109 16 The Urinary System 1. Define important words in this chapter 2. Explain the structure and function of the urinary system 3. Discuss changes in the urinary system due to aging 4. List normal qualities of urine and identify signs and symptoms to report about urine 5. List factors affecting urination and describe how to promote normal urination 6. Discuss common disorders of the urinary system 7. Discuss reasons for incontinence 8. Describe catheters and related care 9. Explain how to collect different types of urine specimens 10. Explain types of tests that are performed on urine 11. Explain guidelines for assisting with bladder retraining Supplemental Tools transparency 16-1 the urinary system transparency 16-2 factors affecting urination handout 16-1: changing drainage bag to leg bag handout 16-2: changing leg bag to drainage bag handout 16-3: taking a urinary specimen from a port handout 16-4: supra pubic catheters chapter 16: exam Assignments textbook reading, pp. 295-314 workbook exercises, pp. 95-98 Overview of Teaching Strategies This chapter focuses on the urinary system and related care. Students will learn more personal care skills as they read about elimination and their role in assisting. An emphasis on promoting privacy and dignity should be made, along with empathizing with residents. Students are given in-depth information on incontinence and how to help prevent it. Adhering to infection prevention measures is important and should be made an integral part of the discussion. A risk of infection is especially high with catheter care. Students need to be aware of this. Tests performed on urine vary from facility to facility. The chapter has an introduction to restorative care with the section on bladder retraining. A positive, helpful attitude should be encouraged. 1. Define important words in this chapter textbook pp. 295-296 Pronounce and define each of the key terms listed in the Learning Objective on pages 295-296. 2. Explain the structure and function of the urinary system textbook pp. 296-297 Sphincter Micturition Voiding Urinary incontinence
110 Display Transparency 16-1 the urinary system Review the functions of the urinary system: Elimination of waste products from the blood Maintenance of water balance in the body Regulation of the levels of electrolytes in the body Assistance in regulation of blood pressure 3. Discuss changes in the urinary system due to aging textbook p. 297 Review normal changes of aging: The kidneys do not filter blood as efficiently. Bladder muscle tone weakens. Bladder holds less urine, causing more frequent urination. Bladder may not empty completely, causing increased chance of infection. 4. List normal qualities of urine and identify signs and symptoms to report about urine textbook pp. 297-298 Discuss normal characteristics of urine: Light, pale yellow, or amber in color Clear or transparent Faint smell Adults produce about 1200 to 1500 ml of urine, although elderly may produce less. Review signs and symptoms of urine to report: Cloudy urine Dark or rust-colored urine Strong-, offensive- or fruity-smelling urine Pain, burning, or pressure when urinating Blood, pus, mucus, or discharge in urine Episodes of incontinence 5. List factors affecting urination and describe how to promote normal urination textbook pp. 298-299 workbook p. 96 Display Transparency 16-2 factors affecting urination Discuss the factors listed on the transparency: Growth and development Psychological factors Fluid intake Physical activity and exercise Personal habits Medications Disorders 6. Discuss common disorders of the urinary system textbook pp. 299-300 workbook p. 96 Pronounce and define the following key term: Urinary tract infection Review the following points about UTIs: Cause: entrance of bacteria into the bladder through the urethra Women are more susceptible than men. Symptoms: burning or pain with urination, blood in urine, frequency of and urgency with urination Prevention: drinking plenty of fluids and juices rich in Vitamin C, wiping from front to back after elimination, taking showers rather than baths Treatment: antibiotics Report cloudy, dark, or foul-smelling urine, burning or discomfort with urination, or frequent urination in small amounts. Chronic renal failure (CRF) Dialysis End-stage renal disease (ESRD)
111 Review the following points about CRF: Kidneys cannot filter waste products from the blood. Becomes worse over time Causes: diabetes, hypertension, chronic urinary tract infections, nephritis Initial signs and symptoms: unintended weight loss, nausea, vomiting, fatigue, headache, frequent hiccups, itching Dialysis is done when the kidneys are no longer able to perform their function. ESRD occurs when kidneys have failed and dialysis or transplantation is required to sustain life. Review the following points about urine retention: Inability to adequately empty the bladder Causes: surgery, obstruction, infection, disorders such as multiple sclerosis and diabetes, enlargement of prostate gland Symptoms: lower abdominal pain, painful urge but inability to urinate, distended bladder, abdominal swelling, frequent urge to urinate, difficulty starting to urinate, weak flow of urine, dribbling Treatment: medication and catheterization 7. Discuss reasons for incontinence textbook pp. 301-302 workbook pp. 96-97 Review causes of incontinence: Confinement to bed Illness Paralysis Circulatory or nervous system disorders Prostate problems Childbirth Emphasize that incontinence is not a normal part of aging and must be reported. Describe the different types of incontinence: Stress incontinence Urge incontinence Mixed incontinence Functional incontinence Overflow incontinence Remind students to be professional and positive when dealing with episodes of incontinence. Review the guidelines for preventing incontinence: Know routines, habits, and signs. Follow toileting schedules and the care plan. Answer call lights promptly. Offer bedpans or take residents to the bathroom often. Encourage fluids. Take daily walks near bathroom. Change wet or soiled incontinence briefs immediately. Change wet or soiled bed linens. Use bed protectors. Check incontinence briefs every two hours. Change wet or soiled clothing immediately. Give good skin care and perineal care. Provide privacy. Be calm, patient, and professional. Be reassuring and positive. 8. Describe catheters and related care textbook pp. 302-307 workbook p. 97 Straight catheter Indwelling catheter Condom catheter Remind students that NAs do not insert, irrigate, or remove catheters. Review guidelines for catheter care: Wear gloves. Do not touch tip of clamp to any other object. Do not let drainage spout touch graduate. Make sure drainage bag hangs lower than hips or bladder. Do not hang drainage bag from bedrail.
112 Keep drainage bag off floor. Keep catheter tubing from touching floor. Keep tubing straight. Keep genital area clean. When cleaning meatus, move in one direction, away from meatus. Report blood in urine, leaks, bag filling suddenly or not filling for several hours, pain, pressure, or odor. Secure tubing properly. Do not disconnect catheter during positioning. Do not re-attach disconnected tubing. Demonstration Demonstrate the following procedures: Providing catheter care Emptying a catheter drainage bag Applying a condom catheter Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. Distribute Handouts 16-1 changing drainage bag to leg bag 16-2 changing leg bag to drainage bag If these procedures are taught at your facility, go over the information on the handouts with students. 9. Explain how to collect different types of urine specimens textbook pp. 307-311 workbook pp. 97-98 Routine urine specimen Calculi Clean-catch specimen 24-hour urine specimen Discuss the following points about urine specimens: Identify the resident. Labeling and storing specimens correctly is important. Discuss what urine straining is. Demonstrate how to strain urine if it is a requirement at your facility. Demonstration Demonstrate the following procedures: Collecting a routine urine specimen. Collecting a clean-catch (mid-stream) urine specimen Collecting a 24-hour urine specimen Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. Distribute Handouts 16-3 taking a urinary specimen from a port 16-4 supra pubic catheters If these procedures are taught at your facility, go over the information on the handouts with students. Review the Five Rights of specimen collection: The right resident The right specimen The right container The right date/time The right storage/delivery 10. Explain types of tests that are performed on urine textbook pp. 311-312 workbook p. 98 Ketones Specific gravity
113 Discuss what urine may be tested for: ph level Glucose and ketones Blood Specific gravity Demonstration Demonstrate the procedure: Testing urine with reagent strips. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. 11. Explain guidelines for assisting with bladder retraining textbook pp. 312-313 workbook p. 98 Discuss how NAs may assist in bladder retraining, including: Explain plan to resident. Follow plan. Follow Standard Precautions. Observe residents elimination habits. Keep a record of elimination, including episodes of incontinence. Offer toileting assistance before and after procedures. Answer call lights promptly. Provide privacy and do not rush resident. Help with perineal care. Encourage fluids. Have resident lean forward to put pressure on the bladder. Dispose of wastes properly. Keep accurate I&O records. Offer positive reinforcement. Never show frustration or anger. Chapter Review Exam distribute chapter 16: exam (appendix c, pp. 323-324) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Answers to Chapter Review in Textbook 1. Urethra 2. Shorter 3. Answers include: elimination of waste products from the blood; maintenance of water balance in the body; regulation of the levels of electrolytes in the body; assistance in regulation of blood pressure 4. Answers include: The kidneys do not filter blood as efficiently. Bladder muscle tone weakens. Bladder holds less urine, causing more frequent urination. Bladder may not empty completely, causing increased chance of infection. 5. Answers include: light, pale yellow or amber in color; clear or transparent; faint smell; adults produce about 1200 to 1500 ml of urine, although elderly may produce less. 6. Answers include: cloudy urine; dark or rustcolored urine; strong-, offensive- or fruitysmelling urine; pain, burning, or pressure when urinating; blood, pus, mucus or discharge in urine; or episodes of incontinence 7. Answers include: Growth and development: Encourage intake of fluids. Provide water and other beverages often. Offer frequent trips to bathroom. Follow a schedule. Respond to call lights and bathroom requests promptly. The best position for women to urinate is sitting, and for men it is standing. Avoid supine position. Promote exercise and activity. Help with perineal care. Wipe from front to back. Assist resident to wash hands. Encourage Kegel exercises. Psychological factors: Provide plenty of privacy. Allow time for urination. Do not rush resident. Leave call light in reach. Respond to call lights and requests for help with toileting immediately. Listen to residents. Report resident concerns to nurse. Fluid intake: Encourage fluid intake. Remind residents to drink often. Be aware of excessive caffeine, sodium, alcohol or sugar in diet. Make sure pitcher and cup are within reach
114 and light enough to lift. Offer a straw. Assist with fluid intake as needed. Physical activity and exercise: Increase daily exercise. Encourage regular walks and other activities. Personal habits: Raise head of bed. Run water in bathroom sink. Medications: Offer toileting assistance often. Keep encouraging fluids even if urination is more frequent. 8. Sitting, standing 9. The female urethra is shorter than the male urethra. 10. Answers include: burning or pain with urination; blood in urine; frequency of and urgency with urination; cloudy, dark, or foul-smelling urine; or frequent urination in small amounts 11. From front to back 12. Dialysis is an artificial means of removing the body s waste products. 13. Answers include: lower abdominal pain; painful urge but inability to urinate; distended bladder; abdominal swelling; frequent urge to urinate; difficulty starting to urinate; weak flow of urine; or dribbling 14. Answers include: confinement to bed; illness; paralysis; circulatory or nervous system disorders; prostate problems; or childbirth 15. Stress incontinence: loss of urine due to an increase in intra-abdominal pressure. Urge incontinence: involuntary voiding due to an abrupt urge to void. Mixed incontinence: symptoms of both urge and stress incontinence are present. Functional incontinence: urine loss caused by environmental, cognitive or physical reasons. Overflow incontinence: due to overflow or over-distension of bladder. 16. Answers include: Know routines, habits, and signs. Follow toileting schedules and the care plan. Answer call lights promptly. Offer bedpans or take residents to the bathroom often. Encourage fluids. Take daily walks near bathroom. Change wet or soiled incontinence briefs immediately. Change wet or soiled bed linens. Use bed protectors. Check incontinence briefs every two hours. Change wet or soiled clothing immediately. Give good skin care and perineal care. Provide privacy. Be calm, patient and professional. Be reassuring and positive. 17. A straight catheter is inserted to drain urine present in the bladder and immediately removed after urine is drained. An indwelling catheter stays inside the bladder for a period of time. 18. Answers include: Wear gloves. Do not touch tip of clamp to any other object. Do not let drainage spout touch graduate. Make sure drainage bag hangs lower than hips or bladder. Do not hang drainage bag from bedrail. Keep drainage bag off floor. Keep catheter tubing from touching floor. Keep tubing straight. Keep genital area clean. When cleaning meatus, move in one direction away from meatus. Report blood in urine, leaks, bag filling suddenly or not filling for several hours, pain, pressure, or odor. Secure tubing properly. Do not disconnect catheter during positioning. Do not re-attach disconnected tubing. 19. Urine that flows back into the bladder from the tubing or bag can cause infection. 20. Toilet paper or stool 21. A clean-catch specimen is collected by first cleaning the perineal area, and then urinating a small amount into the toilet to clear the urethra. After urinating a small amount into the toilet, the sample is collected mid-stream in a clean or sterile container. The resident stops urinating and the container is removed from the stream. 22. A 24-hour urine specimen collects all the urine voided by a resident in a 24-hour period. 23. Answers include: when a resident cannot urinate on his or her own; when an infection in the urinary tract may be present; or when a resident has urinary retention 24. Answers include: ph level, glucose, ketones, blood, and specific gravity 25. 30 minutes 26. Answers will vary.