Chapter004 urinary care

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 4Advanced Urinary Care Skills

Chapter 4Advanced Urinary Care Skills


Renal StructuresRenal Structures

Kidneys- filter blood, make urine

Ureters – drain urine from kidneys to bladder

Bladder- holds urine

Urethra: drains out urine


KidneysKidneys

• Lower back

• Nephrons-cells that filter blood

make urine,

regulates fluid


BladderBladder

-Make min. 600 cc/day

-Average amount 1000-1500 ml/day

-Report output< 200 cc/shift

< 600 cc/24 hours

-Feel urge to urinate:

Male-300-500 ml

Female-250 ml


UrethraUrethra

• Male- 8-9 inches long

• Female- 1 ½ inches long


Internal KidneyInternal Kidney


Bowman’s Capsule/GlumerulusBowman’s Capsule/Glumerulus


Functions of the Renal SystemFunctions of the Renal System

• Rid waste

• Regulate fluids and electrolytes

• Regulate blood pressure

• Calcium metabolism

• Regulate Red Blood Cells production

• Maintain acid base balance

• Maintain homeostasis


Warning signs of Kidney DiseaseWarning signs of Kidney Disease

• Swollen eyes

• Edema

• Increase urination or change in pattern

• Painful urination

• Blood in urine

• Tea color urine

• Hypertension


Renal Calculi/Kidney StonesRenal Calculi/Kidney Stones

Causes: UTI, urine stasis, hereditary,

S/Sx: pain, hematuria, no/decrease urine

PCT: strain urine, I&O, pain management, increase fluid

TX: Lithotripsy


Congenital anomaliesCongenital anomalies

Polycystic disease- cysts in kidneys

tx: dialysis


Hypospadias- Hypospadias-

• urethra on bottom of penis


Hypoplastic kidney- decrease nephronsHypoplastic kidney- decrease nephrons


Paraphimosis- Paraphimosis-

foreskin doesn’t retract

Tx: surgery


Urinary InfectionsUrinary Infections

• UTI

• Cystitis

• Pyleonephritis

• Glomerulonephritis

• Prostatitis

– s/sx: pain, hematuria, frequency, urgency

– fever, confusion

– Tx: ATB., fluids

– PCT: urine specimen, keep clean, I&O


Prevent UTIPrevent UTI

• No bubble baths

• Urinate after sex

• Clean front to back

• No perfumes, dye

• No thongs

• White toilet paper


Causes of Renal FailureCauses of Renal Failure

• Acute

• Dehydration

• Obstruction

• Blood clots

• Trauma

• Infection

• Drugs/meds

• Chronic

• hereditary

• HTN

• Infection

Gout

Diabetes



Treatment for renal failureTreatment for renal failure

• Dialysis

• Strict I&O

• Daily weights

• Fluid restriction

• Treat cause


Renal FailureRenal Failure

• Acute: comes on suddenly,

• reversible

• Chronic: comes on slowly

• nonreversible


DialysisDialysis

• Peritoneal

• * Place fluid in *Fluid absorbs toxins

* Leave in for several hours then drain out

• Hemodialysis

– * Done in hospital setting

– * Take blood out and filter it


TermsTerms

• Frequency/urgency

• Incontinence

Hematuria

• Polyuria

• Anuria


Terms con’tTerms con’t

• Oliguria

• Nocturia

• Incontinence

• Dysuria

• Urinary retention

• Glucosuria

• Pyuria


Meatus Prepuce/foreskin


Fluid BalanceFluid Balance

• Excess fluid

• edema

• Ascities

• Rapid weight gain

• High BP

• Tight skin

• SOB


• Fluid loss

• Concentrated urine

• Rapid weight loss

• Rapid pulse

• Poor skin turgor

• Dry skin

• Mucous membranes dry

• Weak

• Confusion


IncontinenceIncontinence

• Can’t control urine, comes out

• Types:

• 1. Stress

• 2. Urge

• 3. Overflow

• Urinary retention

• retain urine up 3000-4000 ml

• Neurogenic bladder- loss of sensation to bladder

• common in stroke



Diagnosis Diagnosis

• X-rays

• CT scan

• KUB- kidney, ureter, bladder x-ray

• Electrolytes

• BUN, Creatinine blood levels

• Urinalysis- 24 hour urine, CCUA,


IV-P ( intravenous pyleogram)IV-P ( intravenous pyleogram)


CystoscopyCystoscopy


Urine ComponentsUrine Components

• Color:

Pale yellow

Red/brown = bleeding

Blue/green= dyes

Bright yellow= multivitamins

Specific gravity= 1.010-1.030

Ph- 5.5-7.0


Reasons for Catheterization Reasons for Catheterization

• Surgery

• Can’t void b/c- pain or swelling of the urethra (after childbirth)

• urethra is blocked (enlarged prostate gland)

• Empty bladder for procedures

• Check residual


Reasons for Catheterization (cont.)Reasons for Catheterization (cont.)

-monitor urine output

-obtain sterile urine specimen

-incontinent of urine & has pressure ulcers or other skin conditions that can be aggravated by urine

- To give medications


Foley catheter/Indwelling catheterFoley catheter/Indwelling catheter


Indwelling CatheterIndwelling Catheter


Straight catheterStraight catheter


Triple Lumen CatheterTriple Lumen Catheter


Triple lumen catheter:Triple lumen catheter:


Suprapubic catheterSuprapubic catheter



Catheter InformationCatheter Information

• Size: 8-30 Fr. (large # = small catheter)

• Normal 16 fr.

• Insertion: 1 ½ -2 inches –female

• 8-9 inches –male

• Goals: remove ASAP

• maintain sterility


Care of catheterCare of catheter

• I&O q shift

• Bag below bladder

• Peri-care q shift change catheter per policy


Taping a catheterTaping a catheter

Male Female


Risks of Urinary Catheterization Risks of Urinary Catheterization

• Infection—go from bladder - ureters - kidneys

• Urinary tract infection—most common type of HAI

• Urethral trauma— try to force catheter through the urethra, damaging the mucosa lining of urethra, leading to bleeding, swelling, & high risk of infection


General Guidelines for Urinary Catheterization General Guidelines for Urinary Catheterization

• Dr. order required

• Female pt.- positioned in the supine position with legs apart & knees slightly bent

• Male pt.-positioned in supine position

• Refer to Guidelines Box 4-1


QuestionQuestion

Tell whether the following statement is true or false.

You do not need a doctor’s order to catheterize a patient.

A. True

B. False


AnswerAnswer

B. False

You must have a doctor’s order to catheterize a patient, including the type of catheter and the duration the catheter will remain in place.


Catheterization With an Indwelling Catheter Catheterization With an Indwelling Catheter

* Indwelling catheter -closed system

• Balloon holds catheter in place in bladder

• Tubing connects the catheter to the urine drainage bag


Disconnecting Catheter and Tubing Disconnecting Catheter and Tubing


QuestionQuestion

Which catheter is inserted in the abdomen to drain urine?

A. Straight catheter

B. Triple lumen catheter

C. Suprapubic catheter

D. Indwelling catheter


AnswerAnswer

C. Suprapubic catheter

This catheter is inserted via a surgical opening in the lower abdomen above the pubic area, into the bladder. It is often used when there is trauma or surgery to the urethral area.


Collecting a Sterile Urine SpecimenCollecting a Sterile Urine Specimen

• Urine from a newly-inserted catheter - placed directly into specimen container provided in urinary catheter insertion kit.

Urine from catheter that is in place:

• Catheter tubing is clamped below the aspiration port so that urine collects in the tubing.

• A sterile syringe is inserted into the aspiration port and used to withdraw the urine specimen.

Chapter004 urinary care

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homeostasis copyright

ofpenis copyright

cystoscopy copyright

strain urine

urine stasis

hour urine