Prezentace aplikace PowerPoint

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• Basic procedures in healthcare 1
  (SOL / VCA81)
• TOPICS
• 12a) Emptying of the bladder
• 12b) Urine sampling and its examination
• 12c) Bladder catheterization in women and men

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12a) Emptying of the bladder

• urination
• factors affecting micturition
• diuresis
• fluid balance
• monitoring of urine (quantity, colour, odour )
• urinary voiding disorders

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12a) Emptying of the bladder

• Urination (micturition)
• The excretion of urine by the urinary system
  kidneys, ureters, urinary bladder and urethra.

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12a) Emptying of the bladder

• Factors affecting the micturition
• growth and development,
• psychosocial factors,
• food and fluid intake,
• drugs,
• muscle tone,
• pathologies (hypertrophy of the prostate, kidney
  ),
• surgery (e. g. cystoscopy ).

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12a) Emptying of the bladder

• Diuresis
• the definitive amount of urine produced by the
  kidneys per unit time (usually one day), an
  average of 1,5 liters per day,
• ? when the lack of fluids and renal impairment
  (compare to anuria, oliguria),
• ? e. g. at increased fluid intake, diuretic and
  when DM (compare to polyuria),
• the dieresis monitoring is important in many
  diseases and acute conditions (shock, heart and
  renal failure with swelling and others).

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12a) Emptying of the bladder

• Fluid balance
• - measuring and recording fluid intake and output
  over 24 hours,
• use urine bottles, bedpans,sampling containers
  for urinein case there is not introducedperipher
  al urinary catheter,
• remember to write infusion,sauces, compotes,
  vomit,waste drain, diarrhoea,excessive sweating
  etc..

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12a) Emptying of the bladder

• Monitoring of urine quantity
• physiological quantity 1000 2000ml / 24hrs
• Disorders of urine
• polyuria ? urine,
• gt than 3 000ml / 24 hrs
• oliguria ? urine,
• 100 - 500ml / 24 hrs
• anuria urine
• lt than 100ml / 24 hrs

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12a) Emptying of the bladder

• Monitoring of urine colour
• physiological straw yellow,
• dark yellow, reddish increased concentration of
  bile pigments,
• blood in the urine haematuria,
• opacity proteins, mucus, pus.

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12a) Emptying of the bladder

• Monitoring of urine - odour
• fresh urine - an aromatic odour
• older urine - sharp pungent odour
• acetone - metabolic acidosis

indication urine papers
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12a) Emptying of the bladder

• Urinary voiding disorders
• retention urinary retention without the ability
  to emptying, the arrest of
  urination
• pollakiuria frequent urge to urinate,
  accompanied by a small amount of
  urine (frequent symptom of the urinary tract
  inflammation)
• nocturia - increased frequency of urination at
  night
• dysuria pain during urination
• stranguria cutting, burning during urination
• urgent urination a strong sense of urgency with
  little urine
• enuresis nocturna bedwetting in older children
• incontinence spontaneous loss of urine

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12b) Urine sampling and its examination

• general principles of urine sampling
• physical examination of urine
• specific weight of urine
• biochemical urinalysis

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12b) Urine sampling and its examination

• General principles of urine sampling
• usually morning urine is sampled,
• genital organs hygiene before sampling washing
  the urethral orifice with water,
• sampling into pre-labeled containers, clean, dry,
  sterile (should consider the possibility of
  staining with the container during sampling),
• properly completed requisition.
• Specifics of sterile urine sampling
• midstream of urine it means first wash the
  genital by water, then urinein a toilet part of
  the urine, catch the midstream into the sterile
  containerand the rest of urine pee in the
  toilet,
• urine obtained during catheterization.

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12b) Urine sampling and its examination

• Physical examination of urine
• the colour, turbidity, foam, odour, pH, specific
  weight is evaluated,
• physiological pH of urine normal 5,0 - 7,0,
• aciduria lower than 5,0,
• alkaluria higher than 6,5 - 7,0.
• Specific weight of urine - value 1,010 -
  1,025g/cm3
• dependent on the amount of dissolved solids
  (especially chlorides, urea)and the amount of
  discharged fluid,
• measurement in the morning with calibrated
  hydrometer (urometer),
• 100 ml urine in graduated cylinder.

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12b) Urine sampling and its examination
hydrometer in graduated cylinder
hydrometer
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12b) Urine sampling and its examination

• Biochemical urinalysis
• determination of values protein, glucose, ketone
  bodies, bile pigments, haemoglobin, amino acids,
  amylase, creatinine, inorganic compounds,
  nitrogen balance, osmolality, hormone levels,
  medications

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12b) Urine sampling and its examination

• Biochemical urinalysis
• pyuria - pus in the urine,
• proteinuria - protein in the urine,
• glycosuria - carbohydrates in the urine,
• acetonurie - ketone bodies in the urine.

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12b) Urine sampling and its examination

• Individual biochemical examination methods
• urinary sediment (urine sediment),
• urinary sediment according to Hamburger,
• balance sampling for the waste ions, urea, uric
  acid, protein, creatinine, glycosuria,
• Bence-Jones protein,
• creatinine clearance,
• oestriols,
• vanillylmandelic acid (VMA),
• toxicology urine examination.

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12c) Bladder catheterization

• definition
• indication
• types of catheterization
• types of urinary catheters
• tools
• preparation of a patient
• single catheterization procedure of woman with
  simultaneous sampling of urine for examination
• single catheterization procedure of man with
  simultaneous sampling of urine for examination
• indications for the introducing of a permanent
  urinary catheter (PUC)
• tools
• procedure in introducing of PUC
• complication while introducing PUC

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12c) Bladder catheterization

• Catheterization - introducing a sterile catheter
  (catheter) through the urethra into the bladder.
• Indication
• emptying the bladder when retention,
• emptying the bladder before the examination,
  surgery, parturition etc.,
• taking the sterile urine sample to test for
  cultivation and sensitivity,
• introducing of a permanent urinary catheter
  (PUC),
• detection of residual urine,
• bladder instillation (irrigation).

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12c) Bladder catheterization

• Types of catheterization
• Disposable - in order to release disposable
  bladder content(the introduction of a catheter,
  drain urine, removal of catheter, finish the
  procedure).
• Permanent in order toensuring intermittentand
  permanent urinarydiversion. Functionalcharacter
  of catheterscorresponds with this purpose.

urinary catheters
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12c) Bladder catheterization

• Types of urethral catheters
• a) Nelaton catheter - straight used in children
  and women, rarely
  in men,
• b) Tiemann catheter - straight with curved
  conical beak used
  in men,
• c) Foley catheter permanent urinary catheter,
  most commonly used for chronic urine drainage
  into a collection bag plasticor silicone it
  includes balloon to fix urinary catheter, the
  balloon is filled with saline.
• The catheter must be sterile and not damaged.
  Catheters are aseptically stored in a sealed
  plastic bag.
• PUC marking - indicate the numbers expressing the
  girth and average.

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12c) Bladder catheterization
disposable catheter
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12c) Bladder catheterization
disposable catheter
Tiemann catheter
Nelaton catheter
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12c) Bladder catheterization
Permanent catheters
Foley catheters
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12c) Bladder catheterization

• Tools
• permanent Foley catheter,
• saline 1/1,
• syringe according to the size of the balloon 5 -
  20 ml,
• urine sampling bag, a sterile tube,
• sterile swabs, sterile tweezers,
• disinfectant solution for periurethral
  disinfection (Octenisept),
• lubricant and aesthetic, e. g. Mesocain gel,
  Instillagel,
• vomit bowls,
• disposable sterile gloves.
• The possibility of using other tools according to
  the standardsand practices of staff.

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12c) Bladder catheterization

• Preparation of the patient
• familiarization with procedure,
• ensure privacy,
• appropriate position on the back in a slightly
  raised position, man's lower limbs lying in bed,
  womans lower limb are bent at knees slightly
  apart from each other,
• genital hygiene.

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12c) Bladder catheterization

• The procedure for a single catheterization of
  women with simultaneous sampling urine tests
• tools preparation,
• hygienic hand disinfection,
• the patient is lying on your back with bent lower
  limbs,
• inserting vomit bowls next to the legs of the
  patient,
• use of sterile gloves (or 1 glove on nondominant
  hand if we use sterile tweezers to the genital
  disinfection),
• draping the genitals,
• disinfection of the urethral meatus,
• antiseptic swab hold in sterile tweezers and use
  it only once,
•  

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12c) Bladder catheterization

• open female labia with forefinger and thumb of
  one hand,
• with the second hand, in whichwe hold sterile
  tweezerswith sterile swabsand disinfectant,we
  gradually disinfectthe orifice of urethraand
  its surroundings(3 swans right, lestside and
  centre),
• we disinfect alwaysin one direction fromthe
  top down (ventrodorsal) and we never go back!

disinfect the orifice of urethra
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12c) Bladder catheterization

• we put used swabs into the vomit bowls,
• we remove the catheter from the prepared package,
  
• we use to removal either a sterile tweezers or
  the second nurse helps us or we have everything
  prepared on the sterile surface,
• we apply Instillagel (Mezocain gel) on the tip of
  the catheter,
• we gently introduce the catheter into the
  bladder,
• we are introducing, until the urine starts
  leaking into vomit bowls from the other end of
  the catheter,
• we let the first stream to drop into the vomit
  bowl, and then we let the next one (midstream)
  flow into a sterile test tube,
• we let the rest of the urine to flow into the
  vomit bowls or bedpans.

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12c) Bladder catheterization

• after bladder emptying, we gently pull the
  catheter from the urethra,
• we dry the genital using swabs,
• we adjust the patients position and bed,
• we arrange cleaningthe tools,
• we send a urinesample to the laboratory,
• we record it inthe documentation.

bladder catheterization on a model
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12c) Bladder catheterization

• The procedure for a single catheterization of men
  with simultaneous sampling urine tests
• a physician puts on sterile gloves,
• we prepare a tube for sampling urine, sterile
  tampon in a disinfectant solution and sterile
  disposable catheter,
• we place vomit bowls in a bed of the patient,
• the physician pulls the foreskin and he
  disinfects opening of the urethra using 3 swabs -
  a circular motion from the orifice of the urethra
  below,
• we prepare Instillagel or Mesocain gel,
• we give aseptically sterile urinary catheter to
  the physician,
• the physician pulls the curved end of the
  catheter in sterile swab with prepared Mesocain
  (the physician applies Instillagel directly into
  the orifice of the urethra),

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Instillagel - gel in a sterile syringe with local
anestheticand disinfectant antibacterial effect
(for introducing of PUC)
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12c) Bladder catheterization

• the physician slowly introduces a catheter into
  the urethra, the leaking urine is caught in vomit
  bowls and bedpans,
• midstream urine is caught in a test tube,
• the rest of the urine is let to flow into the
  vomit bowls and bedpans,
• after emptying of the bladder, the physician
  gently pulls the catheter from the urethra,
• we clean the urethral meatus from excess of
  lubricant,
• we adjust the position of a patient and the bed,
• we arrange cleaning the tools,
• we send a urine sample to the laboratory,
• we record it in the documentation.

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bladder catheterization on a model
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12c) Bladder catheterization

• Indications of introduction of permanent
  catheter
• urine retention,
• macro-haematuria (bleeding when bladder tumours,
  prostatic adenoma, carcinoma),
• after cystoscopy,
• postoperative catheter introduction (prostate,
  bladder, urethra surgery),
• measurement of diuresis (postoperative renal
  insufficiency, cardiac decompensation).

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12c) Bladder catheterization

• Tools
• the same as in single catheterization,
• plus- syringe,- saline,- collecting bag,-
  hinge on the bed.

urine collection bagwith plastic hinge
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12c) Bladder catheterization

• Procedure for permanent catheterization
• the same as when single catheterization,
• nurse assists to the doctor in the introduction
  of permanent catheterin a male, another nurse
  assistance is possible when introducingof
  permanent catheter in a female,
• it is appropriate to connect the catheter with
  collecting bag,before the introduction of
  urinary catheter,
• after the introduction of urinary catheter, we
  drop all the urine and we introduce the catheter
  by about 2,5 - 5 cm away from the place where
  urine begins flow so we can fill the balloon with
  saline,
• we apply the saline with syringe (the amount of
  the catheter indications) into the other catheter
  entrance which leads to the intravesicalend of
  the catheter,
• we perform a leak test by pulling urinary
  catheter GENTLY!

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12c) Bladder catheterization

• we communicate with the patient during a
  performance,
• dry genitals,
• adjust the bedafter the procedure,
• we arrange cleaningthe tools,
• we record it inthe documentation.

introduced catheter in men
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12c) Bladder catheterization

• Videos
• Single catheterization with the collection of
  urine tests
• - https//www.youtube.com/watch?vvtZL2t7SP0w
•  
• Women catheterization with permanent urinary
  catheter
• - https//www.youtube.com/watch?vR1gaOOJ5XgI
•  
• Removing the permanent urethral catheter
• - https//www.youtube.com/watch?vvuH1fygkYsc

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12c) Bladder catheterization

• Complications of catheterization
• infection when violation of the principles of
  antisepsis,
• traumatic damage to the urethra during rough
  introduction,
• inability to introduce the catheter due to
  urethral anomalies.
• !!! IT IS NECESSARY TO FOLLOW THE PRINCIPLESOF
  ANTISEPSIS DURING THE INTRODUCTION !!!

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Revision

• Name the defects of urine creation.
• How do we monitor the fluid balance?
• What are the guidelines we follow for the urine
  sampling?
• Name the type of bladder catheterization.
• What kinds of catheters do you know?
• List the tools to catheterization.
• List at least 3 indications for PUC introduction.
• Describe the single catheterization procedure of
  women.
• What complications can occur during
  catheterization?
• About what will you educate mobile patient with
  PUC?

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Reference

• MIKŠOVÁ, Zdenka, Marie FRONKOVÁ, Renáta HERNOVÁ a
  Marie ZAJÍCKOVÁ, kapitoly z ošetrovatelské péce
  1. Aktualiz. a dopl. vyd. Praha Grada, 2006,
  90s. ISBN 80-247-1442-6
• VELKÝ LÉKARSKÝ SLOVNÍK online. 2015 cit.
  2015-03-27. Dostupné z www.lekarske.slovniky.cz
• VOŠ ZDRAVOTNICKÁ A STREDNÍ ZDRAVOTNICKÁ ŠKOLA
  HRADEC KRÁLOVÉ. Ošetrovatelské postupy zavedení
  permanentního katetru online.2015
  cit.2015-04-08. Dostupné z http//ose.zshk.cz/v
  yuka/osetrovatelske-postupy.aspx?id15
• PICTURES (if it is not stated differently)
  google.com (key words tubes,urine for
  testing, catheters )