MNA Mosby’s Long Term Care Assistant Chapter 22 Urinary Elimination

Urinary System Removes wastes products from the blood Kidney Ureter Bladder Urethra Meatus meatus

Normal Urination 1500 cc per day Other terms Used: Micturition Voiding Pale yellow, straw colored Clear with no particles Faint 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 – BM Plastic or stainless steel Fracture pan is smaller Follow Standard precautions

Bedpans 2 methods for placing: Lift hips Roll Place in Fowlers Position for use Privacy Gloves! Peri-care Hand washing Report and record

Urinals Used by men Hooks to the bed rail Best position: Standing Dangling High fowlers Gloves Privacy Hand washing Report and record

Bedside Commodes - BSC Resident cannot walk to BR Allows normal position for elimination Clean and replace after each use Gloves Privacy Hand washing Report and record

Urinary Incontinence Stress incontinence – urine leaks during exercise or certain movements. Loss of bladder control Temporary or permanent Good skin care needed

Catheters Inserted by MD, RN or LPN. Sterile technique 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

Catheters Why? 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/C Balloon 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 tubing Catheter care BID Empty bag QS Report and Record

BID Catheter Care Standard Precautions Provide peri-care Hold catheter near meatus Clean from meatus down catheter about 4 inches Repeat 3X Rinse Check to see if tubing is coiled Check to see if collection bag is on bed frame Asses Urine Empty bag QS Report and Record

Emptying a F/C Standard Precautions Paper towel on floor Empty into graduate Measure Check to see if tubing is coiled Check to see if collection bag is on bed frame Asses Urine Empty bag QS Report and Record

Condom Catheter Texas Catheter External Catheters Urinary Sheath Connects to tubing May be connected to leg bag or regular collection bag Secured with Velcro Never use tape

Goal is to gain control of urination Bladder Training Goal is to gain control of urination Increases self esteem, quality of life. Part of care plan 2 methods:

Bladder Training Resident uses urinal, BR at certain times. Provide privacy Allow normal position Allow time (15 minutes) Clamping Catheter (before removal) Clamped for interval to increase bladder tone. Starts with 1 hour Increases to 3 hours Catheter 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

Indwelling catheter used to drain urine Review What is a F/C? Indwelling catheter used to drain urine

Review When is the F/C emptied? Qshift

below 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 Help her wipe back to front when she is finished Tell her to wear gloves 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 Use bath oil to ensure adequate cleaning Wash the rectal area first Use a clean part of the wash cloth for each stroke.

Review QS F/C Every shift pc HS Foley catheter QID After meals BID bedtime 4X day 2X day

Questions??