Foundations

Weigh benefit vs. risk everytime you enter a direct line into a sterile cavity.

• Infants:
• 
15–60 mL per kg
• Produce 8–10 wet diapers per day
• No voluntary control

• Children:
• Toilet training requires mature neuromuscular system
• Adequate communication skills

• Problems include enuresis, nocturnal enuresis

• Older Adults:
• Kidney function decreases
• Urgency and frequency common
• Loss of bladder elasticity and muscle tone leads  to Nocturia, and Incomplete emptying

• Determine the term or terms used to designate voiding, urine and unusual elimination patterns – medical and patient
• Determine if patient has any recent concerns / problems with voiding
• Ask client if he has any of the following S/Sx of excretory dysfunction
• Which of Gordon’s Functional Health Patterns might this fit into? A: Elimination

• Personal
• Sociocultural
• Environmental
• Nutrition
• Hydration
• Activity level
• Medications
• Surgery and anesthesia
• Hydration
• Fluid level
• Pts w/ neurologic injury

• Assess the characteristics of the urine – color, clarity, and odor
• Note if the client takes any medications or foods that could alter the amount and appearance of urine, ie
• --Aldomet – black urine
• --Blackberries, beets = red urine
• --Beta-carotene = yellow or orange urinehttp://www.nlm.nih.gov/medlineplus/ency/article/003139.htm

• Urgency
• Frequency
• Hesitancy
• Dysuria: painful urination
• Nocturia
• Polyuria: a lot of urine (diabetic?)
• Retention
• Incontinence
• Enuresis: bed wetting, usually at night.
• Hematuria: blood in urine.

• Specimen collection:
• Random/timed
• Clean voided or midstream
• Sterile
• Urine culture
• Ph (normal = 4.6.-8.0)
• Protein
• Glucose
• Ketones
• Blood
• Specific gravity (normal = 1.) Indicates dehydration.
• Microscopic

• Label Correctly
• In the presence of the patient
• pt name and med rec #
• Time/date
• Nurses initials
• Identify what the sample is

• Prepare client for examination or intervention
• Same sex chaperone
• Provide privacy, privacy, privacy
• Expose only parts that are to be examined
• Inspect male organs for skin color, intactness, edema and inflammation, genital piercing
• Females – hair growth and distribution, size and shape of labia, edema, discharge, inflammation or excoriation, genital piercing

• Promoting/teaching normal voiding & habits, including privacy
• Stimulating the voiding reflex
• Maintain adequate fluid intake
• Preventing infection/UTI
• Prevent skin breakdown
• Bladder training/conditioning

• Introduction of a sterile 
tube into the bladder

• Intermittent-Straight catheter

• In dwelling catheters:  Foley
, Suprapubic catheter (used for pt w/ certain type of dialysis--> high risk of nfxn.)

• Perineal hygiene – before and after; while catheter in – very important
• Fluid intake
• Catheter care
• Promote comfort

Always clean periarea clean-->dirty. Like everything.

Proper IndicationMaintain closed systemCath CareRemove per policyMonitor patency – free flow of urineFrequent emptying of drainage bagSecure tubing to leg

• Installation of sterile solution can maintain patency in the presence of blood, pus, or sediment
• Check entire system prior to any instillation
• Types – intermittent and continuous closed drainage system
• Education and prep
• Check allergies, esp latex and betadine
• Gather supplies like extra kit, extra gloves, balloon inflation

• Male vs. female:
• --How long is urethra? Women ~3.5"
• --How far do I insert the catheter? (guy to the Y, with guys two sphyncters)

• Cathater Associated UTI
• Prevention:
• Proper Indication
• Maintain closed system
• Cath Care (empty at least q8h and replace q72h)
• Remove per policy
• Monitor patency – free flow of urine (no kinks!)
• Frequent emptying of drainage bag
• Secure tubing to leg

• Installation of sterile solution can maintain patency in the presence of blood, pus, or sediment
• Check entire system prior to any instillation
• Types – intermittent and continuous closed drainage system

• Reassess the client’s urination pattern
• Inspect client’s urine
• Pt/Family demonstration of self-care skills
• Have the client discuss feelings regarding any permanent changes in elimination
• Ask client if expectations are being met

• Societal beliefs about incontinence have not changed much since the turn of the century –
• normal part of aging?
• What do you think?
• What do you think health care providers think?
• Some elderly profess that they are not incontinent unless they wet the floor outside their own home.
• Can change sexual patterns
• Fall risk due to puddles, or bending over to clean puddles.
• Lack of knowledge concerning Rx
• Doubts concerning effectiveness of treatment
• Hope that symptoms may go away on their own
• Fear of examining procedures and surgery
• Not seem an importation enough problem – trivialization
• Relatively low proportion of persons seek Rx for incontinence

• To the individual? To the family And/or caregiver? To the paid caregiver?
• PSYCHOLOGICAL:
• What do you see as the problems?
• PHYSICAL:
• What are the physical impacts?
• What as a nurse are you going to assess?
• Possible nursing diagnoses

Cure or decrease incontinence and/or symptomsPrevent complicationsImprove quality of lifeDecrease care costsAvoid treatment side effects

• Obtain a thorough medical, neurological, and genitourinary hx
• Determine risk factors associated with illnesses, previous operations, OTC and current prescription medicines
• Attn to symptoms and pattern of urine loss – ask client to keep a journal

• Behavioral – all patients should be functional, motivated and able to learn or practice
• Bladder retraining – this is critical!
• Pelvic muscle exercise such as Kegel – for women.
• Biofeedback
• Scheduled toileting – this is critical!
• What else can you think of?