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

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slide2

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
slide3

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
slide4

Coude’ catheter

  • Robinson catheter
  • Ureteral catheter
slide6

-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
slide7

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!
slide8

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
slide9

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
slide11

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
slide12

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
slide13

Ideal Daily fluid Intake and OutputSource/ AMOUNT/ Route/ AMOUNTH2O consumed as fluid/ 1500ml/ urine/ 1400-1500mlH2O present in food/ 750ml / insensible losses/ 350-400mlH2O produced by oxidation/ 350ml / lungs/ 350-400mlskin / 100mlsweat/ 100-200mlfeces /TOTAL/ 2600ml/ TOTAL/ 2300-2600ml

I & O
slide14

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
slide15

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
slide16

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
slide17

Average daily water requirement by age and weight:AGE/ ml/ BODY WEIGHT ml/kg3 days/ 250-350ml/80-1001 year/ 1150-1300ml/ 120-1352 years/ 1350-1500ml/ 115-1254 years/ 1600-1800ml/100-11010 years/ 2000-2500ml/70-8514 years/ 2200-2700ml/ 50-6018 years/ 2200-2700ml/40-60adult /2400-2600ml/ 20-30

I & O
slide18

Nursing Intervention:Intervention/ Rationale1. Ideally intake and output should be monitored/ To obtain an accurate record2. 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 failure3. Daily weights are often done/ Indicate fluid retention or loss4. Identify if patient undergone surgery or with medical problem / May affect fluid loss5. Make sure you know the total amount and fluid sources once you delegate this task/ To get an accurate measurement

slide19

6. Record the type and amount of all fluids and describe the route at least every 8 hours7. If irrigating a nasogastric or another tube or bladder, measure the amount instilled and subtract it from the total output/ To get exact amount8. Keep toilet paper out of client urine output/ For an accurate measurement9. Measure drainage in a calibrated container and observe it at eye level.

slide20

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
slide21

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

slide22

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

slide23

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.
slide24

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.