Management of Clients/Patients with

Elimination Needs

Facilitator: Mr. Onesmo

BSN /RN- TA
onesmoyoyo@gmail.co
m
Different ways of collecting urine and stool
specimen for diagnostic purposes
 Learning objectives
By the end of this session, each student should
be able to:-
• Describe different ways of collecting urine
specimen
• Identify way of collecting stool specimen
• Demonstrate skills of collecting urine and stool
specimen
• Demonstrate skill of urethral catheterization.
 Urine collection
• Urine can be collected for various studies. The
type of testing determines the method of
collection.
• The different methods of urine collection are:
Random collection (routine analysis)
Timed collection
 Collection from a closed urinary drainage system
Clean-voided specimen
 Random Collection
• The practitioner usually writes the order for a
UA (routine urine analysis), which is also called a
random collection.
• It can be collected at any time using a clean cup.
• Instruct the client to urinate into the specimen
cup or into a clean bedpan or urinal.
• Wearing gloves, transfer the urine into a clean
container.
• Submit the specimen immediately to the
laboratory to prevent the growth of bacteria.
Timed Collection/ 24 hours collection
• Collection of a 24-hour urine specimen is
defined as the collection of all the urine
voided in 24 hours, without any spillage of
wastage
• Timed collection is done over a 24-hour
period.
• The urine is collected in a plastic gallon
container that contains preservative(s), some
of which are caustic.
 …..
• Provide the client with specific instructions. The
client is told to void and discard the specimen at
the beginning of the collection.
• The 24-hour collection begins with the first
discarded voiding. The client can void throughout
the test into a clean container, then pour the
urine into the collection bottle.
• The collection container should be refrigerated or
kept on ice throughout the 24 hours. This retards
bacterial growth and stabilizes the analytes.
 Purpose of 24 hours collection
 To detect kidney and cardiac diseases or
conditions
 To measure total urine component
Collection from a Closed Drainage System

• A sterile specimen can be collected from a client

with an indwelling Foley catheter with a closed
drainage system.
• A sterile specimen is used to culture the urine.
• The urine specimen should not be obtained from
the drainage bag.
• The catheter’s closed drainage tubing has an
aspiration port that is used for a sterile specimen
collection
• Refers procedures for urine collection
 Clean-Voided Specimen
• Clean-voided (clean-catch, or midstream)
specimen collection is done to secure a
specimen uncontaminated by skin flora.
• A clean-voided specimen should be obtained
on first voiding in the morning.
• Most adult clients are capable of following
instructions to perform this test.
• Refers procedure…
 Purpose of clean catch
 To collect uncontaminated urine specimen for
culture and sensitivity test.
 To detect the microorganisms causes urinary
tract infection
 To diagnose and treat with specific antibiotic
 Collecting a stool specimen
• Collection of stool specimen deters a process
which is aimed at doing chemical
bacteriological or parasitological analysis of
fecal specimen
Purpose:
• To identify specific pathogens
• To determine presence of ova and parasites
• To determine presence of blood and fat
• To examine for stool characteristics such as
color, consistency and odor
 NOTE
Procuders
• Collecting a Clean-Catch Midstream Urine
Specimen pg. 645
• Obtaining a Residual Urine Specimen from an
Indwelling Catheter pg.. 644
• Assisting patient with bed pans or urinal… pg
1259
• Refer Sue C. DeLaune & Patricia K. Ladner (2011)
Fundamentals of Nursing Standards & Practice 4th
Edition.
Urinary catheterization
 Urinary catheterization
• Urinary catheterization is done when a person
is unable to urinate using a toilet, bedpan,
urinal, bedside commode, or when accurate
urinary output is required
• A urinary catheter is a tube that is inserted
into the bladder through the urethra to allow
the urine in the bladder to drain out.
 Indication for catheterization
urinary catheter is used in many different situations:
• A urinary catheter may be inserted to drain the
bladder before or during a surgical procedure, during
recovery from a serious illness or injury, or to collect
urine for testing
• A urinary catheter may be used for a person who is
incontinent of urine, if the person has wounds or
pressure ulcers that would be made worse by contact
with urine
• A urinary catheter is necessary when a person is
unable to urinate because of an obstruction in the
urethra.
 TYPES OF CATHETERS
• A condom catheter, consists of a soft plastic
or rubber sheath, tubing, and a collection bag
for the urine. The sheath is placed over the
penis and the collection bag is attached to the
leg. Collects urine when there is no need for
catheter insertion.
• A straight catheter, is used when the catheter
is to be inserted and removed immediately.
• An indwelling catheter, also known as Foley
catheter, is left inside the bladder to provide
continuous urine drainage.
 Types of catheters……
• A suprapubic catheter is a type of indwelling
catheter. The suprapubic catheter is inserted
into the bladder through a surgical incision
made in the abdominal wall, right above the
pubic bone.
• A 3-way catheter for continuous bladder
irrigation (CBI) is a type of indwelling catheter.
It is inserted to irrigate the bladder to prevent
obstruction (i.ebleeding)
Catheters
 3-way CBI
• Irrigations performed
on intermittent or
continuous basis to
maintain catheter
patency.
• A closed system can
provide continuous or
intermittent irrigation
without disrupting
sterility
 CARING FOR A PERSON WITH AN
INDWELLING URINARY CATHETER
• Indwelling urinary catheters are connected by
a length of tubing to a urine drainage bag
• The tubing is secured loosely to the person’s
body near the insertion site using a catheter
strap or adhesive tape
• Securing the tubing to the person’s body
prevents the catheter from being accidentally
pulled out during repositioning
 …….

• Coiling the tubing prevents the tubing from

becoming bent or kinked, coiling the tubing and
securing it to the bed linens also keeps the weight
of the tubing from pulling against the person’s
body.
• The drainage bag is then secured to the bed frame
at a level lower than the person’s bladder.
• If the drainage bag and tubing are higher than the
person’s bladder, then gravity could cause old,
contaminated urine to run back down the tubing
and into the person’s bladder, causing an
infection.
 Urinary catheterization -emptying urine
drainage bags
• Urine drainage bags are routinely emptied and the
urine measured at the end of each shift.
• Urine drainage bags should also be emptied if they
are full.
• Leg bags need to be emptied frequently because
they are smaller, and hold less urine.
• Be sure to monitor urine output
– Amount
– Characteristics (color, clarity, sediment, hematuria, odor)
– less than 30 ml/hrof urine indicates a problem
 Procedure of Catheterization
• Insertion of indwelling catheter for both male
and female… pg no: 1264- 1268

Refer Sue C. DeLaune & Patricia K. Ladner (2011)

Fundamentals of Nursing Standards & Practice 4th
Edition.
 Assignment
• What are the complications associated with
indwelling catheterization
 Reference
• Sue C. DeLaune & Patricia K. Ladner (2002)
Fundamentals of Nursing Standards & Practice
2nd Edition.
• Sue C. DeLaune & Patricia K. Ladner (2011)
Fundamentals of Nursing Standards & Practice
4th Edition.