MNAMosby’s Long Term Care Assistant Chapter 22 Urinary Elimination

Urinary System

Removes wastes products from the bloodKidneyUreterBladderUrethraMeatus

meatus

Normal Urination

1500 cc per dayOther terms Used:

MicturitionVoiding

Pale yellow, straw coloredClear with no particlesFaint odor

Terms

Dysuria

Hematuria

Nocturia

Polyuria

Frequency

Incontinence

Urgency

Difficult urination

Bloody urine

frequent urination @ night

Too much urination

Urinating at frequent intervals

Unable to control urination

The need to urinate right away

Bedpans

Used when patient cannot get OOB

Women – voiding and BM

Men – BMPlastic or stainless

steelFracture pan is

smallerFollow Standard

precautions

Bedpans2 methods for

placing:Lift hips Roll

Place in Fowlers Position for use

PrivacyGloves!Peri-careHand washingReport and record

Urinals

Used by menHooks to the bed railBest position:

StandingDanglingHigh fowlers

GlovesPrivacyHand washingReport and record

Bedside Commodes - BSC

Resident cannot walk to BRAllows normal position for

eliminationClean and replace after

each useGlovesPrivacyHand washingReport and record

Urinary Incontinence

Loss of bladder controlTemporary or permanentGood skin care needed

Stress incontinence –

urine leaks during exercise

or certain movements.

Catheters

A tube used to drain or inject fluid through a body opening.

Straight catheter – drains the bladder and is removed

Indwelling catheter – F/C, Foley Catheter, retention catheter. Left in the bladder. Urine drains continuously.

Inserted by MD, RN or LPN.

Sterile technique

CathetersWhy?

Keep bladder empty before, during or after surgery

Promote comfort for those too weak to use bedpan

Keep incontinent resident dry

Protect wounds or dressing from urine

Allow hourly output measurements

Diagnostic uses

Indwelling Catheter - F/CBalloon

Catheter

Balloon port

Collection bag

Drainage port

Indwelling Catheter – F/C

Standard Precautions

Keep collection bag below the level of the bladder

Attach bag to bed frame, not SR

Coil tubingCatheter care BIDEmpty bag QSReport and Record

Catheter CareStandard PrecautionsProvide peri-careHold catheter near meatusClean from meatus down catheter about 4

inchesRepeat 3XRinseCheck to see if tubing is coiledCheck to see if collection bag is on bed frameAsses UrineEmpty bag QSReport and Record

BID

Emptying a F/C

Standard PrecautionsPaper towel on floorEmpty into graduateMeasureCheck to see if tubing is

coiledCheck to see if collection

bag is on bed frameAsses UrineEmpty bag QSReport and Record

Condom Catheter

Texas CatheterExternal CathetersUrinary SheathConnects to tubingMay be connected to

leg bag or regular collection bag

Secured with VelcroNever use tape

Bladder Training

Goal is to gain control of urination

Increases self esteem, quality of life.

Part of care plan2 methods:

Bladder Training

Resident uses urinal, BR at certain times.

Provide privacyAllow normal positionAllow time (15 minutes)

Clamping Catheter (before removal)Clamped for interval to increase bladder tone.Starts with 1 hour Increases to 3 hoursCatheter is removed

Ureterostomy

Surgical removal of bladder with creation of new pathway for urine.

Urinary diversion

Ureterostomy

Ostomy – creation of an artificial opening

Ureterostomy – artificial opening between the ureter and the abdomen

Stoma – artificial opening

Review

What is the best position for using a bedpan ?

Fowlers

Review

Urine normally has an ammonia odor.

True False

Review

Cleansing the genital and anal area is called

Peri-care

Review

What is a F/C?

Indwelling catheter used to drain urine

Review

When is the F/C emptied?

Qshift

Review

Keep the urinary drainage

bag __________ the level of

the bladder.

below

Review

What is the goal of bladder training?

Gain control of urination

Review

What is a tube used to inject or drain fluid through a body opening?

catheter

Review

How much urine does the health adult produce per day?

1500 cc per day

Review

What is the function of the urinary system ?

Remove waste products from the blood

Review

What keeps the catheter in the bladder ?

balloon

Review

Catheters are used to treat incontinence.

True False

Review

Catheter care is provided QD.

True False

Review

Difficult urination?

dysuria

Frequent urination at night?

nocturia

Review

Inability to control urinination?

incontinence

Micturition?

Emptying the bladder

Review

Bloody urine?

hematuria

Too much urine?

polyuria

Review

You are assisting Mrs. Alberta with the bedpan

A. Stay in the room with her

B. Help her wipe back to front when she is finished

C. Tell her to wear gloves

D. Put her in fowlers position after she is placed on the bedpan.

Review

When providing peri-care

A. Use upward strokes, rectal area to urethra

B. Use bath oil to ensure adequate cleaning

C. Wash the rectal area first

D. Use a clean part of the wash cloth for each stroke.

Review

QS

F/C

pc

HS

QID

BID

Every shift

Foley catheter

After meals

bedtime

4X day

2X day

Questions??