Urinary Elimination and Care: A Nursing Guide

1. Clean-catch urinalysis: Used to minimize contamination from skin flora.
2. Timed urinary collection (e.g., 24-hour urine): Used to measure specific substances like urea, uric acid, or creatinine over a full day.
3. Reagent testing: Using chemical strips to check for glucose, protein, or ketones.
4. Straining urine: Used to identify crystals or sediment.

Understanding Urinary Incontinence

Urinary incontinence is the involuntary loss of urine. It is not a single disease but a symptom of various underlying issues:

Catheterization and Nursing Interventions

Guidelines for Insertion

Catheterization is an invasive procedure that requires a physician's order. Because the urinary tract is a sterile environment, nurses must use stringent surgical asepsis during insertion. Failure to maintain sterility can lead to healthcare-acquired urinary tract infections (UTIs). Before setting up the sterile field, the nurse should locate the patient's urinary meatus.

Indwelling Catheter Care

Once a catheter is in place, the nurse is responsible for maintaining the system to prevent infection and ensure patency.

The "Do's" of Indwelling Catheter Care:

• Do perform peri-care using only soap and water.
• Do keep the catheter and tubing free from kinks or obstructions.
• Do maintain a closed system (keep collection bags or leg bags connected).
• Do replace any catheters or bags that become disconnected.
• Do ensure the patient's identifier and implementation date are on the collection container.
• Do disinfect the sampling port before attempting to collect a specimen.

Specialized equipment, such as a triple lumen catheter, may be used for irrigation. These catheters include a port for irrigation, a tube to inflate the balloon, and drainage tubing.

Urinary Tract Infections (UTIs) and Management

UTIs are common complications, especially in patients with catheters. Symptoms must be assessed promptly to prevent the infection from ascending to the kidneys.

Management Strategies:

• Increased fluid intake: To help flush the urinary tract.
• Pharmacology: Antibiotics to treat the infection and urinary analgesics to manage pain.
• Dietary supplements: Cranberry juice is sometimes utilized.
• Hospitalization: If the infection progresses to pyelonephritis (a kidney infection), the patient may require hospitalization for intravenous (IV) antibiotics.

Surgical Urinary Diversions

In cases of severe bladder dysfunction or trauma where the natural urinary path is no longer viable, surgical diversions may be necessary:

• Ileal conduit: A piece of the small intestine is used to create a pathway for urine to exit the body.
• Continent urostomy: A diversion that allows the patient to control when they void.
• Neobladder (Orthoptic bladder substitution): A surgically constructed bladder that allows for more natural voiding patterns.