Ministry of Health of Republic of Belarus
Education establishment
«The Gomel State medical university»
Chair of Internal Disease №1 with Endocrinology Course
It is discussed at the meeting of chair 30.08.2016
Protocol № ______
METHODICAL REVIEW
for practical training of foreign students of the 1st course
«Supervision and hygienic care of patients with function break of genitourinary system»
Theme 10 (Lesson 16; 17)
6h.
1. Training and educational goals, motivation for theme learning, requirements of initial level of knowledge
1.1 Aim of training: Learn the basic principles of care of patients with kidney disease and urinary tract.
1.2 Requirements to initial level of knowledge: during the training the student should
To know:
1. The basic principles of care of patients with kidney disease and urinary tract.
2. The procedure of preparation of patients for instrumental studies of the urinary system.
To be able to:
1. Caring of patients with kidney disease and urinary tract.
2. Prepare the patient for instrumental examination of the urinary system.
2. Checklist from related subjects
1. Anatomy of the kidney and urinary tract.
2. Physiology of the kidneys and urinary tract.
3. Questions on an occupation subject:
Lesson № 16:
1. Methods of monitoring and care of patients with diseases of the genitourinary system.
2. Diuresis, method of registration.
3. Care of patients with urination disturbance.
4. Indications and technique of bladder catheterization for men and women.
Lesson № 17:
5. Methods of collecting urine for the general analysis, Nechiporenko analysis, Zimnitsky analysis, urine sugar analysis, glycosuric profile.
6. Preparation for additional studies of the genitourinary system.
7. Feeding features of patients with kidney and urinary tract diseases.
4. Materials for self-preparation:
Lesson № 16:
1. Methods of monitoring and care of patients with diseases of the genitourinary system.
Nephrology (Greek «nephros» -Kidney, «logos» - teaching) is called a section of internal medicine which studies the etiology, pathogenesis and clinical course of kidney disease, which develops methods of diagnosis, treatment and prevention.
Observation and care of patients with kidney disease and urinary tract should be carried out in two directions.
1. General measures - measures to monitor and care needed by patients with diseases of various organs and systems: monitoring of the general state of the patient, a thermometer, monitor the pulse and blood pressure, the filling temperature of the sheet, providing personal care of the patient, vessel supply, and others.
2. Special events - event monitoring and care designed to help patients with symptoms characteristic of diseases of the urinary - pain in the lumbar region, edema, urination disorders, arterial hypertension and others.
A patient with renal disease and urinary tract requires careful monitoring and careful maintenance. When it appears (or gain) in the patient edema, urinary disturbances, change in urine color, increased blood pressure, dyspepsia, deterioration of the general condition of the patient nurse must immediately inform the doctor.
2. Diuresis, method of registration.
Every 5-10 minutes through the kidneys passes the entire mass of the body's blood; per day kidneys "chased" up to 1000 liters of blood. Urine formed in the kidneys continuously, gradually standing out via ureters into the bladder. In a broad sense, the term "diuresis" refers to the process of formation and excretion of urine, but it is most often used to describe the amount of urine (Greek diureo - Secrete urine). The total amount of urine a person during the day, called circadian diuresis. The average urine output for 1 minute call minute diuresis (this value is used in the calculation of quantitative indicators of kidney function).
The daily amount of urine secreted by adult normal ranges from 1000 to 2000 ml, with an average of 50-80% of an oral liquid. The rest of the volume of fluid is released through the lungs (300-400 ml, during exercise up to 500 ml / day), and skin (300-400 ml / day); about 100 ml is excreted in the feces decorated. Urine output increases when receiving large amounts of fluid and food that increases urine output and, on the contrary, decreases during exercise and in hot weather when sweating, vomiting, diarrhea.
Violation of urine output is the most common symptom of kidney and urinary tract diseases. There are the following changes in urine output.
Polyuria (from the Greek «polys» -Many, «uron» - urine) is an increase in the daily amount of urine of more than 2000 ml. Polyuria is often associated with increased thirst and increased fluid intake.
Oliguria (from the Greek «olygos» - Small, «uron» - urine) is a decrease in the number of allocated urine per day to 500 ml or less.
Anuria (from the Greek «an» - absence, «uron» - Urine) is failure to urine in the bladder, which may be a consequence of the termination of its isolation (100 ml / day or less up to the complete absence of urine).
Ischuria (from the Greek «ischo» -To delay, hinder, «uron» - urine) is the inability to empty the bladder, in spite of the overflow of his urine (urinary retention).
Nicturia for normal renal function characterized by a significant prevalence of daily urine output over the night (the ratio of day to night diuresis in a healthy person is about 4: 1). Nocturia (from the Greek «nyktos» -. Night, «uron» - urine) is change in this ratio in favor of nocturnal diuresis (urine when most stands out day and night).
Enuresis. Often in patients with elderly nocturia combined with incontinence - enuresis (from the Greek "enireo." - Urinate).
Pollakiuria. The frequency of urination is normal 3 to 4 times a day. Pollakiuria (from the Greek «pollakis» -. Many times, often, «uron» - urine) is frequent urination (more than 6-7 times a day).
Dysuria (from the Greek «dys» -Prefix denoting difficulty dysfunction, «uron» -mocha) is the common name of urination disorders in the form of pain, palpitations and / or difficulty of urine excretion of urinary bladder. Dysuria appears common symptom for various inflammatory diseases of the genitourinary system (cystitis, urethritis, pyelonephritis, renal tuberculosis, etc.), Passing for ureteral stones.
Strangury (from the Greek «strangos» -. Something squeezed out, drop, «uron» - urine) - urinating small amounts (drops) because of its steep difficulty.
Methods of determining the water balance and control set out in the methodological development of the theme "Caring for the sick and monitoring diseases of the cardiovascular system."
3. Care of patients with urination disturbance.
Patients with impaired urination require a lot of attention. The patient with enuresis mattress should be covered with oilcloth, spread a sheet on top of it. If you frequently need to give the patient diuresis diapers to lay their crotch; currently special diapers for adults used for this purpose. the patient's skin should be carefully washed baby soap; skin of the hands, feet and physiological folds should be lubricated with baby cream daily. When incontinence each time of departure should undermine the patient for the prevention of pressure ulcers and prevention of skin infection.
If seriously ill, feel the need to empty the bladder, is in the general ward, it is desirable to isolate the sick from other with screen.
When submitting the urinal vessel should be borne in mind that not all patients are free to urinate while lying in bed. Therefore, the urinal vessel should always be warm. Where necessary (unless contraindicated), sometimes it is advisable to put a warm heating pad on the suprapubic area. After voiding the bag is emptied and washed well. Once a day is necessary to rinse the urinal vessel with a weak solution of potassium permanganate or hydrochloric acid to remove its walls formed on a dense precipitate ammonia odor.
Emergency aid to the patient with urinary retention is an early excretion of urine from the bladder. Independently urinate may contribute noise flowing from the tap water, irrigation genitals with warm water, if not contraindicated attachment warmers on the suprapubic area. If these measures proved ineffective, recourse to bladder catheterization, or the imposition of cystostomy.
4. Indications and technique of bladder catheterization for men and women.
Catheterization of the bladder is the introduction of a catheter into the bladder is held to derive from it the urine, bladder irrigation, the introduction of drugs or extraction of urine for testing. It requires special precautions so as not to add to the urinary bladder infections. Therefore catheterization should be performed only when necessary. Catheterization is carried out with the help of soft and hard catheters. Soft catheter is a flexible rubber or polymer tube to 25-30 cm in length and with a diameter up to 10 mm (№1-30). The upper end of the catheter curved, side blind with small oval holes. The outer funnel end of the catheter is extended in order to make it easier to insert the tip of the syringe for administration of drug solutions and rinsing the bladder. Currently used disposable sterile catheters, and often include the bag (see. Fig.). Very easy to work disposable catheters with a hydrophilic lubricant. It (Example EasiCath) made of polyvinyl chloride and over the entire surface covered with a hydrophilic lubricant, which is activated by contact with water and increases in volume, creating a completely smooth and slippery film on the entire surface of the catheter. Catheterization using such a catheter does not require special oils or gels for administration to the bladder. They are widely used for catheterization carried out by the patient himself.
In some cases the catheter may be mounted on a longer term. For this purpose, use disposable Foley catheter. It is a double-lumen tube, one channel is used to remove urine from the bladder, and the other communicates with a spout near the sealed chamber of the catheter. This catheter can be mounted in a bubble in the required time (a day or more) for the permanent removal of urine. Fixing Foley catheter in the bladder is carried out through an original cuff, which is formed by introducing a second catheter lumen in sterile liquid volume of 10-15 ml (see. Fig.).
Administering to a female catheter
Indications.
- Acute urinary retention.
- Washing of the bladder and the insertion of the drugs.
- Collection of Urine for Research.
Contraindications.
- Damage to the bladder, urethral rupture.
- Acute inflammation of the bladder, urethra.
Facilities (sterile):
Bathrobe, cap, mask, waterproof apron, catheters, forceps anatomy - 2 pieces, forceps, tray, clean and sterile gloves, a sterile cloth (gauze) tissue -. In sufficient numbers, sterile disposable Foley catheter or other disposable catheter, sterile syringe 20 ml sterile pp chloride and 0.9% sodium furatsillina solution of 1: 5000, for the collection of urine drainage bag or tray, a container of disinfectant solution, oilcloth underlayer, an antiseptic solution for cleaning the, tube with a sterile lubricant.
The procedure is performed in a bed (it is possible on the gynecological chair in the office of manipulation). Assistant Help simplify the procedure.
Preparation for the procedure:
1. Explain to the patient the need for the procedure, its essence, to get her consent.
2. Carry out hygienic hand antisepsis.
3. Wear clean gloves
4. Place the patient on his back, legs bent at the knees and slightly dissolve in hand.
5. Support under the patient's buttocks with oil cloth napkin (diaper). On top of the protruding edge of the diaper to put the boat (you can use sterile disposable surgical drapes with a slit in the center of the tape down).
6. Prepare the equipment for cleaning the patient.
7. Stand to the right of the patient, in his left hand to take the container (pitcher) with a solution for cleaning the in the right forceps with a napkin. Substitution of patient movements from top to bottom, in sequence from the pubis to the anus.
8. Change napkins, dry skin in the same sequence as the waste dump wipes, gloves in the package with the used material.
9. Prepare equipment for catheterization
10. Wash hands, perform hygienic antiseptic, put on sterile gloves.
Implementation procedure:
1. Extend the left hand labia, right hand with tweezers to take a gauze soaked in a solution of furatsilina.
2. Process the urethral opening move downwards between the small labia.
3. Change the gauze.
4. Apply a cotton swab soaked in furatsilina solution to the opening of the urethra for one minute.
5. Reset the swab into a solution for disinfection, change tweezers. Each swab is used only once, for cleaning the six used tampons.
6. Take the tweezers beak soft catheter at a distance of 4-6 cm from the end, as the stylus.
7. Stroke the outer end of the catheter over the brush and clamp between the fourth and fifth fingers of his right hand.
8. Douse the beak of the catheter with sterile water-soluble lubricant (abundantly).
9. Extend the left hand labia, gently introduce the catheter right by the length of 4-6 cm until urine (see fig.).
10. Lower the free end of the catheter into a container to collect the urine.
11. Reset the tweezers on the tray, followed by disinfection.
12. Push the left hand above the pubis, at the same time removing the catheter after the cessation of self-discharge of urine from the catheter.
13. Remove the catheter and dump it into a container for subsequent disinfection.
14. Remove gloves and place in a container for waste materials.
15. Wash hands, perform hygienic antiseptic.
Introduction catheter to man
Indications:
- Acute urinary retention.
- Washing of the bladder and the insertion of the drugs.
- Preparation of urine for testing.
Contraindications:
- Damage to the bladder, urethral rupture.
- Acute inflammation of the bladder, urethra.
Facilities (sterile):
Bathrobe, cap, mask, waterproof apron, catheters, forceps anatomy - 2 pieces, forceps, tray, clean and sterile gloves, a sterile cloth (gauze) tissue -. In sufficient numbers, sterile disposable Foley catheter or other disposable catheter, sterile syringe 20 ml sterile pp chloride and 0.9% sodium furatsillina solution of 1: 5000, a tray for collecting urine or a urine collection bag, a container of disinfectant solution, oilcloth underlayer, an antiseptic solution for cleaning the, tube with a sterile lubricant (Fig.).