1. Define important words in this chapter

1. Define important words in this chapter
24-hour urine specimen: a urine specimen consisting of all urine voided in a 24-hour period. calculi: kidney stones. catheter: tube inserted through the skin or into a body opening; used to add or drain fluid. chronic renal failure (CRF): progressive condition in which the kidneys cannot filter certain waste products; also called chronic kidney failure.

1. Define important words in this chapter (con’t)
clean-catch specimen: a urine specimen that does not include the first and last urine that is voided; also called mid-stream. condom catheter: a catheter that has an attachment on the end that fits onto the penis; also called an external or Texas catheter. dialysis: a process that cleanses the body of wastes that the kidneys cannot remove due to kidney failure. end-stage renal disease (ESRD): condition in which kidneys have failed and dialysis or transplantation is required.

indwelling catheter: a catheter that stays inside the bladder for a period of time; urine drains into a bag. ketones: chemical substances that the body produces when it does not have enough insulin in the blood. micturition: the process of emptying the bladder of urine; also called urination or voiding. routine urine specimen: a urine specimen that can be collected any time a person voids.

specific gravity: a test performed to measure the density of urine. sphincter: a ring-like muscle that opens and closes an opening in the body. straight catheter: a catheter that does not stay inside the person; it is removed immediately after urine is drained or sampled. urinary incontinence: the inability to control the bladder, which leads to an involuntary loss of urine.

urinary tract infection (UTI): a disorder that causes inflammation of the bladder; also called cystitis. voiding: the process of emptying the bladder of urine; also called urination or micturition.

2. Explain the structure and function of the urinary system
The urinary system consists of two kidneys, two ureters, the urinary bladder, the urethra and the meatus.

Transparency 16-1: The Urinary System

3. Discuss changes in the urinary system due to aging
Normal age-related changes for the urinary system include the following: The kidneys do not filter the blood as efficiently. Bladder muscle tone weakens. Bladder holds less urine, which causes more frequent urination. Bladder may not empty completely, which causes an increased chance of infection.

4. List normal qualities of urine and identify signs and symptoms to report about urine
Report any of the following signs or symptoms to the nurse: Cloudy urine Dark or rust-colored urine Strong-, offensive-, or fruity-smelling urine Blood, pus, mucus, or discharge in urine Protein, glucose, or bacteria in urine Episodes of incontinence

Transparency 16-1: Factors Affecting Urination
Growth and development Psychological factors Fluid intake Physical activity and exercise Personal habits Medications Disorders

6. Discuss common disorders of the urinary
Urinary Tract Infection (UTI) Chronic Renal Failure (CRF) Urine Retention

7. Discuss reasons for incontinence
Types of incontinence are: Stress incontinence Urge incontinence Mixed incontinence Functional incontinence Overflow incontinence

Providing perineal care for an incontinent resident
Equipment: 2 clean bed protectors, 4 washcloths or wipes, towel, gloves, basin with warm water, soap, bath blanket, bath thermometer Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands.

Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. Provide for the resident’s privacy with a curtain, screen, or door. Practice good body mechanics. Adjust bed to safe working level, usually waist high. Lock bed wheels.

Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. Lower head of bed. Position resident lying flat on his or her back. Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should be 105°F. Have the resident check water temperature. Adjust if necessary.

Put on gloves. Cover resident with bath blanket. Move top linens to foot of bed. Remove soiled bed protector from underneath resident by turning resident on his side, away from you. (See procedure Turning a Resident in Chapter 11.) Roll soiled pad into itself with wet side in/dry side out.

Place clean bed protector under his or her buttocks. Return resident to lying on his back. Expose perineal area only. Clean perineal area. For a female resident: Wash the perineum with soap and water from front to back. Use single strokes (Fig ). Fig Using single strokes, wipe from front to back when cleaning.

(con’t) Do not wash from the back to the front. This may cause infection. Use a clean area of washcloth or clean washcloth for each stroke. First wipe the center of the perineum, then each side. Spread the labia majora, the outside folds of perineal skin that protect the urinary meatus and the vaginal opening. Wipe from front to back on each side. Rinse the area in the same way. Dry entire perineal area.

(con’t) Move from front to back, using a blotting motion with towel. Ask resident to turn on her side. Wash, rinse, and dry buttocks and anal area. Cleanse the anal area without contaminating the perineal area. For male resident: If the resident is uncircumcised, retract the foreskin. Gently push skin towards the base of penis.

(con’t) Hold the penis by the shaft. Wash in a circular motion from the tip down to the base (Fig. 16-7). Use a clean area of washcloth or clean washcloth for each stroke. Rinse the penis. If resident is uncircumcised, gently return foreskin to normal position. Then wash the scrotum and groin. The groin is the area from the pubis to the upper thighs. Rinse and pat dry. Ask the resident to turn on his side. Fig Wash the penis in a circular motion from the tip down to the base.

(con’t) Wash, rinse, and dry buttocks and anal area. Cleanse the anal area without contaminating the perineal area. Turn resident on his side away from you. Remove the wet bed protector after drying buttocks. Place a dry bed protector under the resident.

Reposition the resident. Remove bath blanket. Replace top covers. Make resident comfortable. Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Empty, rinse, and wipe basin. Return to proper storage.

Place soiled linens, clothing and bed protector in proper containers. Remove and dispose of gloves properly. Leave call light within resident’s reach. Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

8. Describe catheters and related care
Types of catheters Straight catheter Indwelling catheter Condom catheter

Providing catheter care
Equipment: bath blanket, bed protector, bath basin, soap, bath thermometer, 2-4 washcloths or wipes, towel, gloves Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands.

Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. Lower head of bed. Position resident lying flat on her back. Remove or fold back top bedding. Keep resident covered with bath blanket.

Test water temperature with thermometer or your wrist and ensure it is safe. Water temperature should be 105° F. Have the resident check water temperature. Adjust if necessary. Put on gloves. Avoid contact with clothing and soiled pads or soiled linens throughout procedure.

Ask the resident to flex her knees and raise the buttocks off the bed by pushing against the mattress with her feet. Place clean bed protector under her buttocks. Expose only the area necessary to clean the catheter. Place towel or pad under catheter tubing before washing.

Apply soap to wet washcloth. Clean area around meatus. Use a clean area of the washcloth for each stroke. Hold catheter near meatus. Avoid tugging the catheter. Clean at least four inches of catheter nearest meatus. Move in only one direction, away from meatus (Fig ). Use a clean area of the cloth for each stroke. Fig Hold the catheter near the meatus, so that you do not tug it. Moving in only one direction, away from meatus, helps prevent infection.

Rinse area around meatus, using a clean area of washcloth for each stroke. Pat dry with clean cloth. Rinse at least four inches of catheter nearest meatus. Move in only one direction, away from meatus. Use a clean area of the cloth for each stroke. Remove towel or pad from under catheter tubing.

Replace top covers. Remove bath blanket. Make resident comfortable. Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Empty, rinse, and wipe basin. Return to proper storage.

Dispose of soiled linen in proper containers. Remove and dispose of gloves properly. Leave call light within resident’s reach. Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Emptying a catheter drainage bag
Equipment: graduate (measuring container), alcohol wipes, paper towels, gloves Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

Provide for the resident’s privacy with a curtain, screen, or door. Put on gloves. Place paper towel on the floor under the drainage bag. Place graduate on the paper towel.

Open the drain or clamp on the bag. Allow urine to flow out of the bag into the graduate. Do not let clamp touch the graduate (Fig ). When urine has drained, close clamp. Using alcohol wipe, clean the drain clamp. Replace the drain in its holder on the bag. Fig Keep the spout from touching the graduate while draining urine.

Note the amount and the appearance of the urine. Go into the bathroom. Place graduate on a flat surface and measure at eye level. Empty urine into toilet. Clean and store measuring container. Discard paper towel.

Remove and dispose of gloves properly. Leave call light within resident’s reach. Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure and amount of urine (output) using facility guidelines.

Applying a condom catheter
Equipment: condom catheter and collection bag, catheter tape (if not a self-adhesive catheter), gloves, plastic bag, bath blanket, bed protector, supplies for perineal care Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands.

Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. Lower head of bed. Position resident lying flat on his back. Remove or fold back top bedding. Keep resident covered with bath blanket. Put on gloves.

Adjust bath blanket to expose only genital area. If condom catheter is present, gently remove it. Carefully disconnect condom from tube and immediately cap tube. Do not allow tube to touch anything. Place condom and tape in the plastic bag. Help as necessary with perineal care.

Attach collection bag to leg. Make sure drain stays closed. Move pubic hair away from the penis so it does not get rolled into the condom. Hold penis firmly. Place condom at tip of penis. Roll towards base of penis. Leave at least one inch of space between the drainage tip and glans of penis to prevent irritation.

(con’t) If resident is not circumcised, be sure that foreskin is in normal position. Gently secure condom to penis with special tape provided or use self- adhesive (Fig ). Apply in a spiral. Never wrap tape all the way around penis because it can impair circulation. Fig Gently secure condom to penis with provided tape.

Connect catheter tip to drainage tubing. Do not touch tip to any object but drainage tubing. Make sure tubing is not twisted or kinked. Replace top covers. Remove bath blanket. Make resident comfortable.

Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Dispose of plastic bag properly. Remove and dispose of gloves properly. Leave call light within resident’s reach.

Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

9. Explain how to collect different types of urine specimens
Routine urine specimen Clean-catch (mid-stream) urine specimen 24-hour urine specimen

Collecting a routine urine specimen
Equipment: specimen container and lid, completed label, 2 pairs of gloves, bedpan or urinal if resident cannot get to the bathroom, “hat” for toilet if resident can get to the bathroom, 2 plastic bags, washcloth, towel, toilet paper, paper towel, supplies for perineal care, pen, completed lab requisition slip Identify yourself by name. Identify the resident. Greet the resident by name.

Wash your hands. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. Provide for the resident’s privacy with a curtain, screen, or door.

Put on gloves. Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. Help the resident to the bathroom or commode, or offer the bedpan or urinal. Have resident void into “hat,” urinal, or bedpan. Ask the resident not to put toilet paper or stool in with the sample.

(con’t) Provide a plastic bag to discard toilet paper. After urination, help as necessary with perineal care. Help resident wash his or her hands. Remove and dispose of gloves properly. Wash your hands. Replace bed covers. Make resident comfortable.

Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Put on clean gloves. Take bedpan, urinal, or commode pail to the bathroom. Pour urine into the specimen container. Specimen container should be at least half full.

Cover the urine container with its lid. Do not touch the inside of container. Wipe off the outside with a paper towel and discard. Apply label, and bag the specimen. If using a bedpan or urinal, discard extra urine. Rinse and clean equipment. Use approved disinfectant if facility policy. Store equipment.

Remove and dispose of gloves properly. Leave call light within resident’s reach. Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines. Take specimen and lab slip to designated place promptly.

Collecting a clean-catch (mid-stream) urine specimen
Equipment: specimen kit with container, completed label, cleaning solution, gauze or towelettes, 2 pairs of gloves, bedpan or urinal if resident cannot use the bathroom, plastic bag, washcloth, toilet paper, paper towel, towel, supplies for perineal care, pen, completed lab requisition slip Identify yourself by name. Identify the resident. Greet the resident by name.

Wash your hands. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. Provide for the resident’s privacy with a curtain, screen, or door.

Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. Put on gloves. Open the specimen kit. Do not touch the inside of the container or lid. If the resident cannot clean his or her perineal area, you will do it. Using the towelettes or gauze and cleansing solution, clean the area around the meatus.

(con’t) For females, separate the labia. Wipe from front to back along one side. Discard towelette/gauze. With a new towelette or gauze, wipe from front to back along the other side. Using a new towelette or gauze, wipe down the middle. For males, clean the head of the penis. Use circular motions with the towelettes or gauze. Clean thoroughly.

(con’t) Change towelettes/gauze after each circular motion. Discard after use. If the man is uncircumcised, pull back the foreskin of the penis before cleaning. Hold it back during urination. Make sure it is pulled back down after collecting the specimen. Ask the resident to urinate into the bedpan, urinal, or toilet, and to stop before urination is complete.

Place the container under the urine stream. Do not touch the resident’s body with the container. Have the resident start urinating again. Fill the container at least half full. Have resident stop urinating and remove container if possible. Have the resident finish urinating in bedpan, urinal, or toilet.

After urination, help as necessary with perineal care. Help resident wash his or her hands. Remove and dispose of gloves properly. Wash your hands. Replace bed covers. Make resident comfortable.

Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Cover the urine container with its lid. Do not touch the inside of the container. Wipe off the outside with a paper towel and discard. Apply label, and bag the specimen.

If using a bedpan or urinal, discard extra urine. Rinse and clean equipment. Use approved disinfectant if facility policy. Store equipment. Remove and dispose of gloves properly. Leave call light within resident’s reach. Wash your hands.

Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines. Take specimen and lab slip to designated place promptly.

Collecting a 24-hour urine specimen
Equipment: 24-hour specimen container, completed label, bedpan or urinal for residents confined to bed, “hat” for toilet if resident can get to the bathroom, gloves, washcloth, towel, toilet paper, supplies for perineal care, sign to alert other team members that a 24-hour urine specimen is being collected, lab requisition slip with date and time of first void

Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

(con’t) Emphasize that all urine must be saved. Ask the resident not to put toilet paper or stool in with the sample. Provide for the resident’s privacy with a curtain, screen, or door. Place a sign on the resident’s bed to let all care team members know that a 24-hour specimen is being collected. Sign may read “Save all urine for 24- hour specimen.”

When starting the collection, have the resident completely empty the bladder. Discard the urine. Note the exact time of this voiding. The collection will run until the same time the next day (Fig ). Put on gloves each time the resident voids. Measure I&O each time if needed. Fig One type of form to record urine output over 24 hours. (Reprinted with permission of Briggs Corporation, )

Pour urine from bedpan, urinal, or toilet attachment into the container. Container may be stored on ice or in a special refrigerator when not used. The ice keeps the specimen cool. It also prevents components and chemicals in the urine from breaking down, which can prevent proper analysis. Follow facility policy.

After each voiding, help as necessary with perineal care. Help the resident wash his or her hands. Clean equipment after each voiding. Remove gloves. Wash your hands. After the last void of the 24-hour period, add the urine to the specimen container. Remove the sign.

Make resident comfortable. Return bed to low position if raised. Ensure resident’s safety. Remove privacy measures. Remove and dispose of gloves. Leave call light within resident’s reach. Wash your hands.

Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines. Take specimen containers and lab slip to the designated place promptly.

Testing urine with reagent strips
Equipment: urine specimen as ordered, reagent strip, gloves, paper towel Wash your hands. Put on gloves. Place paper towel on surface before setting urine specimen down. Take a strip from the bottle and recap bottle. Close it tightly.

Dip the strip into the specimen. Follow manufacturer’s instructions for when to remove strip. Remove strip at correct time. Follow manufacturer’s instructions for how long to wait after removing strip. After proper time has passed, compare strip with color chart on bottle. Do not touch bottle with strip.

Read results. Discard used items. Discard specimen in the toilet. Remove gloves. Wash your hands. Record and report results. Document procedure using facility guidelines.

11. Explain guidelines for assisting with bladder retraining
Guidelines for bladder retraining: Follow the plan consistently. Follow Standard Precautions. Observe resident’s elimination habits. Keep a record of elimination. Offer a bedpan, urinal, or trip to the bathroom. Answer call lights promptly. Provide privacy and do not rush the resident. Help the resident with good perineal care. Encourage plenty of fluids, etc.

1. Define important words in this chapter

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