1. Urinary catheters, I & O and 24 hour urine testing
PN 103

2. Catheters - may be used for intermittent or continuous drainage
-may be introduced into the bladder, ureter, or
kidney
-type and size determined by location and cause
of the urinary tract problem
-measured by the French system
-Urethral catheters range in size from 12Fr-24Fr
-Ureteral catheter: 4FR-6Fr and always inserted by
the physician

3. Types of Catheters
-Coude’ -tapered tip, easier to insert when
enlarged prostate is suspected
-Foley -simple uretheral catheter, balloon near the
tip to anchor
-Malecot, Pezzer, or Mushroom –used to drain
urine from the renal pelvis of the kidney, can also
be used for suprapubic drainage
-Robinson –a straight catheter with multiple openings in the
tip to facilitate intermittent drainage
-Ureteral –long, slender catheter passed into the
ureter
-Whistle-tip –has a slanted, larger opening at its tip
to be used if blood is in the urine

4. Coude’ catheter
Robinson catheter
Ureteral catheter

6. -Cystostomy, Vesicostomy or suprapubic
catheter –inserted by the physician through
the abdominal wall above the symphysis
pubis; used to divert urine flow from the
urethra, is connected to a sterile closed
drainage system.
-External (Texas or condom0 catheter –
-drainage system connected to the penis
-noninvasive
-removed daily for cleaning and skin
inspection

7. Nursing Interventions and Patient Teaching
-Principle to prevent and detect infection and
trauma
Aseptic technique for insertion
Record I & O
Adequate hydration
Do not open drainage system after it is in place
except to irrigate the catheter per MD order.
Catheter care twice a day, inspect insertion site
Check system daily for leaks
Avoid placing the drainage bag above the level
of the bladder!

8. Prevent tension on the system of backflow
wile transferring patient
-Ambulate the patient or turn and
reposition every 2 hours
-Observe characteristics of the urine
-Sterile specimen collected through the
drain port
-Report and record assessment findings

9. Self-Catherization
-Uses for spinal cord injury or other
neurological disorders
-Promotes independent function of the
patient.
-Instruct about surgical asepsis, however
at home there is less risk of cross-
contamination and patient will probably
use a modified clean technique
-Instruct in symptoms of UTIs

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11. INTAKE AND OUTPUT
One of the most basic methods of monitoring a client's health is measuring intake and output , commonly called I and O. By monitoring the amount of fluids a client takes in and comparing this to the amount of fluid a client puts out. The health care team can gain valuable insights into the client's general health as well as monitor specific disease conditions.
I & O

12. INTAKE - all those fluids entering the client's body such as water, ice chips, juice, milk, coffee and ice cream. Artificial fluids include: parenteral, central lines, feeding tubes, irrigation and blood transfusion. OUTPUT - all fluid that leaves the client's body such as: urine, perspiration, exhalation, diarrhea, vomiting, drainage from all tubes and bleeding.
I & O

13. Ideal Daily fluid Intake and Output Source/ AMOUNT/ Route/ AMOUNT H2O consumed as fluid/ 1500ml/ urine/ ml H2O present in food/ 750ml / insensible losses/ ml H2O produced by oxidation/ 350ml / lungs/ ml skin / 100ml sweat/ ml feces / TOTAL/ 2600ml/ TOTAL/ ml
I & O

14. Purpose: - helps evaluate client's fluid and electrolyte balance - suggests various diagnosis - influence the choice of fluid therapy - document the client's ability to tolerate oral fluids - recognize significant fluid losses
I & O

15. Mandatory for clients with burns, electrolyte imbalance, recent surgical procedure, severe vomiting or diarrhea, taking diuretics or corticosteroids, renal failure, congestive heart failure, NGT, drainage collection device and IV therapy.
I & O

16. Deviations: Other sources of fluid loss and excessive losses from normal routes: - drainage from catheter or tubes - vomitus - diarrhea - diaphoresis - hemorrhage - ileostomy/ colostomy drainage - excessive urine output
I & O

17. Average daily water requirement by age and weight: AGE/ ml/ BODY WEIGHT ml/kg 3 days/ ml/ year/ ml/ years/ ml/ years/ ml/ years/ ml/ years/ ml/ years/ ml/ adult / ml/ 20-30
I & O

18. Nursing Intervention: Intervention/ Rationale 1
Nursing Intervention: Intervention/ Rationale Ideally intake and output should be monitored/ To obtain an accurate record 2. In critical situations, intake and output should be monitored on an hourly basis/ Urine output less than 500ml in 24 hours or less than 30cc/hour indicates renal failure 3. Daily weights are often done/ Indicate fluid retention or loss 4. Identify if patient undergone surgery or with medical problem / May affect fluid loss 5. Make sure you know the total amount and fluid sources once you delegate this task/ To get an accurate measurement

19. 6. Record the type and amount of all fluids and describe the route at least every 8 hours 7. If irrigating a nasogastric or another tube or bladder, measure the amount instilled and subtract it from the total output/ To get exact amount 8. Keep toilet paper out of client urine output/ For an accurate measurement 9. Measure drainage in a calibrated container and observe it at eye level.

20. A significant change in a client's weight or a significant difference in a client's total intake and output should be reported immediately to the physician.
WEIGHT CHANGES - mild dehydration- 2 to 5% loss - moderate dehydration- 6 to 9% loss - severe dehydration - 10 to 14% loss - death- 20% loss
mild volume overload- 2% gain - moderate volume overload - 5% gain - severe volume overload - 8% gain

21. Clinical Signs of Dehydration: - dry skin and mucous membranes - concentrated urine - poor skin turger - depressed periorbital space - sunken fontanel - dry conjunctiva - cracked lips - decreased saliva - weak pulse

22. Client's signs of fluid excess: - peripheral edema - puffy eyelids - sudden weight gain - ascites - rales in lungs - blurred vision - excessive salivation - distended neck vein

23. Discard the first voiding of the day.
24 hr. Urine – The kidneys excrete substances at various rates and amounts during a 24 hr. period.
Some substances that are measured are: urine protein, urine creatinine, uric acid levels, and catecholamines + 66 other items
Procedure:
Discard the first voiding of the day.
Start the “time” for the 24 hr. collection
Collect urine x 24 hrs.

24. Collection- remind patient not to place toilet paper in collection container. Have patient void before BM to avoid contamination.
-if there is a preservative in the
collection container, may need to
refrigerate or put on ice. If no
preservative, may need to
refrigerate or put on ice. Check
with the lab and for any
institutional procedures.