Fundamentals - Practice & Skills, part 22: Urinary Specimen Collection, Incontinence, and Urinary Tract Infections
August 16, 2021 Updated: August 22, 2021 6 min read
Hi. I'm Meris. And in this video, we're going to be talking about urine characteristics, urinary specimen collection, urinary incontinence, and urinary tract infections, UTIs. I'm going to be following along using our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. And if you already have a set and you'd like to follow along with me, I'm starting on card number 115. Let's get started. So first up, let's just kind of talk about normal, expected characteristics of urine and things that we need to know as our normal values and limits. Our urine output should be, basically, 0.5 to 1.5 milliliters per kilogram per hour. Obviously, this is kind of just a big range. But in general, we are hoping to see about 1,500 mls, which is 1.5 liters per day of urinary output. We do, however, need to alert the provider if our patient's urinary output is ever less than 30 milliliters an hour. That's already below what the standard is for a patient's output. But that indicates that they are actually having severe oliguria, and that needs to be brought to the provider's attention.
Now, specific gravity is a measurement that you'll see reflected in urinalysis, and it talks about how concentrated urine is. So if we have a low specific gravity-- so our normal range is 1.005 to 1.030. Check the lab values deck if you want more on that. But if we have a low urine-specific gravity, this means that we have dilute urine, so it's not concentrated. So we do have a nice, cool, chicken hint here on this card, that dilute urine, with an L, dilute, is going to have low, with an L, specific gravity. So that's how you can remember those, because it can get confusing. Urine should be clear. So if it is hazy or cloudy or malodorous, if it smells bad, that's not a good thing. We want to consider that abnormal.
So moving on. Let's talk about the different types of urinary specimens that we can collect. And there's a lot of information on this part because we talk about routine urinalysis, clean catch, 24-hour urine specimen collection, sterile specimens, all of those things. But big ones I want to bring to your attention, a clean catch urine specimen. So this is going to be done by the patient while they are urinating. And we have different teaching for people who have a penis versus a vulva. If a patient has a penis and is uncircumcised, we need to teach him to retract the foreskin and then clean around the urethral meatus, the opening of the urethra. And then they should replace the foreskin after they're done urinating. If somebody has a vulva, though, we want them to separate the labia so that the urethral opening is exposed and clean from front to back using the designated wipes. Usually, these are Castile soap wipes, but they are going to clean away any kind of grime or dead skin cells from the area so we can get a really good look at what's going on.
No matter what, your patient should begin urinating into the toilet, stop, then urinate into the cup, stop, and then finish urinating into the toilet. This is called midstream clean catch. Another thing here that I want to bring your attention to is the 24-hour urine collection. This is going to be where the patient collects their urine for 24 hours in a designated container, but big patient teaching here is to discard the first void of the day. So if we're saying at 7:00 AM you need to start, so urinate at 7:00 AM and then start collecting the rest of the urine from then on. We don't want that from prior to 7:00 AM to be reflected in the collection. Make sure that they know to keep the container refrigerated as well.
All right. Moving on, let's talk about urinary incontinence. We've got a couple listed here, stress incontinence and urge incontinence. Stress incontinence is when there is urine leaking as a result of increased intra-abdominal pressure. What does this mean? It means when I cough or sneeze or jump or laugh really hard, the pressure in my abdomen's going to increase. And then that's going to put pressure on my bladder, which is going to let a little bit of urine leak. So who is most at risk for this? I'm going to ask you, and pause the video, all right? Okay. So I hope you paused the video. Who is most at risk for stress incontinence? It's going to be patients who have had multiple pelvic surgeries or patients who have had multiple pregnancies or deliveries of infants. That's going to weaken the pelvic floor muscles. Now, urge incontinence means I can't make it to the bathroom when I feel the urge to urinate. In either case, there's different treatments. We have pharmacological, so medications that can be prescribed. And then we also have things like physical therapy, pelvic floor therapy, and things like Kegel exercises, or Kegel exercises, depending on who you ask. And we also have mechanical devices like pessaries which can be inserted to put pressure and decrease the risk of urine leaking.
All right. Last up, let's talk about urinary tract infections. I would say this is one of the things for nursing school you got to know everything about. It just comes up time and time again. It's so common, and there's really important patient teaching. So who is most at risk? Pause the video. Think about it. All right. I hope you paused. Who's most at risk? It's going to be people who have a vulva. The urethra is much shorter if I have a vulva versus a penis. The penis has a longer urethra, so it's harder for bacteria to enter into the urinary stream. Now, that doesn't mean that those are the only people that can get it, but it is an important thing to keep in mind. Signs and symptoms are going to depend based on the patient, but big ones would be abdominal pain, dysuria, which means painful urination, frequency, and urgency, "I have to go to the bathroom all the time. I feel like I really have to go," burning and bad smell, malodorous urine. All of those are going to be big signs. But in the older adult, what is the biggest sign? The biggest sign is going to be confusion and abdominal pain. Very important to know. They may not present with classical symptoms. So we do have some information on how we can diagnose that, here on this card, including things to look for on the urine analysis, which will be very helpful for you. I'd also encourage you to check out that lab values stack for more information.
And then this card, card number 119, we talk about the patient teaching for urinary tract infections. So hugely important for nursing school. Big thing is if you have a vulva, you need to be wiping from front to back. We don't want to bring fecal bacteria up to the urethra, so wipe from front to back. Also, wear cotton underwear, no synthetic fabrics, because these are better at wicking moisture away and not trapping moisture, which bacteria love. Also, avoid bubble baths. Be sure to empty the bladder regularly, and be sure to void after vaginal penetrative intercourse. Very important patient teaching there. A few other things would be increase fluid intake. And cranberry juice can also help to decrease UTI symptoms.
All right. I hope that was a very helpful review for you. If it was, please like this video. Let me know in a comment. And if you have any other great ways to remember things, I would love to hear how you remember that, in the comments, and so would everybody else watching this. Be sure to subscribe to the channel. You want to be the first to know when the next video comes out. And our next video's going to talk about bladder scanners, how to use them, and we're also going to talk about urinary catheters. Super important stuff. I hope I see you there. Thanks so much, and happy studying.
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