1. Chapters 22 & 31 Tanya Comer RN, BSNTanya Comer RN, BSN

2. Urinary Elimination Eliminating waste is a physical need Eliminating waste is a physical need The urinary system The urinary system Removes waste products from the blood Removes waste products from the blood Maintains the body’s water balance Maintains the body’s water balance

3. Normal Urination The healthy adult produces about 1500mL of urine in a day The healthy adult produces about 1500mL of urine in a day Factors affecting urine production include Factors affecting urine production include Age Age Disease Disease Amount and kinds of fluid ingested Amount and kinds of fluid ingested Dietary salt Dietary salt Body temperature and perspiration Body temperature and perspiration Drugs Drugs Frequency of urination is affected by: Frequency of urination is affected by: Amount of fluid intake, habits, and available toilet facilities Amount of fluid intake, habits, and available toilet facilities Activity, work and illness Activity, work and illness

4. Normal Urination Observations Observations Normal urine Normal urine Is pale yellow, straw-colored or amber Is pale yellow, straw-colored or amber Is clear with no particles Is clear with no particles Has a faint odor Has a faint odor Observe urine for color, clarity, odor, amount, particles and blood Observe urine for color, clarity, odor, amount, particles and blood Report complaints of urgency, burning or urination or painful or difficult urination Report complaints of urgency, burning or urination or painful or difficult urination

5. Normal Urination Bedpans are used by Bedpans are used by Persons who cannot be out of bed Persons who cannot be out of bed Women for voiding or BMs Women for voiding or BMs Men for BMs Men for BMs Standard bedpans and fracture pans are used Standard bedpans and fracture pans are used By persons with casts By persons with casts By persons in traction By persons in traction By persons with limited motion By persons with limited motion After spinal cord injury or surgery After spinal cord injury or surgery After a hip fracture After a hip fracture After a hip replacement surgery After a hip replacement surgery

6. Normal Urination Men use urinals to void Men use urinals to void The man stands if possible The man stands if possible Some sit on the side of the bed or lie in bed Some sit on the side of the bed or lie in bed Some men need support when standing Some men need support when standing You may have to place and hold the urinal for some men You may have to place and hold the urinal for some men Remind men Remind men To hang urinals on the bed rails and signal after use To hang urinals on the bed rails and signal after use Not to place urinals on overbed tables and bedside stands Not to place urinals on overbed tables and bedside stands

7. Normal Urination Persons unable to walk to the bathroom often use commodes Persons unable to walk to the bathroom often use commodes The commode allows a normal position for elimination The commode allows a normal position for elimination The commode arms and back provide support and help prevent falls The commode arms and back provide support and help prevent falls Some commodes are wheeled into bathrooms and placed over toilets. They are useful for person who need support when sitting Some commodes are wheeled into bathrooms and placed over toilets. They are useful for person who need support when sitting The container is removed of the commode is used with the toilet The container is removed of the commode is used with the toilet Wheels are locked after the commode is positioned over the toilet. Wheels are locked after the commode is positioned over the toilet.

8. Urinary Incontinence The basic type of incontinence are The basic type of incontinence are Stress Stress Urge Urge Overflow Overflow Functional Functional Reflex Reflex Mixed incontinence Mixed incontinence Transient incontinence Transient incontinence If incontinence is a new problem, tell the nurse at once. If incontinence is a new problem, tell the nurse at once.

9. Urinary Incontinence The following may be needed The following may be needed Good skin care and dry garments and linens Good skin care and dry garments and linens Promoting normal urinary elimination Promoting normal urinary elimination Bladder training Bladder training Catheters Catheters Incontinence is linked to abuse, mistreatment and neglect Incontinence is linked to abuse, mistreatment and neglect Remember incontinence is beyond the persons control Remember incontinence is beyond the persons control If you are becoming short-tempered and impatient, talk to the nurse at once If you are becoming short-tempered and impatient, talk to the nurse at once The person has the right to be free from abuse, mistreatment, and neglect The person has the right to be free from abuse, mistreatment, and neglect

10. Catheters Inserted through the urethra into the bladder, a urinary catheter drains urine into a drainage bag Inserted through the urethra into the bladder, a urinary catheter drains urine into a drainage bag A straight catheter drains the bladder and then is removed A straight catheter drains the bladder and then is removed An indwelling catheter is left in the bladder An indwelling catheter is left in the bladder Catheterization is the process of inserting a catheter. Catheterization is the process of inserting a catheter.

11. Catheters Catheters are used: Catheters are used: Before, during and after surgery Before, during and after surgery For people who are too weak or disable to use the bedpan, urinal, commode, or toilet. For people who are too weak or disable to use the bedpan, urinal, commode, or toilet. To protect wounds and presser ulcers from contact with urine To protect wounds and presser ulcers from contact with urine To allow hourly urinary output measurements To allow hourly urinary output measurements As a last resort for incontinence. As a last resort for incontinence. To collect sterile urine specimens To collect sterile urine specimens For measuring residual urine For measuring residual urine When caring for persons with indwelling catheters, the risk of infection is high. When caring for persons with indwelling catheters, the risk of infection is high.

12. Catheters Drainage systems Drainage systems A closed drainage system is used for indwelling catheters. A closed drainage system is used for indwelling catheters. Nothing can enter the system from the catheter to the drainage bag. Nothing can enter the system from the catheter to the drainage bag. Some people wear leg bags that attach to the thigh or calf when standing up Some people wear leg bags that attach to the thigh or calf when standing up The drainage bag is always kept lower than the bladder to prevent urinary tract infections The drainage bag is always kept lower than the bladder to prevent urinary tract infections

13. Catheters If the drainage system is disconnected accidently tell the nurse at once If the drainage system is disconnected accidently tell the nurse at once Do not touch the ends of the catheter or tubing Do not touch the ends of the catheter or tubing Practice hand hygiene and put on gloves Practice hand hygiene and put on gloves Wipe the end of the tubing with an antiseptic wipe Wipe the end of the tubing with an antiseptic wipe Do not put the ends down Do not put the ends down Do not touch the ends after you clean them Do not touch the ends after you clean them Connect the tubing to the catheter Connect the tubing to the catheter Discard the wipes into a biohazard bag Discard the wipes into a biohazard bag Remove the gloves and practice hand hygiene. Remove the gloves and practice hand hygiene.

14. Catheters Leg bags are changed to drainage bags or bed bags when the person is in bed. Leg bags are changed to drainage bags or bed bags when the person is in bed. Drainage bags are emptied and the urine is measured Drainage bags are emptied and the urine is measured At the end of the shift At the end of the shift When changing from leg bag to a drainage bag When changing from leg bag to a drainage bag When changing from a drainage bag to a leg bag When changing from a drainage bag to a leg bag When the bag is becoming full When the bag is becoming full

15. Catheters Removing indwelling catheters Removing indwelling catheters An indwelling catheter has two lumens An indwelling catheter has two lumens Sterile water is injected through one to inflate the balloon Sterile water is injected through one to inflate the balloon Urine drains from the bladder from the other lumen Urine drains from the bladder from the other lumen A physician's order is needed to remove a catheter A physician's order is needed to remove a catheter Dysuria and urinary frequency are common after removing catheters Dysuria and urinary frequency are common after removing catheters

16. Catheters Condom catheters are often used for incontinent men Condom catheters are often used for incontinent men Condom catheters are self-adhering or taped in place. Condom catheters are self-adhering or taped in place. Follow manufactures directions when applying or removing condom catheters Follow manufactures directions when applying or removing condom catheters

17. Bladder Training Control of urination is the goal Control of urination is the goal The person uses the toilet, commode, bedpan or urinal at certain times The person uses the toilet, commode, bedpan or urinal at certain times The rules for normal elimination are followed The rules for normal elimination are followed The normal position for urination is assumed if possible The normal position for urination is assumed if possible Privacy is important Privacy is important Four methods are: Four methods are: Bladder retraining Bladder retraining Prompted voiding Prompted voiding Habit training/scheduled voiding Habit training/scheduled voiding Catheter clamping Catheter clamping

18. Chapter 22 Review Painful or difficult urination is a.Da.Dysuria b.Mb.Micturition c.Oc.Oliguria d.Ud.Urinary urgency

19. Chapter 22 Review Frequent urination at night is a.Pa.Polyuria b.Nb.Nocturia c.Dc.Dysuria d.Ud.Urgency

20. Chapter 22 Review The loss of urine in response to a sudden, urgent need to void is called a.Oa.Overflow incontinence b.Mb.Mixed incontinence c.Fc.Functional incontinence d.Ud.Urge incontinence

21. Chapter 22 Review Which of the following measures will not prevent a UTI a.Pa.Promoting fluid intake as the nurse directs b.Hb.Having the person wear cotton underwear c.Kc.Keeping the perineal area clean and dry d.Ed.Encouraging the person to do pelvic muscle exercises

22. Chapter 22 Review The goal of bladder training is to a.Ra.Remove the catheter b.Tb.Treat incontinence c.Gc.Gain control of urination d.Pd.Prevent infection

23. Ch 31- Specimens Ordered by doctors, specimens are collected and tested to prevent, detect, and treat disease. Ordered by doctors, specimens are collected and tested to prevent, detect, and treat disease. Most specimens are tested in the laboratory Most specimens are tested in the laboratory All specimens sent to the lab require requisition slips All specimens sent to the lab require requisition slips Some tests are done at the bedside Some tests are done at the bedside

24. Urine Specimens Urine specimens are collected for urine tests Urine specimens are collected for urine tests Random urine specimens is used for a routine UA Random urine specimens is used for a routine UA It is collected anytime during a 24hr period It is collected anytime during a 24hr period Many people can collect the specimen themselves Many people can collect the specimen themselves Weak and ill persons need help Weak and ill persons need help

25. Urine Specimens The 24-hour urine specimen The 24-hour urine specimen All urine voided during a 24-hour period is collected All urine voided during a 24-hour period is collected Urine is chilled on ice or refrigerated during this time Urine is chilled on ice or refrigerated during this time A preservative is added to the collection container for some tests A preservative is added to the collection container for some tests The person voids to begin the test with an empty bladder The person voids to begin the test with an empty bladder Discard this voiding Discard this voiding Save all voidings for the next 24 hours. Save all voidings for the next 24 hours. The test is restarted if The test is restarted if A voiding is not collected A voiding is not collected Toilet tissue was discarded into the specimen Toilet tissue was discarded into the specimen The specimen contains stool The specimen contains stool

26. Urine Specimens The doctor orders type and frequency of urine tests. The nurse may ask you to do these simple tests The doctor orders type and frequency of urine tests. The nurse may ask you to do these simple tests Testing for pH Testing for pH Urine pH measure of urine is acidic or alkaline Urine pH measure of urine is acidic or alkaline A random urine specimen is needed A random urine specimen is needed Testing for glucose Testing for glucose The diabetic person may have sugar and/or ketones in the urine The diabetic person may have sugar and/or ketones in the urine Tests for glucose and ketones are usually done 4 times a day- 30mn before each meal and at bedtime Tests for glucose and ketones are usually done 4 times a day- 30mn before each meal and at bedtime The doctor uses the tests to make drug and diet decisions The doctor uses the tests to make drug and diet decisions

27. Urine Specimens Testing for blood Testing for blood Injury and disease can cause hematuria Injury and disease can cause hematuria Sometimes blood is seen in the urine Sometimes blood is seen in the urine At other times, it is unseen At other times, it is unseen A random urine specimen is needed A random urine specimen is needed Using reagent strips Using reagent strips Do not touch the test area on the strip Do not touch the test area on the strip Dip the strip into the urine Dip the strip into the urine Compare the strip with the color chart on the side of the bottle Compare the strip with the color chart on the side of the bottle

28. Urine Specimens Straining urine Straining urine A stone can develop in the kidney, ureter, or bladder A stone can develop in the kidney, ureter, or bladder Stones vary in size Stones vary in size Stones causing severe pain and urinary system damage may require removal by medical or surgical procedures Stones causing severe pain and urinary system damage may require removal by medical or surgical procedures Some stones pass through the urine Some stones pass through the urine All of the persons urine is strained All of the persons urine is strained Passed stones are sent to the lab for analysis Passed stones are sent to the lab for analysis

29. Stool Specimens Stools are studied for fat, microbes, worms, blood and other abnormal contents Stools are studied for fat, microbes, worms, blood and other abnormal contents Bleeding may occur in very small amounts Bleeding may occur in very small amounts Stools are tested for occult (hidden blood) Stools are tested for occult (hidden blood) Stools are tested for occult blood to screen for colon cancer and other digestive disorders Stools are tested for occult blood to screen for colon cancer and other digestive disorders Occult blood test kits vary. Follow manufacture instructions Occult blood test kits vary. Follow manufacture instructions Urine must not contaminate the stool specimen Urine must not contaminate the stool specimen

30. Sputum Specimens Mucus from the respiratory system is called sputum when expelled through the mouth Mucus from the respiratory system is called sputum when expelled through the mouth Sputum is not saliva Sputum is not saliva Sputum specimens are studied for blood, microbes, and abnormal cells Sputum specimens are studied for blood, microbes, and abnormal cells The person coughs up sputum from the bronchi and trachea The person coughs up sputum from the bronchi and trachea It is easier to collect a specimen in the morning It is easier to collect a specimen in the morning

31. Blood Glucose Testing Blood glucose testing is used for person with diabetes Blood glucose testing is used for person with diabetes The doctor uses the results to regulate the person’s drugs and diet The doctor uses the results to regulate the person’s drugs and diet Capillary blood is obtained through a skin puncture Capillary blood is obtained through a skin puncture A drop of blood is collected A drop of blood is collected A fingertip is the most common site for skin punctures A fingertip is the most common site for skin punctures

32. Blood Glucose Testing To perform a skin puncture To perform a skin puncture Inspect the puncture site carefully for signs of trauma and skin breaks Inspect the puncture site carefully for signs of trauma and skin breaks Do not use swollen, bruised, cyanotic, scarred, or calloused skin. Do not use swollen, bruised, cyanotic, scarred, or calloused skin. Use a sterile, disposable lancet to puncture the skin Use a sterile, disposable lancet to puncture the skin

33. Review Questions Chapter 31 Which specimen is collected for a urinalysis? a.Aa.A random urine specimen b.Ab.A midstream specimen c.Ac.A clean-catch specimen d.Ad.A double-voided specimen

34. Review Questions Chapter 31 Which statement about collecting sputum specimens is incorrect? a.Ta.The person coughs up sputum from the bronchi and trachea b.Ib.It is easier to collect a specimen in the morning c.Tc.The person rinses the mouth with mouthwash before collecting the specimen d.Pd.Privacy is important

35. Review Questions Chapter 31 Glucosuria means a.Sa.Sugar in the urine b.Bb.Blood in the urine c.Ac.A scant amount of urine d.Dd.Difficult or painful urination

36. Review Questions Chapter 31 Hematuria means a.Sa.Sugar in the urine b.Bb.Blood in the urine c.Ac.A scant amount of urine d.Dd.Difficult or painful urination

37. Review Questions Chapter 31 Which statement about collecting urine specimens is incorrect? a.La.Label the container with the requested information b.Tb.Touch only the inside of the container c.Cc.Collect the specimen at the time specified d.Ad.Ask the person to put toilet tissue in the toilet or wastebasket