1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 20 Urinary Elimination

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  NORMAL URINATION  The healthy adult produces about 1500 ml (milliliters) or 3 pints of urine a day.  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: 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

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The person’s elimination needs are assessed. A care plan is developed to ensure that these needs are met. A care plan is developed to ensure that these needs are met.  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, and particles.  Bedpans are used by: Persons who cannot be out of bed Persons who cannot be out of bed Women for voiding and bowel movements Women for voiding and bowel movements Men for bowel movements Men for bowel movements

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Fracture pans are used: By persons with casts By persons with casts By persons in traction By persons in traction By persons with limited back motion By persons with limited back motion After spinal cord injury or surgery After spinal cord injury or surgery After a hip fracture After a hip fracture After hip replacement surgery After hip replacement surgery

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Men use urinals to void. The man stands if possible. The man stands if possible. Some sit on the side of the bed. Some sit on the side of the bed. The man may lie in bed. The man may 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. You may have to place and hold the urinal for some.  Persons unable to walk to the bathroom often use commodes. Some commodes are wheeled into bathrooms and placed over toilets. Some commodes are wheeled into bathrooms and placed over toilets.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  URINARY INCONTINENCE  The basic types of incontinence are: Stress incontinence Stress incontinence 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.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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 products to help keep the person dry Incontinence products to help keep the person dry  Incontinence is linked to abuse, mistreatment, and neglect. Remember, incontinence is beyond the person’s control. Remember, incontinence is beyond the person’s control. 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. The person has the right to be free from abuse, mistreatment, and neglect.

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Persons with dementia may: Void in the wrong places Void in the wrong places Remove incontinence products and throw them on the floor or in the toilet Remove incontinence products and throw them on the floor or in the toilet Resist staff efforts to keep them clean and dry Resist staff efforts to keep them clean and dry

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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.  Catheterization is the process of inserting a catheter.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Catheters are used for the following reasons: Before, during, and after surgery Before, during, and after surgery For people too weak or disabled to use the bedpan, urinal, commode, or toilet For people 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 For diagnostic purposes For diagnostic purposes  You will care for persons with indwelling catheters.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Some people wear leg bags when up. Some people wear leg bags when up. The drainage bag is always lower than the bladder. The drainage bag is always lower than the bladder.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  If a drainage system is disconnected accidentally: Tell the nurse at once. 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. 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. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Leg bags are changed to drainage bags when the person is in bed.  Drainage bags are emptied and measured: At the end of every shift At the end of every shift When changing from a leg bag to a drainage bag When changing from a leg bag to a drainage bag When changing from a drainage to a leg bag When changing from a drainage to a leg bag When the bag is becoming full When the bag is becoming full

15. Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  To apply condom catheters (external catheters, Texas catheters, urinary sheaths): Follow the manufacturer’s instructions. Follow the manufacturer’s instructions. Thoroughly wash the penis with soap and water. Thoroughly wash the penis with soap and water. Dry the penis before applying the catheter. 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. Never use adhesive tape to secure catheters.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THERE ARE TWO BASIC TYPES OF BLADDER TRAINING  The person uses the toilet, commode, bedpan, or urinal at certain times. The person is given 15 or 20 minutes to start voiding. The person is given 15 or 20 minutes to start voiding. The rules for normal elimination are followed. The rules for normal elimination are followed.  The person has a catheter. The catheter is clamped to prevent urine flow from the bladder. The catheter is clamped to prevent urine flow from the bladder. Urine drains when the catheter is unclamped. Urine drains when the catheter is unclamped. When the catheter is removed, voiding is encouraged every 3 to 4 hours or as directed by the nurse and the care plan. When the catheter is removed, voiding is encouraged every 3 to 4 hours or as directed by the nurse and the care plan.

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE PERSON WITH A UROSTOMY  Sometimes the bladder is surgically removed.  A new pathway for urine to leave the body is created. It is called a urinary diversion. It is called a urinary diversion. The nurse provides care after surgery. The nurse provides care after surgery. You may care for persons with long-standing urostomies. You may care for persons with long-standing urostomies.  A pouch is applied over the stoma. Urine drains through the stoma into the pouch. Urine drains through the stoma into the pouch. Urine drains constantly into the pouch. Urine drains constantly into the pouch.

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  DIALYSIS  When the kidneys fail: Little or no urine is produced. Little or no urine is produced. Body waste and excess fluid collect in the blood. Body waste and excess fluid collect in the blood. The person dies if the waste and fluid are not removed. The person dies if the waste and fluid are not removed.  Dialysis is the process that removes excess fluid and waste from the blood. Hemodialysis Hemodialysis Peritoneal dialysis Peritoneal dialysis

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Illness, disease, and aging can affect the private act of voiding.  Residents often depend on the nursing staff to assist with elimination needs.  You must protect the person’s privacy.