07.05 Urinary Elimination

Overview

1. Urinary Elimination
   1. Nursing care priorities
   2. External aids
   3. Internal aids
   4. Surgical interventions

Nursing Points

General

1. Nursing care priorities
   1. Dignity
      1. Provide comfort
      2. Provide privacy
   2. Safety
      1. Reduction of infection
      2. Skin care
   3. Measure output
      1. Measure every device
   4. Urine output output
      1. Check for consistent urine output
      2. Some drugs can change the color of urine
      3. Address concerns with providers as necessary and promptly
2. External aids
   1. Bedside toilet
      1. Use for ambulatory patients
      2. Check for safety
         1. Reduce fall risk
   2. Urinals
      1. For difficult mobility
      2. Available for male and female
   3. Bedpan
      1. Available for female patients to urinate
      2. Use fracture pans for ortho patients
   4. Condom cath
      1. When to use
      2. Orders are sometimes necessary
      3. Check for skin integrity and seal
3. Internal aids
   1. Foley (indwelling urinary catheter)
      1. Coudé
         1. Male insertion with prostate problems
      2. 3-way Foley
         1. Use for continuous bladder irrigation
      3. Use sterile technique for insertion and catheter care
      4. CAUTI (Catheter Associated Urinary Tract Infection
         1. Perform cath care regularly
         2. Remove as soon as possible
   2. In-and-Out Catheter
      1. Single pass to insert and drain bladder
      2. Provider order necessary
      3. Use same care for in-and-out as Foley
4. Surgical interventions
   1. Suprapubic catheter
      1. Used when voiding can’t occur below the level of the bladder
         1. Ex: urethral injury
      2. Sometimes can leak
         1. Check skin integrity
   2. Nephrostomy tube
      1. Used when voiding can’t occur below the level of the kidney
         1. Typically inserted in the back
   3. Ileal conduit
      1. Used when removal of the bladder is necessary
      2. Creates stoma
         1. Provide stoma care
         2. Monitor similar to Foley

Assessment

1. Assess for patient knowledge regarding elimination aids
2. Assess output based on the type of device used
3. Check skin integrity frequently
4. Determine if device is still necessary

Nursing Concepts

1. Elimination
2. Safety
3. Functional Ability
4. Comfort

Patient Education

1. Educate patient on the type of device necessary for care
2. Educate patient on need to notify the nurse for elimination needs
   1. Provide call light, and educate patient on use
   2. Observe patient using call light appropriately
3. Educate patient on long term use of devices such, as ostomies.
   1. Provide teaching for ostomy and stoma management
   2. Utilize teaching methods such as the teach back in reducing the probability of complication