1. Define important words in this chapter

1. 1. Define important words in this chapter • 24-hour urine specimen • a urine specimen consisting of all urine voided in a 24-hour period. • calculi • kidney stones. • chronic renal failure (CRF) • progressive condition in which the kidneys cannot filter certain • waste products; also called chronic kidney failure. • clean-catch specimen • a urine specimen that does not include the first and last urine that is voided; also called mid-stream.

2. 1. Define important words in this chapter • condom catheter • a catheter that has an attachment on the end that fits onto the penis; also called an external or Texas catheter. • dialysis • a process that cleans the body of wastes that the kidneys cannot remove due to kidney failure. • end-stage renal disease (ESRD) • condition in which kidneys have failed and dialysis or transplantation is required to sustain life. • indwelling catheter • a catheter that stays inside the bladder for a period of time; urine drains into a bag.

3. 1. Define important words in this chapter • ketones • chemical substances that the body produces when it does not have enough insulin in the blood. • micturition • the process of emptying the bladder of urine; also called urination or voiding. • routine urine specimen • a urine specimen that can be collected any time a person voids. • specific gravity • a test performed to measure the density of urine.

4. 1. Define important words in this chapter • sphincter • a ring-like muscle that opens and closes an opening in the body. • straight catheter • a catheter that does not stay inside the person; it is removed immediately after urine is drained or collected. • urinary incontinence • the inability to control the bladder, which leads to an involuntary loss of urine. • urinary tract infection (UTI) • a disorder that causes inflammation of the bladder; also called • cystitis.

5. 1. Define important words in this chapter • voiding • the process of emptying the bladder of urine; also called urination or micturition.

6. 2. Explain the structure and function of the urinary system • Define the following terms: • sphincter • a ring-like muscle that opens and closes an opening in the body. • micturition • the process of emptying the bladder of urine; also called urination or voiding. • voiding • the process of emptying the bladder of urine; also called urination or micturition. • urinary incontinence • the inability to control the bladder, which leads to an involuntary loss of urine.

7. 2. Explain the structure and function of the urinary system • The urinary system consists of two kidneys, two ureters, the urinary bladder, the urethra, and the meatus. The kidneys are bean-shaped organs. They lie slightly above the waist against the rear wall of the abdominal cavity and on either side of the spine.

8. Transparency 16-1: The Urinary System

9. 2. Explain the structure and function of the urinary system • Functions of the urinary system: • Elimination of waste products from the blood • Maintenance of water balance in the body • Regulation of the levels of electrolytes in the body • Assistance in regulation of blood pressure

10. 3. Discuss changes in the urinary system due to aging • Normal changes of aging in the urinary system: • The kidneys do not filter blood as efficiently. • Bladder muscle tone weakens. • Bladder holds less urine, causing more frequent urination. • Bladder may not empty completely, causing increased chance of infection.

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

12. 4. List normal qualities of urine and identify signs and symptoms to report about urine • Remember these signs and symptoms of urine to report: • Cloudy urine • Dark or rust-colored urine • Strong-, offensive- or fruity-smelling urine • Pain, burning, or pressure when urinating • Blood, pus, mucus, or discharge in urine • Episodes of incontinence

13. Transparency 16-2: Factors Affecting Urination • • Growth and development • • Psychological factors • • Fluid intake • • Physical activity and exercise • • Personal habits • • Medications • • Disorders

14. 5. List factors affecting urination and describe how to promote normal urination • The following factors (as listed on the transparency) can affect urination: • Growth and development Aging affects the bladder’s ability to hold urine. The bladder is not able to hold the same amount of urine as it did when a person was younger. Older people may have to urinate more often. Urination during the night occurs more frequently with the elderly.

15. 5. List factors affecting urination and describe how to promote normal urination • Factors affecting urination (cont’d.): • Psychological factors A lack of privacy can affect urination. Having a roommate for the first time, being in a place that is not home, and needing help with elimination can disrupt normal elimination patterns. Stress and fear can affect urination. They can cause a person to void frequent, small amounts of urine.

16. 5. List factors affecting urination and describe how to promote normal urination • Factors affecting urination (cont’d.): • Fluid intake The sense of thirst generally decreases as a person ages. Reduced fluid intake decreases urine production. The body’s ability to remove wastes in the urine may be affected. When wastes build up, infections and other problems can occur • Physical activity and exercise A lack of exercise lessens sphincter control, which can increase episodes of incontinence.

17. 5. List factors affecting urination and describe how to promote normal urination • Factors affecting urination (cont’d.): • Personal habits If a resident is confined to bed, urination may be more difficult due to his position. As stated before, the sitting position for women and standing position for men are the best positions for urination. Complete emptying of the bladder may be difficult when having to use a bedpan or urinal. • Medications Some medications affect urination. Residents who have high blood pressure may be taking diuretics, which are medications that reduce fluid in the body by increasing urine output.

18. 5. List factors affecting urination and describe how to promote normal urination • Factors affecting urination (cont’d.): • Disorders Certain disorders affect urination. Fevers cause increased sweating and may decrease urine production. Diabetes, diseases of the bladder or urethra, infection, and congestive heart failure (CHF) can affect urination.

19. 6. Discuss common disorders of the urinary system • Define the following term: • urinary tract infection (UTI) • a disorder that causes inflammation of the bladder; also called cystitis.

20. 6. Discuss common disorders of the urinary system • Remember these points about urinary tract infections (UTIs): • Cause: entrance of bacteria into the bladder through the urethra • Women are more susceptible than men. • Symptoms: burning or pain with urination, blood in urine, frequency of and urgency with urination • Prevention: drinking plenty of fluids and juices rich in Vitamin C, wiping from front to back after elimination, taking showers rather than baths • Treatment: antibiotics • Report cloudy, dark, or foul-smelling urine, burning or discomfort with urination, or frequent urination in small amounts.

21. 6. Discuss common disorders of the urinary system • Define the following terms: • chronic renal failure (CRF) • progressive condition in which the kidneys cannot filter certain • waste products; also called chronic kidney failure. • dialysis • a process that cleans the body of wastes that the kidneys cannot remove due to kidney failure. • end-stage renal disease (ESRD) • condition in which kidneys have failed and dialysis or transplantation is required to sustain life.

22. 6. Discuss common disorders of the urinary system • Remember these points about chronic renal failure (CRF): • Kidneys cannot filter waste products from the blood. • Becomes worse over time • Causes: diabetes, hypertension, chronic urinary tract infections, nephritis • Initial signs and symptoms: unintended weight loss, nausea, vomiting, fatigue, headache, frequent hiccups, itching • Dialysis is done when the kidneys are no longer able to perform their function. • ESRD occurs when kidneys have failed and dialysis or transplantation is required to sustain life.

23. 6. Discuss common disorders of the urinary system • Remember these points about urine retention: • Inability to adequately empty the bladder • Causes: surgery, obstruction, infection, disorders such as multiple sclerosis and diabetes, enlargement of prostate gland • Symptoms: lower abdominal pain, painful urge but inability to urinate, distended bladder, abdominal swelling, frequent urge to urinate, difficulty starting to urinate, weak flow of urine, dribbling • Treatment: medication and catheterization

24. 7. Discuss reasons for incontinence • Know the causes of urinary incontinence: • Confinement to bed • Illness • Paralysis • Circulatory or nervous system disorders • Prostate problems • Childbirth

25. 7. Discuss reasons for incontinence • REMEMBER: • Urinary incontinence is not a normal part of aging and must be reported.

26. 7. Discuss reasons for incontinence • There are different types of incontinence: • Stress incontinence • Urge incontinence • Mixed incontinence • Functional incontinence • Overflow incontinence

27. 7. Discuss reasons for incontinence • Think about these questions: • Why is it so important to be professional and positive when dealing with episodes of incontinence? • How can this make things easier both for residents and for you?

28. 7. Discuss reasons for incontinence • Remember these guidelines for preventing incontinence: • Know routines, habits, and signs. • Follow toileting schedules and the care plan. • Answer call lights promptly. • Offer bedpans or take residents to the bathroom often. • Encourage fluids. • Take daily walks near bathroom. • Change wet or soiled incontinence briefs immediately.

29. 7. Discuss reasons for incontinence • Guidelines for preventing incontinence (cont’d.): • Change wet or soiled bed linens. • Use bed protectors. • Check incontinence briefs every two hours. • Change wet or soiled clothing immediately. • Give good skin care and perineal care. • Provide privacy. • Be calm, patient, and professional. • Be reassuring and positive.

30. 8. Describe catheters and related care • Define the following terms: • straight catheter • a catheter that does not stay inside the person; it is removed immediately after urine is drained or collected. • indwelling catheter • a catheter that stays inside the bladder for a period of time; urine drains into a bag. • condom catheter • a catheter that has an attachment on the end that fits onto the penis; also called an external or Texas catheter.

31. 8. Describe catheters and related care • REMEMBER: • Nursing Assistants do not insert, irrigate, or remove catheters.

32. 8. Describe catheters and related care • Remember these guidelines for catheter care: • Wear gloves. • Do not touch tip of clamp to any other object. • Do not let drainage spout touch graduate. • Make sure drainage bag hangs lower than hips or bladder. • Do not hang drainage bag from bedrail. • Keep drainage bag off floor. • Keep catheter tubing from touching floor.

33. 8. Describe catheters and related care • Guidelines for catheter care (cont’d.): • Keep tubing straight. • Keep genital area clean. • When cleaning meatus, move in one direction, away from meatus. • Report blood in urine, leaks, bag filling suddenly or not filling for several hours, pain, pressure, or odor. • Secure tubing properly. • Do not disconnect catheter during positioning. • Do not re-attach disconnected tubing.

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

35. Providing catheter care • Adjust bed to safe working level, usually waist high. Lock bed wheels. • Lower head of bed. Position resident lying flat on her back. • 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 the resident check water temperature. Adjust if necessary.

36. Providing catheter care • Put on gloves. • Avoid contact with clothing and soiled pads or soiled linens throughout procedure. • Ask the resident to flex her knees and raise the buttocks off the bed by pushing against the mattress with her feet. Place clean bed protector under her buttocks. • Expose only the area necessary to clean the catheter. • Place towel or pad under catheter tubing before washing.

37. Providing catheter care • Apply soap to wet washcloth. If a male resident is uncircumcised, pull back the foreskin first. Clean area around meatus. Use a clean area of the washcloth for each stroke. • Hold catheter near meatus. 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.

38. Providing catheter care • Rinse area around meatus, using a clean area of washcloth for each stroke. Pat dry with clean cloth. • 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. • Remove bed protector and discard. Remove towel or pad from under catheter tubing and place in proper containers.

39. Providing catheter care • Empty basin in toilet and flush toilet. Place in proper area for cleaning or return to storage. • Remove gloves and discard. Wash your hands. • Replace top covers. Remove bath blanket. Make resident comfortable. • Return bed to lowest position. Remove privacy measures. • Leave call light within resident’s reach.

40. Providing catheter care • Wash your hands. • Be courteous and respectful at all times. • Report any changes in the resident to the nurse. Document procedure using facility guidelines.

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

42. Emptying a catheter drainage bag • Place graduate on paper towel on the floor. • Open the drain or clamp on the bag. Allow urine to flow out of the bag into the graduate. Do not let spout or clamp touch the graduate. • When urine has drained, close clamp. Using alcohol wipe, clean the drain clamp. Replace the drain in its holder on the bag. • Go into the bathroom. Place graduate on a flat surface and measure at eye level. Note the amount and the appearance of the urine.

43. Emptying a catheter drainage bag • Place container in area for cleaning or clean and store it according to policy. Discard paper towel. • Remove and discard gloves. Wash your hands. • Leave call light within resident’s reach. • Wash your hands. • Be courteous and respectful at all times. • Report any changes in the resident to the nurse. Document procedure and amount of urine (output) using facility guidelines.

44. Changing a condom catheter • Equipment: condom catheter and collection bag, catheter tape (if not a self-adhesive catheter), gloves, plastic bag, bath blanket, disposable bed protector, supplies for perineal care • Identify yourself by name. Identify the resident. Greet the resident by name. • Wash your hands. • Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. • Provide for the resident’s privacy with a curtain, screen, or door.

45. Changing a condom catheter • Adjust bed to safe working 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. • Put on gloves. • Place clean bed protector under his buttocks. • Adjust bath blanket to expose only genital area.

46. Changing a condom catheter • Gently remove condom catheter. Disconnect condom from tube and immediately cap tube. Do not allow tube to touch anything. Place condom and tape in the plastic bag. • Help as necessary with perineal care. • Move pubic hair away from the penis so it does not get rolled into the condom.

47. Changing a condom catheter • Hold penis firmly. Place condom at tip of penis. Roll towards base of penis. Leave at least one inch of 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. • Gently secure condom to penis with special tape provided or use self-adhesive. Apply in a spiral. Never wrap tape all the way around penis because it can impair circulation.

48. Changing a condom catheter • Connect catheter tip to drainage tubing. Do not touch tip to any object but drainage tubing. Make sure tubing is not twisted or kinked. • Check to see if collection bag is secured to leg. Make sure drain is closed. • Remove bed protector and discard. Dispose of plastic bag properly. Place soiled clothing and linens in proper containers. • Clean and store supplies. • Remove and discard gloves. Wash your hands.

49. Changing a condom catheter • Replace top covers. Remove bath blanket. Make resident comfortable. • Return bed to lowest position. Remove privacy measures. • Leave call light within resident’s reach. • Wash your hands. • Be courteous and respectful at all times. • Report any changes in the resident to the nurse. Document procedure using facility guidelines.

50. Handout 16-1: Changing Drainage Bag to Leg Bag • Some residents use smaller bags called leg bags to collect urine. This type of drainage bag attaches to the resident’s leg and is emptied at the end of each shift and as necessary. Care must be taken when attaching a leg bag to the leg. This is a sterile procedure and requires the use of sterile caps and possibly other sterile supplies. You should have special training before performing this procedure. In addition, the band that wraps around the leg must not be so tight that it affects the circulation to the leg or causes any harm to the skin. • Changing Drainage Bag to Leg Bag • Equipment: gloves, sterile gloves (optional), 2 disposable bed protectors, sterile drape (optional), leg bag, catheter clamp, 2 sterile caps, disposable plastic bag • 1. Identify yourself by name. Identify the resident. Greet the resident by name. • 2. Wash your hands. • 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. • 4. Provide for the resident’s privacy with a curtain, screen, or door. • 5. Adjust bed to safe working level, usually waist high. Lock bed wheels. • 6. Put on gloves. • 7. Ensuring privacy, remove bed linen and lift gown or pull down pajamas. • 8. Turn resident to side, place bed protector under resident and return to back. • 9. Place second bed protector or sterile drape on the bed for supplies. Prepare leg bag for hook-up.