THE URINARY SYSTEM LEARNING PACK

Transcription

1 Page 1 of 25 APPENDIX 1 THE URINARY SYSTEM LEARNING PACK This pack may be used a as learning aid for Care/ Support staff This Learning Pack contains a brief outline of the following areas: The Urinary System Understanding Urine and the Bladder Urinary Incontinence Neurogenic bladder Urinary tract infections Medication Indications for Urinary catheterisation Intermittent Urinary Catheterisation Urethral Catheterisation Suprapubic Catheterisation Catheter Maintenance Solutions Key points for Catheter management Appendices

2 Page 2 of 25 THE URINARY SYSTEM The Urinary System, also known as the urinary tract, is the body s filtering system. As blood passes through the kidneys, waste products are removed and together with excess fluids are excreted as urine. The urinary system also regulates the volume and composition of fluids in the body, keeping an internal chemical balance. The urinary system consists of: Two Kidneys: Each kidney is about cm long and as blood passes through them they filter out waste products that will be excreted from the body as urine. Two Ureters: Each kidney has a ureter, which carries urine away from the kidney into the bladder. The Bladder: The bladder is a hollow muscular organ made up of three types of muscle that stores urine until it is convenient and the muscles at the bladder outlet (urethral sphincter) relax allowing urine to be expelled from the body through the urethra. The Urethra: The female urethra is short (4cm) which causes frequent urinary tract infections. It lies just in front of the vagina. The male urethra is about 20cm long and is made up of three sections: The male urethra transports both urine and semen out of the body. The prostate gland lies at the upper end of the urethra as it leaves the bladder. In older men the prostate gland can enlarge compressing on the urethra and cause problems with urination. The male urethra runs through the penis to an outlet at its tip. Please see the diagrams below.

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4 Page 4 of 25 UNDERSTANDING URINE AND THE BLADDER The kidneys make urine all the time. A trickle of urine is constantly passing to the bladder down the ureters (tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat. The bladder is mainly made of muscle and stores the urine. It expands like a balloon as urine comes down the ureters. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles beneath the bladder that sweep around the urethra (the pelvic floor muscles). When a certain amount of urine is in the bladder one becomes aware that the bladder is getting full. When one goes to the toilet to pass urine, the bladder muscle contracts (squeezes) and the urethra and pelvic floor muscles relax. Complex nerve messages are sent between the brain and the bladder and pelvic floor muscles. These make one aware of how full your bladder is and tell the right muscles to contract (squeeze) or relax at the right time.

5 URINARY INCONTINENCE Page 5 of 25 Incontinence is treatable and not inevitable and all healthcare staff must be aware of the huge social stigma attached to it Noreen Clifford, Jan 2011, Continence Promotion Unit,HSE East Coast. If you have urinary incontinence it means you pass or leak urine when you do not want to. Treatment is aimed at enabling the bladder to empty completely and regularly, preventing infection, controlling incontinence, and preserving kidney function. There are different types, depending on the cause. Stress incontinence. Urine leaks when you cough, laugh, jump, etc. Urgency is the sudden desire to pass urine that is difficult to put off. If one cannot get to the toilet in time then incontinence may occur Urgency incontinence is the involuntary leakage of urine after urgency.as a consequence one will go to the toilet more often. Overactive bladder (OAB) is combination of stress and urgency incontinence and is as result of overactivity of the bladder muscle. Frequency is the complaint of passing urine eight or more times a day. Nocturia is the complaint of waking at night one or more times to pass urine. Neurogenic bladder is due to damage to nerves supplying the bladder. Various nerves converge in the area of the bladder and serve to control the muscles of the urinary tract, which includes the sphincter muscles that normally form a tight ring around the urethra to hold urine back until it is voluntarily released. It is often associated with diseases, injuries, multiple sclerosis, and neural tube defects including spina bifida. Symptoms include the following: Urinary incontinence, characterized by either involuntary release of large volumes of urine or continuous dribbling of small amounts. Bedwetting may occur. Frequent urination Persistent urge to urinate despite recent voiding; a constant feeling that the bladder is not completely empty. Pain or burning on urination. Overflow incontinence is due to a blockage of the urine outlet which upsets the normal control of passing urine. Urine pools in the bladder behind the blockage, but small amounts of urine bypass the blockage and trickle down the urethra. The most common example is incontinence caused by an enlarged prostate gland in men which partly blocks the bladder outlet.

6 Page 6 of 25 Also urine leaks via the urethra due to bladder spasm and this usually occurs when the urethral closing pressure is less than the bladder pressure or contraction. Bladder infection, stones, bladder outlet obstruction, neurogenic bladder can cause the retrograde (backwards) flow of urine from the bladder into the ureters which occurs when the unidirectional valve-like flow between the ureters and bladder fails, (this is called the vescoteric reflex). What are the treatments for OAB/overflow incontinence? Bladder retraining is usually advised at first. This can work well in up to half of cases. Medication may be advised instead of, or in addition to, bladder retraining. Surgery is not commonly advised for incontinence, but may be a last resort in some cases. Surgery may be performed to widen the sphincter to decrease resistance in the bladder outlet and thus maximize bladder emptying. In other cases, the sphincter or lower pelvic muscles may be surgically tightened to improve bladder control. In very severe cases, surgery may be done to reroute the flow of urine so that it empties into an externally worn receptacle creating a stoma. Medication Various medicines are available and include: oxybutynin, tolterodine, trospium chloride, and propiverine. (These also come in different brand names.) They work by blocking certain nerve impulses to the bladder which 'relaxes' the bladder muscle. Oxybutanin also helps decrease bladder spasm, leakage and the reflex mechanism (vesicoteric reflex). This reflex mechanism can be treated initially with antibiotics but long term if the problem gets worse it may require surgery.. Various medications may help improve bladder muscle control and prevent involuntary muscle contractions. Muscle relaxants, antispasmodics and anticholinergic drugs are also helpful. Bethanechol is the most commonly prescribed drug to help stimulate bladder contractions in service users who retain urine. Side-effects are quite common with these medicines, but are often minor and tolerable. Read the information sheet which comes with the medicine for a full list of possible side-effects. The most common is a dry mouth, and simply having frequent sips of water may counter this. Other common side-effects include dry eyes, constipation and blurred vision. However, the medicines have differences, and one may find that if one medicine causes troublesome side-effects, a switch to a different one may suit one better.

7 Page 7 of 25 Urinary Tract Infection UTI S Urinary tract infections don't always cause signs and symptoms, but when they do they can include: Symptoms of Urinary Tract Infections: Passing frequent, small amounts of urine A strong, persistent urge to urinate A burning sensation when urinating Passing frequent, small amounts of urine Urine that appears cloudy Urine that appears bright pink or cola colored - a sign of blood in the urine. Strong-smelling urine Chills Loss of appetite nausea,vomiting Lower abdominal pain Lower back pain or discomfort. Some service users experience UTIs again and again these are called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage Types of urinary tract infection Each type of urinary tract infection may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected. Common types of UTIs include; Cystitis,(bladder) the most common type of UTI, is a bladder infection that can occur when bacteria move up the urethra (the tube-like structure that allows urine to exit the body from the bladder) and into the bladder.

8 Page 8 of 25 Symptoms include; Pelvic pressure, lower abdomen pain, discomfort, frequent, painful urination, blood in urine. Urethritis, when bacteria infect the urethra causing burning with urination. Pylonephritis, a kidney infection that can occur when infected urine flows backward from the bladder to the kidneys, or when an infection in the bloodstream reaches the kidneys. Symptoms include; Blood in urine, upper back and side (flank) pain, high fever, shaking and chills, nausea. Catheterisation A neurogenic bladder usually causes difficulty or full inability to pass urine without use of a catheter or other methods. Catheterisation methods range from intermittent catheterisation, which involves no surgery or permanently attached appliances, to the creation of a stoma, which bypasses the urethra to empty the bladder directly.there are three methods of catheterisation that are commonly used with persons with physical disabilities: 1..Intermittent Self Urinary Catheterisation 2.Urethral Catheterisation 3.Suprapubic Catheterisatiion Catheterisation Training and Policies Cheshire policies and appropriate training available for staff in catheter management,medication administration,infection control,catheter flushing/irrigation, autonomic dysreflexia, intermittent catheterisation. Clinical Practice Policies: CLG 19-28, ICOG1, ICOG2. Management: Assessment and decision to catheterise are clearly documented in service user s Best Possible Health records, including reason(s) for catheterisation and type of catheterisation chosen and next catheter change date. (Use Catheter diary). Psychological needs are addressed as part of the full assessment and access to specialist help/advice offered, if necessary. (Recognising the psychological impact of catheterisation and potential difficulties with body image and sexual functioning allows appropriate support to be offers to the individual (Wilde, 2003).

9 Infection Control: Page 9 of 25 Infection is an inevitable consequence of long-term catheterisation (Winson 1997). Most infections are asymptomatic as a protective layer of mucus on the bladder wall limits bacterial invasion and helps prevent systemic invasion (Getliffe 2003). Antibiotic solutions are not effective in treating catheter-associated urinary tract infection. Good hygiene is essential for preventing catheter-related urinary tract infections. Principles of good practice require that staff must use sterile equipment and an aseptic technique when catheterising service users Medication and catheterisation: Many medications impact on catheter care Anticholerinergics ( For treating gastrointestinal disorders (e.g., gastritis, pylorospasm, diverticulitis, ulcerative colitis.genitourinary disorders (e.g., cystitis, urethritis, prostatitis).respiratory disorders (e.g., asthma, chronic bronchitis) Parkinson's disease and Parkinsonlike adverse medication effects )can cause urinary retention Analgesia can cause constipation which indirectly affects the function of the bladder. Antibiotics can cause bowel dysfunction Warferin and aspirin can increase the risk of haematuria (blood in the urine ) following catheter changes. Intermittent Catheterisation Intermittent catheterisation is recognised as a safe and effective procedure (Bakke et al, 1997) and carries a reduced risk of infection compared to indwelling urinary catheterisation. (Wyndaele, 1990; Bakke, 1991) This is a clean (as opposed to sterile) technique that involves the episodic introduction of a straight catheter into the bladder to remove urine. After the catheter is removed the bladder is empty and the person is catheter-free for intermittent periods. This process is usually done four to five times a day to prevent urinary retention.

10 Page 10 of 25 Studies have shown that those using the clean as opposed to the sterile technique did not encounter problematic urinary tract infection. The advantages include improved quality of life, greater freedom to express one s sexuality and reduced urinary tract complications. Intermittent catheterisation is a technique that may be carried out by the individual themselves (intermittent self-catheterisation), by their carer(s). Persons suitable for intermittent self-catheterisation include: Those who can comprehend the technique and who are highly motivated. Those who have a reasonable degree of manual dexterity and who can position themselves to attain reasonable access to the urethra. Those who have a willing partner or carer to who is trained to assist the service user. The catheters used for intermittent catheterisation can either be single use pre-lubricated catheters or PVC reusable catheters. Reusable catheters are designed to be washed in warm soapy water and dried after each use and reused for a limited period of one week. The catheter should be stored in a plastic container after each use. The bladder must have the capacity to store urine adequately between catheterisations. URETHRAL CATHETERISATION Indwelling Catheters Indications: To relieve incontinence when no other method is practical. To relieve retention. Relief of acute or chronic urinary obstruction. Past medical history and current health status. Urethral Catheterisation is the introduction of a latex or silicone tube into the bladder via the urethra using aseptic technique. The catheter is anchored inside the neck of the bladder by a water filled balloon and is attached to a drainage bag. Catheters come in various sizes and lengths depending on whether one is male or female. Silicone catheters are used for long-term catheterisation. Drainage bags also come in various sizes i.e. 1 and ½ litre bags that can be attached to the leg via straps for daytime use and 2 litre bags for use at night. Leg bags can be attached to the larger night bag for convenience at night. Most bags come with a self-sealing sleeve that can be used to obtain samples of urine without introducing infection.

11 Supra pubic catheter Page 11 of 25 Suprapubic catheter is a tube that's inserted through the abdomen to connect directly into the bladder to drain urine. This type of catheter is commonly used for individuals who have experienced some type of bladder or spinal cord injury and sometimes in men who suffer from prostate problems. Caring for a suprapubic catheter is the same as that of a urethral catheter. Once the insertion site is healed the site and catheter can be cleansed during bathing using soap and water. Why is a Suprapubic Catheter better than a Urethral Catheter? When a urethral catheter is used, the urethra may become damaged over a period of time, resulting in urinary leakage around the catheter. Additionally the balloon of a urethral catheter can cause damage to the bladder neck, leading to urinary leakage. A catheter that is forced through the external sphincter can cause damage. The catheter is less likely to be sat on and accidentally pulled. If a suprapubic catheter becomes blocked, urine can drain via the urethra (although this may not be possible for everyone). This can act as a safety net if a person is affected by autonomic dysreflexia when the catheter blocks. A larger size catheter can be used suprapubically, reducing the risk of blocked catheter. (The larger the catheter, the larger the drainage holes, which reduces the frequency of catheter blockages.) Urethral catheters should not exceed size 14Ch, whereas a suprapubic catheter can be gradually increased over a period of time from a size 16Ch up to a size 20Ch.

12 Disadvantages of a Suprapubic Catheter: Page 12 of 25 A few people experience hypersensitivity around the suprapubic catheter site, but this often reduces with time. If a person is very overweight it may be difficult to site the catheter. The catheter site may produce a discharge. In some people this dries up after a few weeks, but in others it may be persistent. It may be necessary to wear a simple dressing over the site. Spasm may increase for a few weeks after the procedure. All indwelling catheters are more likely to cause urinary tract infections and bladder stones, than other bladder management methods such as intermittent catheterisation or sheath drainage. Key Points for Catheter Management To reduces risk of cross-infection and catheter-related infection; Daily bathing or showering is encouraged. Gloves are worn to empty drainage bags and changed after hand washing between each individual A closed drainage system is maintained as far as possible. Maintaining a closed drainage system reduces the risk of catheter-related infection (Kunin, 1997) Encourage to drink at least 3 litres of fluids (8 glasses) per day to flush through the kidneys and bladder, and to prevent urinary tract infections. If the urine is cloudy, has a bad smell, or has blood in it, seek medical help as there is probably have a bladder infection. Be careful with drinks that have caffeine or alcohol. They can make the bladder fill up suddenly and cause one to get dehydrated. A separate clean container is used for each individual at the time of bag emptying. Contact between drainage tap and container is avoided. Leg bags may also be emptied directly into the toilet. Leg bags should be changed every 5-7 days but if it becomes disconnected from the catheter it should be changed or is visibly dirty /damaged. Night bags ;there are 2 types drainable and non drainable If it is non drainable a new, single-use 2 litre beside bag is used and is emptied and discarded each morning. whereas drainable bags can be reused for up 5-7 nights. Regular observation for: Constipation. Incorrect positioning of drainage tube/kinked tubing. Beside-type drainage bags should be supported above floor level which ensures the maintenance of flow of urine and maximum drainage by gravity, and helps to prevent harmful reflux.

13 Page 13 of 25 Drainage bag over full.trauma to the neck of the bladder may be caused by downwards pull of the catheter if the bag is left to become too full or is not adequately supported. Empty when three quarters full. Balloon under or over inflated. It is usual to have 10mls of water in the catheter balloon. If it is found that the amount of water in the balloon has reduced when the catheter is next changed, do not worry, it is not unusual. If the catheters are falling out before their change date, it will be necessary to replace the water in the balloon i.e. remove the amount in the balloon and insert 10mls of sterile water back into the balloon. Encrustation (Up to 50% of all users of long term catheters) Debris- If a service users intake is low the urine becomes concentrated and any debris is less likely to be flushed from the bladder Catheter size may be too large. Caring for a suprapubic catheter: Use a thigh strap and, if necessary, tape the catheter to the abdomen. This will reduce the likelihood of the catheter being pulled. It is advisable to alternate the leg one wears the leg bag on. This helps the catheter to lie in a different position each day, minimising soreness at the catheter site. Some people use a catheter valve with their suprapubic catheter which enables them to turn their urinary drainage off and on. This may also mean that you may be able to manage without a urinary leg bag. Consult the Continence Promotion Unit. Catheter maintenance solutions: Irrigation is the continuous washing out of the bladders with sterile fluid to prevent and dissolve crystallization in the catheter or the bladder, to remove tissue debris and small blood clots and to prevent and reduce bacterial growth Some service users may benefit by using catheter maintenance solutions to prolong the life of their catheter, avoiding the trauma of recatheterisation. Catheter maintenance solutions are only used following medical advice, prescription and thorough assessment There are many potential causes of catheter blockage, and treatment should be based on clinical evidence.

14 Page 14 of 25 Records maintained of catheter history including: Problems associated with bowel habit Debris in urine Crystals on catheter tip at removal The ph scale The ph scale is measured regularly to decide which type of Catheter Maintenance Solution is required. Urinary ph is a measurement of the acid alkaline content in urine which ranges from 0 to 14 and is measured using a dipstick/uritest. The 0 end of the scale is where the concentration is increasingly acidic. Most biological fluids are between ph 6 and ph8, there are a few exceptions to this like stomach acid. Braun recommends that if there is debris but the ph is normal.9% saline can be used to remove debris. If the ph is >6.8 and there is debris/crystals suby G is to be used and if the person is a persistent blocker and the ph is >7.7 solution R is to be used. Administration of catheter maintenance solutions requires breakage of the closed drainage system increasing the risk of introducing infection and infection control guidelines need to be adhered to: Where a catheter maintenance solution is used, the effect of the treatment is assessed and ongoing care planned accordingly. Records are advised the of solution used, effect on catheter drainage, any adverse reactions and ongoing catheter history as before Keep Best Possible Health Catheter Maintenance. A Best Possible Health Specialised Bladder plan will include annual or as required recommendations to; Commence Bladder / Intake / Output Chart Review need for aids/appliances Healthy bladder information Referral to GP/Physio/Urologist/Continence Promotion Unit.

15 Bladder Assessment Tool: Page 15 of 25 The bladder assessment tool records if the service user has AOB, neurogenic bladder incontinence or overflow incontinence. This will be recorded in the Best Possible Health Continence care plan which will be supervised by a Cheshire nurse/phn/continence Promotion Unit. Checklist for bladder management Best Possible Health Specialised Bladder plan. Catheter Diary. Referral to a urologist with an interest in the Neurogenic bladder for regular (preferably yearly) urodynamics to check bladder and kidney function. Access to Cheshire nurse, PHN, Continence adviser with knowledge of the Neurogenic bladder. An explanation of how good bladder management will protect the kidneys. Ability to recognise urinary tract infections and know how to deal with them. Discuss continence products management techniques with the PHN / Continence nurse that may help the service user to effectively manage the bladder problems. Appendices: Appendix 1. Spina Bifida and bladder problems Most service users with Spina Bifida may experience problems with their bladder. It is important to make an appointment with the G.P. or continence nurse about bladder problems and ensure that service users affected can manage their bladder problems successfully. Latex allergy 23-50% of people have latex sensitivity and this Latex allergy can get worse. It is recommended to avoid exposure to latex in hospital and home. Carry non-latex gloves with you to doctor/dentist/medic-alert bracelet/epi-pen.

16 Page 16 of 25 Appendix 2 Multiple Sclerosis (MS) and Incontinence Approximately, 3 in 4 people with MS will suffer with continence problems, bladder and bowel problems can come and go and can be more pronounced at some times than at other times. It is difficult for service users to discuss continence problems but it is important to talk to a health professional as there is help and support available..incontinence can also develop as a secondary symptom which means that incontinence can be caused by another symptom and not directly by MS nerve damage. These symptoms can include: Getting to a toilet in time. MS makes moving about difficult which can cause problems in getting to a toilet. A visit to an occupational therapist may be able to help with these problems. Restricted physical activity can often lead to constipation and poor muscle tone which can then lead to bladder and bowel problems. A physiotherapist could help and set an exercise programme which could help to alleviate problems. Appendix 3.Autonomic dysreflexia (AD) All staff need to identify if the service user is affected by autonomic dysreflexia when caring for people with spinal cord injuries. Autonomic dysreflexia, occurs at injury levels above T-6 (mid chest). It can develop suddenly and is potentially life threatening and is considered a medical emergency. Definition: AD occurs when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder, poor bowel care or skin problems. The most common cause seems to be overfilling of the bladder. This could be due to a blockage in the urinary drainage device, bladder infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly stones in the bladder Signs or Symptoms of AD are: high blood pressure pounding headache flushed face red blotching on chest sweating above level of injury goose bumps nausea feeling anxious.

17 Page 17 of 25 Staff can help prevent AD by: Keeping the catheter equipment clean and draining freely. Emptying the bladder routinely. Following a regular bowel program. Checking skin daily. Wearing loose fitting clothing and checking for painful stimuli and removing. If signs of distress or autonomic dysreflexia occurs: Stop the any bladder procedure, Sit upright as this will bring blood pressure down slightly. Follow guidelines Contact Accident & Emergency Department On arrival at hospital a person should be specifically coded for immediate attention Remember - Carry a Card! Always remind service user to carry a card which identifies AD. Give this to staff in an Emergency Room or the doctor's office if the service user has an AD attack.

18 Page 18 of 25 Appendix 4. Bladder Assessment Tool and Catheter Diary Does the Service User: Leak urine when they: Laugh Cough Exercise Get up from bed Have leaking or wetting accidents? Yes No Appear to have an urgent need to pass urine? Yes No Is the service user able to hold on for a few minutes? Yes No Or do they have to go immediately? Yes No How Often: Will the service user go to the toilet during the day? 5-7 Times or 7 plus Get up during the night to use the toilet/urinal? or more Does the Service User: Know when they need to use the toilet? Yes No Have difficulty in passing urine? Yes No Have weak flow or post voiding dribble? Yes No Complain they have a full bladder even after going to toilet? Yes No Know when they want to go but are unable to go to toilet? Yes No Have a history of UTI s Yes No How many per year Complain of: Pain Bleeding Discomfort when passing urine Stress OAB Nocturnal Enuresis Neurogenic Or Outflow/ Obstruction Functional Infection Result of Urinalysis Result of MSU Details of Urology / Other investigations

19 Page 19 of 25 Catheter Diary Please ensure this booklet is completed Each time your catheter is changed Service user:... Address G.P.Name and contact details.... Consultant:... Health Care Professional (PHN Nurse/Cheshire Nurse etc.) Name and contact details:... 1a. Reason for catheterization:... 1b. Date of initial catheterization: Recommended catheter:... Manufacturer:... Type:... Charriére (Ch.) size:... Balloon size: Residual: How often catheter should be changed:.. 5. Known Allergies:...

20 Page 20 of 25 Catheter Diary continued Catheter Change Date: Insertion Easy: Yes/No Comments/Problems: Reason for change: Routine Fallen Out Balloon Burse Blocked Catheter Maintenance Solutions/Antibiotic Therapy Give Details: CSU Yes No Name of Nurse/Doctor/Carer:... Due Date of Catheter Change:... Recorded in BPH Daily Continuation sheet Catheter Change Date: Insertion Easy: Yes/No Comments/Problems: Reason for change: Routine Fallen Out Balloon Burse Blocked Catheter Maintenance Solutions/Antibiotic Therapy Give Details: CSU Yes No Name of Nurse/Doctor/Carer:... Due Date of Catheter Change:... Recorded in BPH Daily Continuation sheet

21 Page 21 of 25 Catheter Irrigation (Flushing) Record Name: Cheshire Service Date Date of Next flush Solution used Amount PH Signature Observations Cheshire Ireland Document Name: Catheter Irrigation (Flushing) Record Document Number: CR 01 Version Number: 0 Version Date: 1/6/11 Developed by: Practice Development Coordinator Approved by: National Risk Management Committee Approval Date: 1/6/11 Review Date: 31/5/13

22 Catheterisation Record Page 22 of 25 Name: Date of Insertion Date of Next Change Catheter Type Size Balloon Volume Signature Reason For Change Cheshire Ireland Document Name: Catheterisation Record Document Number: CR 01 Version Number: 0 Version Dat1/6/11 Developed by: Practice Nurse Coordinator Approved by: National Risk Management Committee Approval Date1/6/11 Review Date: 01/6/13

23 Page 23 of 25 INTAKE AND OUTPUT RECORD NAME: DATE: Time Type of Fluids Food Intake Other Output Bowels Comment Oral PEG Vol Flush TOTAL TOTAL IN : TOTAL OUT : PEG Feed Regime Type of PEG Feed Time Started Rate Time Finished Urinalysis Record Blood Protein Leukocytes Glucose Ketones PH Cheshire Ireland Document Name: Input Output Recor Document Number: IOR 01 Version Number: 0 Version Date: Developed by: Nurse Development Forum Approved by: National Risk Management Committee Approval Date: 1/6/11 Review Date: 31/05/13

24 Page 24 of 25 Appendix 5. What does the continence advisory nurse do? There is usually open access to continence promotion clinics and details can be found by contacting your local HSE area. People can also be referred by GPs, practice nurses or public health nurses. The services are for people who have all types of incontinence. At the clinic a detailed assessment is carried out. This will include questions about the nature of a service user s problem and the symptoms. A urinalysis will be carried out and bowel history if appropriate. Other issues will be reviewed such previous surgery, underlying medical condition, current medication, emotional aspects, and mobility problems. Where appropriate, the continence nurse may refer for specialist advice. Urologists, gynaecologists, physiotherapists, dietitians and occupational therapists all have a role in treating various types of incontinence. The continence service can give guidance and advice on issues such as: Readjusting fluid intake Bladder retraining Pelvic floor exercises Individualised toileting programmes Bowel programmes Self catheterization Catheter management Medication review Environment changes Counselling and advice Electrotherapy Diagnosis of Neurogenic Bladder A thorough bladder history is essential to record 24-hour urination patterns, including the actual volume of urine voided, how urgent the feeling is to urinate and any factors that aggravate incontinence. A t the Urology Assessment Unit a physical examination will likely include a rectal, genital, and abdominal exam to check for enlargement of the bladder or other abnormalities. A complete neurological examination is also essential. Tests to measure urine output are conducted. To determine whether urine is retained after voiding, the doctor may use an ultrasound-like instrument that estimates the amount left in the bladder or insert a catheter into the bladder.

25 Page 25 of 25 Urine or blood samples may be taken to look for abnormalities including infection and underlying disorders that might be causing or aggravating the condition. References Mallett, J. & Dougherty, L. (2000). The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Blackwell Publishing, Oxford. Nicol. M., Bavin, C., Bedford-Turner, S., Cronin, P. & Rawlings-Anderson, K. (2004). Essential Nursing Skills. Mosby, United Kingdom. Robertson, B. & O Kell, S. (1995). Study Guide for Health and Social care Support Workers. First Class Books Pub., Bristol. How to Take Care of a Suprapubic Catheter ehow.com An overview of Supra-pubic Catheter Care in Community Practice Deborah Rigby, NHS, Bristol Catheter Care RCN Guidance for Nurses 2008 Why is a Suprapubic Catheter better than a Urethral Catheter? Duke of Cornwall Spinal treatment centre NHS Trust Urinary tract Infections UTIS Bowel and bladder foundation info@bladderand bowelfoundation.org