Chapter 8Urinary & Bowel Elimination

Advanced Skills for Health Care Providers, Second Edition

Barbara Acello, Thomson Delmar, 2007

Objectives:

• Spell and define key terms

• State the purpose of measuring specific gravity of gravity

Objectives continued

• Differentiate an indwelling catheter from a straight catheter

• Explain why the prostate gland may interfere with catheterization

• List guidelines for disinfecting a urinary drainage bag & leg bag

Objectives continued

• State purpose of suprapubic catheter and PCT responsibilities

• State purpose of nephrostomy tube and PCT responsibilities

• List three types of dialysis and describe how each is used

Objectives continued

• Identify PCT responsibilities in caring for patients with peritoneal dialysis

• State purpose of bladder irrigation & describe three methods of performing this procedure

Objectives continued

• State the purpose of the rectal tube, cleansing enema, retention enema, and rectal suppository

• List signs and symptoms of fecal impaction

• Describe purpose of an ostomy & list general guidelines for ostomy care

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Role of the PCT in Assisting Patients with Elimination Procedures

• Important responsibility assisting patients with elimination procedures and tests

• The circumstances of elimination are highly personal

• Respect the patient’s right to privacy !!!!

• Always apply the principles of standard precautions

• Wear PPE appropriate for the procedure

Urine Specific Gravity

• Test that measures how well the kidneys concentrate urine

• Provides useful diagnostic information for many different conditions

• High quantities of glucose and protein in the urine can cause elevated specific gravity

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Urine Specific Gravity continued

• Use a random urine sample

• You will not ask the patient to empty the bladder and drink water

• Specific gravity is most accurate after a patient has been NPO as the urine is more concentrated

Urine Specific Gravity continued

• For accurate results the urine specimen should be room temperature (71°F)

• Some facilities permit testing between 60°F and 100°F

• Wait at least 20 minutes for the specimen to cool especially if the patient is febrile

• Do not refrigerate specimen; • Follow facility policies

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Urine Specific Gravity continued

• Normal specific gravity range for adults is 1.010 to 1.035

• Some facilities use a range from 1.002 to 1.025

• Clinical norms for a 24-hour urine are 1.015 to 1.024

Urine Specific Gravity continued

Values below 1.010 suggest very dilute urine (possible over-hydration) and are present in conditions such as

• Serious renal infections

• Acute (sudden onset) renal failure »

Urine Specific Gravity continued

Values above 1.025 suggest

• Dehydration

• Congestive heart failure

• Patients who have recently received contrast dyes or consumed alcohol can have falsely elevated values

Commonly Used Instruments to Measure Urine Specific Gravity• Urinometer

• Refractometer

Urinometers

• Must be properly calibrated

• Check calibration by using room temperature distilled water; specific gravity of water is 1.000

• Check with RN or policy if you need a calibration conversion chart

Catheter: a tube inserted into the bladder to drain urineTwo types: Indwelling and Straight

• Indwelling, also called a Foley or retention catheter is a closed system attached to a drainage bag

• Straight is inserted to drain the bladder and then is immediately removed

Indwelling catheter is not a treatment for urinary incontinenceRisk of UTI, urinary tract infection, because

the indwelling catheter provides an open passageway to the bladder

Female urethra is 1 ½ to 3 inches long

Male urethra is 6 to 7 inches long

Females have higher risk of infection

Many Different Catheter Sizes

• Like needles, the gauge of the catheter is determined by the size of the lumen

• Unlike needles, low-number gauges indicate small catheters

Catheter Sizes • The abbreviation “Fr” usually appears after

the gauge number 14 gauge is 14Fr

• Catheters are sized using the French scale

• Children: 6Fr, 8Fr, or 10Fr

• Adult females: 14Fr or 16Fr

• Adult males: 14Fr, 16Fr, or 18Fr

• The RN will tell you which size to use

Catheter Lumens

Indwelling catheters have two lumens• One to drain urine from the bladder• The other to inflate the balloon that holds the end of the catheter in the

bladder

Straight catheters have one lumen Only one lumen needed to drain the bladder of urine and then it is removed

Catheters with three lumens Used for medical treatment, ex., continuous irrigation

Inserting a Catheter

• Catheterization requires a physician’s order• Catheter insertion is a sterile procedure because

there is high risk for infection• You may have to add items to a sterile kit• Patients that self-catheterize themselves at

home may use clean technique• Good lighting is necessary• Provide complete privacy !!!!!!

Indwelling Foleys

Foley Kit

Supplies may need to be added