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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.

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A home-based pelvic floor muscle training and bladder training in women with urinary incontinence showed that combined pelvic floor muscle training and bladder training decreased the symptoms and improved the quality of life To strengthen your pelvic floor muscles, squeeze the muscles up to 10 times while standing, sitting or lying down. Do not hold your breath or tighten stomach, bottom or thigh muscles at the same time. When you get used to doing pelvic floor exercises, you can try holding each squeeze for one second

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Advanced Gum Health Prebiotic: A Breakthrough in Oral Care Maintaining oral health is crucial for overall well-being. Beyond traditional methods like brushing, flossing, and regular dental check-ups, recent advancements in dental science have introduced the concept of prebiotics for enhancing gum health. Advanced gum health prebiotics represent a promising frontier in oral care, offering a novel approach to preventing gum disease and promoting a healthy oral microbiome. Understanding the Oral Microbiome The oral cavity hosts a complex ecosystem of microorganisms, collectively known as the oral microbiome. This community includes bacteria, fungi, viruses, and protozoa, which coexist in a delicate balance. A healthy oral microbiome plays a crucial role in maintaining oral health, aiding in digestion, and protecting against pathogens. However, disruptions to this balance can lead to oral health issues such as gum disease, tooth decay, and bad breath. The Role of Prebiotics in Oral Health Prebiotics are non-digestible food components that selectively stimulate the growth and activity of beneficial microorganisms in the gut. Unlike probiotics, which introduce live beneficial bacteria into the system, prebiotics serve as nourishment for the existing beneficial bacteria, promoting their growth and activity. This concept is now being applied to oral health. How Advanced Gum Health Prebiotics Work Advanced gum health prebiotics are designed to support the beneficial bacteria in the oral microbiome, creating an environment that discourages the growth of harmful bacteria. By promoting a balanced microbiome, these prebiotics help prevent gum inflammation, reduce the risk of periodontal disease, and enhance overall oral health. Reduction of Gum Inflammation: By fostering a healthy oral microbiome, prebiotics can reduce inflammation and irritation in the gums, preventing conditions like gingivitis. Prevention of Periodontal Disease: A balanced microbiome can help prevent the progression of gum disease, which, if left untreated, can lead to tooth loss. Enhanced Oral Hygiene: Regular use of prebiotics can complement traditional oral hygiene practices, leading to fresher breath and healthier gums. Natural and Safe: Prebiotics are naturally occurring substances found in various foods, making them a safe and natural addition to oral care routines. The Science Behind Prebiotics Prebiotics work by providing a food source for beneficial bacteria. These substances, often dietary fibers, are not digested by human enzymes but are fermented by the gut microbiota. In the context of oral health, prebiotics promote the growth of beneficial bacteria in the mouth, which can outcompete harmful bacteria for resources and adhesion sites on the teeth and gums. Studies have shown that prebiotics can help reduce levels of harmful bacteria, such as those responsible for periodontal disease and dental caries.

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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

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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

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