Urinary Elimination Care PN 1 Nursing Skill Labs

Urine testing - important points!! always make sure your label is accurate and complete always bring a plastic bag, twist tie and label to the bedside always wear gloves when handling body fluids and consider wearing goggles when emptying drainage bags or whenever there is a risk of splash back

Standard Urine Tests Routine and Microscopic - R&M requires a clean (not sterile) specimen note if female menstruating need about 10 mLs must be sent to lab within about 30 mins or may alter results routine tests for sugar, acetone, pH and SG

normal pH of urine is 6 (<7 is acidic) to discourage growth of bacteria normal SG is to water is 1.0 microscopic tests look for blood, bacteria etc urine can be tested on the unit using dipsticks but this is not as accurate as a lab analysis

dipstick tests can identify sugar, ketones, blood, pH and protein very important to read colour strip at recommended time or results will be false always wear gloves when handling urine specimens

Culture and Sensitivity (C&S) requires a sterile specimen need about 3 mLs of urine indicate on requisition if patient on antibiotics and specify which ones if both R&M and C&S are ordered, you must send two specimens 2 ways to collect - MSU or from catheter

MSU - midstream urine wash perineum or glans penis with soap and water (retract foreskin if uncircumsized) void small amount into toilet or bedpan void into sterile container being careful not to contaminate container by touch empty rest of bladder into toilet/bedpan

Catheter Specimen use sterile port and sterile needle if collecting from tubing specimen from drainage bag may not contain fresh urine use 21 to 25 gauge needle, antiseptic swab and sterile specimen container if no urine in tube, clamp below port for not more than 30 minutes

24 hour urine collection it is critical that all urine in the 24 hour period is collected may require sign over door, in bathroom etc to alert others extra care needed if two clients in same room collection is started at specific time as ordered

ask patient to void at appointed time and discard start collection with next void each void may be collected individually or in one container - know what has been ordered may need to be kept on ice may have preservative in collection bottle

Fluid Balance this is an extremely important function of nursing!!!!! accuracy is crucial if patient on intake/output monitoring you must measure all fluids going in and coming out may include urine, diarrhea, drainage from wounds, emesis etc intake includes fluids, IV’s, liquid meds

if intake is > than output the patient is in a positive (+) fluid balance if intake is < than output the patient is in a negative (-) fluid balance errors in calculating fluid balance can have serious consequences for the patient physicians orders for meds, IV fluids etc are based on this information

Catheters used for incontinence and for accurate fluid balance information indwelling catheters are the most common cause of nosocomial (hospital acquired) infections types include condom catheter, foley catheter and straight (in and out) catheter all drain by gravity so bag must be below bladder at all times

tubing must be kept free of kinks and secured to patient or bedding to prevent pulling always discard urine in toilet when emptying bag discard catheter and bag in biohazard bag when removed

Condom Catheter tubing attaches to leg bag or bedside drainage bag prep skin and let dry apply condom leaving 1-2” dead space at tip apply securely but not too tight!!! secure with velcro strip, foam tape or glue

Indwelling Catheter Care always inserted using sterile technique drape patient to provide privacy perineal care should be done at bath time and at least once more during the day and after each bowel movement wash 10 cm (4”)of catheter using circular motion

inspect and document skin condition around catheter at least daily report any signs of infection or inflammation

Emptying Drainage Bags wear eye protection may also want to wear mask ( check policy) drain bag into measuring container don’t touch the spout to the container wipe spout with alcohol swab when finished record amount on Fluid Balance record