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

Test your knowledge on problems related to bladder dysfunction such as infection, obstruction of urine flow, and impaired bladder contractility. Learn about symptoms like frequency, urgency, and incontinence, as well as the significance of postvoid residual (PVR) measurement.