15.1 Urinary System Assessment and Catheterization

The urinary system plays a crucial role in maintaining our body's balance. It filters waste, regulates fluids, and helps control blood pressure. Understanding how this system works is key to recognizing potential issues and maintaining overall health.

Assessing the urinary system and performing catheterization are essential nursing skills. These procedures help diagnose problems, manage urinary retention, and monitor patient output. Proper technique and care are vital to prevent complications and ensure patient comfort.

Urinary System Anatomy and Physiology

Urinary System Components and Functions

• Urinary system comprises kidneys, ureters, bladder, and urethra
  • Kidneys filter blood and produce urine
  • Ureters transport urine from kidneys to bladder
  • Bladder stores urine until elimination
  • Urethra allows passage of urine out of the body
• Nephrons function as kidney's filtering units
  • Perform filtration, reabsorption, and secretion of substances
  • Maintain fluid and electrolyte balance in the body
• Urine formation involves three main processes
  • Glomerular filtration removes water and small molecules from blood
  • Tubular reabsorption returns essential substances to bloodstream
  • Tubular secretion eliminates additional waste products

Homeostasis and Fluid Balance Regulation

• Urinary system maintains homeostasis through multiple mechanisms
  • Regulates fluid volume (blood pressure control)
  • Balances electrolytes (sodium, potassium, calcium)
  • Manages acid-base balance (pH regulation)
• Antidiuretic hormone (ADH) plays crucial role in fluid balance
  • Increases water reabsorption in kidneys
  • Concentrates urine during dehydration
• Renin-angiotensin-aldosterone system (RAAS) regulates blood pressure
  • Renin triggers production of angiotensin II
  • Angiotensin II stimulates aldosterone release
  • Aldosterone increases sodium and water retention

Micturition Process and Control

• Micturition reflex controls urination process
  • Involves both voluntary and involuntary nervous system components
• Bladder filling triggers stretch receptors
  • Sends signals to spinal cord and brain
• Voluntary control allows for appropriate timing of urination
  • Relaxation of external urethral sphincter
  • Contraction of detrusor muscle in bladder wall
• Normal bladder capacity ranges from 300-400 mL in adults
  • Urge to urinate typically occurs at 150-200 mL

Comprehensive Urinary System Assessment

Health History and Physical Examination

• Conduct thorough health history focused on urinary system
  • Inquire about urinary habits (frequency, urgency, nocturia)
  • Ask about symptoms (pain, burning, hematuria)
  • Assess risk factors for urinary disorders (diabetes, prostate enlargement)
• Perform physical examination of urinary system
  • Inspect abdomen and flank regions for swelling or discoloration
  • Palpate for bladder distension or kidney tenderness
  • Percuss to assess for fluid accumulation or organ enlargement
• Evaluate for signs of urinary retention
  • Palpate for suprapubic fullness or distension
  • Assess for overflow incontinence
• Check for costovertebral angle (CVA) tenderness
  • Indicates possible kidney inflammation or infection
  • Perform by tapping the area between 12th rib and spine

Diagnostic Tests and Procedures

• Conduct urinalysis as primary diagnostic test
  • Assess urine color (pale yellow to amber)
  • Evaluate clarity (clear to cloudy)
  • Measure specific gravity (normal range 1.005-1.030)
  • Check pH (normal range 4.5-8)
  • Test for abnormal substances (protein, glucose, blood, ketones)
• Perform urine culture and sensitivity when infection suspected
  • Identifies causative bacteria
  • Guides appropriate antibiotic selection
• Utilize advanced diagnostic tests as needed
  • Renal function tests (BUN, creatinine)
    • BUN normal range: 7-20 mg/dL
    • Creatinine normal range: 0.6-1.2 mg/dL
  • Imaging studies (ultrasound, CT scan, IVP)
  • Cystoscopy for direct bladder visualization

Urinary Catheterization Techniques

Indications and Preparation

• Recognize indications for urinary catheterization
  • Acute urinary retention (inability to void)
  • Accurate urine output measurement (critically ill patients)
  • Perioperative management (during and after surgery)
• Prepare for catheterization procedure
  • Gather necessary supplies (catheter kit, antiseptic solution)
  • Ensure proper hand hygiene (wash hands, don sterile gloves)
  • Maintain sterile field to prevent contamination

Catheter Insertion and Maintenance

• Perform catheter insertion using sterile technique
  • Cleanse perineal area with antiseptic solution
  • Insert catheter gently into urethra (5-7.5 cm for females, 17-22.5 cm for males)
  • Inflate retention balloon with sterile water (5-10 mL)
  • Secure catheter to patient's thigh to prevent movement
• Maintain catheter properly to prevent complications
  • Perform regular perineal care (at least daily)
  • Assess urine output and characteristics hourly
  • Ensure unobstructed drainage (keep tubing free of kinks)
  • Empty drainage bag when 2/3 full or every 8 hours

Catheter Removal and Documentation

• Remove urinary catheter when no longer clinically indicated
  • Deflate retention balloon completely
  • Gently withdraw catheter while patient takes deep breaths
  • Assess post-removal urinary function (ability to void, residual volume)
• Document catheterization procedure thoroughly
  • Record date and time of insertion/removal
  • Note catheter type and size used
  • Describe patient's response and any complications
  • Include assessment of urine output and characteristics

Urinary Catheterization Complications

Infection and Trauma

• Monitor for urinary tract infections (UTIs)
  • Most common catheter-associated complication
  • Symptoms include fever, cloudy urine, suprapubic pain
  • Obtain urine culture if infection suspected
• Recognize catheter-associated trauma
  • Urethral injury during insertion (false passage)
  • Bladder perforation (rare but serious complication)
  • Manage by stopping procedure and seeking medical intervention

Catheter-Related Discomfort and Obstruction

• Address bladder spasms and discomfort
  • Common side effects of catheterization
  • Manage with anticholinergic medications or catheter adjustments
• Identify and manage catheter obstruction
  • Causes include kinking, blood clots, or sediment
  • Assess urine flow regularly
  • Perform gentle irrigation or catheter replacement if needed
• Prevent catheter encrustation and blockage
  • More common with long-term catheterization
  • Schedule regular catheter changes (every 4-6 weeks)
  • Encourage adequate fluid intake to flush bladder

Prevention Strategies

• Implement strategies to prevent catheter-associated complications
  • Use smallest appropriate catheter size (14-16 Fr for adults)
  • Maintain closed drainage system to reduce infection risk
  • Remove catheter as soon as clinically indicated
  • Perform daily assessment of catheter necessity
• Educate healthcare team on proper catheter care
  • Emphasize importance of hand hygiene
  • Train on aseptic technique for catheter insertion and care
  • Promote early catheter removal to reduce complication risk

Urinary Health Education

Hygiene and Infection Prevention

• Instruct patients on proper perineal hygiene
  • Wipe from front to back after toileting
  • Clean perineal area with mild soap and water daily
  • Avoid use of harsh soaps or douches
• Emphasize importance of hand hygiene
  • Wash hands before and after handling catheter or drainage bag
  • Use alcohol-based hand sanitizer when soap and water unavailable
• Educate on adequate fluid intake
  • Recommend 6-8 glasses of water daily (unless contraindicated)
  • Explain role of hydration in flushing urinary system

Catheter Care and Management

• Teach proper catheter care techniques
  • Keep drainage bag below bladder level to prevent backflow
  • Empty drainage bag regularly (when 2/3 full or every 8 hours)
  • Avoid disconnecting catheter from drainage tubing
• Instruct on mobility with catheter
  • Secure catheter to thigh to prevent pulling
  • Use leg bag for increased mobility during day
  • Switch to larger night bag for overnight drainage

Lifestyle Modifications and Symptom Recognition

• Discuss lifestyle modifications for urinary health
  • Avoid bladder irritants (caffeine, alcohol, spicy foods)
  • Perform pelvic floor exercises (Kegels) when appropriate
  • Maintain healthy weight to reduce pressure on bladder
• Educate on signs and symptoms of urinary tract infections
  • Fever, chills, or malaise
  • Cloudy or foul-smelling urine
  • Increased urgency or frequency of urination
  • Suprapubic pain or discomfort
• Provide guidance on when to seek medical attention
  • Persistent symptoms despite self-care measures
  • Inability to urinate or severe pain
  • Signs of systemic infection (high fever, confusion)