Urinary Elimination Care

1. Urinary Elimination Care PN 1 Nursing Skill Labs

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. inspect and document skin condition around catheter at least daily • report any signs of infection or inflammation

18. 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