Catheterization of the bladder involves introducing a latex or plastic tube through the urethra and into the bladder. The catheter provides a continuous flow of urine in patients unable to control micturition or those with obstructions. It also provides a means of assessing urine output in hemodynamically unstable patients. Because bladder catheterization carries the risk of UTI, blockage, and trauma to the urethra, it is preferable to rely on other measures for either specimen collection or management of incontinence.
Types of Catheterization.
Intermittent and indwelling retention catheterizations are the two forms of catheter insertion
INTERMITTENT CATHETERIZATION
introduce a straight single-use catheter long enough to drain the bladder (5 to 10 minutes
When the bladder is empty, you immediately withdraw the catheter.
COMPLICATION- increases risk of trauma and infection.
INDICATION- It is common for people with spinal cord injury or other neurological problems such as multiple sclerosis to perform self– intermittent catheterization up to every 4 hours daily for months or years.
UTI rate is lower than for patients with long-term indwelling catheters.
INDWELLING CATHETERIZATION-
remains in place for a longer period, until a patient is able to void voluntarily or continuous accurate urine measurements are no longer needed
The straight single-use catheter has a single lumen with a small opening about 1.3 cm ( 1 2 inch) from the tip.
. Urine drains from the tip, through the lumen, and to a receptacle.
An indwelling Foley catheter has a small inflatable balloon that encircles the catheter just above the tip. When inflated the balloon rests against the bladder outlet to anchor the catheter in place.
The indwelling retention catheter often has two or three lumens within the body of the catheter . One lumen drains urine through the catheter to a collecting tube. A second lumen carries sterile water to and from the balloon when it is inflated or deflated. A third (optional) lumen is sometimes used to instill fluids or medications into the bladder. It is easy to determine the number of lumens by the number of drainage and injection ports at the end of the catheter
A second type of intermittent catheter has a curved tip
A Coudé catheter is used on male patients who may have enlarged prostates that partly obstruct the urethra. It is less traumatic during insertion because it is stiffer and easier to control than the straight-tip catheter
Plastic catheters are suitable only for intermittent use because of their inflexibility
Latex catheters are recommended for use up to 3 weeks. Be aware of allergies.
Pure silicon or Teflon catheters are best suited for long-term use (2 to 3 months) because of less encrustation at the urethral meatus
Balloon sizes range from 3 mL (pediatric) to large postoperative volumes (75 mL). In adults the 5-mL and 30-mL sizes are the most common: The 5-mL size allows for optimal drainage, whereas the 30-mL size is used after pros
Bladder catheters are used for urinary drainage, or as a means to collect urine for measurement.
Alternatives to indwelling urethral catheterization should be considered and include external sheath (ie, condom) catheters, suprapubic catheters, intermittent catheterization, and, in some cases, supportive management with protective garments.
Urinary catheterisation is a procedure used to drain the bladder and collect urine, through a flexible tube called a catheter. Urinary catheters are usually inserted by doctors or nurses in hospital or the community
In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra. Catheterization allows urine to drain from the bladder for collection. It may also be used to inject liquids used for treatment or diagnosis of bladder condition
Urinary catheterisation is a procedure used to drain the bladder and collect urine, through a flexible tube called a catheter. Urinary catheters are usually inserted by doctors or nurses in hospital or the community.
Objectives :
-List the indications and contraindications for urinary catheterization.
- Indicate the appropriate catheter type/size.
- Discuss the risks associated with catheterizations.
-Describe the equipment for female/male/pediatric urinary catheterization.
- Discuss a safe method of performing urinary catheterizations .
This is a simplified presentation done by Patrick Nkemba, a student of clinical medicine at Rockview University. it is the product his desire to make the work easier to all the members of his presentation group. It should be noted that no copy right was obtained for the information compiled in this presentation. Therefore, its not for commercial use.
the first receivers of this information are the members of the presentation group.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
More Related Content
Similar to Catheterization Procedure by Anushri Srivastav.pptx
Bladder catheters are used for urinary drainage, or as a means to collect urine for measurement.
Alternatives to indwelling urethral catheterization should be considered and include external sheath (ie, condom) catheters, suprapubic catheters, intermittent catheterization, and, in some cases, supportive management with protective garments.
Urinary catheterisation is a procedure used to drain the bladder and collect urine, through a flexible tube called a catheter. Urinary catheters are usually inserted by doctors or nurses in hospital or the community
In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra. Catheterization allows urine to drain from the bladder for collection. It may also be used to inject liquids used for treatment or diagnosis of bladder condition
Urinary catheterisation is a procedure used to drain the bladder and collect urine, through a flexible tube called a catheter. Urinary catheters are usually inserted by doctors or nurses in hospital or the community.
Objectives :
-List the indications and contraindications for urinary catheterization.
- Indicate the appropriate catheter type/size.
- Discuss the risks associated with catheterizations.
-Describe the equipment for female/male/pediatric urinary catheterization.
- Discuss a safe method of performing urinary catheterizations .
This is a simplified presentation done by Patrick Nkemba, a student of clinical medicine at Rockview University. it is the product his desire to make the work easier to all the members of his presentation group. It should be noted that no copy right was obtained for the information compiled in this presentation. Therefore, its not for commercial use.
the first receivers of this information are the members of the presentation group.
Similar to Catheterization Procedure by Anushri Srivastav.pptx (20)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Damage to the spinal cord above the sacral region causes reflex incontinence. This condition causes loss of voluntary control of urination; but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void
Overflow incontinence occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia
Hyperreflexia, a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage
Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD).
uremic syndrome- An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. As the uremic symptoms worsen, aggressive treatment is indicated for survival
Nocturia - awakening to void one or more times at night
An excessive output of urine is polyuria.
. A urine output that is decreased despite normal intake is called oliguria.
increased urine formation (diuresis)
a stoma (artificial opening)
Urinary Retention. Urinary retention is an accumulation of urine resulting from an inability of the bladder to empty properly.
URINE OVERFLOW- The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape. With retention a patient may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine.
pain or burning during urination (dysuria) as urine flows over inflamed tissues
blood-tinged urine (hematuria)
Urinary incontinence is the involuntary leakage of urine that is sufficient to be a problem. It can be either temporary or permanent, continuous or intermittentUrinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes. Intact efferent and afferent nerves from the bladder to the spinal cord and brain must be present
INTAKE AND OUTPUT OF URINE
Assess the patient’s average daily fluid intake.
at home, ask him or her to estimate his or her intake by showing a measurement on a commonly used glass or cup
Special receptacles (urimeters) that attach between indwelling catheters and drainage bags are a convenient means of accurately measuring urine volume. A urimeter holds 100 to 200 mL of urine. After measuring urine from a urimeter, drain the cylinder
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
When a patient uses a bedpan, promote comfort and normalcy and respect the patient’s privacy as much as possible. Be sure to maintain a professional manner. In addition, provide skin care and perineal hygiene after bedpan use
Regular bedpans have a rounded, smooth upper end and a tapered, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the open end toward the foot of the bed
. A special bedpan called a fracture bedpan is frequently used for patients with fractures of the femur or lower spine
Fracture bedpan - used for patients with fractures of the femur or lower spine. The fracture pan has a shallow, narrow upper end with a flat wide rim, and a deeper, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the deeper, open lower end toward the foot of the bed.
Ordinary Bedpan
EQUIPMENTS
Bedpan (regular or fracture)
Toilet tissue
Disposable clean gloves
Additional PPE, as indicated
Cover for bedpan or urinal (disposable waterproof pad or cover)
ASSESSMENT
Assess the patient’s normal elimination habits.
Determine why the patient needs to use a bedpan (e.g., a medical order for strict bed rest or immobilization).
Assess the patient’s degree of limitation and ability to help with activity.
Assess for activity limitations, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient.
Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient’s ability to help with the procedure or that could become dislodged.
Assess the characteristics of the urine and the patient’s skin
Assisting With Use of a Bedpan When the Patient Has Limited Movement
Patients who are unable to lift themselves onto the bedpan or who have activity limitations that prohibit the required actions can be assisted onto the bedpan in an alternate manner using these actions
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
Male patients confined to bed usually prefer to use the urinal for voiding.
The use of a urinal in the standing position facilitates emptying of the bladder
If the patient is unable to stand, the urinal may be used in bed. Patients may also use a urinal in the bathroom to facilitate measurement of urinary output.
Provide skin care and perineal hygiene after urinal use and maintain a professional manner
EQUIPMENT
Urinal with end cover (usually attached)
Toilet tissue
Clean gloves
Additional PPE, as indicated
ASSESSMENT
Assess the patient’s normal elimination habits.
Determine why the patient needs to use a urinal, such as a physician’s order for strict bed rest or immobilization.
Assess the patient’s degree of limitation and ability to help with activity
Assess for activity limitations, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient.
Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient’s ability to help with the procedure or that could become dislodged.
Assess the characteristics of the urine and the patient’s skin.
Document the patient’s tolerance of the activity. Record the amount of urine voided on the intake and output record, if appropriate. Document any other assessments, such as unusual urine characteristics or alterations in the patient’s skin.
SPECIAL CONSIDERATION
Urinal should not be left in place for extended periods because pressure and irritation to the patient’s skin can result. If patient is unable to use alone or with assistance, consider other interventions, such as commode or external condom catheter.
It may be necessary to assist patients who have difficulty holding the urinal in place, such as those with limited upper extremity movement or alteration in mentation, to prevent spillage of urine.
The urinal may also be used standing or sitting at the bedside or in the patient’s bathroom, if patient is able to do so.
INTERNATIONAL HEALTH AGENCIES BY ANUSHRI SRIVASTAV.pptxAnushriSrivastav
WORLD HEALTH ORGANIZATION
WE CHAMPION HEALTH AND A BETTER FUTURE FOR ALL’
INTRODUCTION- WHO leads and champions global efforts to give everyone, everywhere, an equal chance to live a healthy life.
HISTORY- founded in 1948, 7 April
HEADQUARTERS- Geneva
OFFICES- 6 semi autonomus regional and 150 fields offices
DIRECTOR- Dr. Tedros Adhanam Ghebeyesus
OBJECTIVES-
Direction, co-ordination agencies
Collaboration with local bodies
Help the government in health services
Proper technological assistance
To attain highest possible level of health
Prioritize and support health
Formulate health policies
Disease inspection and analysis
Health education
GOAL: To ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies and provide a further billion people with better health and well being
ORGANIZATION: executive board, secretariat, world health assembly
FUNCTION:
FOR UNIVERSAL HEALTH
Focus on PHCare
Sustainable financing and protection
Access to health products and medicines
Training of health workforce and advice on labor policies
Support people participation in National health policies
Increasing monitoring, data and information
FOR HEALTH EMERGENCIES
Identification, mitigation and risk management
Prevention and support of development of tools
Detect and respond to acute health emergencies
Support delivery of essential health services
FOR HEALTH AND WELL BEING
Address social determinants
Promote intersectoral approach for health
Prioritize health in all policies and healthy settings
THROUGH WORK, ADDRESS
Prevention of non- communicable disease
Mental health promotion
Climate change
Antimicrobial resistance
Elimination and eradication of communicable disease
UNITED NATION FUND FOR POPULATION ACTIVITYINTRODUCTION- SEXUAL AND REPRODUCTIVE HEALTH AGENCY
MISSION- To deliver a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fullfilled
AIM- to improve reproductive and maternal health worldwide
ESTABLISHED YEAR- 1969 (1974 in INDIA)
HEADQUARTER- NEW YORK
DIRECTOR- Dr. Natalia Kanem (2017)
FUNCTION
Develop national healthcare
Increasing the access to birthcontrol
Leading campaigns against child marriage
Prevention of violence against gender
Prevention of female genital mutiliation
Treatment and prevention of STD and RTI
MCH care
HIV prevention and treatment
IEC on sexuality and treatment of infertility and Abortion
FOCUS area:
Reproductive health
Gender equality
Population and development strategies
Girl education
Political participation for women
FGM
Child marriage
UNITED NATION DEVELOPMENT PROGRAMME 1965
ESTABLISHED- 22 November. 1965
HEADQUARTER- New York
HEAD- Achim steiner
STRUCTURE- 170 member countries and territories
INTRODUCTION-
Advocates for change and connect countries to knowledge, experience and resources to help people bulid a better life for themselves
Encourages Human right protection, women empowerment in all its programme
Health System in INDIA BY Anushri Srivastav.pptxAnushriSrivastav
health system in India or Health organization is set up at three level
at central level
at state level
at district level
Headed by Union Ministry of health and family welfare
Apex body of health sector
Make health policies and plans
Instrumental and implements large scale national programmes
Indian System of Medicine and Homeopathy (ISMH) established in March 1995.
ISMH renamed as AYUSH in November 2003.
Ministry of AYUSH formed in 9 November 2014
It has two statutory body
CENTRAL COUNCIL OF INDIAN MEDICINE (CCIM)
CENTRAL COUNCIL OF HOMEOPATHY (CCH)
Routes Of Drug Administration by Anushri Srivastava .pptxAnushriSrivastav
Routes of drug Administration is the main question in any interview you attend or in viva...Many of the times we get confused in between which routes is suitable for which drug and what are the advantages and the side effects.
So, here i have mentioned the routes, their types, sites, angles, and advantages and disadvantages.
There are basically 3 routes-
1. enteral route
2. Parentral route
3. Topical route
ORAL ROUTE
Most common and safest route
Oldest route
Two methods of administration:
Applying topically to the mouth
Swallowing for absorption along the GIT into systemic circulation
Abbreviation used: po
SUBLINGUAL ROUTE
Sublingual route of drug administration is where the drug is placed under the tongue
ADVANTAGES
Economical
Quick termination
First pass avoided
Quick absorption
DISADVANTAGES
Bitter drugs
Irritation oral mucosa
Large quantities not given
Few drugs are absorbed
BUCCAL ROUTE
The drug is placed between the gums and inner lining of the cheeks(buccal pouch) e.g.
ADVANTAGES
Avoid first pass effect
Rapid Absorption
Drug stability
DISADVANTAGES
Inconvenience
Advantages lost if swallowed
Small dose limit
RECTAL ROUTE
Drug is administered to rectum through enema and suppository e.g. chlorpromazine,
aspirin, etc.
ADVANTAGE
Used in child
Used in vomiting
DISADVANTAGE
Inconvenient
Absorption is slow and erratic
Irritation and inflammation of rectal mucosa can occur.
INJECTABLES
INTRADERMAL
SUBCUTANEOUS
INTRAMUSCULAR
INTRAVENOUS
INTRA-ARTICULAR
INTRA-ARTERIAL
INTRATHECAL
TIME OF ASSESSMENT
At place of birth
Postnatal assessment- done 3 times
Institutional Delivery
24hrs or next day
At time of discharge
Within 4-6 weeks age of baby
Home Delivery
Within 3 days
Other two assessments are same as institutional delivery.
INITIAL ASSESSMENT
Immediate after birth
APGAR Scoring
Review of maternal and perinatal history
Assessment of gestational age
Anthropometric Measurement
Detailed head to foot examination
APGAR SCORING
Given by Dr. Virginia Apgar
It contains 5 objective criteria and done twice , one minute after birth and five minute are birth.
If APGAR score is
10= best possible conditions
7-10 = no difficulty in adjustment in extrauterine life
4-6 = moderate difficulty or mild depression
Equal to or less than 3 = severe depression
At 5 min, APGAR correlates more closely with infants' neurologic status at one year of age
ASSESSMENT OF GESTATIONAL AGE AT BIRTH
last menstrual period is clue for calculation of gestational age but the mother may forget the last menstrual period or may suffer from menstrual irregularities.
physical characteristics is reliable to assess maturity but limited value in less than 36 weeks of maturity due to chances are intrauterine growth retardation.
neurologic characteristics are more reliable
FIRST DAY EXAMINATION
vital signs
general behavior
feeding behavior
pattern of elimination
anthropometric measurement
gestational assessment
skin
head
Face
Eyes
Nose
ears
Mouth
Nick
Chest
abdomen
Genitalia
back
Buttocks
hips
extremities
neurological
special senses
REFLEXES
Vital signs
Temperature is recorded usually by axillary method.
Temperature: 36.5 to 37.5 degree Celsius
Respiration: 30 - 60 breaths per minute
Blood pressure: 80/40- 60/25 mmHg
Pulse: 120 – 160 beat per minute
General behavior
posture , position, general alertness ,activity, crying ,response to stimulation, sleeping pattern , etc. should be assessed carefully.
Feeding behavior
suckling and swallowing reflex, vomiting regurgitation, choking, frothiness (which may be due to tracheoesophageal fistula) should be evaluated to detect associated problems.
Pattern of elimination
passage of meconium and urine should be observed and S for presence of any anomalies. the new unit passes urine and meconium within 24 hours and afterwards for first few days, the baby voids 10 to 15 times and average 6 stools per day.
Anthropometric measurement
head circumference : 35 – 37 cm
chest circumference :33- 35 cm
weight : 2.5- Well 3 kg
length : 48 – 53 cm (avg. 50 cm)
Gestational assessment
It can also be done on first day if it is not done on the day of delivery or if the baby is having any problem on that day.
Skin
detect cyanosis, jaundice, pallor and plethora. lanugo hair, vernix , skin turgor, edema, ecchymosis, petechiae, erythema toxicum (rash), dryness or peeling hemangiomas, Mongolian spot, etc. should we look for. presence of any abrasions.
World Health Organization developed the policy of health as a response to the problems of health in the developing countries, and established the primary health care concept. The strategy was introduced in 1978 in the first conference of WHO for health in the Alma Ata / Kazakhstan resulting 5 principles and 8 elements of PHC.
According to Alma Ata Conference,
Primary Health Care is an essential health care made universally accessible to individuals and acceptable to them, through their full participation and at the cost the community and country can afford.
According to World Health Organization,
Primary health care is a whole of society approach to health that aims at ensuring the highest possible level of health and wellbeing and their equitable distribution by focusing on peoples need and as early as possible along the continum from health promotion, rehabilitation and palliative care, and as close as feasible to peoples everyday environment.
concept/ principles
Equitable distribution
Community Participation
Focus on prevention
Use of appropriate technologies
Multi-sectoral approach
OBJECTIVES
To reduce in the prevalence of preventable, communicable and other disease
To provide comprehensive primary health care to the community through the Primary Health Centers.
To achieve and maintain an acceptable standard of quality of care.
To make the services more responsive and sensitive to the needs of the community
CHARACTERISTICS
Accessibility
Acceptability
Adaptability
Availability
Closeness
Comprehensible
Appropriateness
Continuity
Coordination
elements
Education for health
Locally endemic disease control
Expanded programs on immunization
Maternal and child health and family planning
Environment Sanitation and promotion of safe water Supply
Nutrition and promotion of adequate food supply
Treatment of communicable diseases and common illness
Supply of essential drugs
From Service delivery angle, PHCs may be of two
types, depending upon the delivery case load –
Type A PHC: PHC with delivery load of less than 20 deliveries in a month,
Type B PHC: PHC with delivery load of 20 or more deliveries in a month
PHC control by State Government
Current number of PHCs in India- 10,453
Recommended bed capacity for PHC – 4-6 beds
Each PHC acts as a referral center of- 6 Sub centers
OPD service- 6 hours
ROLE OF COMMUNITY HEALTH NURSE
Planner/ Programmer
Care provider
Community Organizer
Service Coordinator
Trainer / Health Educator
Health Monitor
Change Agent
Recorder/ Reporter/ Statistician
Reseacher
https://www.who.int/news-room/fact-sheets/detail/primary-health-care
https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2012/primay-health-centres.pdf
The concept of Primary Health Centre (PHC) is not new to India. The Bhore Committee in 1946 gave the concept of a PHC.
According to K Park,
Primary health center as a basic unit, to provide, as close to the people as possible, an integrated curative and preventive health care to the rural populations with emphasis on preventive and promotive aspects of health care.
The primary health center is the basic structural and functional unit of the public health services in developing countries, to provide accessible affordable and available primary health care to people.
The objectives of IPHS for PHCs are:
To provide comprehensive primary health care to the community through the Primary Health Centers.
To achieve and maintain an acceptable standard of quality of care.
To make the services more responsive and sensitive to the needs of the community.
From Service delivery angle,
PHCs may be of two types, depending upon the delivery case load – Type A and Type B.
Type A PHC: PHC with delivery load of less than 20 deliveries in a month,
Type B PHC: PHC with delivery load of 20 or more deliveries in a month
SERVICES
Medical care
Maternal Child Health care including family planning
MTP
Management of Reproductive tract infections/STDs
Nutrition Services
School Health
Adolescent HealthCare
Promotion of Safe drinking water and Basic Sanitation
Prevention and control of locally endemic diseases
Collection and Reporting of vital events
Other National Health Programmes
Oral Health
Physical Medicine and Rehabilitation
Health Education and Behavior Chang Communication
Referral Services
Training
Basic Laboratory and Diagnostic services
Monitoring and Supervision
Functional Linkage with Sub center
Mainstreaming Of AYUSH
Record and Reports of vital events
Selected surgical procedures
Maternal Death Review
INFRASTRUCTURE
Location
Area
Sign age
Entrance
Disaster Prevention Measures
Waiting Area
OPD
Wards
Operational Theatre
Labor Room
Minor OT/ Dressing Room/Injection Room/ Emergency
All the drugs available at the Sub-Centre level should also be available at the PHC, perhaps in greater quantities, (if required).
Oxygen Inhalation
Diazepam
Acetyl Salicylic Acid
Ibuprofen
Paracetamol
Chlorpheniramine Maleate
Dexchlorpheniramine Maleate
Dexamethasone
Pheniramine Maleate
Promethazine
Ampicillin
Benzylpenicillin
Cloxacillin , etc.
EMERGENCY DRUGS
Inj. Adrenaline,
Inj. Hydrocortisone,
Inj. Dexamethasone,
Ambu bag (Paediatric),
Sterile hypodermic syringe for single use with reuse prevention feature 2ml and 5ml syringes, Needles (Size 24, 22, 20).
AYUSH DRUGS
Ayurvedic Medicines for PHCs (Sanjivani Vati, Godanti Mishran)
Unani Medicines for PHCs (Arq-e-Ajeeb,Arq-e-Gulab)
Normal Delivery Kit.
Equipment for assisted vacuum delivery.
Equipment for assisted forceps delivery.
Standard Surgical Set (for minor procedures like episiotomies stitching).
Equipment for Manual Vacuum Aspiration.
Equipment for New Born Care and Neonatal Resuscitation.
IUCD insertion kit.
PHC
Myasthenia Gravis is a rare autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscles groups.
The peak age at onset in women is during childbearing years; in men the peak onset of myasthenia gravis is between the ages of 50 and 70 years.
June month is celebrated as myasthenia awareness month.
Myasthenia Gravis was first recognized as a distinct clinical entity by THOMAS WILL , a Oxford Physician.
The first modern description was made in 1877 by Samuel wilk , a London Physician
Myasthenia Gravis is an autoimmune disorder characterized by weakness and rapid fatigue of any of the muscles under your voluntary control.
According to WORLD HEALTH ORGANIZATION,
Myasthenia Gravis is an acquired disease of the neuromuscular junction characterized by muscular weakness and fatigability.
Myasthenia Gravis can be caused due to:
Idiopathic
Autoimmune attack
Autoantibodies to Acetylcholine receptors
Autoantibodies to Tyrosine kinase receptors
Thymic tumor
Congenital
Family History
Young Women(Age 20 and 30 )
Men aged 50 and older
People with vitamin deficiency especially Vitamin D
classification
Ocular Muscle weakness
Mild weakness of muscles other than ocular muscles
Moderate weakness of muscles other than ocular muscles
Severe weakness of muscles other than ocular muscles
Intubation
Clinical manifestation
Ptosis
Diplopia
Impaired speech
Dysphagia
Difficulty in chewing
Change facial expression
Generalized Weakness
Bulbar Symptoms i.e. weakness of muscles of face and throat
Bland facial expression
Dysphonia
It is a term for voice impairment
Impaired Facial motility and expression
Voice often fades after a long conversation
Muscles of the shoulder and hip are more often affected than the distal muscles
Myasthenia crisis is an acute exacerbation of muscle weakness resulting in respiratory failure.
triggers
Emotional Stress
Pregnancy
Menstruation
Another illness
Trauma
Temperature Extremes
Hypokalemia
Ingestion of drugs like Aminoglycosides, Anticonvulsants, etc
Psychotropic drugs like Benzodiazepines, Lithium, Antidepressants
complications
Aspiration
Respiratory Insufficiency
Respiratory Tract Infection
Cardiomyopathies
Any other autoimmune diseases
Diagnostic evaluation
History Collection
Physical Examination
Electromyography and Single fiber EMG
Tensilon test
IV injection of Anticholinesterase agent edrophonium chloride
Chest CT scan
Acetylcholine receptors antibodies
Magnetic Resonance Imaging
Medical management
Anticholinesterase drugs like Physostigmine and neostigmine
Corticosteroids like Prednisone (alternate day)
Immunosuppressants like Azathioprine, Mycophenolate Mofetil ,etc.
Plasmapheresis
IV Immunoglobulin G
Surgical management
Thymectomy
Removal of thymus gland if there is a tumor exist.
Nursing management
Assess the patient condition
Provide comfortable position
Monitor Vitals
Assess for dyspnea, dysphagia, dysphonia ,etc
The kidneys contain many coils of tiny blood vessels. Each of these is called a glomerulus. Glomeruli filter substances from the blood into the urine. Glomerulonephritis is a type of kidney disease where these coils become inflamed. This makes it hard for the kidneys to filter the blood.
Glomerulonephritis is an inflammation of the glomeruli within the kidneys.
It is of two type acute glomerulonephritis and chronic glomerulonephritis
Glomerulonephritis is defined as an inflammation of the glomerulus of the nephron in the kidney
Glomerulonephritis is defined as an inflammation or infection of the glomeruli
Glomerulonephritis is divided into two types:-
Acute glomerulonephritis
Chronic glomerulonephritis
Acute glomerulonephritis is an acute or sudden inflammation of the glomeruli within the kidneys
It is an immune mediated inflammatory disease of the capillary loops in the renal glomeruli. the antigen antibody complex deposition within the glomeruli results in glomerular injury which is manifested as hematuria, oliguria, edema and hypertension
abrupt onset
commonly seen in preschool are in early school age group of male children
Incidence
twice more common in males
mostly seen in children between five and eight years of age
peak incidence is seen at seven years of age
Etiology and risk factor
Nephritogenic strains of Group A beta streptococcus hemolyticus (type 12)
Initial infection of upper respiratory tract on a skin usually one to three weeks before the onset of symptoms
Systemic autoimmune diseases. With these types of diseases, the body’s immune system attacks healthy cells by mistake. Systemic means that many parts of the body are affected. An example of this is systemic lupus erythematosus (SLE or lupus).
Polyarteritis nodosa. This is an inflammatory disease of the arteries.
Granulomatosis with polyangiitis. This is a progressive disease that leads to widespread inflammation of all of the body's organs.
Henoch-Schönlein purpura. This disease causes small or large purple lesions (purpura) on the skin and internal organs. It causes other symptoms in several organ systems.
Alport syndrome. This is a form of inherited glomerulonephritis that affects both boys and girls. But boys are more likely to have kidney problems. Treatment focuses on preventing and treating high blood pressure and preventing kidney damage.
Hepatitis B. This infection can be passed from mother to baby or rarely contracted through a blood transfusion.
Other infections like bacterial endocarditis , viruses , HIV ,etc.
IgA nephropathy
Advanced ,irreversible impairment of renal function with or without symptoms
it may develop as primary disease or may occur in SLE ,drug induced nephropathies ,and polyarteritis nodosa
pathological changes – diffuse thickening of glomerular basement membrane are focal segmental glomerulosclerosis with variable deposition of immunoglobulin ,complement and fibrin.
GFR is reduced
mesangial cells proliferation may occur
Cancer of the oral cavity are associated with the use of tobacco and alcohol as they seems to have a synergistic carcinogenic effect.
More common after the age of 35 years, with 65 years behind the average age of diagnosis.
Oral cavity cancer is two times more common in men than in women.
The common sites of oral malignant lesions are lower lip (mostly), lateral border and undersurface of tongue, labial commissure and buccal mucosa.
According to NATIONAL CANCER INSTITUTE,
‘Oral cancer is defined as the cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth).’
According to FDI World Dental Federation,
‘Oral cancer is a type of head and neck cancer and is any cancerous tissue growth located in the oral cavity.’
Oral cancer is defined as the abnormal uncontrolled growth of cells in the oral cavity, characterized by lesions, thickened mass and dysphagia.
There are two types of oral cancer:-
Oral cavity cancer
(cancer that starts in mouth)
Oropharyngeal cancer
(cancer that starts in throat behind the mouth)
Head and Neck Squamous Cell Carcinoma (HNSCC) is a term used for the cancers of oral cavity, pharynx and larynx, accounts 90% malignant tumors.
The exact cause is unknown
Long term use of tobacco
History of frequent alcohol consumption
Prolong sunlight exposure may lead to lip cancer
Irritation from the pipe stem resting on the lip in Pipe smokers
HPV contributes 25% of oral cancer cases
Multiple oral sex partners
Low serum Vitamin A, C and E levels
Smoked meat ingestion
Poor oral hygiene
Recurrent herpetic lesion may lead to lip cancer
Immunosuppression
Syphilis
Chronic irritation (jagged tooth, ill fitting prosthesis, chemical or mechanical irritants)
TNM CLASSIFICATION OF ORAL CANCER
T- Primary tumor
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor 2 cm or less in greatest dimension
T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension
T3 Tumor more than 4 cm in greatest dimension
T4a Tumor invades through cortical bone, into deep/ extrinsic muscle of tongue, maxillary sinus, or skin of face
T4b Tumor invades masticator space, pterygoid plates, or skull base, or encases internal carotid artery
N- Regional Lymph nodes
NX Regional lymph node cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2 Metastasis in lymph node, more than 3 cm but not more than 6 cm in greatest dimension
N3 Metastasis in a lymph node more than 6 cm in greatest dimension
M- Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
Lip Cancer
Indurated
Painless ulcer
Tongue Cancer
Ulcer or area of thickening
Soreness or pain
Increased salivation
Slurred speech
Dysphagia
Toothache
Earache(later sign)
Oral Cavity Cancer
Leukoplakia
Also known as Smoker's patch, white patch
Therapeutic Positions are used to promote comfort of the patient.
Proper turning and positioning allows the health care provider to make clients, as comfortable as possible, prevent contractures, and pressure sore, and facilitate diagnostic test for surgical intervention.
To relieve pressure to new positions every 2 hours.
Three factors significant in positioning are- Pressure, Friction and Shear
According to Annamma Jacob,
Positioning is defined as placing the patient in good body alignment as needed therapeutically.
According to nurseinfo.in,
Positioning is defined as placing the person in such a way to perform therapeutic interventions to promote the health of an individual
PURPOSE
To promote comfort
To prevent complication
To stimulate circulation
To promote normal physiologic functions.
ARTICLES
Clean, dry, firm bed
Different types of mattress
Bed Boards
Pillows
Footboards/ Foot boot
Sandbags
Hand rolls
Trochanter rolls
Bed blocks
Over bed Table
Additional Sheets
Trapeze bar
PRINCIPLES
Maintain good body mechanics.
Obtain assistance as required.
Ensure that mattress is firm and level of bed is at working height.
Ensure that sheets are clean and dry.
Avoid placing a body part directly over another to prevent pressure.
Plan a regular position change schedule for the patient for 24 hours..
Ensure patient comfort.
Wash hand before and after procedure
TYPES OF POSITIONING
Fowler’s Position
Orthopenic Position
Prone Position
Lateral/ Side Lying Position
Sims’s Position/ Semi- Prone Position
Lithotomy Position
Trendelenburg Position
Reverse Trendelenburg Position
Supine Position
Dorsal Recumbent Position
Knee-chest Position
Rose Position
Other Position
FOWLER’S POSITION
Purpose
To relieve or minimize dyspnea
To relieve tension on abdominal sutures
ORTHOPENIC POSITION
High fowler’s position with over bed table placed in front of the client.
Client to rest with both hands on over the bed table/on pillow placed on it and lean forward. Leaning forward facilitates respiration by allowing maximum chest expansion.
Indications:
Patient with severe dyspnea
Cardiac Patients
Position for thoracentesis
Patient with chest drainage tubes
Relieve Respiratory distress
Pericarditis
ARDS
COPD
Emphysema
Asthma
PRONE POSITION
The client is in flat position only abdomen with head turned to one side. The head rest on a pillow, one or both hands beyond the head or at the sides.
Indication
Patients with pressure sores, burns, injuries, and operations on back
For patients after 24 hours of amputation of lower limbs
Position for renal biopsy
To prevents aspiration
NTD
Recovery positions after anesthesia
LATERAL POSTION
Also known as SIDE LYING POSITION.
Client lies on the side with weight on his hips, shoulder pillow support, and stabilizes. Upper most leg, arm, head and back.
In this position, trunk is right angle to bed.
Indication
To promote lung and cardiac function
During seizure attack and air embolism (Left lateral)
Patient with pyloric stenosis after meals.
BIBLIOGRAPHY:
Datta Parul, Textbook of Pediatric Nursing, edition 4, The medical sciences publishers, 4838/24 Ansari road, Daryaganj, New Delhi, 110002, India
INTRODUCTION
Leukemia is the most common type of childhood malignancy.
It is characterized by persistent and uncontrolled production immature and abnormal WBCs.
It is a disease of abnormal proliferation and maturation of bone marrow which interferes with the production of normal RBCs, WBCs and platelets.
Leukemia is defined as uncontrolled neoplastic proliferation of leukocyte precursors.
According to National Cancer Institute,
Leukemia is defined as a cancer that starts in blood-forming tissue, such as the bone marrow, and causes large number of abnormal cells to be produced and enter the bloodstream.
95-98% of childhood leukemia are acute type.
70-75% of acute lymphocytic leukemia.
common malignancy of children less than 15 years.
peak incidence is four years of age.
males are more affected than females.
twice more common in white then black in children.
The exact cause is unknown.
viruses like HPV ,Epstein Barr virus ,human T cell lymphoma leukemia virus (HTLV).
Radiations
exposure to chemicals and drugs like benzene and Dilantin
familial predisposition
chromosomal abnormalities like Down syndrome
Genetic like Fanconi's anemia ,bloom syndrome
ACUTE LYMPHOCYTIC LEUKEMIA
Primary disorder of bone marrow in which normal bone marrow elements are replaced by immature or undifferentiated blast cells.
develop when lymphoid cell line is affected.
characterized by anemia, thrombocytopenia, neutropenia, especially granulocytopenia.
the incidence rate is one in 2000 live birth.
the peak age of onset is 3 to 7 years and males are more affected than females
According to French American British classification on the basis of cell morphology it is classified as
L1
L2
L3
According to type of cell it is classified as
T cell
B cell
Pre-B cell
Null cell
T cell
10 to 15% ,high risk ,seen in older children especially males ,featured as mediastinal mass ,hepatosplenomegaly ,high WBC count ,CNS involvement and has poor prognosis.
B cell
1 to 2% children ,aggressive form ,poor prognosis and high-risk type.
Pre-B cell
Good prognosis and respond well to therapy.
Null cell
No cellular surface markers (80% ).
Great imitator, with vague and varied signs and symptoms, resembling almost any disease.
Peripheral blood examination which shows decrease hemoglobin, RBC, hematocrit and platelet count
bone marrow analysis in which large number of lymphoblasts and lymphocytes with hypercellular visible.
chest X-ray
CSF
Chemotherapy
radiation therapy
bone marrow transplantation
supportive and symptomatic management
Chemotherapy
Remission induction chemotherapy
Vincristine, Prednisolone, Asparaginase and Adriamycin are given for 4-6 weeks.
maintenance therapy or systemic continuation
6 MP (Mercaptopurine) and MTX (Methotrexate) are given for 2.5-3 years.
late intensification or THERAPY
Measles is a highly infectious disease of childhood caused by Measles virus. It is characterized by fever, catarrhal symptoms of the upper respiratory tract infections followed by typical rash.
Measles is defined as an acute and highly contagious viral disease characterized by fever, runny nose, cough, red eyes and a spreading skin rash.
Causative agent: Rubeola virus, a RNA virus of paramyxoviridae family
Reservoir: Human
Source: Infected Human
Period of Communicability: Approximately 4 days prior and 4 days after the appearance of the rash
Mode of Transmission:
Airborne transmission(virus remains active and contagious in the air or on infected surfaces for up to 2 hours)
Droplet transmission i.e. it is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions
Portal of entry: Respiratory tract and Conjunctiva
Incubation Period: 10-15 days
Host:
Children between age of 1 and 5 years
Older children
Malnourished children
Environment: Winter and spring month ,Low socio-economic status .
Clinical manifestations of measles are in three stages:
STAGE 1: Prodromal/ Catarrhal Stage:
starts after 10 days of infection and lasts up to 3-5 days-
- Fever
- Malaise
- Coryza
- Sneezing
- Nasal Discharge
- Brassy Cough
- Redness of eye
- Lacrimation
- Photophobia
- Lymphadenopathy
- Vomiting
- Diarrhea
- Koplik spot – grayish or bluish white spots, fine tiny grain like papules on a faint red base, smaller than the head of pin.
- Spots appear before the appearance of rash
- Found on buccal mucosa opposite to first and second molar
- Usually disappear after the rash, appears a day
Stage 2: Eruptive Stage:
- Typical irregular dusky red macular or maculopapular rash found behind the ears and face first, usually 3-5 days after the onset of disease
- Then it spread to neck, trunk, limbs, palms and soles in the next 3-4 days.
- Anorexia
-Malaise
-Cervical lymphadenopathy
-Fever and rash usually disappear in 4-5 days in the same order of appearance
- Fine shedding of superficial skin of face, trunk and limbs leaving brownish discoloration that persists 2 months or more
Stage 3: Convalescent or Post- Measles Stage:
-Fever and rash disappear
-Child remains sick for number of days and lose weight
- Gradual deterioration into chronic illnesses due to bacterial or viral infections, nutritional and metabolic disturbances or other complications.
prevention- Active Immunization with live attenuated vaccines 0.5 ml subcutaneously in single dose at 9-12 months of age.
management,nursing management, nursing diagnosis
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2. CONTENT
INTRODUCTION
TYPES OF CATHETER
FEMALE INDWELLING CATHETERIZATION
FEMALE INTERMITTENT CATHETERIZATION
MALE INDWELLING CATHETERIZATION
MALE INTERMITTENT CATHETERIZATION
REMOVAL OF CATHETERIZATION
3. INTRODUCTION
Catheterization of the bladder involves introducing a latex or plastic tube
through the urethra and into the bladder. The catheter provides a
continuous flow of urine in patients unable to control micturition or
those with obstructions. It also provides a means of assessing urine
output in hemodynamically unstable patients. Because bladder
catheterization carries the risk of UTI, blockage, and trauma to the
urethra, it is preferable to rely on other measures for either specimen
collection or management of incontinence.
5. INTERMITTENT CATHETERIZATION
introduce a straight single-use catheter long enough to drain the
bladder (5 to 10 minutes
When the bladder is empty, you immediately withdraw the
catheter.
COMPLICATION- increases risk of trauma and infection.
INDICATION- It is common for people with spinal cord injury or
other neurological problems such as multiple sclerosis to perform
self– intermittent catheterization up to every 4 hours daily for
months or years.
UTI rate is lower than for patients with long-term indwelling
catheters.
6.
7. INDWELLING CATHETERIZATION-
remains in place for a longer period, until a patient is able to void voluntarily or
continuous accurate urine measurements are no longer needed
The straight single-use catheter has a single lumen with a small opening about 1.3 cm ( 1
1 2 inch) from the tip.
. Urine drains from the tip, through the lumen, and to a receptacle.
An indwelling Foley catheter has a small inflatable balloon that encircles the catheter just
above the tip. When inflated the balloon rests against the bladder outlet to anchor the
catheter in place.
The indwelling retention catheter often has two or three lumens within the body of the
catheter . One lumen drains urine through the catheter to a collecting tube. A second
lumen carries sterile water to and from the balloon when it is inflated or deflated. A third
(optional) lumen is sometimes used to instill fluids or medications into the bladder. It is
easy to determine the number of lumens by the number of drainage and injection ports
at the end of the catheter
8. A second type of intermittent catheter has a curved tip
A Coudé catheter is used on male patients who may have enlarged prostates that
partly obstruct the urethra. It is less traumatic during insertion because it is stiffer
and easier to control than the straight-tip catheter
9. Plastic catheters are suitable only for intermittent use because of their
inflexibility
Latex catheters are recommended for use up to 3 weeks. Be aware of
allergies.
Pure silicon or Teflon catheters are best suited for long-term use (2 to 3
months) because of less encrustation at the urethral meatus
Balloon sizes range from 3 mL (pediatric) to large postoperative volumes
(75 mL). In adults the 5-mL and 30-mL sizes are the most common: The 5-
mL size allows for optimal drainage, whereas the 30-mL size is used after
prostatectomies to provide hemostasis of the prostatic bed
Use only sterile water to inflate the balloon because saline crystallizes,
resulting in incomplete deflation of the balloon at the time of removal
Generally
children require an 8- to 10-Fr,
women require a 14- to 16-Fr,
men require a 16- to 18-Fr
10. GUIDELINES FOR CARE OF THE
PATIENT WITH AN INDWELLING
CATHETER
Use an indwelling catheter only when necessary.
Use strict hand hygiene principles.
Use sterile technique when inserting a catheter.
Secure the catheter properly to the patient’s thigh or abdomen after
insertion.
Keep the drainage bag below the level of the patient’s bladder to maintain
drainage of urine and prevent the backflow of urine into the patient’s
bladder. • Keep the drainage bag and tubing off the ground.
Maintain a closed system whenever possible.
If necessary, obtain urine samples using aseptic technique via a closed
system.
11. Keep the catheter free from obstruction to maintain free flow to the urine.
Avoid irrigation unless needed to relieve or prevent obstruction.
Ensure that patient maintains adequate fluid intake.
Empty the drainage bag when one-half to two-thirds full or every 3 to 6
hours. (When emptying the drainage bag, do not touch drainage bag
spout to the collection device.)
Clean drainage bags daily using a commercial cleaning product or vinegar
solution (1 part vinegar to 3 parts water).
Provide daily routine personal hygiene
12. EQUIPMENT
Sterile catheter kit that contains:
Sterile gloves
Sterile drapes (one of which is fenestrated [having a window-like opening])
Sterile catheter (Use the smallest appropriate-size catheter, usually a 14F to 16F catheter with a 5-
to 10-mL balloon .
Antiseptic cleansing solution and cotton balls or gauze squares; antiseptic swabs
Lubricant
Forceps
Prefilled syringe with sterile water (sufficient to inflate indwelling catheter balloon)
Sterile basin (usually base of kit serves as this)
Sterile specimen container (if specimen is required)
13. Flashlight or lamp
Waterproof, disposable pad
Sterile, disposable urine collection bag and drainage tubing (may be
connected to catheter in catheter kit)
Velcro leg strap or tape
Disposable gloves
Additional PPE, as indicated
Washcloth and warm water to perform perineal hygiene before and
after catheterizatioN
14. PROCEDURE OF CATHERTERIZATION OF FEMALE URINARY BLADDER
ACTION RATIONALE
1. Review the patient’s chart for any limitations in
physical activity. Confirm the medical order for
indwelling catheter insertion
Physical limitations may require adaptations in
performing the skill. Verifying the medical order ensures
that the correct intervention is administered to the right
patient.
2. Bring the catheter kit and other necessary equipment
to the bedside. Obtain assistance from another staff
member, if necessary.
Bringing everything to the bedside conserves time and
energy. Arranging items nearby is convenient, saves time,
and avoids unnecessary stretching and twisting of
muscles on the part of the nurse. Assistance from
another person may be required to perform the
intervention safely
3. Perform hand hygiene and put on PPE, if indicated. prevent the spread of microorganisms.
4. Identify the patient ensures the right patient receives the intervention and
helps prevent errors.
5. Close curtains around bed and close the door to the
room, if possible. Discuss the procedure with the patient
and assess the patient’s ability to assist with the
procedure. Ask the patient if she has any allergies,
especially to latex or iodine.
ensures the patient’s privacy
promotes reassurance and provides knowledge about
the procedure
15. ACTION RATIONALE
6. Provide good lighting. Artificial light is recommended
(use of a flashlight requires an assistant to hold and
position it). Place a trash receptacle within easy reach
necessary to see the meatus clearly
A readily available trash receptacle allows for prompt
disposal of used supplies and reduces the risk of
contaminating the sterile field
7. Adjust the bed to a comfortable working height,
usually elbow height of the caregiver
Stand on the patient’s right side if you are right-handed,
patient’s left side if you are left-handed.
Having the bed at the proper height prevents back and
muscle strain. Positioning allows for ease of use of
dominant hand for catheter insertion
8. Assist the patient to a dorsal recumbent position with
knees flexed, feet about 2 feet apart, with her legs
abducted. Drape patient . Alternately, the Sims’, or
lateral, position can be used. Place the patient’s buttocks
near the edge of the bed with her shoulders at the
opposite edge and her knees drawn toward her chest .
Allow the patient to lie on either side, depending on
which position is easiest for the nurse and best for the
patient’s comfort. Slide waterproof pad under patient.
Proper positioning allows adequate visualization of the
urinary meatus. Embarrassment, chilliness, and tension
can interfere with catheter insertion; draping the patient
will promote comfort and relaxation. The Sims’ position
may allow better visualization and be more comfortable
for the patient, especially if hip and knee movements
are difficult. The smaller area of exposure is also less
stressful for the patient. The waterproof pad will protect
bed linens from moisture
16. ACTION RATIONALE
9. Put on clean gloves. Clean the perineal area with
washcloth, skin cleanser, and warm water, using a different
corner of the washcloth with each stroke. Wipe from
above orifice downward toward sacrum (front to back).
Rinse and dry. Remove gloves. Perform hand hygiene
again
Gloves reduce the risk of exposure to blood and body
fluids. Cleaning reduces microorganisms near the urethral
meatus and provides an opportunity to visualize the
perineum and landmarks before the procedure. Hand
hygiene reduces the spread of microorganisms.
10. Prepare urine drainage setup if a separate urine
collection system is to be used. Secure to bed frame
according to manufacturer’s directions.
This facilitates connection of the catheter to the drainage
system and provides for easy access
11. Open sterile catheterization tray on a clean overbed
table using sterile technique.
Placement of equipment near the worksite increases
efficiency. Sterile technique protects patient and prevents
transmission of microorganisms.
12. Put on sterile gloves. Grasp upper corners of drape and
unfold drape without touching unsterile areas. Fold back a
corner on each side to make a cuff over gloved hands. Ask
patient to lift her buttocks and slide sterile drape under
her with gloves protected by cuff.
The drape provides a sterile field close to the meatus.
Covering the gloved hands will help keep the gloves
sterile while placing the drape.
13. Based on facility policy, position the fenestrated sterile
drape. Place a fenestrated sterile drape over the perineal
area, exposing the labia .
The drape expands the sterile field and protects against
contamination. Use of a fenestrated drape may limit
visualization and is considered optional by some
practitioners and/or facility policies
17. ACTION RATIONALE
14. Place sterile tray on drape between patient’s thighs. This provides easy access to supplies
15. Open all the supplies. Fluff cotton balls in tray before
pouring antiseptic solution over them. Alternately, open
package of antiseptic swabs. Open specimen container if
specimen is to be obtained
It is necessary to open all supplies and prepare for the
procedure while both hands are sterile
16. Lubricate 1 to 2 inches of catheter tip. Lubrication facilitates catheter insertion and reduces tissue
trauma.
17. With thumb and one finger of nondominant hand,
spread labia and identify meatus. Be prepared to maintain
separation of labia with one hand until catheter is inserted
and urine is flowing well and continuously. If the patient is
in the side-lying position, lift the upper buttock and labia
to expose the urinary meatus (
Smoothing the area immediately surrounding the meatus
helps to make it visible. Allowing the labia to drop back
into position may contaminate the area around the
meatus, as well as the catheter. The nondominant hand is
now contaminated.
18. Use the dominant hand to pick up a cotton ball or
antiseptic swab. Clean one labial fold, top to bottom (from
above the meatus down toward the rectum), then discard
the cotton ball. Using a new cotton ball/swab for each
stroke, continue to clean the other labial fold, then directly
over the meatus
Moving from an area where there is likely to be less
contamination to an area where there is more
contamination helps prevent the spread of
microorganisms. Cleaning the meatus last helps reduce
the possibility of introducing microorganisms into the
bladder
18. ACTION RATIONALE
19. With your uncontaminated, dominant hand, place the
drainage end of the catheter in receptacle. If the catheter
is preattached to sterile tubing and drainage container
(closed drainage system), position catheter and setup
within easy reach on sterile field. Ensure that clamp on
drainage bag is closed
This facilitates drainage of urine and minimizes risk of
contaminating sterile equipment.
20. Using your dominant hand, hold the catheter 2 to 3
inches from the tip and insert slowly into the urethra .
Advance the catheter until there is a return of urine
(approximately 2 to 3 inches [4.8 to 7.2 cm]). Once urine
drains, advance catheter another 2 to 3 inches (4.8 to 7.2
cm). Do not force catheter through urethra into bladder.
Ask patient to breathe deeply, and rotate catheter gently if
slight resistance is met as catheter reaches external
sphincter
The female urethra is about 1.5 to 2.5 inches (3.6 to 6.0
cm) long. Applying force on the catheter is likely to injure
mucous membranes. The sphincter relaxes and the
catheter can enter the bladder easily when the patient
relaxes. Advancing an indwelling catheter an additional 2
to 3 inches (4.8 to 7.2 cm) ensures placement in the
bladder and facilitates inflation of the balloon without
damaging the urethra
21. Hold the catheter securely at the meatus with your
nondominant hand. Use your dominant hand to inflate the
catheter balloon . Inject entire volume of sterile water
supplied in prefilled syringe.
Bladder or sphincter contraction could push the catheter
out. The balloon anchors the catheter in place in the
bladder. Manufacturer provides appropriate amount of
sterile water for the size of catheter in the kit; as a result,
use entire syringe provided in the kit
19. ACTION RATIONALE
22. Pull gently on catheter after balloon is inflated to feel
resistance.
Improper inflation can cause patient discomfort and
malpositioning of catheter.
23. Attach catheter to drainage system if not already
preattached
Closed drainage system minimizes the risk for
microorganisms being introduced into the bladder
24. Remove equipment and dispose of it according to
facility policy. Discard syringe in sharps container. Wash
and dry the perineal area, as needed.
Proper disposal prevents the spread of microorganisms.
Placing syringe in sharps container prevents reuse.
Cleaning promotes comfort and appropriate personal
hygiene.
25. . Remove gloves. Secure catheter tubing to the
patient’s inner thigh with Velcro leg strap or tape . Leave
some slack in catheter for leg movement.
Proper attachment prevents trauma to the urethra and
meatus from tension on the tubing. Whether to tape the
drainage tubing over or under the leg depends on gravity
flow, patient’s mobility, and comfort of the patient.
26. Assist the patient to a comfortable position. Cover the
patient with bed linens. Place the bed in the lowest
position
Positioning and covering provides warmth and promotes
comfort
27. Secure drainage bag below the level of the bladder.
Check that drainage tubing is not kinked and that
movement of side rails does not interfere with catheter or
drainage bag.
This facilitates drainage of urine and prevents the backflow
of urine.
20. ACTION RATIONALE
28. Put on clean gloves. Obtain urine specimen
immediately, if needed, from drainage bag. Label
specimen. Send urine specimen to the laboratory
promptly or refrigerate it.
Catheter system is sterile. Obtaining specimen
immediately allows access to sterile system. Keeping
urine at room temperature may cause microorganisms,
if present, to grow and distort laboratory findings
29. Remove gloves and additional PPE, if used. Perform
hand hygiene.
Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand
hygiene prevents the spread of microorganisms
30. Document the type and size of catheter and balloon
inserted, as well as the amount of fluid used to inflate
the balloon. Document the patient’s tolerance of the
activity. Record the amount of urine obtained through
the catheter and any specimen obtained. Document any
other assessments, such as unusual urine characteristics
or alterations in the patient’s skin. Record urine amount
on intake and output record, if appropriate.
To maintain records
21.
22. Intermittent Female Urethral Catheterization
ACTION
1. Check the medical record for the order for intermittent urethral catheterization.
Review the patient’s chart for any limitations in physical activity. Bring the catheter
kit and other necessary equipment to the bedside. Obtain assistance from another
staff member, if necessary. Perform hand hygiene. Put on PPE, as indicated, based
on transmission precautions.
2. Identify the patient. Discuss the procedure with the patient and assess the
patient’s ability to assist with the procedure. Ask the patient if she has any allergies,
especially to latex or iodine.
3. Close curtains around bed and close the door to the room, if possible.
4. Provide good lighting. Artificial light is recommended (use of a flashlight requires
an assistant to hold and position it). Place a trash receptacle within easy reach.
23. ACTION
5. Raise the bed to a comfortable working height. Stand on the patient’s right side if
you are right-handed, patient’s left side if you are left-handed.
6. Put on disposable gloves. Assist the patient to dorsal recumbent position with
knees flexed, feet about 2 feet apart, with her legs abducted. Drape patient.
Alternately, use the Sims’, or lateral, position. Place the patient’s buttocks near the
edge of the bed with her shoulders at the opposite edge and her knees drawn
toward her chest. Slide waterproof drape under patient.
7. . Put on clean gloves. Clean the perineal area with washcloth, skin cleanser, and
warm water, using a different corner of the washcloth with each stroke. Wipe from
above the orifice downward toward the sacrum (front to back). Rinse and dry.
Remove gloves. Perform hand hygiene again.
8. Open sterile catheterization tray on a clean overbed table using sterile technique.
24. ACTION
9. Put on sterile gloves. Grasp upper corners of drape and unfold drape without
touching unsterile areas. Fold back a corner on each side to make a cuff over gloved
hands. Ask patient to lift her buttocks and slide sterile drape under her with gloves
protected by cuff.
10. Place a fenestrated sterile drape over the perineal area, exposing the labia, if
appropriate.
11. Place sterile tray on drape between patient’s thighs
12. Open all the supplies. Fluff cotton balls in tray before pouring antiseptic solution
over them. Alternately, open package of antiseptic swabs. Open specimen container if
specimen is to be obtained.
13. Lubricate 1 to 2 inches of catheter tip
14. With thumb and one finger of nondominant hand, spread labia and identify
meatus. If the patient is in the side-lying position, lift the upper buttock and labia to
expose the urinary meatus. Be prepared to maintain separation of labia with one hand
until catheter is inserted and urine is flowing well and continuously
25. ACTION
15. Use the dominant hand to pick up a cotton ball. Clean one labial fold, top to bottom (from above the
meatus down toward the rectum), then discard the cotton ball. Using a new cotton ball for each stroke,
continue to clean the other labial fold, then directly over the meatus
16. With the uncontaminated, dominant hand, place drainage end of catheter in receptacle. If a specimen
is required, place the end into the specimen container in the receptacle
17. Using the dominant hand, hold the catheter 2 to 3 inches from the tip and insert slowly into the
urethra. Advance the catheter until there is a return of urine (approximately 2 to 3 inches [4.8 to 7.2 cm]).
Do not force the catheter through the urethra into the bladder. Ask the patient to breathe deeply, and
rotate the catheter gently if slight resistance is met as the catheter reaches external sphincter
18. Hold the catheter securely at the meatus with the nondominant hand while the bladder empties. If a
specimen is being collected, remove the drainage end of the tubing from the specimen container after
required amount is obtained and allow urine to flow into receptacle. Set specimen container aside and
place lid on container
26. ACTION
19. Allow the bladder to empty. Withdraw catheter slowly and smoothly after urine
has stopped flowing. Remove equipment and dispose of it according to facility policy.
Discard syringe in sharps container to prevent reuse. Wash and dry the perineal area,
as needed.
20. Remove gloves. Assist the patient to a comfortable position. Cover the patient
with bed linens. Place the bed in the lowest position.
21. Put on clean gloves. Secure the container lid and label specimen. Send urine
specimen to the laboratory promptly or refrigerate it.
22. Remove gloves and additional PPE, if used. Perform hand hygiene
27. Catheterizing the Male Urinary Bladder
Sterile catheter kit that contains:
Sterile gloves
Sterile drapes (one of which is fenestrated [having a window-like opening])
Sterile catheter (Use the smallest appropriate-size catheter, usually a 14F to 16F
catheter with a 5- to 10-mL balloon
Antiseptic cleansing solution and cotton balls or gauze squares; antiseptic swabs
Lubricant
Forceps
Prefilled syringe with sterile water (sufficient to inflate indwelling catheter balloon)
Sterile basin (usually base of kit serves as this)
Sterile specimen container (if specimen is required)
28. Flashlight or lamp
Waterproof, disposable pad
Sterile, disposable urine collection bag and drainage tubing (may be
connected to catheter in catheter kit)
Velcro leg strap or tape
Disposable gloves
Additional PPE, as indicated
Washcloth and warm water to perform perineal hygiene before and
after catheterization
29. PROCEDURE
ACTION RATIONALE
1. Review chart for any limitations in
physical activity. Confirm the medical
order for indwelling catheter insertion
Physical limitations may require
adaptations in performing the skill.
Verifying the medical order ensures
that the correct intervention is
administered to the right patient
2. Bring catheter kit and other
necessary equipment to the bedside.
Obtain assistance from another staff
member, if necessary.
Bringing everything to the bedside
conserves time and energy. Arranging
items nearby is convenient, saves time,
and avoids unnecessary stretching and
twisting of muscles on the part of the
nurse. Assistance from another person
may be required to perform the
intervention safel
30. ACTION RATIONALE
3. Perform hand hygiene and put on PPE,
if indicated
Hand hygiene and PPE prevent the
spread of microorganisms. PPE is
required based on transmission
precautions.
4. Identify the patient Identifying the patient ensures the right
patient receives the intervention and
helps prevent errors
5. . Close curtains around bed and close
the door to the room, if possible. Discuss
the procedure with the patient and assess
patient’s ability to assist with the
procedure. Ask the patient if he has any
allergies, especially to latex or iodine
This ensures the patient’s privacy. This
discussion promotes reassurance and
provides knowledge about the
procedure. Dialogue encourages patient
participation and allows for
individualized nursing care. Some
catheters and gloves in kits are made of
latex. Some antiseptic solutions contain
iodine.
31. ACTION RATIONALE
6. Provide good lighting. Artificial light is
recommended (use of a flashlight requires
an assistant to hold and position it). Place a
trash receptacle within easy reach.
Good lighting is necessary to see the
meatus clearly. A readily available trash
receptacle allows for prompt disposal of
used supplies and reduces the risk of
contaminating the sterile field.
7. Adjust the bed to a comfortable working
height, usually elbow height of the
caregiver. Stand on the patient’s right side
if you are righthanded, patient’s left side if
you are left-handed
Having the bed at the proper height
prevents back and muscle strain.
Positioning allows for ease of use of
dominant hand for catheter insertion
8. Position the patient on his back with
thighs slightly apart. Drape the patient so
that only the area around the penis is
exposed. Slide waterproof pad under
patient.
This prevents unnecessary exposure and
promotes warmth. The waterproof pad will
protect bed linens from moisture.
32. ACTION RATIONALE
9. Put on clean gloves. Clean the genital
area with washcloth, skin cleanser, and
warm water. Clean the tip of the penis first,
moving the washcloth in a circular motion
from the meatus outward. Wash the shaft
of the penis using downward strokes
toward the pubic area. Rinse and dry.
Remove gloves. Perform hand hygiene
again.
Gloves reduce the risk of exposure to blood
and body fluids. Cleaning the penis
reduces microorganisms near the urethral
meatus. Hand hygiene reduces the spread
of microorganisms.
10. Prepare urine drainage setup if a
separate urine collection system is to be
used. Secure to bed frame according to
manufacturer’s directions.
This facilitates connection of the catheter
to the drainage system and provides for
easy access
11. Open sterile catheterization tray on a clean
overbed table, using sterile technique.
Placement of equipment near worksite increases
efficiency. Sterile technique protects patient and
prevents spread of microorganisms
33. ACTION RATIONALE
12. Put on sterile gloves. Open sterile drape
and place on patient’s thighs. Place
fenestrated drape with opening over penis
This maintains a sterile
working area.
13. Place catheter set on or next to patient’s
legs on sterile drape.
Sterile setup should be
arranged so that the nurse’s
back is not turned to it, nor
should it be out of the nurse’s
range of vision
14. Open all the supplies. Fluff cotton balls in
tray before pouring antiseptic solution over
them. Alternately, open package of antiseptic
swabs. Open specimen container if specimen
is to be obtained. Remove cap from syringe
prefilled with lubricant.
It is necessary to open all
supplies and prepare for the
procedure while both hands
are sterile
34. ACTION RATIONALE
15. Place drainage end of catheter in receptacle. If the
catheter is preattached to sterile tubing and drainage
container (closed drainage system), position catheter and
setup within easy reach on sterile field. Ensure that clamp
on drainage bag is closed
This facilitates drainage of urine and
minimizes risk of contaminating sterile
equipment.
16. Lift penis with nondominant hand. Retract foreskin in
uncircumcised patient. Be prepared to keep this hand in
this position until catheter is inserted and urine is flowing
well and continuously. Using the dominant hand and the
forceps, pick up a cotton ball or antiseptic swab. Using a
circular motion, clean the penis, moving from the meatus
down the glans of the peniS. Repeat this cleansing
motion two more times, using a new cotton ball/swab
each time. Discard each cotton ball/swab after one use.
The hand touching the penis becomes
contaminated. Cleansing the area
around the meatus and under the
foreskin in the uncircumcised patient
helps prevent infection. Moving from
the meatus toward the base of the
penis prevents bringing
microorganisms to the meatus.
35. ACTION RATIONALE
17. Hold penis with slight
upward tension and
perpendicular to patient’s
body. Use the dominant hand
to pick up the lubricant
syringe. Gently insert tip of
syringe with lubricant into
urethra and instill the 10 mL of
lubricant
The lubricant causes the urethra to distend
slightly and facilitates passage of the catheter
without traumatizing the lining of the urethra. If
the prepackaged kit does not contain a syringe
with lubricant, the nurse may need assistance in
filling a syringe while keeping the lubricant sterile.
Some institutions use lidocaine jelly for
lubrication before insertion of the catheter. The
jelly comes prepackaged in a sterile syringe and
serves a dual purpose of lubricating and numbing
the urethra. A medical order is necessary for the
use of lidocaine jelly
36. ACTION RATIONALE
18. Use the dominant hand to pick up the
catheter and hold it an inch or two from the tip.
Ask the patient to bear down as if voiding. Insert
catheter tip into meatus. Ask the patient to take
deep breaths. Advance the catheter to the
bifurcation or “Y” level of the ports. Do not use
force to introduce the catheter. If the catheter
resists entry, ask patient to breathe deeply and
rotate catheter slightly
Bearing down eases the passage of the catheter
through the urethra. The male urethra is about
20 cm long. Having the patient take deep breaths
or twisting the catheter slightly may ease the
catheter past resistance at the sphincters.
Advancing an indwelling catheter to the
bifurcation ensures its placement in the bladder
and facilitates inflation of the balloon without
damaging the urethra
19. Hold the catheter securely at the meatus with
your nondominant hand. Use your dominant
hand to inflate the catheter balloon. Inject the
entire volume of sterile water supplied in the
prefilled syringe. Once the balloon is inflated,
the catheter may be gently pulled back into
place. Replace foreskin over catheter. Lower
penis
Bladder or sphincter contraction could push the
catheter out. The balloon anchors the catheter in
place in the bladder. Manufacturer provides
appropriate amount of solution for the size of
catheter in the kit; as a result, use entire syringe
provided in the kit
37. ACTION RATIONALE
20. Pull gently on catheter after balloon is
inflated to feel resistance.
Improper inflation can cause patient discomfort
and malpositioning of catheter.
21. Attach catheter to drainage system, if
necessary
Closed drainage system minimizes the risk for
microorganisms being introduced into the
bladder
22. Remove equipment and dispose of it
according to facility policy. Discard syringe in
sharps container. Wash and dry the perineal area
as needed.
Proper disposal prevents the spread of
microorganisms. Placing syringe in sharps
container prevents reuse. Promotes comfort and
appropriate personal hygiene
23. Remove gloves. Secure catheter tubing to the
patient’s inner thigh or lower abdomen (with the
penis directed toward the patient’s chest) with
Velcro leg strap or tape. Leave some slack in
catheter for leg movement.
Proper attachment prevents trauma to the
urethra and meatus from tension on the tubing.
Whether to take the drainage tubing over or
under the leg depends on gravity flow, patient’s
mobility, and comfort of the patient
38. ACTION RATIONALE
24. Assist the patient to a comfortable position.
Cover the patient with bed linens. Place the bed in
the lowest position
Positioning and covering provides warmth and
promotes comfort.
25. Secure drainage bag below the level of the
bladder. Check that drainage tubing is not kinked
and that movement of side rails does not interfere
with catheter or drainage bag.
This facilitates drainage of urine and prevents the
backflow of urine
26. Put on clean gloves. Obtain urine specimen
immediately, if needed, from drainage bag. Label
specimen. Send urine specimen to the laboratory
promptly or refrigerate it
Catheter system is sterile. Obtaining specimen
immediately allows access to sterile system.
Keeping urine at room temperature may cause
microorganisms, if present, to grow and distort
laboratory findings.
27. Remove gloves and additional PPE, if used.
Perform hand hygiene
Removing PPE properly reduces the risk for
infection transmission and contamination of other
items. Hand hygiene prevents the spread of
microorganisms.
39. DOCUMENTATION
Document the type and size of catheter and balloon inserted, as
well as the amount of fluid used to inflate the balloon. Document
the patient’s tolerance of the activity. Record the amount of urine
obtained through the catheter and any specimen obtained.
Document any other assessments, such as unusual urine
characteristics or alterations in the patient’s skin. Record urine
amount on intake and output record, if appropriate.
40. Intermittent Male Urethral Catheterization
ACTION
1. . Check the medical record for the order for intermittent urethral catheterization.
Review chart for any limitations in physical activity. Bring the catheter kit and other
necessary equipment to bedside. Obtain assistance from another staff member, if
necessary. Perform hand hygiene. Put on PPE, as indicated, based on transmission
precautions
2. Identify the patient. Discuss the procedure with the patient and assess the patient’s
ability to assist with the procedure. Discuss any allergies with the patient, especially
to iodine and latex.
3. Close curtains around bed and close the door to the room, if possible
4. Provide good lighting. Artificial light is recommended. Place a trash receptacle
within easy reach.
5. Raise the bed to a comfortable working height. Stand on the patient’s right side if
you are right-handed, patient’s left side if you are left-handed.
41. ACTION
6. Position patient on his back with thighs slightly apart. Drape patient so that only the area around
the penis is exposed. Slide waterproof pad under patient.
7. Put on clean gloves. Clean the genital area with washcloth, skin cleanser, and warm water. Clean
the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. Wash
the shaft of the penis using downward strokes toward the pubic area. Rinse and dry. Remove gloves.
Perform hand hygiene again.
8. Open sterile catheterization tray on a clean overbed table using sterile technique
9. Put on sterile gloves. Open sterile drape and place on patient’s thighs. Place fenestrated drape
with opening over penis
10. Place catheter set on or next to patient’s legs on sterile drape
11. . Open all the supplies. Fluff cotton balls in tray before pouring antiseptic solution over them.
Alternately, open package of antiseptic swabs. Open specimen container if specimen is to be
obtained
12. Remove cap from syringe prefilled with lubricant.
42. ACTION
13. Lift penis with nondominant hand. Retract foreskin in uncircumcised patient. Be prepared to keep
this hand in this position until catheter is inserted and urine is flowing well and continuously
14. Using the dominant hand and the forceps, pick up a cotton ball or antiseptic swab. Using a circular
motion, clean the penis, moving from the meatus down the glans of the penis. Repeat this cleansing
motion two more times, using a new cotton ball/swab each time. Discard each cotton ball/swab after
one use.
15. Hold penis with slight upward tension and perpendicular to patient’s body. Use the dominant hand
to pick up the lubricant syringe. Gently insert tip of syringe with lubricant into urethra and instill the
10 mL of lubricant.
16. With the uncontaminated, dominant hand, place drainage end of catheter in receptacle. If a
specimen is required, place the end into the specimen container in the receptacle.
17. Use the dominant hand to pick up the catheter and hold it an inch or two from the tip. Ask the
patient to bear down as if voiding. Insert catheter tip into meatus. Ask the patient to take deep breaths
as you advance the catheter 6 to 8 inches (14.4 to 19.2 cm) or until urine flows
43. ACTION
18. Hold the catheter securely at the meatus with the nondominant hand while the
bladder empties. If a specimen is being collected, remove the drainage end of the
tubing from the specimen container after the required amount is obtained and
allow urine to flow into the receptacle. Set specimen container aside.
19. Allow the bladder to empty. Withdraw catheter slowly and smoothly after urine
has stopped flowing. Remove equipment and dispose of it according to facility
policy. Discard syringe in sharps container to prevent reuse. Wash and dry the
genital area, as needed. Replace foreskin in forward position, if necessary.
20. . Remove gloves. Assist the patient to a comfortable position. Cover the patient
with bed linens. Place the bed in the lowest position.
21. Put on clean gloves. Cover and label the specimen. Send the urine specimen to
the laboratory promptly or refrigerate it.
22. Remove gloves and additional PPE, if used. Perform hand hygiene.
44. Removing an indwelling catheter
Removal of an indwelling catheter is performed using clean technique. Take care
to prevent trauma to the urethra during the procedure.
Completely deflate the catheter balloon before catheter removal to avoid
irritation and damage to the urethra and meatus.
The patient may experience burning or irritation the first few times he/she voids
after removal, due to urethral irritation.
If the catheter was in place for more than a few days, decreased bladder muscle
tone and swelling of the urethra may cause the patient to experience difficulty
voiding or an inability to void.
Monitor the patient for urinary retention.
encourage adequate oral fluid intake to promote adequate urinary output.
45. equipments
Syringe sufficiently large to accommodate the volume of solution used
to inflate the balloon (balloon size/inflation volume is printed on the
balloon inflation valve on the catheter at the bifurcation)
Waterproof, disposable pad
Disposable gloves
Additional PPE, as indicated
Washcloth and warm water to perform perineal hygiene after catheter
removal
46. Procedure
ACTION RATIONALE
1. Confirm the order for catheter removal in the
medical record
Verifying the medical order ensures that the
correct intervention is administered to the right
patient.
2. Bring necessary equipment to the bedside Bringing everything to the bedside conserves
time and energy. Arranging items nearby is
convenient, saves time, and avoids unnecessary
stretching and twisting of muscles on the part of
the nurse.
3. Perform hand hygiene and put on PPE, if
indicated.
Hand hygiene and PPE prevent the spread of
microorganisms. PPE is required based on
transmission precautions
4. Identify the patient. Identifying the patient ensures the right patient
receives the intervention and helps prevent
errors.
47. ACTION RATIONALE
5. . Close curtains around the bed and close the
door to the room, if possible. Discuss the
procedure with the patient and assess the patient’s
ability to assist with the procedure
This ensures the patient’s privacy. This discussion
promotes reassurance and provides knowledge
about the procedure. Dialogue encourages patient
participation and allows for individualized nursing
care.
6. Adjust bed to comfortable working height,
usually elbow height of the caregiver. Stand on the
patient’s right side if you are right-handed,
patient’s left side if you are left-handed
Having the bed at the proper height prevents back
and muscle strain. Positioning allows for ease of
use of dominant hand for catheter removal
7. Position the patient as for catheter insertion.
Drape the patient so that only the area around the
catheter is exposed. Slide waterproof pad between
the female patient’s legs or over the male patient’s
thighs.
Positioning allows access to site. Draping prevents
unnecessary exposure and promotes warmth. The
waterproof pad will protect bed linens from
moisture and serve as a receptacle for the used
catheter after removal.
48. ACTION RATIONALE
8. Remove the leg strap, tape, or other
device used to secure the catheter to the
patient’s thigh or abdomen
This action permits removal of catheter
9. Insert the syringe into the balloon
inflation port. Allow water to come back by
gravity. Alternately, aspirate the entire
amount of sterile water used to inflate the
balloon. Refer to manufacturer’s instructions
for deflation. Do not cut the inflation port.
Removal of sterile water deflates the balloon to allow
for catheter removal. All of the sterile water must be
removed to prevent injury to the patient. Aspiration by
pulling on the syringe plunger may result in collapse
of the inflation lumen; contribute to the formation of
creases, ridges, or cuffing at the balloon area; and
increase the catheter balloon diameter size on
deflation, resulting in difficult removal and urethral
trauma
10. Ask the patient to take several slow deep
breaths. Slowly and gently remove the
catheter. Place it on the waterproof pad and
wrap it in the pad.
Slow deep breathing helps to relax the sphincter
muscles. Slow gentle removal prevents trauma to the
urethra. Using a waterproof pad prevents contact with
the catheter.
49. ACTION RATIONALE
11. Wash and dry the perineal area, as
needed.
Cleaning promotes comfort and
appropriate personal hygiene
12. Remove gloves. Assist the patient to a
comfortable position. Cover the patient
with bed linens. Place the bed in the
lowest position.
These actions provide warmth and
promote comfort and safety.
13. Put on clean gloves. Remove
equipment and dispose of it according to
facility policy. Note characteristics and
amount of urine in drainage bag.
Proper disposal prevents the spread of
microorganisms. Observing the
characteristics ensures accurate
documentation.
14. Remove gloves and additional PPE, if
used. Perform hand hygiene.
Removing PPE properly reduces the risk
for infection transmission and
contamination of other items. Hand
hygiene prevents the spread of
microorganisms
50. DOCUMENTATION
Document the type and size of catheter removed and the amount of
fluid removed from the balloon.
Also document the patient’s tolerance of the procedure.
Record the amount of urine in the drainage bag.
Note the time the patient is due to void. Document any other
assessments, such as unusual urine characteristics or alterations in the
patient’s skin.
Also record urine amount on intake and output record, if appropriate.
51. BIBLIOGRAPHY
Erbs and Kozier. Fundamental of Nursing Concepts, Process and Practice.
Edition VIII: USA; Page no. 1284
Lynn Pamela. Taylors Clinical Nursing Skills- A Nursing Process approach.
Edition III: wolters Kluwer health; Page no. 616