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Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Urinary Elimination.

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Presentation on theme: "Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Urinary Elimination."— Presentation transcript:

1 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Urinary Elimination

2 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  Eliminating waste is a physical need.  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 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  NORMAL URINATION  The healthy adult produces about 1500 mL, or 3 pints, of urine a day.  Many factors affect urine production. Age Age Disease Disease The amount and kinds of fluid ingested The amount and kinds of fluid ingested Dietary salt Dietary salt Body temperature Body temperature Perspiration Perspiration Drugs Drugs

4 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  Frequency of urination is affected by: The amount of fluid intake, habits, and available toilet facilities The amount of fluid intake, habits, and available toilet facilities Activity, work, and illness Activity, work, and illness  Observations Normal urine: 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. Observe urine for color, clarity, odor, amount, and particles. Report complaints of urgency, burning on urination, or painful or difficult urination. Report complaints of urgency, burning on urination, or painful or difficult urination.

5 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  Bedpans are used by persons who cannot be out of bed. Women use bedpans for voiding and bowel movements. Women use bedpans for voiding and bowel movements. Men use them for bowel movements. Men use them for bowel movements. Standard bedpans and fracture pans are used. Standard bedpans and fracture pans are used. Fracture pans are used: 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

6 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  Men use urinals to void. To use the urinal: To use the urinal:  The man stands if possible.  Some sit on the side of the bed or lie in bed.  Some men need support when standing.  You may have to place and hold the urinal for some men. Remind men: Remind men:  To signal after using the urinal  Not to place urinals on overbed tables and bedside stands

7 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Persons unable to walk to the bathroom often use commodes. The commode : The commode :  Allows a normal position for elimination  Provides support and helps prevent falls Some commodes are wheeled into bathrooms and placed over toilets. 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.

8 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  URINARY INCONTINENCE  Urinary incontinence is the loss of bladder control. It may be temporary or permanent. It may be temporary or permanent.  The basic types of incontinence are: Stress incontinence (dribbling) Stress incontinence (dribbling) Urge incontinence Urge incontinence Overflow incontinence Overflow incontinence Functional incontinence Functional incontinence Reflex incontinence Reflex incontinence Mixed incontinence Mixed incontinence  If incontinence is a new problem, tell the nurse at once.

9 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  Incontinence is embarrassing.  The person is uncomfortable.  Skin irritation, infection, and pressure ulcers are risks.  Falling is a risk.  The person’s pride, dignity, and self-esteem are affected.  Good skin care and dry garments and linens are essential.

10 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  Promoting normal urinary elimination prevents incontinence in some people. Others need bladder training. Others need bladder training. Sometimes catheters are needed. Sometimes catheters are needed.  Incontinence products help keep the person dry.  Incontinence is linked to abuse, mistreatment, and neglect. Caring for persons with incontinence is stressful. Caring for persons with incontinence is stressful. If you find yourself becoming short-tempered and impatient, talk to the nurse at once. If you find yourself becoming short-tempered and impatient, talk to the nurse at once.  The person has the right to be free from abuse, mistreatment, and neglect.

11 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  CATHETERS  Inserted through the urethra into the bladder, a urinary catheter drains urine. A straight catheter drains the bladder and then is removed. A straight catheter drains the bladder and then is removed. An indwelling catheter (retention or Foley catheter) is left in the bladder. An indwelling catheter (retention or Foley catheter) is left in the bladder.  A balloon near the tip is inflated with sterile water after the catheter is inserted. It prevents the catheter from slipping out of the bladder.  Tubing connects the catheter to the drainage bag.  Catheterization is the process of inserting a catheter.

12 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Catheters often are used: Before, during, and after surgery Before, during, and after surgery For persons who are too weak or disabled to use the bedpan, urinal, commode, or toilet For persons who are too weak or disabled to use the bedpan, urinal, commode, or toilet To protect wounds and pressure ulcers from contact with urine To protect wounds and pressure 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  Catheters do not treat the cause of incontinence. For certain diagnostic purposes For certain diagnostic purposes  When caring for persons with indwelling catheters, the risk of infection is high.

13 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  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. The drainage bag must not touch the floor. The drainage bag must not touch the floor. The drainage bag is always kept lower than the person’s bladder. The drainage bag is always kept lower than the person’s bladder. Some people wear leg bags when up. Some people wear leg bags when up.

14 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  If the drainage system is disconnected accidentally, 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 tube with an antiseptic wipe. Wipe the end of the tube with an antiseptic wipe. Wipe the end of the catheter with another antiseptic wipe. Wipe the end of the catheter with another antiseptic wipe. Do not put the ends down. Do not put the ends down.  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.

15 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Leg bags are changed to drainage bags when the person is in bed. Leg bags are changed to drainage bags when the person is in bed. Drainage bags are emptied and urine is measured: Drainage bags are emptied and urine is 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 the bag is becoming full

16 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  Removing indwelling catheters An indwelling catheter has two lumens (passage- ways). An indwelling catheter has two lumens (passage- ways).  Sterile water is injected through one lumen to inflate the balloon.  Urine drains from the bladder through the other lumen. A doctor’s order is needed to remove a catheter. A doctor’s order is needed to remove a catheter. Most people need bladder training first. Most people need bladder training first. Dysuria and frequency are common after removing catheters. Dysuria and frequency are common after removing catheters.

17 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  Condom catheters (external catheters, Texas catheters, urinary sheaths) are often used for incontinent men. A condom catheter is a soft sheath that slides over the penis. A condom catheter is a soft sheath that slides over the penis. To apply a condom catheter: To apply a condom catheter:  Follow the manufacturer’s instructions.  Thoroughly wash the penis with soap and water.  Dry the penis before applying the catheter. Condom catheters are self-adhering or applied with elastic tape. Condom catheters are self-adhering or applied with elastic tape.  Never use adhesive tape to secure catheters.

18 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  BLADDER TRAINING  Bladder training helps some persons with urinary incontinence.  Some persons need bladder training after indwelling catheter removal.  Control of urination is the goal of bladder training.  You assist with bladder training as directed by the nurse and the care plan.


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