preparation? inserting a Foley catheter the morning of the procedure checking that the client has signed a consent form for the procedure maintaining the client without liquids before the procedure explaining to the client that the procedure will be painful

checking that the client has signed a consent form for the procedure The client would sign a consent form for the procedure since it is invasive. This would be completed by the procedural health care provider after explaining the purpose, risks, and benefits of the procedure. The will check that this consent is signed before the procedure beings. The client does not need to have fluids withheld nor have a catheter inserted for this procedure. The procedure is usually painless, so the client would not be told to expect pain as a normal part of the procedure.

The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate? strongly aromatic, amber clear, dark amber cloudy, foul odor light yellow, clear

cloudy, foul odor The nurse anticipates that the client has an infection, which is characterized by cloudy, foul-smelling urine. Urine is normally light yellow and clear. Dark amber urine that is strongly aromatic could indicate dehydration, but would not create the symptoms noted.

The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate? hypovolemia balanced fluids dehydration kidney injury

dehydration The nurse anticipates that the client may be dehydrated, which is characterized by strongly aromatic, dark amber urine. The symptoms are not associated with hypovolemia, balanced fluids, nor kidney injury.

The nurse is caring for an 18-year-old client with a urinary tract infection. What is a factor that affects the pattern of urine elimination in this client? diminished bladder capacity integrity of the spinal cord degenerative changes in the cerebral cortex relaxation of pelvic floor muscle tone

integrity of the spinal cord Patterns of urinary elimination depend on the integrity of the spinal cord as well as physiologic, emotional, and social factors. Diminished bladder capacity, relaxation of pelvic floor muscle tone, and degenerative changes in the cerebral cortex are age-related changes that increase the risk of incontinence and lead to urinary urgency, respectively, in older adults.

A client at the health care facility has been diagnosed with total urinary incontinence. How will the nurse describe the condition of the client? loss of bladder control as a result of adverse medication effects or psychological stress need to void is perceived frequently, with short-lived ability to sustain control of flow loss of large amount of urine when intra-abdominal pressure rises loss of urine without any identifiable pattern or warning

loss of urine without any identifiable pattern or warning The nurse will describe the client's condition as the loss of urine without any identifiable pattern or warning. Stress incontinence can be described as loss of urine when intra-abdominal pressure rises. Urge incontinence can be described as the need to void being perceived frequently with a short-lived ability to sustain control of flow. Psychological stress and medication effects can contribute to incontinence, but not necessarily to total incontinence.

A nurse is caring for a client who gave birth 4 months ago. The client informs the nurse that they have been experiencing a sudden loss of urine whenever they laugh; this is causing embarrassment to them. Which type of urinary incontinence is this client experiencing? urge incontinence functional incontinence stress incontinence reflex incontinence

stress incontinence The nurse should document the client's condition as stress incontinence following weakening of perineal and sphincter muscle tone secondary to giving birth. Reflex incontinence is caused by damage to motor and sensory tracts in the lower spinal cord secondary to trauma. Urge incontinence is caused by bladder irritation secondary to infection. Functional incontinence is caused by impaired mobility, impaired cognition, or an inability to communicate.