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

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

3. Normal Urination 1500 cc per day Other terms Used: Micturition Voiding
Pale yellow, straw colored
Clear with no particles
Faint odor

4. Terms Dysuria Hematuria Nocturia Polyuria Frequency Incontinence
Urgency
Difficult urination
Bloody urine
frequent night
Too much urination
Urinating at frequent intervals
Unable to control urination
The need to urinate right away

5. Bedpans Used when patient cannot get OOB Women – voiding and BM
Men – BM
Plastic or stainless steel
Fracture pan is smaller
Follow Standard precautions

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

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

8. 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

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

10. 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

11. 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

12. Indwelling Catheter - F/C
Balloon
Catheter
Balloon port
Collection bag
Drainage port

13. 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

14. 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

15. 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

16. 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

17. 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:

18. 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

19. Ureterostomy
Surgical removal of bladder with creation of new pathway for urine.
Urinary diversion

20. Ureterostomy Ostomy – creation of an artificial opening
Ureterostomy – artificial opening between the ureter and the abdomen
Stoma – artificial opening

21. Review
What is the best position for using a bedpan ?
Fowlers

22. Review
Urine normally has an ammonia odor.
True False

23. Review
Cleansing the genital and anal area is called
Peri-care

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

25. Review
When is the F/C emptied?
Qshift

26. below Review Keep the urinary drainage bag __________ the level of
the bladder.
below

27. Review
What is the goal of bladder training?
Gain control of urination

28. Review
What is a tube used to inject or drain fluid through a body opening?
catheter

29. Review
How much urine does the health adult produce per day?
1500 cc per day

30. Review
What is the function of the urinary system ?
Remove waste products from the blood

31. Review
What keeps the catheter in the bladder ?
balloon

32. Review
Catheters are used to treat incontinence.
True False

33. Review
Catheter care is provided QD.
True False

34. Review
Difficult urination?
dysuria
Frequent urination at night?
nocturia

35. Review
Inability to control urinination?
incontinence
Micturition?
Emptying the bladder

36. Review
Bloody urine?
hematuria
Too much urine?
polyuria

37. 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.

38. 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.

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

40. Questions??