1. Define the following term:
Urination
the act of passing urine from the bladder through the urethra to the outside of the body; also known as micturition or voiding.

2. 1. List qualities of urine and identify signs and symptoms about urine to report
The following are normal characteristics of urine:
Adults produce about 1200 to 1500 mL of urine, although elderly may produce less
Light, pale yellow, or amber in color
Clear or transparent
Faint smell

3. 1. List qualities of urine and identify signs and symptoms about urine to report
REMEMBER:
Medications, certain foods or dyes, and vitamins/supplements might affect the color and/or odor of urine, but anything unusual should be reported right away.

4. 1. List qualities of urine and identify signs and symptoms about urine to report
Report these signs and symptoms related to urine:
Cloudy urine
Dark or rust-colored urine
Strong, offensive, or fruity-smelling urine
Pain, burning, or pressure when urinating
Blood, pus, mucus, or discharge
Protein or glucose in urine
Incontinence

5. Define the following terms:
Fracture pan
a bedpan that is flatter than the regular bedpan.
Portable commode
a chair with a toilet seat and a removable container underneath; used for elimination.

6. Transparency 16-1: Factors Affecting Urination
Normal changes of aging
Bladder cannot hold as much urine.
Elderly people may need to urinate more.
Bladder may not empty completely, causing risk of infection.
Psychological factors
Lack of privacy
Stress, depression, anxiety
Fluid intake

7. Transparency 16-1: Factors Affecting Urination (cont’d.)
Muscle tone
Medications
Disorders
Bladder disease
Infection
Arthritis
Congestive heart disease
Neurological diseases
Diabetes

8. 2. List factors affecting urination and demonstrate how to assist with elimination
REMEMBER:
It is very important to promote dignity and provide privacy while assisting residents with toileting.

9. Assisting a resident with the use of a bedpan
Equipment: bedpan, bedpan cover, protective pad or sheet, bath blanket, toilet paper, disposable washcloths or wipes, soap, towel, 2 pairs of gloves
Wash your hands.
Identify yourself by name. Identify the resident by name.

10. Assisting a resident with the use of a bedpan (cont’d.)
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
Provide for resident’s privacy with curtain, screen, or door.
Adjust bed to a safe working level, usually waist high. Before placing bedpan, lower the head of the bed. Lock bed wheels.

11. Assisting a resident with the use of a bedpan (cont’d.)
Put on gloves.
Cover the resident with the bath blanket. Ask him to hold it while you pull down the top covers underneath. Do not expose more of the resident than you have to.
Place a protective pad under the resident’s buttocks and hips. To do this, have the resident roll toward you. If the resident cannot do this, you must turn the resident toward you. Be sure resident cannot roll off the bed.

12. Assisting a resident with the use of a bedpan (cont’d.)
(cont’d.) Move to the empty side of bed. Place the protective pad on the area where the resident will lie on his back. The side of protective pad nearest the resident should be fanfolded (folded several times into pleats).
Ask the resident to roll onto his back, or roll him as you did before. Unfold the rest of protective pad so it completely covers the area under and around the resident’s hips.

13. Assisting a resident with the use of a bedpan (cont’d.)
Ask the resident to remove undergarments or help him do so.
Place bedpan near his hips in the correct position. Standard bedpan should be positioned with the wider end aligned with the resident’s buttocks. Fracture pan should be positioned with handle toward foot of bed.

14. Assisting a resident with the use of a bedpan (cont’d.)
If resident is able, ask him to raise hips by pushing with feet and hands at the count of three. Slide the bedpan under his hips.
If the resident cannot do this himself, place your arm under the small of his back and tell him to push with his heels and hands on your signal as you raise his hips. Place the bedpan underneath the resident.
wider end

15. Assisting a resident with the use of a bedpan (cont’d.)
(cont’d.) If a resident cannot help you in any way, keep the bed flat and roll the resident onto the far side. Slip the bedpan under the hips and gently roll the resident back onto the bedpan, keeping the bedpan centered underneath.
Remove and discard gloves. Wash your hands.
Raise the head of the bed. Prop the resident into a semi-sitting position using pillows.

16. Assisting a resident with the use of a bedpan (cont’d.)
Check the bedpan to be certain it is in the correct position. Make sure the blanket is still covering the resident. Place toilet tissue and washcloths or wipes within resident’s reach. Ask resident to clean his hands with the hand wipe when finished, if he is able.
Place the call light within resident’s reach. Ask resident to signal when done. Leave the room.

17. Assisting a resident with the use of a bedpan (cont’d.)
When called by the resident, return and put on clean gloves.
Lower the head of the bed. Make sure resident is still covered. Do not overexpose the resident.
Remove bedpan carefully and cover bedpan.

18. Assisting a resident with the use of a bedpan (cont’d.)
Provide perineal care if assistance is needed. For female residents, wipe from the front to the back. Dry the perineal area with a towel. Help the resident put on undergarment. Place the towel in a hamper or bag, and discard disposable supplies.

19. Assisting a resident with the use of a bedpan (cont’d.)
Take bedpan to the bathroom. Empty the bedpan carefully into the toilet unless a specimen is needed. Note color, odor, and consistency of contents before flushing. If you notice anything unusual about the stool or urine (for example, the presence of blood), do not discard it. You will need to inform the nurse.

20. Assisting a resident with the use of a bedpan (cont’d.)
Turn the faucet on with a paper towel. Rinse the bedpan with cold water first and empty it into the toilet. Place bedpan in proper area for cleaning or clean it according to facility policy.
Remove and discard gloves.
Wash your hands.
Make resident comfortable. Remove bath blanket and cover resident.

21. Assisting a resident with the use of a bedpan (cont’d.)
Return bed to lowest position. Remove privacy measures.
Place call light within resident’s reach.
Report any changes in resident to the nurse.
Document procedure using facility guidelines.

22. Assisting a male resident with a urinal
Equipment: urinal, protective pad or sheet, washcloths or wipes, 2 pairs of gloves
Wash your hands.
Identify yourself by name. Identify the resident by name.
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

23. Assisting a male resident with a urinal (cont’d.)
Provide for resident’s privacy with curtain, screen, or door.
Adjust bed to a safe working level, usually waist high. Lock bed wheels.
Put on gloves.
Place a protective pad under the resident’s buttocks and hips, as in earlier procedure.

24. Assisting a male resident with a urinal (cont’d.)
Hand the urinal to the resident. If the resident is not able to help himself, place urinal between his legs and position penis inside the urinal. Replace covers.
Remove and discard gloves. Wash your hands.

25. Assisting a male resident with a urinal (cont’d.)
Place wipes within resident’s reach. Ask the resident to clean his hands with the hand wipe when finished, if he is able. Leave call light within reach while resident is using urinal. Ask resident to signal when done. Leave the room.
When called by the resident, return and put on clean gloves.

26. Assisting a male resident with a urinal (cont’d.)
Remove urinal or have resident hand it to you. Empty contents into toilet unless specimen is needed or the urine is being measured for intake/output monitoring. Note color, odor, and qualities (for example, cloudiness) of contents before flushing.

27. Assisting a male resident with a urinal (cont’d.)
Turn the faucet on with a paper towel. Rinse the urinal with cold water first and empty it into the toilet. Place urinal in proper area for cleaning or clean it according to facility policy.
Remove and discard gloves.
Wash your hands.
Make resident comfortable.

28. Assisting a male resident with a urinal (cont’d.)
Return bed to lowest position. Remove privacy measures.
Place call light within resident’s reach.
Report any changes in resident to the nurse.
Document procedure using facility guidelines.

29. Assisting a resident to use a portable commode or toilet
Equipment: portable commode with basin, toilet paper, washcloths or wipes, gloves
Wash your hands.
Identify yourself by name. Identify the resident by name.
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

30. Assisting a resident to use a portable commode or toilet (cont’d.)
Provide for resident’s privacy with curtain, screen, or door.
Help resident out of bed and to the portable commode or bathroom. Make sure resident is wearing non-skid shoes and that the laces are tied.
If needed, help resident remove clothing and sit comfortably on toilet seat. Put toilet tissue within reach.

31. Assisting a resident to use a portable commode or toilet (cont’d.)
Provide privacy. Leave call light within reach while resident is using commode. Ask resident to signal when done. Leave the room.
When called by resident, return and apply gloves.
Give perineal care if help is needed. Wipe female residents from front to back.

32. Assisting a resident to use a portable commode or toilet (cont’d.)
Help resident to wash hands after using commode. Dispose of soiled washcloth or wipes properly.
Help resident back to bed. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs.
Remove waste container. Empty into toilet. Note color, odor, and consistency of contents.

33. Assisting a resident to use a portable commode or toilet (cont’d.)
Rinse container. Pour rinse water into toilet. Place container in proper area for cleaning or clean it according to facility policy.
Remove and dispose of gloves properly.
Wash your hands.
Return bed to lowest position. Remove privacy measures.

34. Assisting a resident to use a portable commode or toilet (cont’d.)
Place call light within resident’s reach.
Report any changes in resident to the nurse.
Document procedure using facility guidelines.

35. Define the following terms:
Urinary tract infection (UTI)
inflammation of the bladder and the ureters that results in a painful burning during urination and the frequent feeling of needing to urinate; also called cystitis.
Cystitis
inflammation of the bladder that may be caused by bacterial infection.
Calculi
kidney stones that form when urine crystallizes in the kidneys.

36. Define the following terms:
Nephritis
an inflammation of the kidneys.
Renovascular hypertension
a condition in which a blockage of arteries in the kidneys causes high blood pressure.

37. Define the following terms:
Chronic kidney failure
condition that occurs when the kidneys cannot eliminate certain waste products from the body; also called chronic renal failure.
Kidney dialysis
an artificial means of removing the body’s waste products.

38. 3. Describe common diseases and disorders of the urinary system
There are different types of incontinence:
Stress incontinence
Urge incontinence
Mixed incontinence
Functional incontinence
Overflow incontinence

39. 3. Describe common diseases and disorders of the urinary system
REMEMBER:
Incontinence is not a normal part of aging and may signal an illness. It is a major risk factor for pressure sores.

40. 3. Describe common diseases and disorders of the urinary system
Remember these guidelines for urinary incontinence:
Offer to assist with toileting often.
Follow toileting schedules.
Answer call lights and requests for assistance promptly.
Document carefully and accurately any time a resident’s skin or anything touching resident’s skin is wet from urine, even if it is a small amount.
Wash urine off immediately and completely.

41. 3. Describe common diseases and disorders of the urinary system
Guidelines for urinary incontinence (cont’d.):
Incontinent residents who are bedbound should have plastic, latex or disposable sheets under them to protect the bed. Place a draw sheet over it to absorb moisture and protect skin.
Use disposable incontinence pads or briefs as needed to keep body wastes away from skin. Change wet briefs promptly and do not refer to them as “diapers.”
Be reassuring and understanding with incontinent residents.

42. 3. Describe common diseases and disorders of the urinary system
Guidelines for urinary incontinence (cont’d.):
Incontinent residents who are bedbound should have plastic, latex or disposable sheets under them to protect the bed. Place a draw sheet over it to absorb moisture and protect skin.
Use disposable incontinence pads or briefs as needed to keep body wastes away from skin. Change wet briefs promptly and do not refer to them as “diapers.”
Be reassuring and understanding with incontinent residents.

43. Providing perineal care for an incontinent resident
Equipment: 2 clean protective pads, 4 washcloths or wipes, 1 towel, gloves, basin with warm water, soap, bath blanket, bath thermometer
Wash your hands.
Identify yourself by name. Identify the resident by name.
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

44. Providing perineal care for an incontinent resident (cont’d.)
Provide for resident’s privacy with curtain, screen, or door.
Adjust bed to a safe level, usually waist high. Lock bed wheels.
Lower head of the bed. Position resident lying flat on his or her back.

45. Providing perineal care for an incontinent resident (cont’d.)
Test water temperature with thermometer or your wrist to ensure safety. Water temperature should be 105°F. Have resident check water temperature. Adjust if necessary.
Put on gloves.
Cover resident with bath blanket. Move top linens to foot of bed.

46. Providing perineal care for an incontinent resident (cont’d.)
Remove soiled protective pad from under resident by turning resident on his side, away from you. (See procedure “Turning a resident” in Chapter 10.) Roll soiled pad into itself with wet side in/dry side out.
Place clean protective pad under his or her buttocks.
Return resident to lying on his back.

47. Providing perineal care for an incontinent resident (cont’d.)
Expose perineal area only; avoid overexposure of the resident. Clean the perineal area.
For a female resident: Wash the perineum with soap and water from front to back. Use single strokes. 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.

48. Providing perineal care for an incontinent resident (cont’d.)
(cont’d.) 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. Move from front to back, using a blotting motion with towel.

49. Providing perineal care for an incontinent resident (cont’d.)
(cont’d.)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 a male resident:
If the resident is uncircumcised, retract the foreskin. Gently push skin towards the base of penis.
Hold the penis by the shaft. Wash in a circular motion from the tip down to the base.

50. Providing perineal care for an incontinent resident (cont’d.)
(cont’d.)Use a clean area of washcloth or clean washcloth for each stroke. Rinse the penis. If the resident is uncircumcised, gently return foreskin to its normal position. Then wash the scrotum and groin. Rinse and pat dry. Ask the resident to turn on his side. Wash, rinse, and dry buttocks and anal area. Cleanse the anal area without contaminating the perineal area.

51. Providing perineal care for an incontinent resident (cont’d.)
Turn resident on his side away from you. Remove the wet protective pad after drying buttocks.
Place a dry protective pad under the resident.
Reposition the resident and make the resident comfortable.
Replace top covers and remove bath blanket.

52. Providing perineal care for an incontinent resident (cont’d.)
Place soiled linens, clothing and protective pads in proper containers.
Empty, rinse, and wipe basin. Return to proper storage.
Remove and dispose of gloves properly.
Wash your hands.

53. 3. Describe common diseases and disorders of the urinary system
Remember these points about urinary tract infections (UTI):
Being bedbound is a risk factor for increased incidence of UTIs.
Women are more likely than men to contract a UTI.
Women should wipe the perineal area from front to back after elimination.

54. 3. Describe common diseases and disorders of the urinary system
Remember these guidelines for preventing UTIs:
Encourage residents to wipe front to back and do the same when providing perineal care.
Give careful perineal care when changing incontinent briefs.
Encourage plenty of fluids.
Offer to assist with toileting often.
Taking showers, rather than baths, helps prevent UTIs.
Report cloudy, dark, or foul-smelling urine, or if resident urinates often and in small amounts.

55. 3. Describe common diseases and disorders of the urinary system
The following can be symptoms of calculi:
Abdominal pain
Flank or back pain
Groin pain
Burning/pain during urination
Frequent urination
Blood in urine
Nausea, vomiting
Chills, fever

56. 3. Describe common diseases and disorders of the urinary system
REMEMBER:
Straining urine to detect the presence of calculi might be among an NA’s duties. If so, a routine urine specimen (see LO 5) is poured through a strainer or 4x4-inch piece of gauze and any stones are wrapped in the filter and sent to a lab.

57. 3. Describe common diseases and disorders of the urinary system
Remember these points about nephritis:
Symptoms include decreased urinary output, rust-colored urine and a burning feeling during urination.
A person with nephritis often has swollen face, eyelids, and hands from retaining fluid.
Older people can develop a chronic form of nephritis.

58. 3. Describe common diseases and disorders of the urinary system
REMEMBER:
Residents may take medications to control high blood pressure related to renovascular hypertension. The condition may require surgery.

59. 3. Describe common diseases and disorders of the urinary system
The following can be symptoms of chronic renal (kidney) failure:
High blood pressure
Decreased urine output or no urine output
Darkly colored urine
Anemia
Nausea, vomiting
Loss of appetite
Weight changes

60. 3. Describe common diseases and disorders of the urinary system
Symptoms of chronic renal (kidney) failure (cont’d.):
Fatigue and weakness
Headaches
Difficulty sleeping
Back pain
Edema
Stool that is bloody or black

61. Define the following terms:
Straight catheter
a catheter that does not remain inside the person; it is removed immediately after urine is drained.
Indwelling catheter
a type of catheter that remains inside the bladder for a period of time; urine drains into a bag.
Condom catheter
catheter that has an attachment on the end that fits onto the penis; also called an external or “Texas” catheter.

62. 4. Describe guidelines for urinary catheter care
REMEMBER:
NAs do not insert, irrigate, or remove catheters.

63. 4. Describe guidelines for urinary catheter care
Remember these guidelines for urinary catheter care:
Keep drainage bag lower than the resident’s hips or bladder to prevent infection and let gravity allow drainage.
Keep drainage bag off floor.
Prevent kinks and twists in tubing.
Keep genital area clean.

64. 4. Describe guidelines for urinary catheter care
Observe and report the following when a resident has a urinary catheter:
Bloody urine
Bag not filling after several hours
Bag filling suddenly
Catheter not in place
Urine leaking from catheter
Resident reporting pain or pressure
Odor

65. 4. Describe guidelines for urinary catheter care
REMEMBER:
Wear gloves during catheter care and wash your hands afterwards.

66. Providing catheter care
Equipment: bath blanket, protective pad, bath basin, soap, bath thermometer, 2-4 washcloths or wipes, 1 towel, gloves
Wash your hands.
Identify yourself by name. Identify the resident by name.
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

67. Providing catheter care (cont’d.)
Provide for resident’s privacy with curtain, screen, or door.
Adjust bed to a safe working level, usually waist high. Lock bed wheels.
Lower head of bed. Position resident lying flat on his back.

68. Providing catheter care (cont’d.)
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 resident check water temperature. Adjust if necessary.
Put on gloves.

69. Providing catheter care (cont’d.)
Ask the resident to flex his knees and raise the buttocks off the bed by pushing against the mattress with his feet. Place clean protective pad under his buttocks.
Expose only the area necessary to clean the catheter; avoid overexposure of resident.
Place towel or pad under catheter tubing before washing.

70. Providing catheter care (cont’d.)
Apply soap to wet washcloth. Clean area around meatus. Use a clean area of the washcloth for each stroke.
Hold catheter near meatus to avoid tugging the catheter.
Clean 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.

71. Providing catheter care (cont’d.)
Dip a clean washcloth in the water. Rinse area around meatus, using a clean area of washcloth for each stroke.
Dip a clean washcloth in the water. 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.

72. Providing catheter care (cont’d.)
Remove towel or pad from under catheter tubing. Replace top covers and remove bath blanket.
Dispose of linen in proper containers.
Empty, rinse, and wipe basin. Return to proper storage.
Remove and dispose of gloves.

73. Providing catheter care (cont’d.)
Wash your hands.
Return bed to lowest position. Remove privacy measures.
Place call light within resident’s reach.
Report any changes in resident to the nurse.
Document procedure using facility guidelines.

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

75. Emptying the catheter drainage bag (cont’d.)
Provide for resident’s privacy with curtain, screen, or door.
Put on gloves.
Place paper towel on the floor under the drainage bag. Place measuring container on the paper towel.

76. Emptying the catheter drainage bag (cont’d.)
Open the drain or spout on the bag. Allow urine to flow out of the bag into the measuring container. Do not let spout touch the measuring container.
When urine has drained, close spout. Using alcohol wipe, clean the drain spout. Replace the drain in its holder on the bag.
Note the amount and the appearance of the urine. Empty into toilet.

77. Emptying the catheter drainage bag (cont’d.)
Clean and store measuring container.
Remove and dispose of gloves.
Wash your hands.
Document procedure and amount of urine.

78. Applying a condom catheter
Equipment: condom catheter and collection bag, catheter tape, gloves, plastic bag, bath blanket, supplies for perineal care
Wash your hands.
Identify yourself by name. Identify the resident by name.
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

79. Applying a condom catheter (cont’d.)
Provide for resident’s privacy with curtain, screen, or door.
Adjust bed to a safe level, usually waist high. Lock bed wheels.
Lower head of bed. Position resident lying flat on his back.
Remove or fold back top bedding. Keep resident covered with bath blanket.

80. Applying a condom catheter (cont’d.)
Put on gloves.
Adjust bath blanket to expose only genital area.
If condom catheter is present, gently remove it. Place it in the plastic bag.
Help as necessary with perineal care.
Attach collection bag to leg.

81. Applying a condom catheter (cont’d.)
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 and roll towards base of penis. Leave space between the drainage tip and glans of penis to prevent irritation. If resident is not circumcised, be sure that foreskin is in normal position.

82. Applying a condom catheter (cont’d.)
Gently secure condom to penis with tape provided.
Connect catheter tip to drainage tubing. Make sure tubing is not twisted or kinked.
Discard used supplies in plastic bag. Place soiled clothing and linens in proper containers. Clean and store supplies.

83. Applying a condom catheter (cont’d.)
Remove and dispose of your gloves.
Wash your hands.
Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs.

84. Applying a condom catheter (cont’d.)
Return bed to lowest position. Remove privacy measures.
Place call light within resident’s reach.
Report any changes in resident to the nurse.
Document procedure using facility guidelines.

85. Define the following terms:
Specimen
a sample that is used for analysis in order to try to make a diagnosis.
Routine urine specimen
a urine specimen that can be collected any time a person voids.
“Hat”
in health care, a collection container that is sometimes inserted into a toilet to collect and measure urine or stool.

86. Define the following terms:
Clean catch specimen
a urine specimen that does not have the first and last urine included.
24-hour urine specimen
a urine specimen consisting of all urine voided in a 24-hour period.

87. 5. Identify types of urine specimens that are collected
Remember these points about urine specimens:
NAs must wear gloves for these procedures.
Tagging and storing specimens correctly is important.
Be sensitive to the fact that residents may find it embarrassing or uncomfortable to have others handling their body wastes.
If you feel the task is unpleasant, do not make it known.
Remain professional.

88. Collecting a routine urine specimen
Equipment: urine specimen container and lid, label (labeled with resident’s name, room number, date and time), gloves, bedpan or urinal (if resident cannot use a portable commode or toilet), “hat” for toilet (if resident can get to the bathroom), 2 plastic bags, washcloth, towel, paper towel, supplies for perineal care, lab slip, if required
Wash your hands.
Identify yourself by name. Identify the resident by name.

89. Collecting a routine urine specimen (cont’d.)
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
Provide for resident’s privacy with curtain, screen, or door.
Put on gloves.
Help the resident to the bathroom or commode, or offer the bedpan or urinal.

90. Collecting a routine urine specimen (cont’d.)
Have resident void into “hat,” urinal, or bedpan. Ask the resident not to put toilet paper in with the sample. Provide a plastic bag to discard toilet paper.
After urination, help as necessary with perineal care. Help resident wash his or her hands. Make the resident comfortable.
Take bedpan, urinal, or commode pail to the bathroom.

91. Collecting a routine urine specimen (cont’d.)
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.
Place the container in a plastic bag.

92. Collecting a routine urine specimen (cont’d.)
If using a bedpan or urinal, discard extra urine. Rinse and clean equipment. Store.
Remove and dispose of gloves.
Wash your hands.
Return bed to lowest position if adjusted. Remove privacy measures.

93. Collecting a routine urine specimen (cont’d.)
Place call light within resident’s reach.
Report any changes in resident to the nurse.
Take specimen and lab slip to proper area. Document procedure using facility guidelines. Note amount and characteristics of urine.

94. Collecting a clean catch (mid-stream) urine specimen
Equipment: specimen kit with container and lid, label (labeled with resident’s name, room number, date and time), cleansing solution, gauze or towelettes, gloves, bedpan or urinal (if resident cannot use a portable commode or toilet), plastic bag, washcloth, paper towel, towel, supplies for perineal care, lab slip, if required
Wash your hands.
Identify yourself by name. Identify the resident by name.

95. Collecting a clean catch (mid-stream) urine specimen (cont’d.)
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
Provide for resident’s privacy with curtain, screen, or door.
Put on gloves.
Open the specimen kit. Do not touch the inside of the container or lid.

96. Collecting a clean catch (mid-stream) urine specimen (cont’d.)
If the resident cannot clean his or her perineal area, you will need to do it. Using the towelettes or gauze and cleansing solution, clean the area around the meatus. 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.

97. Collecting a clean catch (mid-stream) urine specimen (cont’d.)
(cont’d.) For males, clean the head of the penis. Use circular motions with the towelettes or gauze. Clean thoroughly. Change towelettes/gauze after each circular motion. Discard after use. If the man is uncircumcised, gently 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.

98. Collecting a clean catch (mid-stream) urine specimen (cont’d.)
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. Have the resident start urinating again. Fill the container at least half full. Have the resident finish urinating in bedpan, urinal, or toilet.
Cover the urine container with its lid. Do not touch the inside of container. Wipe off the outside with a paper towel.

99. Collecting a clean catch (mid-stream) urine specimen (cont’d.)
Place the container in a plastic bag.
If using a bedpan or urinal, discard extra urine. Rinse and clean equipment. Store.
After urination, assist as necessary with perineal care.
Remove and dispose of gloves.

100. Collecting a clean catch (mid-stream) urine specimen (cont’d.)
Wash your hands. Help resident wash his or her hands.
Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs.
Return bed to lowest position if adjusted. Remove privacy measures.
Place call light within resident’s reach.

101. Collecting a 24-hour urine specimen
Equipment: 24-hour specimen container with lid, bedpan or urinal (for residents confined to bed), “hat” for toilet (if resident can get to the bathroom), plastic bag, gloves, washcloth, towel, supplies for perineal care, sign to alert other team members that a 24-hour urine specimen is being collected, lab slip, if required
Wash your hands.
Identify yourself by name. Identify the resident by name.

102. Collecting a 24-hour urine specimen (cont’d.)
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Emphasize that all urine must be saved.
Provide for resident’s privacy with 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.”

103. Collecting a 24-hour urine specimen (cont’d.)
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.
Label the container. Write resident’s name, room number, and dates and times the collection period began and ended.
Put on gloves each time the resident voids.

104. Collecting a 24-hour urine specimen (cont’d.)
Pour urine from bedpan, urinal, or toilet attachment into the container. Container may be stored on ice when not used. The ice will keep the specimen cool. Follow facility policy.
After each voiding, help as necessary with perineal care. Help the resident wash his or her hands.
Clean equipment according to facility policy, after each voiding.

105. Collecting a 24-hour urine specimen (cont’d.)
Remove gloves.
Wash your hands.
After the last void of the 24-hour period, add the urine to the specimen container. Remove the sign.
Place container in plastic bag.
Remove and dispose of gloves.

106. Collecting a 24-hour urine specimen (cont’d.)
Wash your hands.
Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs.
Return bed to lowest position if adjusted. Remove privacy measures.
Place call light within resident’s reach.

107. Collecting a 24-hour urine specimen (cont’d.)
Report any changes in resident to the nurse.
Take specimen and lab slip to proper area. Document procedure using facility guidelines. Make sure to include the time of the last void of the 24-hour collection period.

108. 6. Explain types of tests performed on urine
Urine may be tested for
pH levels
Glucose and ketones
Blood
Specific gravity

109. Testing urine with reagent strips
Equipment: urine specimen as ordered, reagent strip, gloves
Wash your hands.
Put on gloves.
Take a strip from the bottle and recap bottle. Close it tightly.
Dip the strip into the specimen.

110. Testing urine with reagent strips (cont’d.)
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.

111. Testing urine with reagent strips (cont’d.)
Read results.
Discard used items. Discard specimen in the toilet.
Remove and dispose of gloves.
Wash your hands.
Document procedure using facility guidelines.

112. 7. Explain guidelines for assisting with bladder retraining
NAs may assist in bladder retraining, using the following guidelines:
Follow standard precautions. Wear gloves.
Explain the schedule to the resident. Follow the schedule.
Keep a record of resident’s bladder habits. This will help you predict when a resident will need to eliminate.
Offer trips to the bathroom before long procedures.
Always be sensitive and professional.

113. 7. Explain guidelines for assisting with bladder retraining
Guidelines for bladder retraining (cont’d.):
Encourage plenty of fluids.
Answer call lights promptly.
Provide privacy.
If resident has trouble urinating, try running water in the sink or suggest she lean forward slightly.
Never rush resident.
Assist with good perineal care.

114. 7. Explain guidelines for assisting with bladder retraining
Guidelines for bladder retraining (cont’d.):
Discard wastes properly.
Discard clothing protectors and incontinence briefs properly.
If your facility uses washable bed pads or briefs, follow standard precautions when rinsing before placing these items in the laundry.
Keep an accurate record of urination, including episodes of incontinence.
Never show frustration or anger.

115. 7. Explain guidelines for assisting with bladder retraining
REMEMBER:
Always keep a positive attitude when assisting residents who are incontinent and have “accidents.” Think about how you would feel if you were unable to control elimination.