1. 1. List qualities of urine and identify signs and symptoms about urine to report
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 an NA should report anything unusual about a resident’s urine right away.

4. 1. List qualities of urine and identify signs and symptoms about urine to report
NAs should report the following 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
Urinary incontinence

5. 2. List factors affecting urination and demonstrate how to assist with elimination
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; also called a bedside commode.

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
• Muscle tone
• Medications
• Disorders
- Bladder disease
- Infections
- Arthritis
- Congestive heart disease
- Neurological diseases
- Diabetes

7. 2. List factors affecting urination and demonstrate how to assist with elimination
REMEMBER: A fracture pan is flatter than a regular bedpan and is used for residents who cannot assist with raising their hips onto a regular bedpan. There are many adaptive and safety devices to make elimination easier for residents.

8. 2. List factors affecting urination and demonstrate how to assist with elimination
REMEMBER: It is essential that an NA always 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, bath blanket, toilet paper, disposable wipes, towel, 2 pairs of gloves
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.

10. Assisting a resident with the use of a bedpan
5. Adjust bed to a safe working level, usually waist high. Before placing bedpan, lower the head of the bed. Lock bed wheels.
6. Put on gloves.
7. Cover the resident with the bath blanket and ask him to hold it while you pull down the top covers underneath. Do not expose more of the resident than you need to.

11. Assisting a resident with the use of a bedpan
8. 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 (see Chapter 10). Be sure resident cannot roll off the bed. Move to the empty side of bed and 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) and tucked under the resident.

12. Assisting a resident with the use of a bedpan
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.
9. Ask the resident to remove undergarments, or help him do so.

13. Assisting a resident with the use of a bedpan
10. Place the bedpan near his hips in the correct position. A standard bedpan should be positioned with the wider end aligned with the resident’s buttocks. A fracture pan should be positioned with the handle toward the foot of bed.
11. If resident is able, ask him to raise his hips by pushing with feet and hands at the count of three. Slide the bedpan under his hips.

14. Assisting a resident with the use of a bedpan
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.
If a resident cannot help you in any way, keep the bed flat and roll the resident away from you. Slip the bedpan under the hips and gently roll the resident back onto the bedpan. Keep the bedpan centered underneath.

15. Assisting a resident with the use of a bedpan
12. Remove and discard gloves. Wash your hands.
13. Raise the head of the bed. Prop the resident into a semi-sitting position using pillows.
14. Make sure the bath blanket is still covering the resident. Place toilet paper and disposable wipes within resident’s reach. Ask resident to clean his hands with a wipe when finished if he is able.

16. Assisting a resident with the use of a bedpan
15. Place the call light within resident’s reach. Ask resident to signal when done. Leave the room and close the door.
16. When called by the resident, return and put on clean gloves.
17. Lower the head of the bed. Make sure resident is still covered.
18. Remove bedpan carefully and cover bedpan.

17. Assisting a resident with the use of a bedpan
19. Provide perineal care if help is needed. Wipe female residents from front to back. Dry the perineal area with a towel. Help the resident put on undergarment. Cover the resident and remove the bath blanket.
20. Place the towel and bath blanket in a hamper or bag, and discard disposable supplies.

18. Assisting a resident with the use of a bedpan
21. Take bedpan to the bathroom. Empty the bedpan carefully into the toilet unless a specimen is needed or urine is being measured for intake/output monitoring. 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.

19. Assisting a resident with the use of a bedpan
22. Turn the faucet on with a paper towel. Rinse the bedpan with cold water and empty it into the toilet. Flush the toilet. Place bedpan in proper area for cleaning or clean it according to facility policy.
23. Remove and discard gloves.
24. Wash your hands.
25. Make resident comfortable.
26. Return bed to lowest position. Remove privacy measures.

20. Assisting a resident with the use of a bedpan
27. Place call light within resident’s reach.
28. Report any changes in resident to the nurse.
29. Document procedure using facility guidelines.

21. Assisting a male resident with a urinal
Equipment: urinal, protective pad, disposable wipes, 2 pairs of gloves
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.

22. Assisting a male resident with a urinal
5. Adjust bed to a safe working level, usually waist high. Lock bed wheels.
6. Put on gloves.
7. Place a protective pad under the resident’s buttocks and hips, as in earlier procedure.
8. Hand the urinal to the resident. If the resident is not able to help himself, place urinal between his legs and position the penis inside the urinal. Replace covers.

23. Assisting a male resident with a urinal
9. Remove and discard gloves. Wash your hands.
10. Place disposable wipes within resident’s reach. Ask the resident to clean his hands with the hand wipe when finished if he is able. Place the call light within reach while resident is using urinal. Ask resident to signal when done. Leave the room and close the door.
11. When called by the resident, return and put on clean gloves.
12. Discard disposable wipes.

24. Assisting a male resident with a urinal
13. 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.
14. Turn the faucet on with a paper towel. Rinse the urinal with cold water and empty it into the toilet. Flush the toilet. Place urinal in proper area for cleaning or clean it according to facility policy.

25. Assisting a male resident with a urinal
15. Remove and discard gloves.
16. Wash your hands.
17. Make resident comfortable.
18. Return bed to lowest position. Remove privacy measures.
19. Place call light within resident’s reach.
20. Report any changes in resident to the nurse.
21. Document procedure using facility guidelines.

26. Assisting a resident to use a portable commode or toilet
Equipment: portable commode with basin, toilet paper, disposable wipes, towel, 3 pairs of gloves
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.

27. Assisting a resident to use a portable commode or toilet
5. Lock bed wheels. Make sure resident is wearing non-skid shoes and that the laces are tied. Help resident out of bed and to the portable commode or bathroom.
6. Put on gloves.
7. If needed, help resident remove clothing and sit comfortably on toilet seat. Put toilet paper and disposable wipes within reach. Ask resident to clean his hands with a wipe when finished if he is able.

28. Assisting a resident to use a portable commode or toilet
8. Remove and discard your gloves. Wash your hands.
9. Provide privacy. Place call light within reach while resident is using commode. Ask resident to signal when done. Leave the room and close the door.
10. When called by resident, return and put on clean gloves. Provide perineal care if help is needed. Wipe female residents from front to back. Dry the perineal area with a towel. Help the resident put on clothing.

29. Assisting a resident to use a portable commode or toilet
11. Place the towel in a hamper or bag, and discard disposable supplies.
12. Remove and discard gloves. Wash your hands.
13. Help resident back to bed. Make resident comfortable.
14. Put on clean gloves.

30. Assisting a resident to use a portable commode or toilet
15. When using a portable commode, remove waste container. Empty it into the toilet unless a specimen is needed or the urine is being measured for intake/output monitoring. Empty into toilet. Note color, odor, and consistency of contents.

31. Assisting a resident to use a portable commode or toilet
16. Turn the faucet on with a paper towel. Rinse the container with cold water and empty it into the toilet. Flush the toilet. Place container in proper area for cleaning or clean it according to facility policy.
17. Remove and discard gloves.
18. Wash your hands.
19. Make sure bed is in lowest position. Remove privacy measures.
20. Place call light within resident’s reach.

32. Assisting a resident to use a portable commode or toilet
21. Report any changes in resident to the nurse.
22. Document procedure using facility guidelines.

33. 3. Describe common diseases and disorders of the urinary system
Define the following terms: urinary incontinence the inability to control the bladder, which leads to an involuntary loss of urine. 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.

34. 3. Describe common diseases and disorders of the urinary system
Define the following terms: calculi kidney stones that form when urine crystallizes in the kidneys. nephritis an inflammation of the kidneys. renovascular hypertension a condition in which a blockage of arteries in the kidneys causes high blood pressure.

35. 3. Describe common diseases and disorders of the urinary system
Define the following terms: chronic renal failure a condition that occurs when the kidneys cannot eliminate certain waste products from the body; also called chronic kidney failure. kidney dialysis an artificial means of removing the body’s waste products when the kidneys are no longer able to function properly.

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

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

38. 3. Describe common diseases and disorders of the urinary system
NAs should remember these guidelines for urinary incontinence:
Offer to assist with toileting often. Follow toileting schedules.
Answer call lights and requests for help immediately.
Document carefully and accurately any time a resident’s skin or anything touching his skin is wet from urine, even if it is a small amount.
Wash urine off immediately and completely. Keep residents clean, dry, and free from odor. Observe the skin carefully.

39. 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.”
Encourage residents to drink plenty of fluids.
Be reassuring and understanding with incontinent residents.

40. 3. Describe common diseases and disorders of the urinary system
NAs should know these facts about urinary tract infections (UTIs):
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.

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

42. 3. Describe common diseases and disorders of the urinary system
REMEMBER:
When changing incontinence briefs the NA should assemble all needed items beforehand, including a protective pad, perineal care supplies, disposable wipes, gloves, and a clean brief. The NA should put gloves on before handling the brief.

43. 3. Describe common diseases and disorders of the urinary system
The symptoms of calculi (kidney stones) are as follows:
Abdominal pain
Flank or back pain
Groin pain
Burning/pain during urination
Frequent urination
Blood in urine
Nausea, vomiting
Chills, fever

44. 3. Describe common diseases and disorders of the urinary system
REMEMBER:
Straining urine to detect the presence of calculi is sometimes among an NA’s duties. If so, a routing urine specimen (see Learning Objective 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.

45. 3. Describe common diseases and disorders of the urinary system
NAs should know these facts 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.

46. 3. Describe common diseases and disorders of the urinary system
NAs should know these facts about renovascular hypertension:
Residents may take medication to control high blood pressure related to renovascular hypertension.
The condition may require surgery.

47. 3. Describe common diseases and disorders of the urinary system
The symptoms of chronic renal/kidney failure are as follows:
High blood pressure
Decreased urine output or no urine output
Dark urine
Anemia
Nausea, vomiting
Loss of appetite
Weight changes

48. 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

49. 4. Describe guidelines for urinary catheter care
Define the following terms: catheter a thin tube inserted into the body to drain fluids or inject fluids. straight catheter a catheter that does not remain inside the person; it is removed immediately after urine is drained or collected.

50. 4. Describe guidelines for urinary catheter care
Define the following terms: 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.

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

52. 4. Describe guidelines for urinary catheter care
NAs should follow these guidelines when residents have a catheter:
Keep drainage bag lower than the resident’s hips or bladder to prevent infection and let gravity allow drainage.
Keep drainage bag off floor.
Keep tubing straight.
Keep genital area clean.

53. 4. Describe guidelines for urinary catheter care
NAs should observe and report the following when caring for a resident with a urinary catheter:
Bloody or unusual-looking urine
Bag not filling after several hours
Bag filling suddenly
Catheter not in place
Urine leaking from catheter
Resident reporting pain or pressure
Odor

54. 4. Describe guidelines for urinary catheter care
REMEMBER:
NAs must wear gloves while providing catheter care and wash their hands afterwards.

55. Providing catheter care
Equipment: bath blanket, protective pad, bath basin with warm water, soap, bath thermometer, 2-4 washcloths or disposable wipes, towel, gloves
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.

56. Providing catheter care
5. Adjust bed to a safe working level, usually waist high. Lock bed wheels.
6. Lower head of bed. Position resident lying flat on her back.
7. Remove or fold back top bedding, keeping resident covered with bath blanket.

57. Providing catheter care
8. Test water temperature with thermometer or on the inside of your wrist to ensure it is safe. Water temperature should be no higher than 105°F. Have resident check water temperature. Adjust if necessary.
9. Put on gloves.
10. Ask the resident to flex her knees and raise her buttocks off the bed by pushing against the mattress with her feet. Place clean protective pad under her buttocks.

58. Providing catheter care
11. Expose only the area necessary to clean the catheter. Avoid overexposing the resident.
12. Place towel or pad under catheter tubing before washing.
13. Wet washcloth in basin and apply soap to washcloth. Clean area around meatus. Use a clean area of the washcloth for each stroke.
14. Hold catheter near meatus to avoid tugging the catheter.

59. Providing catheter care
15. Clean at least four inches of catheter nearest the meatus. Move in only one direction, away from the meatus. Use a clean area of the cloth for each stroke.
16. Dip a clean washcloth in the water. Rinse area around the meatus, using a clean area of washcloth for each stroke.

60. Providing catheter care
17. Dip a clean washcloth in the water. Rinse at least four inches of catheter nearest the meatus. Move in only one direction, away from the meatus. Use a clean area of the washcloth for each stroke.
18. Remove towel or pad from under catheter tubing. Replace top covers and remove bath blanket.
19. Dispose of linen in proper containers.

61. Providing catheter care
20. Empty basin into the toilet and flush. Place basin in proper area for cleaning or clean and store it according to facility policy.
21. Remove and discard gloves.
22. Wash your hands.
23. Remove bath blanket and replace top covers. Make resident comfortable. Check that the catheter tubing is free from kinks and twists and that it is securely fastened to the leg.

62. Providing catheter care
24. Return bed to lowest position. Remove privacy measures.
25. Place call light within resident’s reach.
26. Report any changes in resident to the nurse.
27. Document procedure using facility guidelines.

63. Emptying the catheter drainage bag
Equipment: graduate (measuring container), alcohol wipes, paper towels, gloves
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Put on gloves.

64. Emptying the catheter drainage bag
6. Place paper towel on the floor under the drainage bag. Place graduate on the paper towel.
Open the drain or spout on the bag so that the urine flows out of the bag and into the graduate. Do not let spout or clamp touch the graduate.
8. When urine has drained, close spout. Using alcohol wipes, clean the drain spout. Replace the drain in its holder on the bag.

65. Emptying the catheter drainage bag
9. Go into the bathroom. Place graduate on a flat surface and measure at eye level. Note the amount and the appearance of the urine. Empty into toilet and flush toilet.
10. Clean and store graduate. Discard paper towels.
11. Remove and discard gloves.
12. Wash your hands.
13. Document procedure and amount of urine.

66. Changing a condom catheter
Equipment: condom catheter and collection bag, catheter tape, plastic bag, bath blanket, protective pad, supplies for perineal care, gloves
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.

67. Changing a condom catheter
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Lower head of bed. Position resident lying flat on his back.
7. Remove or fold back top bedding, keeping resident covered with bath blanket.
8. Put on gloves.
9. Place a clean protective pad under his buttocks.
10. Adjust bath blanket to only expose genital area.

68. Changing a condom catheter
11. If condom catheter is present, gently remove it. Place condom and tape in the plastic bag.
12. Assist as necessary with perineal care.
13. Move pubic hair away from the penis so it does not get rolled into the condom.

69. Changing a condom catheter
14. Hold penis firmly. Place condom at tip of penis and roll toward base of penis. Leave space (at least one inch) between the drainage tip and glans of penis to prevent irritation. If resident is not circumcised, be sure that foreskin is in normal position.
15. Gently secure condom to penis with special tape provided. Apply tape in a spiral manner.

70. Changing a condom catheter
16. Connect catheter tip to drainage tubing. Make sure tubing is not twisted or kinked.
17. Check to see if collection bag is secured to leg. Make sure drain is closed.
18. Discard used supplies in plastic bag. Place soiled clothing and linens in proper containers. Clean and store supplies.
19. Remove and discard gloves.
20. Wash your hands.

71. Changing a condom catheter
21. Remove bath blanket. Make resident comfortable.
22. Return bed to lowest position. Remove privacy measures.
23. Place call light within resident’s reach.
24. Report any changes in resident to the nurse.
25. Document procedure using facility guidelines.

72. 5. Identify types of urine specimens that are collected
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 can be inserted into a toilet to collect and measure urine or stool.

73. 5. Identify types of urine specimens that are collected
Define the following terms: clean-catch specimen a urine specimen that does not include the first and last urine voided; also called mid-stream. 24-hour urine specimen a urine specimen consisting of all urine voided in a 24-hour period.

74. 5. Identify types of urine specimens that are collected
NAs should remember the following when collecting urine specimens:
Gloves must be worn for these procedures.
Tagging and storing specimens correctly is important.
NAs should be sensitive to the fact that residents may find it embarrassing or uncomfortable to have others handling their body wastes.
If the task is unpleasant to the NA, she must not make it known.
The NA must remain professional.

75. Collecting a routine urine specimen
Equipment: urine specimen container with completed label (labeled with resident’s name, date of birth, room number, date, and time) and lid, specimen bag, 2 pairs of gloves, bedpan or urinal (if resident cannot use a portable commode or toilet), hat for toilet (if resident uses portable commode or toilet), plastic bag, toilet paper, disposable wipes, paper towels, supplies for perineal care, laboratory slip
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.

76. Collecting a routine urine specimen
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Put on gloves.
6. Fit hat to toilet or commode, or provide resident with bedpan or urinal.

77. Collecting a routine urine specimen
7. Ask resident to 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 separately.
8. Place toilet paper and disposable wipes within resident’s reach. Ask resident to clean his hands with a wipe when finished if he is able.
9. Remove and discard gloves. Wash your hands.

78. Collecting a routine urine specimen
10. Place the call light within resident’s reach. Ask resident to signal when done. Leave the room and close the door.
11. When called by the resident, return and put on clean gloves. Provide perineal care if help is needed.
12. Take bedpan, urinal, or hat to the bathroom.
13. Pour urine into the specimen container. Specimen container should be at least half full.

79. Collecting a routine urine specimen
14. Cover the urine container with its lid. Do not touch the inside of container. Wipe off the outside with a paper towel and apply label.
15. Place the container in a clean specimen bag.
16. Discard extra urine in toilet. Turn the faucet on with a paper towel. Rinse the bedpan, urinal, or hat with cold water and empty it into the toilet. Flush the toilet. Place equipment in proper area for cleaning or clean it according to facility policy.

80. Collecting a routine urine specimen
17. Remove and discard gloves.
18. Wash your hands.
19. Remove privacy measures.
20. Place call light within resident’s reach.
21. Report any changes in resident to the nurse.
22. Take specimen and lab slip to proper area. Document procedure using facility guidelines. Note amount and characteristics of urine.

81. Collecting a clean-catch (mid-stream) urine specimen
Equipment: specimen kit with container with completed label (labeled with resident’s name, date of birth, room number, date, and time) and lid, specimen bag, cleaning solution, gloves, bedpan or urinal (if resident cannot use a portable commode or toilet), plastic bag, toilet paper, disposable wipes, paper towels, supplies for perineal care, lab slip
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.

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

83. Collecting a clean-catch (mid-stream) urine specimen
7. If the resident cannot clean his or her perineal area, you will need to do it. Use the wipes and cleaning solution to do this. Be sure to use a clean area of the wipe or a clean wipe for each stroke. See bed bath procedure in Chapter 13 for a reminder on how to give perineal care.
8. Ask the resident to urinate a small amount into the bedpan, urinal, or toilet, and to stop before urination is complete.

84. Collecting a clean-catch (mid-stream) urine specimen
9. Place the container under the urine stream and have the resident start urinating again. Fill the container at least half full. Ask the resident to stop urinating and remove the container. Have the resident finish urinating in bedpan, urinal, or toilet.
10. After urination, provide a plastic bag so resident can discard toilet paper. Give perineal care if help is needed. Ask resident to clean his hands with a wipe if he is able.

85. Collecting a clean-catch (mid-stream) urine specimen
11. Cover the urine container with its lid. Do not touch the inside of container. Wipe off the outside with a paper towel and apply label.
12. Place the container in a clean specimen bag.
13. Discard extra urine in toilet. Turn the faucet on with a paper towel. Rinse the bedpan or urinal with cold water and empty it into the toilet. Flush the toilet. Place equipment in proper area for cleaning or clean it according to facility policy.

86. Collecting a clean-catch (mid-stream) urine specimen
14. Remove and discard gloves.
15. Wash your hands.
16. Make resident comfortable.
17. Return bed to lowest position if adjusted. Remove privacy measures.
18. Place call light within resident’s reach.
19. Report any changes in resident to the nurse.

87. Collecting a clean-catch (mid-stream) urine specimen
20. Take specimen and lab slip to proper area. Document procedure using facility guidelines. Note amount and characteristics of urine.

88. 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 use portable commode or toilet), gloves, disposable wipes, supplies for perineal care, sign to alert other team members that a 24-hour urine specimen is being collected, form for recording output, laboratory slip
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.

89. Collecting a 24-hour urine specimen
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Emphasize that all urine must be saved.
4. Provide for resident’s privacy with curtain, screen, or door.
5. 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.”

90. Collecting a 24-hour urine specimen
6. 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.
7. Label the container with the resident’s name, date of birth, room number, and dates and times the collection period began and ended.
8. Wash hands and put on gloves each time the resident voids.

91. Collecting a 24-hour urine specimen
9. Pour urine from bedpan, urinal, or hat into the container. Container may be stored at room temperature, in the refrigerator, or on ice. Follow facility policy.
10. After each voiding, help as necessary with perineal care. Ask the resident to clean his hands with a wipe after each voiding.
11. After each voiding, place equipment in proper area for cleaning or clean it according to facility policy.

92. Collecting a 24-hour urine specimen
12. Remove and discard gloves.
13. Wash your hands.
14. After the last void of the 24-hour period, remove the sign. Take specimen and lab slip to proper area. Document procedure using facility guidelines. Make sure to include the time of the last void before the 24- hour collection period began and the last void of the 24-collection period.

93. 6. Explain types of tests performed on urine
Urine may be tested for any of the following:
pH levels
Glucose and ketones
Blood
Specific gravity

94. Testing urine with reagent strips
Equipment: urine specimen as ordered, reagent strip, gloves
1. Wash your hands.
2. Put on gloves.
3. Take a strip from the bottle and recap bottle. Close it tightly.
4. Dip the strip into the specimen.
5. Follow manufacturer’s instructions for when to remove strip. Remove strip at correct time.

95. Testing urine with reagent strips
6. 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.
7. Read results.
8. Discard used items. Discard specimen in the toilet. Flush toilet.
9. Remove and discard gloves.
10. Wash your hands.
11. Document procedure using facility guidelines.

96. 7. Explain guidelines for assisting with bladder retraining
If an NA assists in bladder retraining he must remember these 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.
Encourage plenty of fluids.

97. 7. Explain guidelines for assisting with bladder retraining
Guidelines for bladder retraining (cont’d):
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.
Discard wastes properly.

98. 7. Explain guidelines for assisting with bladder retraining
Guidelines for bladder retraining (cont’d):
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.
Offer positive words for successes or attempts to control the bladder.
Never show frustration or anger.
Be positive and patient.

99. 7. Explain guidelines for assisting with bladder retraining
Think about these questions:
How would you feel if you were unable to control elimination?
How would you feel about having others assist you in cleaning up an “accident?”

100. 7. Explain guidelines for assisting with bladder retraining
REMEMBER:
It is very important for NAs to keep a positive attitude when assisting residents who are incontinent.

101. Exam Multiple Choice. Choose the correct answer.
What color should urine normally be?
(A) Dark
(B) Pale yellow
(C) Rust-colored
(D) Pale red
Which of the following statements is true of urination?
(A) Indwelling catheters do not affect muscle tone.
(B) Alcohol and caffeine decrease urine output.
(C) A lack of privacy and stress can affect urination.
(D) The bladder holds more urine as people age, causing them to urinate less frequently.

102. Exam
A _______ is used for residents who cannot assist to raise their hips onto a bedpan.
(A) Fracture pan
(B) Urinal
(C) Portable commode
(D) Toilet
Which of the following statements is true of properly positioning a standard bedpan?
(A) A standard bedpan should be positioned with the narrower end aligned with the resident’s buttocks.
(B) A standard bedpan can be positioned either toward the foot or head of the bed.
(C) A standard bedpan should be positioned with the wider end aligned with the resident’s buttocks.
(D) A standard bedpan should be positioned sideways and slightly tilted.

103. Exam The best position for women to have normal urination is
(A) Sitting
(B) Standing
(C) Lying
(D) Crouching
When providing perineal care for a female resident, the nursing assistant should
(A) Wipe from front to back
(B) Wipe from back to front
(C) Wipe the anal area first
(D) Use the same area of the washcloth for each stroke

104. Exam The best position for men to urinate is (A) Sitting (B) Standing
(C) Lying
(D) Crouching
A healthy person needs to take in at least _________ ounces of fluid each day.
(A) 36
(B) 48
(C) 64
(D) 110

105. Exam Which is true of nursing assistants and catheters?
(A) NAs remove but do not insert catheters.
(B) NAs insert but do not remove catheters.
(C) NAs irrigate catheters only when the nurse tells them to do so.
(D) NAs observe and report regarding catheters.
Which type of urinary catheter remains inside a person for a period of time?
(A) Drainage catheter
(B) Straight catheter
(C) Indwelling catheter
(D) I&O catheter

106. Exam
Which type of urine specimen does not include the first and last urine in the sample?
(A) Routine
(B) Clean-catch
(C) 24-hour
(D) Morning
Guidelines for proper catheter care by a nursing assistant include the following:
(A) Making sure the drainage bag hangs higher than the level of the hips or bladder
(B) Disconnecting the catheter when positioning or transferring the resident
(C) Keeping the genital area clean to prevent infection
(D) Resting the drainage bag on the floor

107. Exam Dip strips can test urine for (A) Heart attack risk
(B) High blood pressure
(C) Influenza
(D) pH level
If a resident is going through bladder retraining, the NA should
(A) Withhold fluids to stop episodes of incontinence
(B) Ask for advice from the resident’s friends on how to determine when the resident needs a bedpan
(C) Express disappointment when the resident is not successful during the retraining
(D) Be positive and professional when handling incontinence

108. CHAPTER 16 PRACTICE
1. Guidelines for proper catheter care by a nursing assistant include the following: (A) Making sure the drainage bag hangs higher than the level of the hips or bladder (B) Disconnecting the catheter when positioning or transferring the resident (C) Keeping the genital area clean to prevent infection (D) Resting the drainage bag on the floor (D) NAs observe and report regarding catheters. 2. Which of the following statements is true of urination? (A) Indwelling catheters do not affect muscle tone. (B) Alcohol and caffeine decrease urine output. (C) A lack of privacy and stress can affect urination. (D) The bladder holds more urine as people age, causing them to urinate less frequently. 3. A healthy person needs to take in at least _________ ounces of fluid each day. (A) 36 (B) 48 (C) 64 (D) Dip strips can test urine for (A) Heart attack risk (B) High blood pressure (C) Influenza (D) pH level

109. CHAPTER 16 PRACTICE ANSWERS
C- KEEPING THE GENITAL AREA CLEAN TO PREVENT INFECTION
C- LACK OF PRIVACY AND STRESS CAN AFFECT URINATION
C- 64 OUNCES
D- pH level