ANATOMY AND PHYSIOLOGY OF IV.

URETHRA
THE URINARY SYSTEM
- serves only as a passageway for the
elimination of urine
- extends from the bladder to the
urinary meatus (opening)

ALTERED URINE PRODUCTION

● POLYURIA
- _________________________
- >30 ml/hour or >1500 ml/day
- causes: DM, diabetic insipidus, too
I. KIDNEY many diuretics

Fxn:
● OLIGURIA
- _________________________ - ____________________
- creates urine as a waste by-product
- eliminate liquid waste called urea ● ANURIA
- “A WET BED” - ____________________
A — _____________________ - <100 ml/day
W — _____________________
E — _____________________ ALTERED URINE ELIMINATION
T — _____________________ ● URINARY FREQUENCY
B — _____________________
E — _____________________ - voiding at frequent intervals that is
more than 4 to 6 times per day
D — _____________________
● _______________
Location: _________________________
- voiding two or more times at night
II. URETERS
● DYSURIA
Fxn:
- _______________
- passageway of urine from the kidneys to
the bladder ● ENURESIS
Size (ADULT):
- _________________________
_________________________
● URINARY INCONTINENCE
III. BLADDER
- uncontrolled leakage of urine
- triangle-shaped, hollow
- two categories: acute and chronic
organ
Causes:
Fxn:
- UTI
- reservoir for urine and as the organ of
- urethritis
excretion
- urinary tract
- normal bladder capacity is between
- pregnancy
_________________________
- restricted mobility
Location: Lower abdomen
- delirium
 ● URINARY RETENTION COLORS OF URINE

- impaired emptying of bladder CLEAR - too much water

sx: ____________________ PALE/TRANSPARENT - enough water

● _________________________ _______________ - dehydrated

- patient doesn’t perceive bladder fullness ORANGE - _________________________
and is unable to control the urinary
sphincters DARK ORANGE/BROWN -
_________________________

Characteristics of Normal and Abnormal DARK BROWN/BLACK - liver disease,

alkaptonuria
NORMAL ABNORMAL
CHARACTER _______________ - blood in urine or from
medications
ISTICS
_______________ - from a dye. GREEN = UTI
1200-1500 mL
CLOUDY - UTI
Amount in 24 <1200 - >1500
hours (adult) mL WHITE/MILKY - chyluria

Color, clarity Clear,

transparent, Dark amber, BLADDER IRRIGATION
amber cloudy dark
orange, red or - is a technique to flush or wash out
dark brown the bladder with a specified solution
mucous plugs, carried out on a physician’s order.
viscid thick
Purposes:

- primary use as following a

Odor Faint aromatic Offensive genitourinary surgery to keep the
bladder clear and free from blood
Sterility clots or sediment
No Microorganisms - to prevent and treat infection
microorganisms present - to maintain patency of the catheter
- to allow free flow of draining urine
pH 4-5.8
Over 8, under - to relieve congestion and pain in
4.5 cases of inflammatory conditions
- to instill medication
1.010 - 1.025
Specific Over 1.025, TYPES OF BLADDER IRRIGATION
Gravity under 1.010
A. CLOSED BLADDER IRRIGATION
- are systems used to irrigate the
Glucose Not present Present bladder without disrupting the sterile
alignment of the catheter and
drainage system
Not present
- used most frequently in clients who
Ketone Bodies
have had genitourinary surgery
(acetone)
- irrigates through a three-way
catheter
 ● Post TURP (transurethral resection of
the prostate)

CONTRAINDICATION
● Traumatic injury to the lower urinary
tract

COMPLICATIONS
● ____________________
Nx: Keep bladder empty
● Bladder distention
● One lumbar drains urine of the patient ● Trauma to the bladder wall
● One is from the irrigating solution
● One is to inflate the catheter EQUIPMENT
● Clean gloves
EQUIPMENT ● Sterile gloves
● Disposable water-resistant towel
● Clean gloves (2 pairs)
● Sterile irrigating solution
● Indwelling catheter in place
● Sterile irrigating set
● Drainage tubing and bag (if not in place)
● Sterile basin
● Antiseptic swabs
● Sterile 50 ml asepto syringe
● Sterile receptacle
● Antiseptic swabs
● Sterile irrigating solution
● Sterile protective cap (for catheter
- warmed or at room temperature drainage tubing)
- label the irrigant clearly with “Bladder
Irrigation” including information about SOLUTIONS USED
any medication that has been added to the
original solution, date, time, and nurse’s ● Distilled water
initials. ● _______________
● Infusion tubing
ASSESSMENT
● IV pole ● Assess LOC and ability to cooperate.
● Palpate bladder for distention and
B. OPEN BLADDER IRRIGATION
tenderness.
- also used to maintain catheter patency.
● Observe urine color, amount, clarity
However, this system is used when bladder
and presence of mucus and clot
irrigations are required less frequently (e.g.,
debris.
every 8 hours)
● Ask the patient to describe bladder
- this type of irrigation requires the nurse to
pain.
aseptically break the closed drainage system
(usually done manually by the nurse using an ● Review the I&O record.
asepto syringe) ● Verify that the hourly output into the
- irrigates through a two-way foley catheter drainage bag is in the appropriate
proportion to the irrigating solution
entering the bladder.
INDICATIONS
● Urinary retentions
ROLES AND RESPONSIBILITIES OF A
● Blood clot
NURSE
● Pus inside the catheter
• Maintains the patient's comfort.
• Ensures urinary catheter patency and urine PROCEDURE
drains freely.
1. Verify the physician’s order
• Monitors the degree of haematuria and the 2. Identify the patient
presence of clots and adjusts the irrigation 3. Introduce yourself to the patient
fluid infusion rate accordingly.
4. Explain the procedure to the patient
• Ensures an adequate supply of infusing 5. Assess the patient to determine if the
fluids is nearby and stored at room intervention is still appropriate
temperature to avoid bladder spasm. 6. Gather all necessary equipment
needed
• Responsible for documentation.
7. Perform hand hygiene
A. For closed continuous irrigation, open 8. Adjust bed to the appropriate height.
the flow clamp on the urinary drainage If the side rail is raised, it should not
tubing (if present). restrain the patient’s movement
- Open the regulating clamp on the 9. Provide privacy
irrigating tubing and adjust the flow rate 10. Position and drape the patient
as prescribed by the primary care 11. Place label on the irrigation solution
provider or to 40-60 drops per minute if bag
not specified. 12. Clearly mark the bag FOR
- Assess the drainage for the amount of BLADDER IRRIGATION ONLY
drainage should equal the amount of 13. Hang bag on the IV pole
irrigant entering the bladder plus
14. Using aseptic technique, insert the
expected urine output.
spike or tip of the sterile irrigation
B. For closed intermittent irrigation,
tubing into the bag containing the
determine whether the solution is to
irrigation solution.
remain in the bladder for a specified
time. 15. Close clamp on tubing, fill the drip
chamber one-half by squeezing the
- If the solution is to remain in the bladder (a
chamber
bladder irrigation or instillation), apply the
flow clamp to urinary drainage tubing. 16. Open the clamp to completely fill
the tubing and remove air
- If the solution is being instilled to irrigate
the catheter, open the flow clamp on the 17. Wear clean gloves
urinary drainage tubing. 18. Using aseptic technique, wipe off the
- Open the flow clamp on the irrigating irrigation port of triple-lumen
tubing, allowing the specified amount of catheter with antiseptic swab and
solution to infuse. Clamp the tubing. connect to irrigating tubing
After the specified period the solution is to be 19. Calculate the drip rate and adjust
retained, open the drainage tubing flow clamp rate of roller clamp according to
and allow the bladder to empty. physician’s order
- Assess the drainage for amount, color, and 20. If urine is bright red or has clots,
clarity. The amount of drainage should increase the irrigation rate until
equal the amount of irrigant entering the drainage appears pink
bladder plus expected urine output. 21. Replace bag of irrigation solution as
- Assess the client and the urinary output. needed
22. Empty catheter drainage as needed.
● Assess the client's comfort.
Bag will fill rapidly and may need to
● Empty the drainage bag and measure emptied every 1-2 hours
the contents. Subtract the amount of irrigant 23. Compare urine output with infusion
instilled from the total volume of drainage to of irrigation solution every hour
obtain the volume of urine output.
24. Assist client to apposition of comfort
- Document the procedure and results in the and place needed items within reach
client record using forms or checklists 25. Raise side rails and low the bed to
supplemented by narrative notes when the lowest position
appropriate.
 26. Aftercare of equipment If the patient becomes confused or
27. Remove gloves
agitated post-turp
28. Perform hand hygiene
29. Chart including the patient’s response TURP SYNDROME- occurs when there is an
and unexpected outcomes. excessive amount of irrigation fluid absorbed
through an open prostatic sinusoid during the
operative procedure.
PATIENT MANAGEMENT
Signs and Symptoms
If the amount of drainage is less than the irrigant
infused - restlessness
- agitation
- Turn off the irrigation.
- confusion
- Check for kinks/loops in the catheter or
drainage bag tubing. - seizures

- Palpate the bladder - coma

- and note any patient pain or discomfort. Complications on Cardio:

- Bladder scan is useful to determine ● WATER INTOXICATION
bladder volume.
● HYPONATREMIA
- Check the height of the IV pole and for
overflowing of the drip chamber (can Management:
affect patency).
- Correct Sodium Imbalances =
- If unsuccessful, notify the relevant PNSS+CBI
medical officer.
If there is an increase in hematuria or clots WOF: Cerebral Edema
present
- Correct Volume Overload = Fluid
- Increase the infusion rate and observe Restriction + loop diuretics (ex:
the drainage and patient comfort. furosemide)

- If unsuccessful, notify the relevant ASSESS PATIENT FOR:

medical officer. - Orientation to time
If the patient is experiencing pain - Person and pace
- If ALOC: notify physician
- Turn off the irrigation and check for
kinks, loops or clots in the catheter or CLOSED IRRIGATION OPEN IRRIGATION
drainage bag tubing
- Palpate the bladder to determine
distention.
- Check drainage to determine if output is
adequate.
If there is leakage around the catheter (bypassing)

ASSESS FOR:

- obstruction
- bladder spasm
Prepared by:
- med mngt:
PCI: Cherie Chel L. Icalina — BSN IV -
● DITROPAN – relaxes smooth muscles NEUMAN
● PRO-BANTHINE – decrease muscle spasm
AVOID cold irrigation fluid