Bladder Dysfunction Quiz

Urinary Catheterization and Care

• Maintain a closed urinary drainage system to prevent infection and urine backflow into the bladder.
• Check for kinks or occlusion in the drainage tubing or catheter in the absence of urine drainage.
• Irrigate or flush the catheter with sterile solution to maintain patency, with two types of irrigation: closed catheter irrigation and open irrigation.

Continuous Bladder Irrigation (CBI)

• CBI is a continuous infusion of a sterile solution into the bladder, usually using a three-way irrigation closed system with a triple-lumen catheter.
• Frequently used following genitourinary surgery to keep the bladder clear and free of blood clots or sediment.

Indwelling Catheter Care

• Promptly remove the indwelling catheter after it's no longer needed, followed by perineal care, to decrease the incidence and prevalence of infection.
• Monitor patients for timing of voiding after catheter removal and quantity voided.

Alternatives to Urethral Catheters

• Suprapubic and condom catheters are available alternatives to avoid the risks associated with urethral catheters.

Urine Specimens

• Collect routine urinalysis, clean-catch or midstream specimens, and sterile specimens from indwelling catheters.
• Obtain 24-hour urine specimens as needed.

Promoting Normal Urination

• Maintain normal voiding habits through schedule, urge, privacy, position, and hygiene.
• Create a conducive environment by closing the door and bedside curtain, asking visitors to leave the room, and masking the sounds of voiding with running water.
• Respond to requests for assistance with toileting as quickly as possible.

Preventing Urinary Tract Infections (UTIs)

• Promote adequate fluid intake, perineal hygiene, and voiding at regular intervals to prevent UTIs.
• Suggest avoiding fluids 2 hours before bedtime to prevent nocturia.

Urinary Retention and Incontinence

• Urinary retention is the inability of the bladder to empty, leading to overflow incontinence or incontinence associated with chronic retention of urine.
• Postvoid residual (PVR) is the amount of urine left in the bladder after voiding, measured by ultrasound or straight catheterization.
• Incontinence caused by urinary retention is characterized by frequency, urgency, small volume voiding, or incontinence of small volumes of urine.

Urinary Tract Infections (UTIs)

• UTIs are usually caused by Escherichia coli and are characterized by location (upper or lower urinary tract) and signs and symptoms of infection.
• Symptoms of a lower urinary tract infection (bladder) include burning or pain with urination, irritation or inflammation of the bladder, urgency, frequency, incontinence, suprapubic tenderness, and foul-smelling cloudy urine.

Catheter-Associated UTIs (CAUTIs)

• CAUTIs are associated with increased hospitalizations, morbidity, mortality, longer hospital stays, and increased hospital costs.

Urinary Incontinence (UI)

• UI is the involuntary leakage of urine, with common forms including:
  • Stress incontinence: involuntary loss of urine associated with pressure exerted on the bladder.
  • Urge incontinence: sudden, intense urge to urinate followed by an involuntary loss of urine.
  • Overflow incontinence: frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
  • Functional incontinence: caused by factors that prohibit or interfere with a patient's access to the toilet or other acceptable receptacle for urine.
  • Mixed incontinence: incontinence that has multiple interacting risk factors.

Nursing Diagnosis and Interventions

• Urinary problems amenable to nursing therapy may lead to one or more nursing diagnoses, including:
  • Functional urinary incontinence
  • Stress urinary incontinence
  • Urge urinary incontinence
  • Risk for infection
  • Toileting self-care deficit
  • Impaired skin integrity
  • Impaired urinary elimination
  • Urinary retention
• Goals for nursing interventions include:
  • Producing sufficient quantity of urine to maintain fluid, electrolyte, and acid-base balance.
  • Emptying the bladder completely at regular intervals without discomfort.
  • Providing care for urinary diversion and knowing when to notify the physician.
  • Developing a plan to modify factors contributing to current or future urinary problems.
  • Correcting unhealthy urinary habits.

Laboratory and Diagnostic Testing

• Nurses are responsible for collecting urine specimens for laboratory testing, with the type of test determining the method of collection.
• Label all specimens with the patient's name, date, time, and type of collection.
• Urine specimens must reach the laboratory within 2 hours of collection or be preserved according to laboratory protocol.

Catheterization

• Urinary catheterization is the placement of a tube through the urethra into the bladder to drain urine and requires a medical order and aseptic technique.
• Reasons for urinary catheterization include:
  • Relieving urinary retention
  • Prolonged patient immobilization
  • Obtaining a sterile urine specimen
  • Accurate measurement of urinary output in critically ill patients
  • Assisting in healing open sacral or perineal wounds in incontinent patients
  • Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations
  • Providing improved comfort for end-of-life care