Urinary elimination

Understanding of catheterization procedure for Nursing students.

1. URINARY ELIMINATION BY, MR. BASAVARAJ NURSING TUTOR, NAVODAYA CON RAICHUR.

2. LEARNING OBJECTIVES Review of anatomy and physiology Composition and characteristics of urine. Factors influencing Urination Alteration in Urinary Elimination Types and Collection of urine specimen, Observation, urine testing Facilitating urine elimination : (assessment, types, equipment's, procedures and special considerations) Providing urinal/bed pan, Condom drainage. Catheterization, Care of urinary drainage, and perineal care.

3. INTRODUCTION Urinary elimination is defined as expulsion of waste products from the body through the urinary system. It is essential to maintain homeostasis of the body. It helps in removal of metabolic waste products from the body.

4. Review of anatomy and physiology Organs of urine elimination Kidney: Ureters Urinary Bladder Urethra

5. Kidney Kidney: there are two kidneys present retroperitoneally in each side It consists of two parts i.e Medulla and cortex. Nephron is the Structural and functional unit of urinary system. Blood supply is by Renal artery and venous blood is drained to renal vein. Renal pelvis is the point where renal artery enters the kidney, and renal vein and ureters leave the kidney.

6. Functions of kidney 1. Excratory function: Excretion of metabolites. drugs and Toxins from the body. 2. Homeostatic function: Maintenance of water balance. Maintenance of electrolyte balance. Maintenance of acid-base balance. 3 . Endocrine (Hormonal) function. Renin secretion by JG cells. Secretion of Erythropoietin Hormone. Secretion of prostaglandins . 4. The kidney converts Vitamin D3 active 1,25-dihydroxycholecalciferol.

7. Ureters: There are two ureters descends from each kidney. They are made-up of Smooth muscles and inner lining is by transitional epithelium. These ureters carries the urine from kidney to urinary Bladder. Each ureters are around 10 to 12 (20 to 30cm) inch longer. Upper half of the ureter located in Abdominal cavity and lower half is present in Pelvic cavity. Clinical significance Ureteral stones Reflux of Urine Congenital malformation Ca ureters

8. Urinary Bladder It is a hallow muscular organ present in pelvic cavity which store the urine produced by kidney before eliminating. Superiorly connected to ureters and inferiorly to Urethra. Ca bladder, cystitis, incontinence, retention and Spastic bladder are the main clinical significance.

9. Mechanism of urine formation

10. Nephron structure

11. Composition of urine 95% of volume of normal urine is due to water. Organic components Urea (end product of protein metabolism) Uric acid (end product of purines) Creatinine Amino acids Metabolites of Hormones In-organics Cations: Na 2+ , K + , Ca 2+ etc Anions: Cl - , SO 4 2- , HCO 3 - etc

12. Characteristic of Urine Physical characters Color : pale yellow to deep Amber Odor : odorless Volume : 1 to 2 liters per 24 hours Specific gravity : 1.003-1.032 (1.010) Other characters pH : 4.5 to 8.0 (6.8) Blood cells : nil Protein : nil Glucose : nil Ketone bodies : nil

13. Factors influencing urination Lifestyle Fluid and food intake Environment Psychological factor Medications Muscle tone and activity Pathological condition Surgical and diagnostic procedures

14. Alteration in urine elimination Polyuria: urine volume in excess of 3L/day. Oliguria : urine volume less than 500 ml/day. Anuria : urine volume less than 100 ml/day. Nocturia : frequent night time urination. Dysuria :difficulty in urination/ burning maturation. Enuresis :bed wetting. Urinary incontinence and :involuntary dribbling of urine. Urinary retention : inability to void the urine/ empty the bladder completely.

15. Cont …….. Haematuria : blood in the urine. Proteinuria : presence of protein in the urine. Glycosuria : presence of glucose in urine.

16. Urine specimen collection Proper collection of specimen is important to maximize the outcome of laboratory test for the diagnosis of infectious diseases. A variety of laboratory test can be performed to make a presumptive or definitive diagnosis so that therapy can begin.

17. Types of urine specimen collection Random specimen collection. First morning specimen. Clean catch or midstream urine. Urine sample collection from catheter. Supra pubic aspiration.

18. Diagnostic tests Routine urine analysis. Blood test (BUN and Creatinine Clearance). Cystoscopy. Intravenous pyelogram IVP. Urine culture and sensitivity. CT Scan.

19. Facilitating urine elimination Providing urinal/bed pan, Condom drainage. Catheterization, Care of urinary drainage, and perineal care.

20. Catheterization “Urinary catheterization is the insertion of a hollow tube through the urethra into the bladder for removing urine”. It is a aseptic procedure for which sterile equipment's are required Size of the catheter used 8-10 f are used for children's. 12-14 are used for female adults. 14,16, and 18 are used for male adults.

21. Purposes of urinary catheter To relieve from urinary retention. To obtain a sterile urine specimen. To measure residual urine. To empty the bladder before, during and after the surgery. To measure the urine output accurately.

22. Types of catheterization Intermittent catheter: an intermittent catheter is used to drain the bladder for short period or at once. It will have only single lumen. Indwelling/retention catheter: This type of catheter placed in to bladder and secured there for a period of time. Supra pubic catheterization: In this catheter is used to bladder by making a small incision above the pubic area.

23. Procedure of catheterization Preparation . Insertion of catheter. After care and removal of urinary catheter.

24. Preparation Preparation of patient: Prepare the patient mentally by explaining the procedure to gain cooperation. Prepare the part (urethral opening). Provide privacy and position the patient . Prepare the articles: Catheter Bladder wash set 10cc/20cc syringe Sterile water Cotton balls with betadine Lubricant Sterile gloves Urine bag Micropore

25. Procedure of inserting catheter Explain the procedure to the patient. Provide privacy and adequate lightening and collect all articles. Position the male patient in supine position and female patient in dorsal recommend position. Wash the hands. Drape the perineal area. Open the sterile catheter kit, using sterile technique. Put on the sterile gloves. Lubricate the catheter with sterile lubricant. Retract the foreskin of the penis in male and open the labial folds in female.

26. Continued…….. Clean the urethra in a circular manner from inside to outer. Hold the penis in 90 angle, insert the catheter and allow urinary sphincter to relax. Lower the catheter and continue to advance the catheter. Note: never force the catheter to advance and discontinue the procedure if there is resistance. When the catheter reaches bladder urine starts to flow, gently insert until 1-2 inches beyond where urine is noted. Inflate the balloon, using correct amount of sterile liquid.

27. Continued……… Gently pull the catheter until inflation balloon is sung against bladder neck, and connect the catheter to drainage system. Fix the tube with micropore and keep bag below the bladder level. After care of procedure and articles Discard the waste, Remove gloves and replace the articles. Wash hands, and document the procedure.

28. Catheter care Fix the catheter to thigh or abdominal wall of the patient. Always keep urine bag below the bladder level. Everyday morning catheter care should be given with aseptic techniques. Maintain close drainage system. Irrigate bladder with antimicrobials. Routinely examine for any signs of infection. Don’t collect urine sample from urine bag or catheter directly. Provide Perineal care. Don’t allow the faecal matter to contaminate the catheter.

29. Removal of Urinary catheter Once patient got relieved from the condition physician can plan to remove the catheter. Take a Sterile 10/20cc syringe. Deflate the catheter. Pull the catheter gently until catheter come out. Discard the catheter, wash hands and document the procedure.

30. THANK YOU