Transcript PN1lab notes\Urinary Elimination Care

Urinary Elimination Care
PN 1 Nursing Skill Labs
Urine testing - important points!!



always make sure your label is accurate
and complete
always bring a plastic bag, twist tie and
label to the bedside
always wear gloves when handling body
fluids and consider wearing goggles
when emptying drainage bags or
whenever there is a risk of splash back
Standard Urine Tests
Routine and Microscopic - R&M





requires a clean (not sterile) specimen
note if female menstruating
need about 10 mLs
must be sent to lab within about 30 mins
or may alter results
routine tests for sugar, acetone, pH and
SG




normal pH of urine is 6 (<7 is acidic) to
discourage growth of bacteria
normal SG is 1.010 to 1.025 - water is
1.0
microscopic tests look for blood, bacteria
etc
urine can be tested on the unit using
dipsticks but this is not as accurate as a
lab analysis


dipstick tests can identify sugar, ketones,
blood, pH and protein
very important to read colour strip at
recommended time or results will be
false
 always
wear gloves when
handling urine specimens
Culture and Sensitivity (C&S)





requires a sterile specimen
need about 3 mLs of urine
indicate on requisition if patient on
antibiotics and specify which ones
if both R&M and C&S are ordered, you
must send two specimens
2 ways to collect - MSU or from catheter
MSU - midstream urine




wash perineum or glans penis with soap
and water (retract foreskin if
uncircumsized)
void small amount into toilet or bedpan
void into sterile container being careful
not to contaminate container by touch
empty rest of bladder into toilet/bedpan
Catheter Specimen




use sterile port and sterile needle if
collecting from tubing
specimen from drainage bag may not
contain fresh urine
use 21 to 25 gauge needle, antiseptic
swab and sterile specimen container
if no urine in tube, clamp below port for
not more than 30 minutes
24 hour urine collection




it is critical that all urine in the 24 hour
period is collected
may require sign over door, in bathroom
etc to alert others
extra care needed if two clients in same
room
collection is started at specific time as
ordered





ask patient to void at appointed time and
discard
start collection with next void
each void may be collected individually
or in one container - know what has
been ordered
may need to be kept on ice
may have preservative in collection
bottle
Fluid Balance





this is an extremely important function of
nursing!!!!!
accuracy is crucial
if patient on intake/output monitoring you
must measure all fluids going in and
coming out
may include urine, diarrhea, drainage
from wounds, emesis etc
intake includes fluids, IV’s, liquid meds




if intake is > than output the patient is in
a positive (+) fluid balance
if intake is < than output the patient is in
a negative (-) fluid balance
errors in calculating fluid balance can
have serious consequences for the
patient
physicians orders for meds, IV fluids etc
are based on this information
Catheters




used for incontinence and for accurate
fluid balance information
indwelling catheters are the most
common cause of nosocomial (hospital
acquired) infections
types include condom catheter, foley
catheter and straight (in and out)
catheter
all drain by gravity so bag must be below
bladder at all times



tubing must be kept free of kinks and
secured to patient or bedding to prevent
pulling
always discard urine in toilet when
emptying bag
discard catheter and bag in biohazard
bag when removed
Condom Catheter





tubing attaches to leg bag or bedside
drainage bag
prep skin and let dry
apply condom leaving 1-2” dead space
at tip
apply securely but not too tight!!!
secure with velcro strip, foam tape or
glue
Indwelling Catheter Care




always inserted using sterile technique
drape patient to provide privacy
perineal care should be done at bath
time and at least once more during the
day and after each bowel movement
wash 10 cm (4”)of catheter using circular
motion


inspect and document skin condition
around catheter at least daily
report any signs of infection or
inflammation
Emptying Drainage Bags






wear eye protection
may also want to wear mask ( check
policy)
drain bag into measuring container
don’t touch the spout to the container
wipe spout with alcohol swab when
finished
record amount on Fluid Balance record