Urinary Elimination SV Slides PDF

Chapter 46: Urinary Elimination SHAE FLORES MSN, RN Scientific Knowledge Base v Kidneys v Ureters v Bladder v Urethra  Kidneys v Anatomy Nephrons Glomerulus v Erythropoietin v Renin-angiotensin system Major role in blood pressure  Ureters v Attached to each kidney pelvis v...

Chapter 46: Urinary Elimination SHAE FLORES MSN, RN Scientific Knowledge Base v Kidneys v Ureters v Bladder v Urethra  Kidneys v Anatomy Nephrons Glomerulus v Erythropoietin v Renin-angiotensin system Major role in blood pressure  Ureters v Attached to each kidney pelvis v Carries urinary waste to bladder Bladder v Hollow, distensible, muscular organ that holds urine v Expands  Urethra v Hollow tube Transports urine from bladder to the outside of the body Risks for infection men vs women Act of Urination v Micturition: Bladder holds urine until volume triggers a sensation of urge Brain gives the bladder permission to empty Bladder contracts Urinary sphincter relaxes Urine leaves through the urethra Factors Influencing Urination v Growth and development v Pathological conditions v Sociocultural factors v Surgical procedures v Psychological factors v Medications v Personal habits v Diagnostic Examinations v Fluid intake Box 46.1 pg. 1229  Common Urinary Elimination Problems v Urinary retention Inability to partially or completely empty the bladder v Urinary tract infection Results from catheterization or procedure (CAUTI) v Urinary incontinence Involuntary leakage of urine v Nocturnal enuresis Children who wet the bed at night without waking from sleep v Urinary diversion Diversion of urine to external source Table 46.1 pg. 1230 Common Urinary Elimination Problems v Nephrostomy Tubes Nursing Knowledge Base v Infection Control and Hygiene Urinary tract is sterile v Growth and Development Infants/Children/Elderly v Psychosocial Implications Need for privacy Self-image and self-esteem Critical Thinking v Successful critical thinking requires synthesis of: Knowledge Experience Information gathered from patients Critical thinking attitudes Intellectual and professional standards Nursing Process/CJM v Through the patient’s eyes Box 46.5 pg. 1236 – Nursing Assessment Questions Understanding Table 46.2 pg. 1237 – Common Symptoms Expectations of treatment v Self-care ability v Cultural considerations v Health literacy v Nursing history Pattern of urination Symptoms of urinary alterations Nursing Process/CJM v Physical assessment Inspection and Palpation Ø Kidney Ø Bladder External genitalia and urethral meatus Ø All patients with urinary catheter Ø Catheter related trauma/damage o Securing catheter tubing to leg Perineal skin  Nursing Process/CJM v Assessment of urine Intake and output Characteristics of urine Ø Color Ø Clarity Ø Odor Normal characteristics of urine pg. 1237 Laboratory Diagnostic Testing v Laboratory Tests Urinalysis Culture and sensitivity v Collect Samples for Urine Analysis Random specimen Midstream UA Sterile specimen Double voided specimen 24-hour time collected Diagnostic Examinations v Indirect visualization Radiographic studies o Intravenous pyelogram v Direct visualization Cystoscopy Cystourethroscopy Diagnostic Examinations v Nursing responsibilities before testing: Ensure a signed consent is completed (Invasive/Contrast) Assess the patient for any allergies Administer bowel-cleansing agents as ordered Ensure that the patient adheres to the appropriate pretest diet or nothing by mouth (NPO) v Responsibilities after testing include: Assessing I&O Assessing voiding and urine Encouraging fluid intake Nursing Process/CJM v Nursing diagnoses/problems common to patients with urinary elimination problems: Impaired urinary elimination Self-care deficit, toileting Risk for infection Urinary retention Urinary incontinence Impaired skin integrity Pain Nursing Process/CJM v Goals and outcomes Set realistic and individualized goals along with relevant outcomes Collaborate with the patient v Setting priorities Patient’s immediate physical and safety needs Patient expectations and readiness to perform some self-care activities v Teamwork and collaboration Nursing Process/CJM v Health promotion Patient education Promoting normal micturition Ø Maintaining elimination habits Ø Maintaining adequate fluid intake Promoting complete bladder emptying Ø Encourage a 2nd void Ø Aid in assuming normal position of voiding Ø Use sensory stimuli Preventing infection PureWick System  Nursing Process/CJM v Acute care Catheterization Ø Types of catheters Ø Sizes § 5 Fr vs 18 Fr Nursing Process/CJM v Catheterization Catheter drainage systems Routine catheter care Nursing Process/CJM v Catheterization Preventing catheter associated infection Ø Hygiene Ø Back flow of urine in the bladder Ø Drainage bag and nozzle should never touch the floor Catheter irrigations and instillations  Nursing Process/CJM v Removal of indwelling catheters Reduce risk of HAUTI v Alternatives to catheterization Suprapubic catheters § Blockage of urethra (BPH) § Long term External catheters § Condom catheters Nursing Process/CJM v Medication Classes Anticholinergics – decrease bladder irritation Cholinergics – increase bladder ability to contract Antimuscarinics – treat urgency, frequency, nocturia and urgency UI Antibiotics: treat urinary tract infections v Be familiar with the medications and indications for all medications your patient is taking. Pg. 1252 Nursing Process/CJM v Continuing and restorative care Lifestyle changes Pelvic floor muscle training Ø Kegel exercises Bladder retraining Toileting schedules Intermittent catheterization Ø Skin care Catheterization v Types of Catheters to Review Intermittent Indwelling Ø Short term = < 2 weeks Ø Long term = > 1 month Suprapubic Condom Indications for Catheterization v Need accurate measurement of urine Post surgery, critically ill patients v Relief of bladder distention v Sterile specimen – intermittent catheterization v Measure residual v Long term management of incompetent bladders Key Points with Catheter Insertion v Verify provider’s orders v Appropriate size v Sterile technique v Ensure catheter is in the bladder v Proper care to prevent UTIs Nursing measures with drainage system Appropriate peri care for clients with indwelling catheters v Measuring output from drainage system Removal of Indwelling Catheter v Don’t cut balloon tip v Remove inflation solution with syringe v Check label on catheter for solution quantity v Connect syringe and ensure complete removal of solution before withdrawing v Ask client to take a deep breath, let it out, and remove catheter. v Measure urine in drainage bag and record as output Evaluation v Through the patient’s eyes Assess the patient’s self-image, social interactions, sexuality, and emotional status v Patient outcomes Use the expected outcomes developed during planning to determine whether interventions were effective Evaluate for changes in the patient’s voiding pattern and/or presence of symptoms Evaluate patient/caregiver compliance with the plan Safety Guidelines for Nursing Skills v Follow principles of surgical and medical asepsis as indicated v Identify patients at risk for latex allergies v Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.