Review

 Anuria  Oliguria  Polyuria  Nocturia  Dysuria  Hematuria

 Ureterostomy – one or both ureters to the abdominal surface  Nephrostomy – a tube from the renal pelvis to the abdominal surface  Pouched systems for urine diversions are similar to those for bowel diversions with similar body image concerns.

 Impaired Urinary Elimination  Stress Urinary Incontinence  Functional Urinary Incontinence, Urge Urinary Incontinence  Reflex Urinary Incontinence  Risk for Impaired Skin Integrity  Risk for Infection  Disturbed Body Image  Ineffective Coping  Pain

 Focus on:  Degree of dysfunction  Priority for care measures related to elimination  The return or adaptation of urinary function to as close to normal as possible

PURPOSE: Urinary Catheters Are Used To: Assess bladder functionAccurately monitor urinary output Obtain urine specimensManage urinary incontinence Irrigate the bladderRelieve bladder distention and discomfort Manage urinary retention Instill medications into the bladder Allow for healing after surgical procedures

1. Relief of acute urinary obstruction or retention 2. Preventing contamination during complex surgical procedures 3. Accurate measurement of urine in critically ill patients 4. Maintaining dry tissue during perineal or sacral wound healing in incontinent patients 5. Optimal management of patients who are immobilized for an extended period 6. Support of patient comfort at the end of life

 Ms. James is on the telephone to Katie, her nurse. Katie knows she had been in to the clinic yesterday afternoon and was diagnosed with a UTI. It’s 9 A.M., and Ms. James was seen at 7 P.M. yesterday evening. She tells Katie that she is taking her medications as ordered, and the symptoms of her UTI are not getting any better. She wonders if this medication will work to cure her UTI. She tells you that she’s had them before and that she felt the burning go away the first day she took the antibiotic. “It’s day 2 of the treatment, and nothing is getting better!”

1. What does Katie the nurse assess over the phone with Ms. James? Select all that apply.  A.How often she is voiding, and how much urine she is passing  B.What symptoms she is experiencing from the UTI  C.Whether she can empty her bladder when she voids, and whether she sees any abdominal distention  D.How much fluid she has drunk in the last 24 hours  E.Whether she has taken a multivitamin and mineral supplement for the day

 Ms. James has only voided a small amount once since she got up this morning. She tells Katie that she is not drinking fluids, because it burns too much and hurts to void. Ms. James is self-restricting fluid intake to prevent painful urination.

2. What can Katie suggest to Ms. James to help her void and decrease the pain she has when starting her stream?  A.She can encourage Ms. James to flush fluids, increasing her fluid intake to 2500 mL daily.  B.She can encourage Ms. James to use a heating pad over her lower abdomen while she is resting and pour warm water over her perineum while she is on the toilet trying to void.  C.She can tell Ms. James to put a cold pack over her lower abdomen and to pour iced water over her perineum when she is on the toilet trying to void.  D.She can tell Ms. James to go directly to the emergency room to have someone catheterize her.

3. Which of the following are important to teach the patient who has recurrent UTIs? Select all that apply.  A.Proper hand hygiene with toileting  B.Wiping front to back  C.Perineal care only after sexual intercourse  D.Use bubble baths and powders as well a feminine hygiene sprays to prevent UTIs  E.Avoid the urge to void, holding the urine in the bladder until it subsides