Catheter removal should occur as soon as the woman’s con-dition allows. Depending on local protocol, a catheter speci-men of urine (CSU) may be obtained before removal to screen for infection. Traditionally catheters are removed early in the morning. However, Kelleher (2002) suggests that removal at midnight allows the woman to rest and begin a normal voiding pattern in the morning. The reader is encour-aged to be aware of the evolving research on this issue.
PROCEDURE: removing an indwelling catheter
•
Gain informed consent and ensure privacy.•
Gather equipment:■ disposable receiver
■ 10 mL syringe (depending on catheter design) (check insertion documentation)
ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:
• understanding and applying the measures necessary to facilitate normal micturition, including advising and educating the woman
• undertaking all the clinical procedures described correctly, particularly in relation to prevention of infection
• recognizing deviations from the norm, managing them, and if necessary referring
• correct documentation of all care.
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14| Chapter
Principles of elimination management: micturition and catheterization
normal habits and ensuring adequate luid intake.
•
Catheterization of the bladder is indicated in certain clinical circumstances. Infection is one of the greatest risks; the midwife must be aware of all the care that contributes towards reducing the risk.SUMMARY
•
All aspects of childbearing can affect and be affected by the urinary tract.•
Micturition can be inluenced in three main ways:stimulating the micturition relex, maintaining
SELF-ASSESSMENT EXERCISES
The answers to the following questions may be found in the text:
1. Which factors inluence micturition?
2. Describe how childbearing affects micturition and therefore the measures that the midwife can undertake to promote good urinary care.
3. Describe the advantages and disadvantages of bedpan use.
4. List the situations in which a midwife is likely to undertake catheterization for a childbearing woman.
5. Discuss the similarities and differences between indwelling and intermittent catheterization.
6. Which is the most likely complication to occur from catheterization and how may this be prevented in all stages of care?
REFERENCES
Abbott, H., Bick, D., MacArthur, C., 1997. Health after birth. In:
Henderson, C., Jones, K. (Eds.), Essential Midwifery. Mosby, London, pp. 285–318.
Baston, H., 2011. Female bladder catheterisation: step by step. Pract.
Midwife 14 (1), 26–28.
Begley, C., 2014. Physiology and care during the third stage of labour. In:
Marshall, J., Rayner, M. (Eds.), Myles Textbook for Midwives, sixteenth ed.
Elsevier, Edinburgh.
Blackburn, S.T., 2013. Maternal, Fetal and Neonatal Physiology: A Clinical Perspective, fourth ed. Elsevier, Maryland Heights. (Chapter 11).
Dolman, M., 2007. Mainly women. In:
Getliffe, K., Dolman, M. (Eds.), Promoting Continence: A Clinical and Research Resource, third ed.
Elsevier, Edinburgh. (Chapter 3).
Doyle, P., Birch, L., 2011. Urine
elimination in pregnancy: indications for catheterization. Br. J. Midwifery 19 (9), 550–556.
Gee, H., Glynn, M., 1997. The
physiology and clinical management of labour. In: Henderson, C., Jones, K.
(Eds.), Essential Midwifery. Mosby, London, pp. 171–202.
Getliffe, K., Fader, M., 2007. Catheters and containment products. In:
Getliffe, K., Dolman, M. (Eds.), Promoting Continence: A Clinical and Research Resource, third ed.
Elsevier, Edinburgh. (Chapter 10).
Jamieson, E.M., McCall, J., Whyte, L., 2002. Clinical Nursing Practices, fourth ed. Churchill Livingstone, Edinburgh.
Johnston, P.G.B., Flood, K., Spinks, K., 2003. The Newborn Child, ninth ed.
Churchill Livingstone, Edinburgh.
Kelleher, M., 2002. Removal of urinary catheters: midnight vs. 0600 hours.
Br. J. Nurs. 11 (2), 84–90.
Leaver, R.B., 2007. The evidence for urethral meatal cleansing. Nurs.
Stand. 21 (41), 39–42.
Loveday, H., Wilson, J., Pratt, R., et al., 2014. epic3: National evidence-based guidelines for preventing healthcare associated infections in NHS hospitals in England. J. Hosp. Infect. 86 (Suppl. 1), S1–S70.
McCormick, T., Ashe, R., Kearney, P., 2008. Urinary tract infection in
pregnancy. Obstet. Gynaecol. 10 (3), 156–162.
NICE (National Institute for Health and Care Excellence), 2008. Antenatal care Routine care for the healthy pregnant woman CG62. NICE, London.
Available online: <www.nice.org.uk>
(accessed 6 March 2015).
NICE (National Institute for Health and Care Excellence), 2014a. Postnatal Care NICE clinical guideline 37.
NICE, London. Available online:
<www.nice.org.uk> (accessed 6 March 2015).
NICE (National Institute for Health and Care Excellence), 2014b. Intrapartum Care: care of healthy women and their babies during childbirth. NICE clinical guideline 190. NICE, London.
Available online: <www.nice.org.uk>
(accessed 6 March 2015).
Nicol, M., Bavin, C., Bedford-Turner, S., et al., 2000. Essential Nursing Skills, second ed. Mosby, Edinburgh, p. 185.
SIGN (Scottish Intercollegiate Guidelines Network), 2012. SIGN 88
Management of suspected bacterial urinary tract infection in adults.
Health Improvement Scotland,
Edinburgh. Available online: <http://
www.sign.ac.uk/pdf/sign88.pdf>
(accessed 9 January 2015).
Simkin, P., Ancheta, R., 2011. The Labor Progress Handbook, third ed. Willey Blackwell, Chichester.
Thompson, D., 2015. Urinary elimination. In: Potter, P.A., Perry, A.G., Stockert, P., Hall, A. (Eds.),
Essentials for Nursing Practice, eighth ed. Elsevier, St Louis. (Chapter 34).
Verralls, S. (Ed.), 1993. Anatomy and Physiology Applied to Obstetrics, third ed. Churchill Livingstone, Edinburgh.
Walsh, D., 2004. Care in the irst stage of labour. In: Henderson, C.,
Macdonald, S. (Eds.), Mayes
Midwifery: A Textbook for Midwives, thirteenth ed. Baillière Tindall, London, pp. 428–457.
Winder, A., 1999. Female urinary catheterisation. Community Nurse 5 (10), 33–34, 36.
Principles of elimination management: urinalysis
Chapter
LEARNING OUTCOMES
Having read this chapter, the reader should be able to:
•
recognize the components of ‘normal’ urine and gain some understanding of the signiicance of the abnormal indings of urinalysis•
discuss the midwife’s role and responsibilities in relation to urinalysis, identifying when and how it is undertaken.Urinalysis is a screening tool commonly used by midwives to identify when further testing is required. While urinalysis may be an effective screening tool, it should not be used in isolation when considering whether or not treatment is required (Steggall 2007). Urinalysis is not sensitive and speciic enough to screen routinely for asymptomatic bac-teriuria (Awonuga et al 2011); a midstream specimen of urine (MSU) (p. 139) should be obtained for diagnostic purposes if required. This chapter considers the compo-nents of ‘normal’ urine, the signiicance of abnormal ind-ings and the procedure for undertaking urinalysis. Although pregnancy tests can also be undertaken using a specimen of urine, this is not discussed within this chapter.
Deinition
Urinalysis is the testing of both the physical characteristics and the composition of freshly voided urine and is under-taken for the purposes of:
•
screening: for systemic and renal disease•
diagnosis: of a suspected condition•
management and planning: as a baseline and for planning and monitoring care.15
CHAPTER CONTENTS
Learning outcomes 127
Deinition 127
The physical characteristics of urine 128
Composition of urine 128
Normal occurrences during childbirth 128 Indications for urinalysis 128
Signiicance of indings 128
Colour 128
Clarity 128
Odour 128
Speciic gravity 129
pH 129
Bilirubin: bilirubinuria 129
Blood: haematuria 129
Glucose: glycosuria 129
Ketones: ketonuria 129
Leucocytes 129
Nitrites 129
Protein: proteinuria 129
Urobilinogen: urobilinogenuria 130
Equipment for urinalysis 130
PROCEDURE: urinalysis 130
Role and responsibilities of the midwife 130
Summary 131
Self-assessment exercises 131
References 131
INDICATIONS FOR URINALYSIS
•
At each antenatal visit.•
On admission to hospital for any reason, as a baseline observation.•
Speciic maternal disorders or treatment, e.g.hypertensive disease, diabetes mellitus, anticoagulant therapy.