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Urinary Elimination
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State standard
20) Understand principles of and successfully perform skills related to toileting, intake and output, and bedpan or bedside commode use. Incorporate guidelines for residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following:
a. Urine characteristics, and abnormalities that should be reported to the charge nurse
b. Common disorders of bladder and bowels
c. Factors affecting elimination of urine or stool d. Types of urine specimens obtained
e. Catheter care/emptying urinary bag
f. Procedure for collecting urine and stool specimens
g. Care guidelines for ostomy
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Objectives
Students will be able to…
Identify devices used in urinary elimination.
Demonstrate how to provide catheter care to a female
Demonstrate how to place a bedpan and empty a catheter bag.
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Introduction:
Eliminating waste is a physical need.
The urinary system removes waste products from the blood and maintains the body’s water balance.
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Normal Urination
The healthy adult excretes about 1500 milliliters (ml) (3 pints) of urine a day.
Factors affecting urine production include:
Age
Disease
The amount and kinds of fluid ingested
Dietary salt
Body temperature
Perspiration
Drugs
Urination, micturition, and voiding mean the process of emptying urine from the bladder.
Certain factors affect frequency, including:
The amount of fluid intake
Personal habits
People usually void at bedtime, after getting up, and before meals.
Some people void every 2 to 3 hours.
Available toilet facilities
Activity, work, and illness
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Urine observations
Normal urine:
Is pale yellow, straw colored, or amber
Is clear with no particles
Has a faint odor
Observe urine for color, clarity, odor, amount, and particles.
Some foods affect urine color and odor.
Certain drugs change urine color.
Report the following to the nurse:
Any urine that looks or smells abnormal
Complaints of urgency, burning on urination, or painful or difficult urination
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7. Assistance devices for urination:
Bedpans p. 375
used by persons who cannot get out of bed.
Women use bedpans for voiding and bowel movements.
Men use them for bowel movements.
Made of plastic or metal.
Metal bedpans are warmed with water and dried before use.
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Fracture pans
A fracture pan has a thin rim and is approximately 1/2 inch deep at one end.
Fracture pans are used:
By persons with casts
By persons in traction
By persons with limited back motion
After spinal cord injury or surgery
After a hip fracture
After hip replacement surgery
Fracture pans provide more comfort for persons with osteoporosis and those with painful joints from arthritis.
Review Giving the Bedpan p. 376
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Urinals
Men use urinals to void.
The urinal hooks to the bed rail within the man’s reach.
Some agencies do not use bed rails.
Follow agency policy for where to place urinals.
Men stand, sit on the side of the bed, or lie in bed to use the urinal.
Some men need support when standing.
You may have to place and hold the urinal for some men.
After voiding, the cap is closed.
Remind men:
To hang urinals on bed rails, or place them according to agency policy
To signal when urinals need emptying
Not to place urinals on overbed tables and bedside stands
Review ~ Giving the Urinal p. 379
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Commodes
A commode is a chair or wheelchair with an opening for a bedpan or container.
Persons unable to walk to the bathroom often use commodes.
Commodes allow a normal position for elimination.
Some commodes are wheeled into bathrooms and placed over toilets.
The container is removed if the commode is used with the toilet.
Wheels are locked after the commode is positioned over the toilet.
Review ~ Helping the Person to the Commode p381
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Urinary Incontinence
Urinary incontinence is the involuntary loss of urine from the bladder.
It may be temporary or permanent.
Basic types of incontinence (review page 382)
Stress
Urge
Overflow
Functional
Reflex
Mixed
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12. Effects of incontinence:
Incontinence is embarrassing.
Skin irritation, infection, and skin breakdown can occur.
Falling is a risk.
The person’s pride, dignity, and self-esteem are affected.
Loss of independence, social isolation, and depression are common.
Review box 18-3 page 383
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Persons with Dementia
may void in the wrong places.
Some persons remove incontinence products and throw them on the floor or in the toilet.
Some resist staff efforts to keep them clean and dry.
Check with the nurse and the care plan for measures to help the person.
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Incontinence is linked to abuse, mistreatment, and neglect.
Caring for persons with incontinence is stressful.
Remember, incontinence is beyond the person’s control.
Be patient.
If you become short-tempered and impatient, talk to the nurse at once.
The person has the right to be free from abuse, mistreatment, and neglect.
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Catheters
Urinary catheters drain urine from the bladder.
Catheterization - process of inserting a catheter.
A doctor or nurse performs a catheterization.
Straight catheter
drains the bladder and is removed
Indwelling catheter
is left in the bladder.
Urine drains constantly into a drainage bag.
A balloon near the tip is inflated after the catheter is inserted.
The balloon prevents the catheter from slipping out.
Tubing connects the catheter to the collection bag.
The risk of infection is high.
Suprapubic Cath
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Purposes of catheters
Before, during, and after surgery to keep the bladder empty
For persons who are too weak or disabled to use the bedpan, commode, or toilet
To protect wounds and pressure ulcers from contact with urine
To allow hourly urinary output measurements
As a last resort for incontinence
The cause of incontinence is not treated.
For diagnostic purposes
To collect sterile urine specimens
To measure how much urine is left in the bladder (residual urine)
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Drainage systems
A closed drainage system is used for indwelling catheters.
Nothing can enter the system from the catheter to the drainage bag.
Infection can occur if microbes enter the drainage system.
The bag hangs from the bed frame, chair, or wheelchair.
The bag must not touch the floor.
The bag is always lower than the level of the person’s bladder.
Some people wear leg bags when up.
The bag attaches to the thigh or calf.
If a catheter disconnects accidentally, tell the nurse at once.
Do the following:
Practice hand hygiene, and put on gloves.
Wipe the end of the tube with an antiseptic wipe.
Wipe the end of the catheter with another antiseptic wipe.
Do not put the ends down. Do not touch the ends after you clean them.
Connect the tubing to the catheter.
Discard the wipes into a biohazard bag.
Remove the gloves, and practice hand hygiene.
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Leg bags are changed to drainage bags when the person is in bed.
Drainage bags are emptied and urine measured:
At the end of every shift
When changing from a leg bag to a drainage bag
When changing from a drainage bag to a leg bag
When a leg bag is becoming full
Review Changing a leg bag to a drainage bag p. 389
Emptying a urinary drainage bag p. 391
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Condom catheters
are often used for incontinent men.
a soft, rubber sheath that slides over the penis.
also called external catheters, Texas catheters, and urinary sheaths.
Tubing connects the catheter and the drainage bag.
Figure on page 392
To apply a condom catheter:
Follow the manufacturer’s instructions.
Thoroughly wash the penis with soap and water and dry it before applying a catheter.
Secure the catheter in place with elastic tape.
Never use adhesive tape to secure catheters.
Adhesive tape does not expand.
Injury to the penis can occur.
Review applying a Condom Catheter p. 392
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Activity
We will now watch the following videos…
Assisting with a bedpan
Measures and records urinary output
Catheter care female
You will demonstrate the following skills using your step by step rubrics.
Catheter Care
Emptying a Drainage bag
Placing a bedpan
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