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Chapter004 urinary care

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The role of the PCT while caring for the urinary system

The role of the PCT while caring for the urinary system

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  • 1. Chapter 4Advanced Urinary Care Skills Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Renal StructuresKidneys- filter blood, make urineUreters – drain urine from kidneys to bladderBladder- holds urineUrethra: drains out urine Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Kidneys• Lower back• Nephrons-cells that filter blood make urine, regulates fluid Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Bladder-Make min. 600 cc/day-Average amount 1000-1500 ml/day-Report output< 200 cc/shift < 600 cc/24 hours-Feel urge to urinate: Male-300-500 ml Female-250 ml Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Urethra• Male- 8-9 inches long• Female- 1 ½ inches long Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Internal Kidney Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Bowman’s Capsule/Glumerulus Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Functions of the Renal System• Rid waste• Regulate fluids and electrolytes• Regulate blood pressure• Calcium metabolism• Regulate Red Blood Cells production• Maintain acid base balance• Maintain homeostasis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Warning signs of Kidney Disease• Swollen eyes• Edema• Increase urination or change in pattern• Painful urination• Blood in urine• Tea color urine• Hypertension Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Renal Calculi/Kidney StonesCauses: UTI, urine stasis, hereditary,S/Sx: pain, hematuria, no/decrease urinePCT: strain urine, I&O, pain management, increase fluid Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Congenital anomaliesPolycystic disease- cysts in kidneys tx: dialysis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Hypospadias-• urethra on bottom of penis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Hypoplastic kidney- decrease nephrons Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Paraphimosis-foreskin doesn’t retractTx: surgery Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Urinary Infections• UTI• Cystitis• Pyleonephritis• Glomerulonephritis• Prostatitis – s/sx: pain, hematuria, frequency, urgency – fever, confusion – Tx: ATB., fluids – PCT: urine specimen, keep clean, I&O Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Prevent UTI• No bubble baths• Urinate after sex• Clean front to back• No perfumes, dye• No thongs• White toilet paper Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Causes of Renal Failure• Acute • Chronic• Dehydration • hereditary• Obstruction • HTN• Blood clots • Infection• Trauma Gout• Infection Diabetes• Drugs/meds Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Treatment for renal failure• Dialysis• Strict I&O• Daily weights• Fluid restriction• Treat cause Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Renal Failure• Acute: comes on suddenly,• reversible• Chronic: comes on slowly• nonreversible Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Dialysis• Peritoneal • Hemodialysis• * Place fluid in – * Done in hospital *Fluid setting absorbs toxins – * Take blood out and filter it * Leave in for several hours then drain out Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Terms• Frequency/urgency• Incontinence Hematuria• Polyuria• Anuria Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Terms con’t• Oliguria• Nocturia• Incontinence• Dysuria• Urinary retention• Glucosuria• Pyuria Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Meatus Prepuce/foreskin Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Fluid Balance• Excess fluid• edema• Ascities• Rapid weight gain• High BP• Tight skin• SOB Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. • Fluid loss• Concentrated urine• Rapid weight loss• Rapid pulse• Poor skin turgor• Dry skin• Mucous membranes dry• Weak• Confusion Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Incontinence• Can’t control urine, comes out• Types:• 1. Stress• 2. Urge• 3. Overflow• Urinary retention• retain urine up 3000-4000 ml• Neurogenic bladder- loss of sensation to bladder• common in stroke Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 29. Diagnosis• X-rays• CT scan• KUB- kidney, ureter, bladder x-ray• Electrolytes• BUN, Creatinine blood levels• Urinalysis- 24 hour urine, CCUA, Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 30. IV-P ( intravenous pyleogram) Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 31. Cystoscopy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 32. Urine Components• Color: Pale yellow Red/brown = bleeding Blue/green= dyes Bright yellow= multivitamins Specific gravity= 1.010-1.030 Ph- 5.5-7.0 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 33. Reasons for Catheterization• Surgery• Can’t void b/c- pain or swelling of the urethra (after childbirth)• urethra is blocked (enlarged prostate gland)• Empty bladder for procedures• Check residual Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 34. Reasons for Catheterization (cont.)-monitor urine output-obtain sterile urine specimen-incontinent of urine & has pressure ulcers or other skin conditions that can be aggravated by urine- To give medications Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 35. Foley catheter/Indwelling catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 36. Indwelling Catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 37. Straight catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 38. Triple Lumen Catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 39. Triple lumen catheter: Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 40. Suprapubic catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 41. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 42. Catheter Information• Size: 8-30 Fr. (large # = small catheter)• Normal 16 fr.• Insertion: 1 ½ -2 inches –female• 8-9 inches –male• Goals: remove ASAP• maintain sterility Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 43. Care of catheter• I&O q shift• Bag below bladder• Peri-care q shift change catheter per policy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 44. Taping a catheterMale Female Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 45. Risks of Urinary Catheterization• Infection—go from bladder - ureters - kidneys• Urinary tract infection—most common type of HAI• Urethral trauma— try to force catheter through the urethra, damaging the mucosa lining of urethra, leading to bleeding, swelling, & high risk of infection Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 46. General Guidelines for UrinaryCatheterization• Dr. order required• Female pt.- positioned in the supine position with legs apart & knees slightly bent• Male pt.-positioned in supine position• Refer to Guidelines Box 4-1 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 47. QuestionTell whether the following statement is true or false.You do not need a doctor’s order to catheterize a patient.A. TrueB. False Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 48. AnswerB. FalseYou must have a doctor’s order to catheterize a patient, including the type of catheter and the duration the catheter will remain in place. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 49. Catheterization With an IndwellingCatheter* Indwelling catheter -closed system• Balloon holds catheter in place in bladder• Tubing connects the catheter to the urine drainage bag Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 50. Disconnecting Catheter and Tubing Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 51. QuestionWhich catheter is inserted in the abdomen to drain urine?A. Straight catheterB. Triple lumen catheterC. Suprapubic catheterD. Indwelling catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 52. AnswerC. Suprapubic catheterThis catheter is inserted via a surgical opening in the lower abdomen above the pubic area, into the bladder. It is often used when there is trauma or surgery to the urethral area. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 53. Collecting a Sterile Urine Specimen• Urine from a newly-inserted catheter - placed directly into specimen container provided in urinary catheter insertion kit.Urine from catheter that is in place:• Catheter tubing is clamped below the aspiration port so that urine collects in the tubing.• A sterile syringe is inserted into the aspiration port and used to withdraw the urine specimen. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins