Palpation of the kidney
- not normally palpable
- however palpation could detect enlargement
Which kidney is lower?
- right kidney
- easier to detect
Renal dysfunction?
Where is the tenderness?
- tenderness between bottom rib and spine
Auscultation for bruits (kidneys)
Auscultate to assess for bruits (low pitched murmurs)
- indicate renal artery stenosis or aortic aneurysm
Ascites
- accumulation of fluid in the peritoneal cavity which may occur with kidneys as well as liver dysfunction
Percussion over bladder
- after patient voids
- begin at midline (above umbilicus), proceeds downward
- sound changes from tympanic to dull
- dullness over the bladder after voiding = incomplete bladder emptying
Palpating the bladder
- palpated only if it is moderately distended
- feels like a smooth firm round mass rising out of abdomen (usually at midline)
- > 150mL of urine
Short-term catheterization (fewer than 14 days) (5)
1) obstruction to urine flow (ex: prostate enlargement)
- when bladder, urethra, and surrounding structures have been surgically repaired
2) prevent urethral obstruction from blood clots
3) prostate surgery
4) ) measuring urinary output on critically ill clients
5) continuous or intermittent bladder irrigations are required
Long-term catheterization (more than 14 days)
1) severe urinary retention (recurrent UTI)
2) skin rashes, ulcers or wounds irritated by contact with urine
3) terminal illness when bed linen changes or toileting are painful for client
Intermittent catheterization (insertion and removal of a catheter several times a day to empty the bladder.)
1) relieve discomfort due to bladder distention
2) obtain sterile urine specimen
3) assess residual urine volume
4) management of urethral structures
5) long term
- spinal cord q6h
- neuromuscular degeneration
- incompetent bladders
What is a straight catheter? (5)
- single lumen
- urine drains from tip, through lumen, into a receptacle
- intermittently
- in and out to drain when required
- sterile
Coude catheter
- curved tip
- male patients = enlarged prostate
- less traumatic, stiffer/easier to control
In-dwelling or Foley catheter
- retained for longer periods in the bladder
- small balloon that anchors it against the bladder neck
- remains in place until daily review of necessity indicates removal
- requires frequent cleaning
Triple lumen
clot drainage & irrigation
Plastic
intermittent use only, due to there inflexibility
Latex and rubber catheters
recommended use up to three weeks
- be aware of allergies
Silicon and teflon
- long term (2-3 mo)
- cause less encrustation at urethral meatus
- durable/comfort
Hydrophilic coated catheters
- more comfortable and less likely to inflame urethral tissue than non-hydrophilic catheters
- encrustation develops slowly
Silver hydrogel catheters
- short term use
- delaying onset of bacteriuria
- antimicrobial
Order for catheterization
- type
- size
- type of drainage system
- frequency of catheterization
List information required in order for urinary catheterization?
- physician order
- strict aseptic technique
- organize equipment before procedure
- steps for insertion for either indwelling or single use catheters are the same
Female Catheterization
1) When would you position the client in the Sim’s (side-lying) position?
2) Why do cleanse the client from below the clitoris downward?
3) How much of the catheter do you lubricate for the female client?
4) How far will you likely insert the catheter before you see urine flow?
5) Why do you hold the catheter with the non-dominant hand while you inflate the balloon?
6) Why do you secure the catheter to the inner thigh with tape?
1) abduct hip in supine position
- sims or side-lying
- inverted bedpan
2) Cleansing from the area of least contamination to area of the most contamination. Use a single cotton ball for each wipe.
3) 2.5 - 5cm
4) 5 - 7.5 cm after urine flow starts advance 2.5 - 5cm - never force against resistance.
5) The dominate hand is sterile and is needed to inflate the balloon.
6) Reduces pressure on the urethra, thus reducing possible tissue injury.
Male Catheterization
1) When would you position the male client supine, with knees slightly apart?
2) What do you do if a client is not circumcised?
3) Describe how to clean around the urinary meatus of a male client.
4) How much of the catheter do you lubricate for the male client?
5) How far will you likely insert the catheter before you see urine flow?
6) Why do you hold the penis perpendicular to the body for insertion ?
1) Supine
2) Pull back on foreskin, clean from meatus to rest of glans penis x3
3) With sterile hand (dominate hand) pick up the cotton ball with forceps to clean the penis. Move in circular motion from urethra meatus down to base of glans. Repeat cleansing three more times, using clean cotton ball each time.
4) 12.5 -17.7cm
5) 17 - 22.5 cm after urine flow starts advance 2.5 - 5cm - never force against resistance.
6) Straightens urethral canal to ease catheter insertion.
Disconnection
alcohol swabs on both ends
