Catheterization and Incontinence Care

Elimination & Catheterization

• Risks of Catheterization: CAUTI (most common), bladder spasms, periurethral abscess, chronic pyelonephritis, urosepsis, urethral trauma/erosion, fistula/stricture formation, kidney stones.
• Catheterization Care: Sterile technique; follow Table 50.22 (p. 1224). Clean meatus and tubing with soap and water. Prevent UTIs, maintain urine flow, prevent infection, promote normal urine output, and maintain skin/mucosal integrity. (Wilkenson pp. 737-739)
• Teaching: Emphasize cleanliness and reporting infection symptoms. (Wilkenson p. 740)
• Expected Urine Output: 1500 mL/day. Minimum: 30 mL/hr. Normal range: 800-2000 mL/day.
• Catheter Insertion:
  • Female: Gently insert 2-3 inches until urine flows, then advance another 1-2 inches.
  • Male: Gently insert 7-9 inches until urine flows, then advance almost to catheter bifurcation (Y-connector). Hold catheter at meatus with non-sterile hand.

Incontinence

• Stress Incontinence: Involuntary urine loss due to pressure on the bladder.
• Urge Incontinence: Sudden, intense urge to urinate with involuntary leakage.
• Overflow Incontinence: Bladder unable to fully empty, leading to frequent dribbling or leaking. Often caused by bladder obstruction or nerve damage.
• Reflex Incontinence: Involuntary urine loss due to reflex action, often from neurological conditions.
• Functional Incontinence: Inability to reach the bathroom due to physical or cognitive limitations.

Dialysis

• Peritoneal Dialysis: Dialysate (cleansing fluid) passed into the abdomen via catheter. Absorbs waste from abdominal blood vessels, then fluid is removed. Can be done manually or using a machine.

• Hemodialysis: Machine filters blood pumped out of the body via an artificial kidney. Cleaned blood is returned to the body. Usually done 3-5 times a week in a center, but can be home-based.

• AV Fistula Assessment:

  • Thrill: Palpable vibration (buzzing) on skin, indicating turbulent blood flow.
  • Bruit: Audible whooshing/rumbling sound (heard with stethoscope), also indicating turbulent blood flow,

• Dialysis Purpose: Correct fluid/electrolyte imbalances and remove waste in kidney failure.

• Dialysis Assessment (Before/After): Assess dry weight, vital signs, blood electrolytes, creatinine, BUN, blood glucose. (See ATI p. 421)

• Dry Weight: Patient's weight after dialysis.

ACE Inhibitors

• Purpose: Slow kidney damage progression by lowering blood pressure, reducing kidney stress.
• Adverse Effects: Dry cough, hyperkalemia, hypotension; discontinue if cough persists.
• Patient Teaching: Regular follow-up appointments, continue medication even if blood pressure is normal, take medication at the same time daily.
• Nursing Considerations: Monitor blood pressure and pulse before administering the medication. Watch for signs of heart failure (e.g., edema).

Blood Glucose Monitoring

• Method: Finger prick before meals and at bedtime.
• Abnormal Electrolyte Concerns: Life-threatening. Monitor ECGs and frequent lab tests (e.g., potassium)

Chronic Kidney Disease (CKD) Labs

• eGFR: Estimated Glomerular Filtration Rate (normal 90-120 ml/min; decreased in CKD). Indicates kidney function.
• BUN: Blood Urea Nitrogen (increased in CKD). Normal = 6-24 mg/dL
• Serum Creatinine: (Increased in CKD). Normal = 0.74-1.35 mg/dL (men).
• Urine Microalbumin: Indicates kidney damage.
• Electrolytes: Serum potassium should be carefully monitored; check for imbalances. (Potassium is important)

Cancer

• Lung Cancer: Smoking is the leading cause. Common symptoms: persistent cough, hemoptysis, weight loss.
• Lung Cancer Types: Non-Small Cell (NSCLC), Small Cell.
• Diagnosis: Chest X-ray, MRI, CT scan, biopsy.
• Treatment: Radiation, chemo, surgery, palliative care, hospice.
• Prognosis: Dependent on staging; poor in stage 4.
• Paraneoplastic Syndromes: Lung tumors can inappropriately secrete ACTH, causing a tanned appearance.

Blood Glucose Management, Hyperglycemia. Hypoglycemia

• Hyperglycemia Symptoms: Increased thirst, frequent urination, fatigue, potential risk of Hyperosmolar Hyperglycemic State.
• Hypoglycemia Symptoms: Shaking, confusion, sweating. Treated with quick source of glucose.
• Sick Day Education: Continue insulin, frequent glucose checks, hydration.

Hodgkin's vs. Non-Hodgkin's Lymphoma

• Hodgkin's: Characterized by Reed-Sternberg cells.
• Non-Hodgkin's: Can involve cancerous B cells, T cells, or NK cells

Hypertension Risk Factors

• Sodium Intake, Sedentary Lifestyle, Unhealthy Diet, Alcohol Consumption, Chronic Stress, Chronic Pain, Obesity

Peripheral Artery Disease Risk Factors

• Unhealthy Diet, Sedentary Lifestyle, Smoking, Diabetes, High LDL cholesterol

Medications and IV Fluids

• Isotonic: 0.9% NaCl, 5% Dextrose (hydration)
• Hypotonic: 0.45% NaCl, D2.5W (rehydration)
• Hypertonic: 3-5% NaCl, 10-50% Dextrose (fluid overload)
• IV Site Assessment: Cool/swollen= infiltration; Warm/swollen = infection
• IV Medication Adminstration: Hang medication bag above primary IV bag.

Mobility

• Chronic Conditions Affecting Mobility: Rheumatoid Arthritis (RA), Osteoarthritis (OA), fibromyalgia, muscular dystrophy, multiple sclerosis (MS).

TB

• Primary TB: Bacteria spread through lungs, can infect others, within first two years. Symptoms- Low-grade fever, night sweats, weight loss, fatigue.
• Post-Primary TB: Two or more years after infection; still infectious.
• Latent TB: Bacteria inactive, no symptoms; can progress to TB disease, requires treatment.

Systemic Lupus Erythematosus (SLE)

• Nursing Diagnoses: Disturbed body image, fatigue, ineffective health maintenance behaviors, acute pain, powerlessness, impaired religiosity, chronic sorrow, spiritual distress. Risk for decreased cardiac tissue perfusion, impaired resilience, and impaired skin integrity. Monitor for butterfly rash.

Pain Assessment

• PQRST: Provocation (what makes it better or worse), Quality, Region/Radiation, Severity, Timing. Pain scale: 0-10.

Wound Care Assessment

• Stages of Pressure Ulcers (Decubitus Ulcer): 1,2,3,4,unstageable, deep tissue injury.
• Wound Drainage: Serous, serosanguineous, sanguineous, purulent.
• Abnormal Findings: Redness, warmth, bad odor, infection like drainage, maceration, pain, etc..
• Unusual Wound Characteristics: Dehiscence (wound opening). Evisceration (internal organs exposed.) Sloughs and eschars are non-healing wound characteristics.

Medical Terminology

• Asterixis: Neurological jerking movements (cirrhosis, liver failure).
• Hemoconcentration: Blood cell concentration increase due to plasma loss.
• Orthostatic Hypotension: Blood pressure drop when moving from lying to standing
• Thyroidectomy: Thyroid gland removal.
• Microalbuminuria: Slightly elevated urine albumin.
• Arteriovenous Fistula (AVF): Surgical connection between artery and vein
• Hemoptysis: Coughing up blood.
• Mental Fogginess: Difficulty thinking clearly, focusing, or remembering. (brain fog)
• Inguinal: Groin or lower abdomen regions
• Exophthalmos: Bulging eyes (Graves disease).
• Cobblestone Wound: Granulation tissue present
• Maceration: Skin softening and breakdown due to moisture.
• Slough: Yellow, white, or tan, moist wound material
• Eschar: Dead tissue after injury or infection.
• Exudate: Fluid, cells, etc. leaking from blood vessels into tissue.

Kahoot! Answers

(Provided answers directly from the Kahoot! questions).

This quiz covers essential topics related to catheterization and incontinence care, including risks, care techniques, and expected urine output. Emphasis is placed on maintaining a sterile technique and understanding the importance of cleanliness to prevent infections. Test your knowledge on proper catheter insertion methods and incontinence management strategies.