Urinary Elimination Fall23 PDF

URINARY ELIMINATION ALECIA HOLLIS, MSN, RN URINARY SYSTEM  URINARY SYSTEM KIDNEYS: THEIR ROLE IS TO HELP MAINTAIN THE COMPOSITION AND VOLUME OF THE BODY FLUIDS. THEY FILTER AND EXCRETE BLOOD CONSTITUTES THAT ARE NOT NEEDED AND RETAIN THOSE THAT ARE NEEDED. ...

URINARY ELIMINATION ALECIA HOLLIS, MSN, RN URINARY SYSTEM  URINARY SYSTEM KIDNEYS: THEIR ROLE IS TO HELP MAINTAIN THE COMPOSITION AND VOLUME OF THE BODY FLUIDS. THEY FILTER AND EXCRETE BLOOD CONSTITUTES THAT ARE NOT NEEDED AND RETAIN THOSE THAT ARE NEEDED.  TERMS ANURIA NEPHROTOXIC BACTERIURIA NOCTURIA ENURESIS OLIGURIA CONDOM CATHETER POLYURIA GLYCOSURIA PROTEINURIA INCONTINENCE PVR HEMATURIA PYURIA KEGEL EXERCISES SPECIFIC GRAVITY MICTURITION SEPSIS  NEPHRONS Remove the end product of metabolism which include: Urea Urine Creatinine Uric acid Nephrons maintain balance with the selective secretion of water, electrolytes  URINARY SYSTEM URETER BLADDER: MUSCLE INNERVATED BY AUTONOMIC NERVOUS SYSTEM SYMPATHETIC INHIBITS IMPULSES TO THE BLADDER AND MOTOR IMPULSES TO THE INTERNAL SPHINCTER PARASYMPATHETIC CARRIES MOTOR IMPULSES TO BLADDER AND INHIBITORY IMPULSES TO INTERNAL SPHINCTER  WHAT CAN EFFECT URINATION DEVELOPMENTAL AGE AGING FLUID AND FOOD INTAKE PSYCHOLOGICAL VARIABLES ACTIVITY AND MUSCLE TONE PATHOLOGIC CONDITIONS MEDICATIONS  FLUIDS AND FOODS CAFFEINE – DIURETIC EFFECT ALCOHOL – DIURETIC EFFECT HIGH SODIUM CONTENT – RETENTION OF FLUID  DECREASED MUSCLE TONE AFFECTING URINARY CONTROL INDWELLING CATHETERS CHILDBEARING DECREASED ESTROGEN LEVELS DAMAGE TO MUSCLES RELATED TO TRAUMA  A MALE CLIENT INFORMS THE NURSE THAT HE IS CONCERNED ABOUT DRIBBLING AND INCONTINENCE OF SMALL AMOUNTS OF URINE AFTER THE REMOVAL OF AN INDWELLING URINARY CATHETER. THE NURSE IS AWARE THAT THE CATHETER WAS IN PLACE FOR 3 WEEKS PRIOR TO BEING REMOVED. WHICH IS THE NURSE'S BEST RESPONSE TO THE CLIENT? A. "IT WILL TAKE A LITTLE WHILE FOR THE BLADDER TO REESTABLISH CONTROL AS THE STRENGTH OF THE MUSCLE IMPROVES, AND AN ACCIDENT IS NOT UNUSUAL." B. "DRIBBLING AND INCONTINENCE OFTEN MEAN THE BLADDER HAS LOST MUSCLE TONE, AND THE CATHETER WILL LIKELY NEED TO BE REINSERTED." C. "YOUR SYMPTOMS ARE A NORMAL PART OF THE AGING PROCESS. THE BLADDER LOSES TONE AS YOU AGE." D. "I WILL INFORM THE HEALTH CARE PROVIDER, AND WE WILL LIKELY NEED TO PERFORM A CYSTOSCOPY TO LOOK AT YOUR BLADDER TO LOOK FOR PROBLEMS."  DISEASES ASSOCIATED WITH RENAL PROBLEMS CONGENITAL URINARY TRACT ABNORMALITIES POLYCYSTIC KIDNEY DISEASE URINARY TRACT INFECTION URINARY CALCULI HYPERTENSION DIABETES MELLITUS GOUT CONNECTIVE TISSUE DISORDERS  EFFECTS OF MEDICATIONS ON URINE PRODUCTION AND ELIMINATION DIURETICS—PREVENT REABSORPTION OF WATER AND CERTAIN ELECTROLYTES IN TUBULES CHOLINERGIC MEDICATIONS—STIMULATE CONTRACTION OF DETRUSOR MUSCLE, PRODUCING URINATION ANALGESICS AND TRANQUILIZERS—SUPPRESS CNS, DIMINISH EFFECTIVENESS OF NEURAL REFLEX NEPHROTOXIC DRUGS – ABUSE OF ASPIRIN OR IBUPROFEN, ANTIBIOTICS – GENTAMICIN  MEDICATIONS AFFECTING COLOR OF URINE ANTICOAGULANTS—RED URINE DIURETICS—PALE YELLOW URINE PYRIDIUM—ORANGE TO ORANGE-RED URINE ELAVIL—GREEN OR BLUE-GREEN URINE LEVODOPA—BROWN OR BLACK URINE  HOW TO RECOGNIZE ALTERATION Question client Physical during nursing history Explore the duration, assessment Percussion of kidneys severity, and precipitating Palpate bladder factors Assess urinary meatus Note patient’s perception of the problem Assess the skin Check adequacy of Measure intake and patient’s self-care output BLADDER SCANNER  A NURSE IS ASSESSING A CLIENT WHO IS COMPLAINING OF DIFFICULTY URINATING. WHICH ASSESSMENT WOULD BE A PRIORITY? A. ASKING THE CLIENT WHEN HE OR SHE HAD LAST URINATED B. DETERMINING ANY PAIN WHEN PALPATING THE LOWER ABDOMEN C. PALPATING THE BLADDER ABOVE THE SYMPHYSIS PUBIS D. OBTAINING THE BLADDER SCANNER TO CHECK THE URINE VOLUME  SPECIAL ASSESSMENT MEASURING URINE OUTPUT CONTINENT INCONTINENT DEVICES FOR COLLECTING AND MEASURING URINE  MEASURING URINE OUTPUT NORMAL ADULT OUTPUT: NORMAL ADULT URINE OUTPUT 0.5 TO 1 ML/KG/HR OR 1500 IN 24 HOURS FOR CHILDREN, THE EXPECTED URINE OUTPUT IS CLOSER TO 1ML/KG/HOUR ASK PATIENT TO VOID INTO BEDPAN, URINAL, OR SPECIMEN CONTAINER IN BED OR BATHROOM. POUR URINE INTO APPROPRIATE MEASURING DEVICE. PLACE CALIBRATED CONTAINER ON FLAT SURFACE AND READ AT EYE LEVEL. NOTE AMOUNT OF URINE VOIDED AND RECORD ON APPROPRIATE FORM. DISCARD URINE IN TOILET UNLESS SPECIMEN IS NEEDED. OUTPUT FROM AND INDWELLING CATHETER CLEAN GLOVES CALIBRATED MEASURING DEVICE DO NOT TOUCH MEASURING DEVICE WITH DRAINAGE SPOUT. OPEN THE CLAMP. RECLAMP THE TUBE AND WIPE THE SPOUT WITH AN ALCOHOL PAD. REPLACE THE TUBE. CRITICALLY ILL PATIENTS MAY REQUIRE HOURLY MEASUREMENTS. URIMETER.  ASSESSING URINE VOLUME( 1,200-1,500 ML) COLOR, CLARITY (STRAW, AMBER, TRANSPARENT) ODOR (FAINT AROMATIC) STERILITY (NO MICROORGANISMS) PH (4.5-8) NORMAL 5-6 SPECIFIC GRAVITY (1.010 -1.025) GLUCOSE (NOT PRESENT  URINE SPECIMENS ROUTINE URINALYSIS CLEAN-CATCH OR MIDSTREAM SPECIMEN STERILE SPECIMEN 24 HOUR URINE SPECIMENS POINT OF CARE OR DIP STICK URINE  PVR INCOMPLETE BLADDER EMPTYING IS DIAGNOSED BY POSTVOID CATHETERIZATION A VOLUME < 50 ML IS NORMAL < 100 ML IS USUALLY ACCEPTABLE IN PATIENTS 65 OR OLDER  DIAGNOSTIC PROCEDURES BOX 37-2 CYSTOSCOPY INTRAVENOUS PYELOGRAM RETROGRADE PYELOGRAM RENAL ULTRASOUND COMPUTED TOMOGRAPHY (CT) RENAL BIOPSY  A STUDENT NURSE IS PREPARING TO MEASURE A CLIENT’S OUTPUT. WHICH INTERVENTIONS SHOULD THE STUDENT NURSE TAKE (SELECT ALL THAT APPLY) A. USE AN APPROPRIATE MEASURING CONTAINER B. WEAR GLOVES WHEN HANDLING THE URINE C. MEASURE THE URINE CONTAINER AT EYE LEVEL D. NOTING THE COLOR AND CLARITY OF THE URINE E. RECORD URINE UNDER OUTPUT IN THE FLOW SHEET. F. LEAVE URINE FOR UAP TO DISCARD  PLANNED PATIENT GOALS PRODUCE SUFFICIENT QUANTITY OF URINE TO MAINTAIN FLUID, ELECTROLYTE, AND ACID–BASE BALANCE. EMPTY BLADDER COMPLETELY AT REGULAR INTERVALS WITHOUT DISCOMFORT. PROVIDE CARE FOR URINARY DIVERSION AND KNOW WHEN TO NOTIFY PHYSICIAN. DEVELOP PLAN TO MODIFY FACTORS CONTRIBUTING TO CURRENT OR FUTURE URINARY PROBLEMS. CORRECT UNHEALTHY URINARY HABITS.  MAINTAINING NORMAL VOIDING HABITS SCHEDULE URGE TO VOID PRIVACY POSITION HYGIENE  INTERVENTIONS PROMOTE NORMAL VOIDING PATTERNS ENCOURAGE FLUID INTAKE OF 6 TO 8 OZ GLASSES UNLESS CONTRAINDICATED STRENGTH MUSCLE TONE: KEGEL EXERCISES OR PFMT (PELVIC FLOOR MUSCLE TRAINING) ASSIST WITH TOILETING ASSESS FOR UTI: S/S DYSURINA, URINARY FREQUENCY, URGENCY, CLOUDY URINE WITH FOUL ODER. KEGEL EXERCISES  INTERVENTIONS MAINTAINING SKIN INTEGRITY APPLYING EXTERNAL URINARY DRAINAGE DEVICES PERFORMING URINARY CATHETERIZATIONS PERFORMING BLADDER IRRIGATIONS PROVIDING CARE FOR CLIENTS WITH INDWELLING URINARY CATHETERS AND URINARY DIVERSIONS  IDENTIFY UTI RISK FACTORS SEXUALLY ACTIVE WOMEN WOMEN USING A DIAPHRAGM FOR CONTRACEPTION POSTMENOPAUSAL WOMEN THOSE WITH INDWELLING URINARY CATHETER INDIVIDUALS WITH DIABETES MELLITUS ELDERLY  URINE CULTURE IS USED TO IDENTIFY THE PATHOGENIC BACTERIAL ORGANISMS IN THE URINE AS AN INDICATOR FOR APPROPRIATE THERAPEUTIC INTERVENTIONS TO TREAT URINARY TRACT INFECTIONS. - COLONY COUNTS OF 100,00/ML OR MORE INDICATE URINARY TRACT INFECTION (UTI). INTERFERING FACTORS: ANTIBIOTIC THERAPY INITIATE BEFORE SPECIMEN COLLECTION IMPROPER COLLECTION TECHNIQUES SPECIMEN STORAGE  PRIMARY PREVENTION ENCOURAGE CLIENT TO DRINK 6 TO 8 OZ GLASSES OF WATER A DAY DO NOT POSTPONE GOING TO BATHROOM DRY PERINEAL AREA AFTER URINATION OR DEFECATION FRONT TO BACK VOID AFTER INTERCOURSE TAKE SHOWERS RATHER THAN BATHS WEAR COTTON CROTCH UNDERWEAR; AVOID TIGHT FITTING CLOTHING DRINK 10 OZ GLASS OF CRANBERRY OR BLUEBERRY JUICE OBSERVE AND REPORT S/S OF UTI  TYPES OF URINARY INCONTINENCE TRANSIENT-APPEARS SUDDENLY, USUALLY DUE TO ILLNESS STRESS—INCREASE IN INTRA-ABDOMINAL PRESSURE URGE—URINE LOST DURING ABRUPT AND STRONG DESIRE TO VOID MIXED—SYMPTOMS OF URGE AND STRESS INCONTINENCE PRESENT OVERFLOW—OVERDISTENTION AND OVERFLOW OF BLADDER FUNCTIONAL—CAUSED BY FACTORS OUTSIDE THE URINARY TRACT. ALTERED ENVIRONMENT (FOR EXAMPLE: HOSPITALIZED). MAY HAVE SENSORY, COGNITIVE OR MOBILITY DEFICITS REFLEX—EMPTYING OF THE BLADDER WITHOUT SENSATION OF NEED TO VOID. NEUROLOGIC IMPAIRMENT (SPINAL CORD) TOTAL—CONTINUOUS, UNPREDICTABLE LOSS OF URINE (NEUROLOGIC – SPINAL CORD)  THOSE AT RISK FEMALE HISTORY OF MULTIPLE PREGNANCIES AND VAGINAL BIRTHS, AGING, CHRONIC URINARY RETENTION, URINARY BLADDER SPASM, RENAL DISEASE AND CHRONIC BLADDER INFECTION. MEDICATION THERAPY: DIURETICS, OPIODS, ANTICHOLINERGICS, CCB, SEDATIVES OBESITY CONFUSION, DEMENTIA, IMMOBILITY, DEPRESSION PHYSIOLOGICAL CHANGES OF AGING DECREASE ESTROGEN LEVELS  ASSESSMENT SUBJECTIVE : CLIENT MAY COMPLAIN LOSS OF URINE WHEN LAUGHING, COUGHING AND SNEEZING. ENURESIS BLADDER SPASMS FREQUENCY, URGENCY, NOCTURIA URINARY RETENTION ASSESS DIETARY HABITS  ASSESSMENT OBJECTIVE: R/O UTI LABS: CREATININE AND BUN POST VOID RESIDUAL URINE A. BLADDER ULTRASOUND B. CATHERIZATION PVR SHOULD BE 50 ML OR < >150 ML OFTEN IS RECOMMENDED AS GUIDELINE FOR CATHETERIZATION  BUN BLOOD UREA NITROGEN USED TO EVALUATE RENAL FUNCTION AND GLOMEULAR FILTRATION RATE IF NORMAL FUNCTIONING LIVER. UREA IS THE BY PRODUCT OF PROTEIN METABOLISM THAT OCCURS IN THE LIVER. NORMAL RANGE: ADULT 10-20 MG/DL INFANT AND CHILD 5-18 MG/DL NEWBORN: 3-12 MG/DL LEVELS ARE INCREASED IN RENAL DISEASE AND DECREASED IN LIVER DISEASE.  CREATININE IS USED TO DIAGNOSE IMPAIRED RENAL FUNCTION BY PRODUCT OF CREATINE PHOSPHATE, WHICH IS USED IN SKELETAL MUSCLE CONTRACTION MORE ACCURATE THAN BUN NOT AFFECTED BY LIVER FUNCTION NORMAL RANGES: ADULT: FEMALE: 0.5-1.0 MG/DL MALE: 0.6-1.2MG/DL ADOLESCENT: 0.5-1.0 MG/DL CHILD: 0.3-0.7 MG/DL INFANT 0.2-0.4 MG/DL >4 IS CRITICAL VALUE DECREASED IN DECREASE MUSCLE MASS  INTERVENTIONS BEHAVIORAL MODIFICATIONS 1ST KEGEL EXERCISES BIOFEEDBACK ELECTRICAL STIMULATION TIME VOIDING OR BLADDER TRAINING URINATE AT SCHEDULE INTERVALS GRADUALLY INCREASE URINATION INTERVALS AFTER NO INCONTINENCE EPISODES FOR 3 DAYS WORKING TOWARD 4HOUR INTERVAL HOLD URINE UNTIL THE SCHEDULED TOILETING TIME  INTERVENTIONS TEACH THE CLIENT TO KEEP AN INCONTINENCE DIARY BLADDER COMPRESSION TECHNIQUES (CREDE, VALSALVA, DOUBLE VOIDING, SPLINTING) TO HELP MANAGE REFLEX INCONTINENCE AVOID CAFFEINE AND ALCOHOL : CAUSES DIURESIS AND THE URGE TO URINATE  INTERVENTIO NS PHARMACOLOGICAL TREATMENTS WILL DEPEND ON TYPE OF INCONTINENCE TOPICAL ESTROGEN USED IN POSTMENOPAUSAL WOMEN COLLAGEN MAY BE INJECTED INTO THE TISSUE AROUND THE URETHRA MECHANICAL TREATMENT PESSARIES EXTERNAL BARRIERS The nurse is assessing a female client who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse’s best reply? A. You are experiencing stress incontinence. Do you know how to do Kegel exercises?” B. “You are experiencing reflex incontinence. Have you had a spinal cord injury in the past?” C. “You are experiencing total incontinence. Have you had any surgeries or trauma that may be causing this?” D. “You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately?”  EXTERNAL URINE COLLECTION DEVICE CONDOM CATH FEMALE EXTERNAL CATH Male pure “WICK” wick  CONDOM CATHETER ALTERNATIVE TO AN INDWELLING CATHETER SELF ADHESIVE – SEE MANUFACTURER’S INSTRUCTIONS FASTEN SECURELY BUT DO NOT CONSTRICT CONNECTED TO TUBING AND A COLLECTION BAG (MAY BE A LEG BAG) TIP OF THE TUBING SHOULD REMAIN 1” – 2” ABOVE THE TIP OF THE PENIS  CATHETERS CONDOM CATHETER FOR MALE CLIENTS INTERMITTENT (STRAIGHT) INDWELLING (FOLEY) SUPRAPUBIC TYPES OR URINARY CATHETERS A SUPRAPUBIC CATHETER POSITIONED IN THE BLADDER  REASONS FOR CATHETERIZATION RELIEVING URINARY RETENTION OBTAINING A STERILE URINE SPECIMEN OBTAINING A URINE SPECIMEN WHEN USUAL METHODS CAN’T BE USED EMPTYING BLADDER BEFORE, DURING, OR AFTER SURGERY MONITORING CRITICALLY ILL PATIENTS  SUPPLIES FOR INDWELLING URINARY CATHETER INSERTION STERILE URINARY CATHETER KIT 14F – 16F ADULT 5F – 8F INFANTS 8F – 12F CHILDREN 5ML, 10ML BALLOON  POSITIONS FOR INSERTING AN INDWELLING URINARY CATHETER FEMALE – DORSAL RECUMBENT POSITION ALTERNATE - SIMS POSITION, LATERAL POSITION MALE SUPINE, THIGHS SLIGHTLY APART  PROCEDURE – INSERTION OF AN INDWELLING URINARY CATHETER FEMALE REVIEW MALE REVIEW  DOCUMENTATION OF THE INSERTION OF A INDWELLING CATHETER DOCUMENT THE SIZE AND TYPE OF CATHETER DOCUMENT THE AMOUNT OF STERILE WATER INSERTED INTO THE BALLOON DOCUMENT THE PATIENT’S TOLERANCE OF THE PROCEDURE RECORD THE AMOUNT OF URINE OBTAIN INITIALLY DOCUMENT THE CHARACTERISTICS OF THE URINE DOCUMENT ANY ABNORMAL CHARACTERISTICS OF THE PERINEAL SKIN REMOVAL OF AN INDWELLING URINARY CATHETER EMPTY THE BAG AND MEASURE DEFLATE THE BALLOON -DO NOT CUT THE BALLOON PORT HAVE THE PATIENT TAKE SEVERAL DEEP BREATHS (TO RELAX) GENTLY REMOVE THE CATHETER AND PROVIDE PERINEAL CARE DOCUMENT NOTIFY THE PRIMARY CARE PROVIDER IF THE NURSING CARE OF CLIENTS WITH INDWELLING CATHETERS ENCOURAGE CLIENT TO DRINK AT LEAST 2-3L OF FLUID A DAY HAND HYGIENE ENCOURAGE INTAKE OF FOODS THAT CREATE ACIDIC URINE PERINEAL CARE( MILD SOAP AND WATER) CHANGE CATHETER AND DRAINAGE SYSTEM ONLY WHEN NECESSARY CATHETERIZE ONLY WHEN NECESSARY MAINTAIN STERILE CLOSED-DRAINAGE SYSTEM REMOVE CATHETER AS SOON AS POSSIBLE AVOID BATHS, TAKE SHOWER  Wash Wash hands before and after caring for client Clean the perineal area thoroughly, especially around Clean the meatus, daily and after each bowel movement Cleanse the catheter by cleaning gently from the Cleanse meatus outward Use mild soap and water or perineal cleanser to the Use CATH clean the perineal area Avoid Avoid powder and lotions after cleaning CARE Make sure the patient maintains a generous fluid Make intake Assess Assess urine volume and character. Record and Record and Maintain I &O and record every 8 Maintain hours Maintain Maintain a closed system Keep Keep bag below the bladder HAZARDS OF URETHRAL CATHETERIZATION SEPSIS TRAUMA  OLDER ADULT INCOMPLETE EMPTYING OF THE BLADDER DECREASED SPHINCTER CONTROL BLADDER-OUTLET OBSTRUCTION DUE TO ENLARGED PROSTATE GLAND PELVIC FLOOR RELAXATION DUE TO ESTROGEN DEPLETION REDUCED RENAL BLOOD FLOW  HEALTH CARE ASSOCIATED INFECTIONS HAI’S NOSOCOMIAL – ORIGINATING IN A HOSPITAL EXOGENOUS ENDOGENOUS IATROGENIC  HAI’S 4 TARGET AREAS URINARY TRACT INFECTIONS SURGICAL SITE INFECTIONS BLOODSTREAM INFECTIONS PNEUMONIA $28 BILLION TO $33 BILLION DOLLARS ON AVERAGE – 19 EXTRA DAYS IN THE HOSPITAL  UTI LEADING CAUSE OF MORBIDITY AND HEALTHCARE EXPENDITURES IN PERSONS OF ALL AGES. ABOUT ½ OF ALL PATIENTS WITH INDWELLING CATHETERS BECOME INFECTED WITHIN 1 WEEK AFTER INSERTION WOMEN ARE MORE LIKELY TO DEVELOP UTI’S  PATIENTS AT RISK FOR UTIS SEXUALLY ACTIVE WOMEN WOMEN WHO USE DIAPHRAGMS FOR CONTRACEPTION POSTMENOPAUSAL WOMEN **INDIVIDUALS WITH INDWELLING URINARY CATHETER** INDIVIDUALS WITH DIABETES MELLITUS ELDERLY PEOPLE  SIGNS AND SYMPTOMS OF UTI HEMATURIA EARLY SIGN OF BLADDER INFECTION OTHER SIGNS OF UTI PRESENCE OF BACTERIA IN A CLEAN CATCH SPECIMEN DYSURIA URINARY FREQUENCY OR URGENCY CLOUDY URINE FOUL SMELLING URINE A FEMALE CLIENT IS DIAGNOSED WITH A URINARY TRACT INFECTION (UTI) AND STATES THIS IS HER SECOND ONE IN THE LAST 6 MONTHS. IN TEACHING THE CLIENT ABOUT HEALTH PROMOTION, THE NURSE WOULD INCLUDE WHICH STATEMENT? A. “FLUID INTAKE IS NOT A FACTOR WITH URINARY TRACT INFECTIONS.” B. “CLEAN THE PERINEAL AREA FROM BACK TO FRONT WHEN USING THE BATHROOM.” C. “ROUTINE TUB BATHS ARE FINE AS LONG AS YOU ARE BATHING APPROPRIATELY.” D. “TRY TO URINATE IMMEDIATELY AFTER SEXUAL INTERCOURSE.” LOCATION OF AN ILEAL CONDUIT  URINARY DIVERSIONS ILEAL CONDUIT (INCONTINENT)  URINARY DIVERSIONS CONTINENT KOCK ILEAL RESERVOIR MITROFANOFF  PATIENT EDUCATION FOR URINARY DIVERSION EXPLAIN REASON FOR DIVERSION AND RATIONALE FOR TREATMENT DEMONSTRATE EFFECTIVE SELF-CARE BEHAVIORS DESCRIBE FOLLOW-UP CARE AND SUPPORT RESOURCES REPORT WHERE SUPPLIES MAY BE OBTAINED IN COMMUNITY VERBALIZE RELATED FEARS AND CONCERNS DEMONSTRATE A POSITIVE BODY IMAGE  NURSING CARE OF THE OSTOMY ASSESS THE STOMA ASSESS INTAKE AND OUTPUT KEEP THE CLIENT AS FREE OF ODORS AS POSSIBLE. NOTE ANY CHANGES IN URINE COLOR, ODOR, OR CLARITY (MUCOUS SHREDS ARE COMMONLY SEEN IN THE URINE OF CLIENTS WITH AN ILEAL DIVERSION) FREQUENTLY ASSESS THE CONDITION OF THE STOMA AND SURROUNDING SKIN ENCOURAGE THE CLIENT TO PARTICIPATE IN CARE AND TO LOOK AT THE STOMA.  A NURSE IS CARING FOR A CLIENT WHO HAS JUST UNDERGONE SURGERY TO CREATE AN ILEAL CONDUIT FOR URINARY ELIMINATION VIA A STOMA. WHICH FACT ABOUT THIS PROCEDURE SHOULD THE NURSE MENTION TO THE CLIENT? A. THIS URINARY DIVERSION IS ONLY TEMPORARY. B. THE CLIENT WILL NEED TO CHANGE THE URINARY POUCH EVERY 4 HOURS. C. THE CLIENT WILL HAVE TO WEAR AN EXTERNAL APPLIANCE TO COLLECT URINE. D. URINATION CAN BE VOLUNTARILY CONTROLLED AFTER THE STOMA HEALS FROM THE INITIAL SURGERY. IRRIGATING INDWELLING CATHETER CONTINUOUS BLADDER IRRIGATION  NURSING DIAGNOSES URINARY FUNCTIONING AS THE PROBLEM INCONTINENCE PATTERN ALTERATION URINARY RETENTION URINARY FUNCTIONING AS THE ETIOLOGY ANXIETY CAREGIVER ROLE STRAIN RISK FOR INFECTION  EVALUATION CLIENT HAS REGULAR VOIDING PATTERNS EMPTY BLADDER COMPLETELY AT REGULAR INTERVALS WITHOUT DISCOMFORT PROVIDE CARE FOR URINARY DIVERSION AND KNOW WHEN TO NOTIFY HEALTH CARE PROVIDER CORRECT UNHEALTHY HABITS DEVELOP A PLAN TO MODIFY ANY FACTORS THAT CONTRIBUTE TO CURRENT URINARY PROBLEMS.