1. Indications for a Foley Cath
    Weigh benefit vs. risk everytime you enter a direct line into a sterile cavity.
  2. Urinary Elimination considerations for developemental stages.
    • 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
  3. GU Assessment
    • 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
  4. Factors Affecting Urinary Elimiation
    • Personal
    • Sociocultural
    • Environmental
    • Nutrition
    • Hydration
    • Activity level
    • Medications
    • Surgery and anesthesia
    • Hydration
    • Fluid level
    • Pts w/ neurologic injury
  5. Things to look for during GU assessment
    • 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 urine
  6. Common GU terms to be familiar with.
    • 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.
  7. urine Testing
    • 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
  8. Urine Specimen
    • Label Correctly
    • In the presence of the patient
    • pt name and med rec #
    • Time/date
    • Nurses initials
    • Identify what the sample is
  9. GU Nursing Diagnosis P
    • 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
  10. Nursing Diagnosis
    • Promoting/teaching normal voiding & habits, including privacy
    • Stimulating the voiding reflex
    • Maintain adequate fluid intake
    • Preventing infection/UTI
    • Prevent skin breakdown
    • Bladder training/conditioning
  11. Urinary Catheterization
    • 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.)
  12. Catheter Care
    • Perineal hygiene – before and after; while catheter in – very important
    • Fluid intake
    • Catheter care
    • Promote comfort

    Always clean periarea clean-->dirty. Like everything.
  13. continued
    Proper IndicationMaintain closed systemCath CareRemove per policyMonitor patency – free flow of urineFrequent emptying of drainage bagSecure tubing to leg
  14. Foley Insertion
    • 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)
  15. CAUTI
    • 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
  16. Inserting a cath
    • 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
  17. Evaluation
    • 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
  18. Keeping secrets of incontinence
    • 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
  19. What is the impact of incontinence?
    • To the individual? To the family And/or caregiver? To the paid caregiver?
    • What do you see as the problems?
    • What are the physical impacts?
    • What as a nurse are you going to assess?
    • Possible nursing diagnoses
  20. Treatment goals
    Cure or decrease incontinence and/or symptomsPrevent complicationsImprove quality of lifeDecrease care costsAvoid treatment side effects
  21. Assessment of incontinence
    • 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
  22. Treatment of incontinence
    • 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?
Card Set
Urinary Elimination