N105: Essentials of Nursing Care - Health Differences

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 51 of 160 When assessing and treating patients consider the following: • Nursing assessment: normal findings include an average volume per voiding is 200ml to 250ml; the normal output per 24 hours is 1500ml; color is yellow, light to dark, and clear; urine should have a faint but inoffensive odor; urine is sterile; obtain a health history regarding the patient’s usual pattern (how often, how much, the times, and any recent changes in the pattern); check hydration status and appearance of the urine; normal urine consists of 96% water and 4 percent solutes (urea, ammonia, creatanine, uric acid, sodium, chloride, potassium, sulfate, magnesium andphosphorus) • Diagnostic tests: BUN end product of protein metabolism is produced in relatively constant quantities by the muscles. Creatinine is a sensitive measurement of renal function. • Culture and sensitivity: a clean catch or mid-stream urine collection is performed when the urine is collected for an analysis of bacteria; a culture is grown and exposed to various antibiotics to determine which of themwill eradicate, or are sensitive to the bacterial infection; the client is instructed to wash the urethral meatus with an antiseptic wipe to remove surface bacteria, void a small amount into the toilet, then void a small specimen into the sterile collection cup for analysis by the lab • Specimens from a urinary catheter: specimen collection is a sterile procedure; while wearing gloves, the access port on the tubing is cleaned with alcohol or Betadine and allowed to dry; a sterile syringe is inserted into the cleaned port, 5-10cc of urine is removed, and the specimen is placed in a sterile collection cup; if there is no urine in the tubing, the tubing should be clamped for 30 minutes, and specimen collection reattempted at that time • Implementation : maintain normal urinary elimination; promote fluid intake; assess clients at risk for UTI or stones and teach to consume 2-3 L of fluid daily (contraindicated if client has kidney failure or heart failure); maintain normal voiding habits; maintain proper position, privacy, relaxation, and timing and assisting with toileting Urinary Incontinence Management • Bladder training: the client postpones voiding or inhibits the sensation of urgency and voids according to a timetable rather than according to the client’s urge • Habit training: keep clients dry by having them void at regular intervals, do not attempt to delay voiding if the urgeoccurs • Kegels: pelvic muscle exercises • Skin integrity: continually moist skin becomesmacerated • Drainage: apply an external urinary drainage device (condomcatheter) Managing Urinary Retention • Crede’s maneuver: apply manual pressure on the bladder to promote bladder emptying; this is very effective with a flaccid bladder • Catheterization: performed under a strict sterile technique; straight catheters are inserted to