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Nur 111 > Catheterization > Flashcards

Catheterization Flashcards

1
Q

Internal Sphincter

A

no control ( smooth muscle)

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2
Q

External Sphincter

A

can control ( skeletal muscles)

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3
Q

micturition process

A

urination process from brain sending signals

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4
Q

Kidneys-

Ureters-

Bladder - ( state the name)

Urethra-

A

Kidneys- filters wastes toxins, water from blood, nephron forms the urine

Ureters- transports urine through
peristaltic waves

Bladder - detrusor muscle that rises above
pubic bone when full, fills from
bottom upwards

Urethra- transports urine from the bladder to the
body’s exterior through the urinary meatus.

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5
Q

bladder capacity

urge to urinate

A

500-1000 ml

200- 450 ml

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6
Q

afferent pathway

efferent pathway

A

bladder to spinal cord

spinal cord to bladder

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7
Q

Impulses from sacral ( state 3 sacral)

allows voluntary control to void .

A

2 , 3 , 4

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8
Q

Factors causing interruption to void
( 4)

A
  1. Anesthesia
  2. Drugs

3.surgery

  1. childbirth
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9
Q

Anesthesia (general/ spinal)

explain spinal in the purpose of efferent pathways

A

General: acute urinary retention can follow all types of anesthetics or operations due to suppression of
urinary reflex.- inability to sense bladder fullness.General anesthesia induces unconsciousness, Airway Management: Airway control is required in general anesthesia,

Spinal medication: blocks the transmission of the afferent and efferent pathways, unable to sense the need to void, and inability of bladder muscles and urethral
sphincters to respond.
while spinal anesthesia induces regional anesthesia and blocks sensation in specific parts of the body.
whereas spinal anesthesia is administered regionally, targeting specific nerve pathways.but not in spinal anesthesia, where patients maintain spontaneous breathing.

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10
Q

Drugs ( define the classification, 2 drugs DEFINE AND STATE SIDE
EFFECTS)

( remember professor D *cant ……)

state the differences

A

Anticholinergics: HELP TP Decrease MUSCLSE

a.Atropine- used in surgery to decrease secretions (saliva),and increase heart rate.

SE: decreased urgency to void and retention.

b.Glycopyrolate (robinul)- reduces salivary secretions, GI anti-spasmodic, decreases GI motility,
SE: urinary hesitancy and retention

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11
Q

spinal vs epidural

A

Spinal anesthesia is injected directly into the cerebrospinal fluid, whereas epidural anesthesia is administered into the epidural space outside the spinal cord.

Onset and Duration: Spinal anesthesia acts quickly and has a shorter duration of action, while epidural anesthesia has a slower onset and can be prolonged through continuous infusions.

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12
Q

Surgery:

Kidney-
Ureters- EXPLAIN WHAT THIS TECHNIQUE PURPOSE
Bladder-
Urethra-

A

Kidney- potential for blood in urine called

Ureters- ureteroscopy* help grabs stone and bring it out* with stone extraction, blood in urine, spasm * because their irriatied

Bladder- TURBT * removes tumorr*: bladder spasm, observe for bleeding

Urethra- swelling from surgical manipulation,
cysto (BLADDERRR)

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13
Q

Pregnancy and Childbirth:

Hormonal changes -( relation to bladder muscle)

Muscles- (discuss results)

Trauma- ( give an examples)

Nerve injury - ( which branches)

A

Hormonal changes in pregnancy
cause the bladder muscle to lose tone

Muscles- pelvic floor tissue stretching during
delivery resulting in nerve damage

Trauma- Surgical instrumentation and difficult labor/delivery cause swelling, pain
ex)forceps /vacuum can cause hematoma on baby head

Nerve injury during delivery (afferent nerve
branches (S2-4)

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14
Q

Retention:

A

 Urine fills the bladder but unable to empty properly
 Does not respond to the micturition reflex
***Assess the abdomen for evidence
of bladder distention/tenderness

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15
Q

urinary retention types (3)

A
  1. Overflow
  2. Mechanical
    3.Functional
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16
Q

Retention with overflow:( how much)

A

Bladder unable to respond to reflex, urine accumulates, bladder stretches, feelings of pressure, external urethral spasms & unable to hold back urine.

 Urethra temporarily opens to let a
small overflow of urine out (25-60 ml)

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17
Q

Mechanical Retention of Urine:
( congenital * 3
vs acquired 4 )

A

 Congenital * at birth*:
-urethral stricture (narrowing)
-urinary tract malformation
-spinal cord deformity

 Acquired * happens *:
-calculus/tumor
-inflammatory/hyperplasia * access growth of tissue / enlargement ex) prostate ),
-trauma/pregnancy
-enlarged prostate

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18
Q

Functional Retention
( define/ examples 7 /kinds of drugs * 5*)

A

Neurogenic bladder- impaired nerve pathways may interfere with normal
micturition.

ie: MS, Parkinson’s disease, diabetes, spinal trauma , shy bladder, anxiety, aging

medications : given for pain/surgery
- narcotics
- sedatives
- antihistamines
- anti cholingeric
- gerenal and spinal anesthesia

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19
Q

Medications for retention and urgency? 2

A
  1. Cholinergic (urecholine)
    stimulates the bladder to
    contract, which improves
    urine flow (retention)
  2. Anti-cholinergic (ditropan)
    for pts with over active
    bladder. Anti-spasmodic
    that relaxes the muscles in
    the bladder to help decrease
    problems of urgency and
    frequent urination
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20
Q

Residual ( steps)

ASSESS BY?

A

amount urine in bladder 10-15 post void.

Assess by:
1. Bladder scanner: prior to use of a catheter to
determine amount of urine retained in bladder

  1. AFTER voiding (10-15 min)
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21
Q

ditropan

helps what kind of issues

A

for pts with over active
bladder. Anti-spasmodic
that relaxes the muscles in
the bladder to help decrease
problems of urgency and
frequent urination

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22
Q

Bladder scan-

A

used to
estimate volume of urine
in bladder

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23
Q

void

A

void

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24
Q

rebound tenderness

A

apendictitis

25
Q

a rounded swelling above pubis

A

pt have absnce of urine.

The best way to assess for a distended bladder. This swelling represents the distended bladder rising above the pubis into the abdominal cavity. The client might experience tenderness or pressure above the symphysis

26
Q

Nursing Intervention ( non-invasive) ( 8)

A

Promote normal
voiding:
Privacy
Comfort
Run water
Positioning
Warm water
Crede = pushing down on abdomen
Massage spine
(S2,3,4 level)
Bladder scan

27
Q

bladder decompressions
(purpose/ when volume of urine is)

A

helps decompression of bladder/drain urinary to make it smaller

when volume of urine is known to be
excessive (>1L), notify provider for
guidance r/t gradual bladder decompressio

28
Q

Catheterization (purpose /4types)

A

(invasive)
Purpose: Place catheter into the urinary bladder to
allow drainage of urine (strict asepsis!!!!)

Types of catheters:
Straight
Retention (double lumen foley)
Triple
supra above pubic / urthera is bypassed
Coude

29
Q

Types of catheters:
Straight

A

-Straight catheters are used to drain the
Temporary Use: Straight catheters are designed for short-term use and are typically used on an as-needed basis.

No Balloon: Unlike indwelling catheters, straight catheters do not have a balloon to hold them in place; they rely on manual insertion and removal.

30
Q

Purpose of catheters ( 6) contd.

A

To obtain a sterile urine specimen
 Measure the amount of residual urine
 Empty the bladder prior to surgery
 Prevent post op bladder distention
 Prevent urine from coming in contact with an
incision or open wound/skin breakdown
 To obtain accurate intake and output (I&O)
 Provide continuous or intermittent bladder irrigation

31
Q

void

A

void

32
Q

Triple lumen

A

(bladder/prostate sugery pts)
- need to retention
-clamp it

Facilitate continuous bladder irrigation or for instillation of medication. This catheter is primarily used following urological surgery or in case of bleeding from a bladder or prostate tumor and the bladder may need continuous or intermittent irrigation to clear blood clots or debris.

33
Q

Supra

bypasseswhat

A

suprapubic catheter is a type of urinary catheter that is surgically inserted into the bladder through the abdominal wall, just above the pubic bone.

Suprapubic catheterization is often performed when long-term or permanent urinary drainage is required, or when other methods of catheterization (such as urethral catheterization) are not suitable or have failed.

by passes urethera

34
Q

Coude

A

men with enlarge prostate

35
Q

Retention Catheter
indwelling/foley

A

It is held in place by a balloon filled with sterile water, preventing it from slipping out. Foley catheters are commonly used in healthcare settings for patients who are unable to urinate naturally due to various medical conditions or surgeries. Here are the steps for inserting and managing a Foley catheter:

36
Q

Catheter Size

 Infants and young children-
 Children-
 Adults -
 Elderly, thin adults-
 Large meatal opening -

A

 French system: the internal diameter of catheter-
the larger the number, the larger the lumen size

 Infants and young children- 5-8 Fr

 Children- 8-10 Fr

 Adults 14-16 Fr ( normal 14)

 Elderly, thin adults- 12-14 Fr

 Large meatal opening -20-30 ( for weak bigger )

37
Q

Retention Catheter Balloon Size

Child-

Normal size adult-

Long term use, post-op TURP, continuous
bladder irrigation-

A

Child- 3ml balloon with 5ml sterile water

Normal size adult- 5ml balloon with 10ml
sterile water

-30ml
*Not recommended to pre-test the balloon
prior to insertion

38
Q

Inserting a Urinary Catheter

 Prepare patient-
-Female Postioning
-Male- Postioing
-Pt with issues positions
tips:( 3)

A
  1. An indwelling catheter must be ordered by a
    physician and is inserted only by a licensed nurse. (nursing students can with rn )
  2. Prepare patient- explain
  3. Wash hands, gather equipment
    Female- supine, knees flexed.

Tips:
need good lighting for visualization
Variations in technique
bearing down may ease catheter insertion
Male- supine, legs straight

Pt sims postion with issues.

39
Q

Application of Lubricant
Female-
Male-

A

Female- 1-2 (4inches) up the catheter. deep breath

Male- up to the Y connector
*hold penis at a 90 degree angle
5-7 inchess

40
Q

Maintain Sterile Technique
Female Steps ( 3 steps)

If catheter is placed in vagina steps

A
  1. Cleansing Labia-
  2. Hold labia with non dominant hand-
    3.Once hand is
    positioned, keep in place-
    DO NOT LET GO!

4.If catheter is placed in the vagina:
 Leave it there
 Begin with new catheter
 NEVER use contaminated catheter

41
Q

urinary stasis

A

urinary stayed in bladder

42
Q

Male Tips

Catheterizations

A

cleanse urinary meatus in a circular
motion from meatus outwards

Hold penis at a 90 degree angle

43
Q

Secure Urinary Catheter

explainpurpose whyyyyyy

A

Anchor tubing using tape or
catheter leg band check tubing.

causes infection if not tape to prevent movement.

44
Q

Risks of Catheterization
(3)

A

 Infection- Catheter associated urinary tract
infections (CAUTI) account for 80% of
hospital acquired infections
 Trauma
 Reflux

45
Q

Removal of Catheter (6)

think about nurse duties

A

 Wear clean gloves
 Check balloon size
 Completely deflate balloon (10ml syringe)
 Measure urine output (U/O)
 Observe for urinary retention post removal
 Assess for signs of UTI (dysuria/frequency/fever/confusion * delrious/dementia )

46
Q

Self or Intermittent
catheterization

A

Single use catheter to drain the bladder
Reasons:
 Neurogenic bladder
 Spinal cord injury

47
Q

Self Catheterization (4)

A

Goal- empty bladder, prevent UTI
 Good vision
 Manual dexterity
 Cognitive ability ( no dementia)
 Motivation

48
Q

Bladder Irrigation
Closed System
(triple lumen catheter)
five steps

DONTFORGET LAST STEP

A

Irrigation solution and tubing

Run in amount of fluid per
physician order*

Clamp during irrigation (retain bladder)

Unclamp to drain irrigant*
and urine

Subtract irrigant from urine* ( if i have 260 / 60 was irrgaint = my total is 200)

49
Q

Benefits of self catheter (6)

A

 Decrease in UTI’s
 Independence
 Decrease in reflux
 Normal sexual relations
 Release from dribbling
 Return to work

50
Q

Closed intermittent bladder
Irrigation via
specimen port using

state last important step when documenting findings

A

wash hands

cleanse specimen [port with alcohol

draw up sterile irrigation solution into 60 ml syringe, connect to specimen port( 10ml)

clamp drainage tubing

Unclamp drainage tubing and
allow irrigant and urine to drain

Subtract irrigant from urine total

51
Q

Bladder irrigation–
Open System

A

Physician order/Not recommended

52
Q

Obtaining a Sterile Urine Specimen
from a Catheter- ( 6 steps)

A
  1. Clamp drainage bag tubing below
    the level of the specimen port for 15-30 min
  2. Put on clean gloves
  3. Cleanse specimen port with alcohol and insert needless
    access device with a 20-30 ml syringe into self sealing
    specimen port @ 90 degrees and withdraw urine.
  4. Place into sterile specimen container
  5. ***Must unclamp tubing
  6. Send to lab promptly for
    analysis per facility policy ( ASAP or it’ll get infected)
53
Q

Assessment for retention (4)

A
  • abdominal assessment ( IPP- no A)
  • assess I&O
  • bladder scan - used to estimate
    volume of urine in bladder

-palpating the bladder

54
Q

Inserting a Urinary Catheter steps men

A

Catheterization in Men:
**1. Prepare the Patient:

Explain the procedure to the patient, ensuring informed consent.
Gather necessary supplies: sterile catheter, sterile lubricant, sterile gloves, antiseptic solution, drainage bag, and drapes.
**2. Position the Patient:

Have the patient lie on their back with knees bent and legs apart, or in a dorsal lithotomy position (similar to a gynecological exam position).
**3. Prepare and Cleanse:

Wash hands thoroughly and put on sterile gloves.
Cleanse the urethral meatus and surrounding area with an antiseptic solution.
**4. Insert the Catheter:
hold peepee @ 90 degree
Lubricate the catheter tip with sterile lubricant.
Hold the penis upright, perpendicular to the body.
Insert the catheter gently and slowly into the urethra until urine starts to flow.
Continue inserting the catheter about 2-3 inches more after urine starts flowing to ensure it is in the bladder.
**5. Secure the Catheter:

Secure the catheter to the patient’s thigh or abdomen using tape or a catheter stabilization device.
Connect the catheter to a drainage bag.
**6. Ensure Comfort and Safety:

Ensure the catheter is draining properly and that the patient is comfortable.
Wash hands and provide appropriate perineal care.

55
Q

Inserting a Urinary Catheter steps woman

A

Insert the Catheter:

Lubricate the catheter tip with sterile lubricant.
With one hand, separate the labia.
Insert the catheter gently and slowly into the urethra until urine starts to flow.
Continue inserting the catheter about 2-3 inches more after urine starts flowing to ensure it is in the bladder.
**5. Secure the Catheter:

Secure the catheter to the patient’s thigh using tape or a catheter stabilization device.
Connect the catheter to a drainage bag.
**6. Ensure Comfort and Safety:

Ensure the catheter is draining properly and that the patient is comfortable.
Wash hands and provide appropriate perineal care.
In both cases, it’s essential to use sterile techniques, maintain patient dignity, and ensure proper catheter placement and securement to prevent complications. Proper training and following institutional protocols are essential for performing urinary catheterization safely and effectively.

56
Q

balloon purpose in catheterizations

A

the balloon in a catheter is essential for ensuring proper placement, stability, and retention inside the
bladder.
It is a key component that allows the catheter to fulfill its purpose of draining urine effectively and safely. Healthcare professionals carefully inflate and deflate the balloon according to specific guidelines to ensure patient comfort and prevent complications.

57
Q

obtaining specimen

A

NOT FROM BAG

  • need to clamp bag ( 15 minutes)
    -send to labs asap
    if not refrigerate it
58
Q

Benign prostatic hyperplasia meaning

A

With this condition, the urinary stream may be weak, or stop and start

59
Q

REMEMBER THE PURPOSE OF IRRGATION

A client, who had a transurethral resection of the prostate (TURP), has a three-way indwelling urinary catheter with continuous bladder irrigation. In which of the following circumstances should the nurse increase the flow rate of the continuous bladder irrigation?

When drainage is continuous but slow.

When drainage appears cloudy and dark yellow.

When drainage becomes bright red.

When there is no drainage of urine and irrigating solution.

A
  1. The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the fow of irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindi-cated when there is no return of urine and irrigating solution.

The infusion rate should be increased if the drainage is cherry colored or if clots are seen.

Nur 111 (18 decks)

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