BEA KHARLA F.

MAMARADLO
Dagupan City Region 1 Medical Center I. ACTIVITIES Nursing has the highest risk for back injuries of any profession. You must do everything possible to protect your back. Most of these injuries are preventable. Stop and think before you do something that may injure yourself. Assess the situation and get help! Never try to move a patient by yourself. You could end your hands-on nursing career with one wrong move. Proper body mechanics are essential in transferring and moving patients to sitting positions in bed. Hospital beds and tables are usually on wheels, but they have safety locks. Be sure to unlock them first. Also consider the additional weight of the patient to the weight of the bed before attempting to move it. Never skip any steps even if the patient is a small child. One wrong move can cost you your job and your back. Use gait belts and draw sheets whenever possible. And always get help from another team member. II. LEARNING/ INSIGHTS Follow these rules when lifting or transferring patients to protect your back:  Keep your lower back in its normal curved or arched position at all times.  Move as close to the bed or patient as you can.  Never twist; always pivot or side step.  When lifting, set your feet in a position to give yourself a solid, wide base of support.  Keep your stomach muscles tight, bow slightly at the hips, and then squat.  Keep your head up and hold your shoulders upright. If you held a yardstick along your back, it would be perfectly straight.  Push up from your knees and use your own momentum to help you lift.  If you do get hurt, report it right away and seek medical treatment. Early intervention is the key to successful treatment and prevention of permanent dysfunction. The trend now is to combine anti-inflammatory medications with physical therapy and as much normal activity as can be tolerated. Be aware of your rights and consult an attorney if you are injured on the job. Keep a journal of all events and conversations. Be proactive and protect your body. Report dangerous situations and remind your coworkers if you see one of them using poor body mechanics. The nursing shortage is bad enough without nurses unnecessarily injuring themselves. Twelve percent of nurses leave the profession because of back injuries. If even half of the injuries can be prevented, it will go a long way toward helping to ease this crisis.

III.ISSUES AND CONCERNS In the Emergency Room as well as in wards, it is very important for nurses to perform proper lifting and moving patients. Performing such tasks in the right way prevents nurses from experiencing any injuries which is in the first place preventable. Also, by doing the proper way, patients are also saved from any injuries. As I observe, there are still nurses who perform lifting and transferring patients in the wrong way. This bothers me because one of the primary responsibilities of us nurses to our patients is safety. This concern must be addressed in order not to deprive patients on their right.

RN HEALS MONTHLY JOURNAL DECEMBER 2011 IV.RECOMMENDATION Every nurse must be equipped on the principles of proper lifting and moving of patients in order to prevent injuries both for her and her patient. It is very important to perform such principles to prevent any harm. The training offered by R1MC which is LIFTING is beneficial for both patients, nurses as well as to institutional workers. All nurses of the R1MC must undergo such training to give quality care to patients.

Prepared by:

Noted by:

_Bea Kharla F. Mamaradlo, RN_ RNheals Nurse

__Fe S. Maramba, RN Senior Nurse

_____

Noted by:

Approved by:

MS. LIZA P MAMARIL, RN . OIC Assistant Chief Nurse for Training and Research

MR. ROSAURO P CATABAY, RN, MAN OIC Chief Nurse

BEA KHARLA F. MAMARADLO

Dagupan City Region 1 Medical Center I. ACTIVITIES In urinary catheterization ("cathing" for short), a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for treatment or diagnosis of bladder conditions. A clinician, often a nurse, usually performs the procedure, but self-catheterization is also possible. The catheter may be a permanent one (indwelling catheter), or an intermittent catheter removed after each catheterization.

II. LEARNING/ INSIGHTS MALE CATHETERIZATION

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Place the patient in the supine position with legs extended and flat on the bed. Prepare the catheterization tray and catheter and drape the patient appropriately using the sterile drapes provided. Place a sterile drape under the patient s buttocks and the fenestrated (drape with hole) drape over the penis. Apply water-soluble lubricant to the catheter tip. With your non-dominant hand, grasp the penis just below the glans and hold upright. If the patient is uncircumcised, retract the foreskin. Replace the foreskin at the end of the procedure. With your dominant hand, cleanse the glans using chlorhexidine soaked cotton balls. Use each cotton ball for a single circular motion. Place the drainage basin containing the catheter on or next to the thighs. With you non-dominant hand, gently straighten and stretch the penis. Lift it to an angle of 60-90 degrees. At this time you may use the urojet to anesthetize the urinary canal, which will minimize the discomfort. With your dominant hand, insert the lubricated tip of the catheter into the urinary meatus. Continue to advance the catheter completely to the bifurcation i.e. until only the inflation and drainage ports are exposed and urine flows (this is to ensure proper placement of the catheter in the bladder and prevent urethral injuries and hematuria that result when the foley catheter balloon is inflated in the urethra). Note: If resistance is met during advancement of the catheter: Pause for 10-20 seconds. Instruct the patient to breathe deeply and evenly. Apply gentle pressure as the patient exhales If you still meet resistance, stop the procedure and repeat above steps. Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 35cc of sterile water. Improperly inflated balloons can cause drainage and leakage difficulties. Gently pull back on the catheter until the balloon engages the bladder neck. Attach the urinary drainage bag and position it below the bladder level. Secure the catheter to the thigh. Avoid applying tension to the catheter. Remove drapes and cover patient. Ensure drainage bag is attached to bed frame. Remove your gloves and wash hands. Note: Never inflate a balloon before establishing that the catheter is in the bladder and not just in the urethra. If the patient reports discomfort, withdraw the fluid from the balloon and advance the catheter a little further, then re-inflate the balloon.

FEMALE CATHETERIZATION y Place the patient in the supine position with the knees flexed and separated and feet flat on the bed, about 60 cm apart. If this position is uncomfortable, instruct the patient either to flex only one knee and keep the other leg flat on the bed, or to spread her legs as far apart as possible. A lateral position may also be used for elderly or disabled patients. With the thumb, middle and index fingers of the non-dominant hand, separate the labia majora and labia minora. Pull slightly upward to locate the urinary meatus. Maintain this position to avoid contamination during the procedure. With your dominant hand, cleanse the urinary meatus, using forceps and chlorhexidine soaked cotton balls. Use each cotton ball for a single downward stroke only. Place the drainage basin containing the catheter between the patient s thighs. Pick up the catheter with your dominant hand. Insert the lubricated tip of the catheter into the urinary meatus. Advance the catheter about 5-5.75 cm, until urine begins to flow then advance the catheter a further 1-2 cm. Note: If the catheter slips into the vagina, leave it there to assist as a landmark. With another lubricated sterile catheter, insert into the urinary meatus until you get urine back. Remove the catheter left in the vagina at this time. Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 30-35cc of sterile water. Improperly inflated balloons can cause drainage and leakage difficulties. Gently pull back on the catheter until the balloon engages the bladder neck.

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Combating infection Everyday care of catheter and drainage bag is important to reduce the risk of infection. Such precautions include:
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Cleansing the urethral area (area where catheter exits body) and the catheter itself. Disconnecting drainage bag from catheter only with clean hands Disconnecting drainage bag as seldom as possible. Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically. Use of a thin catheter where possible to reduce risk of harming the urethra during insertion. Drinking sufficient liquid to produce at least two liters of urine daily Sexual activity is very high risk for urinary infections, especially for catheterized women.

III.ISSUES AND CONCERNS Urinary catheterization is one of the procedures usually perform by nurses especially in the Emergency Room. It is a procedure that must be performed in an aseptic way. However, I still can see nurses who perform catheterization not in an aseptic way. This is disturbing because according to studies, catheterization is one of the leading causes of nosocomial infection. Thus, in order for nurses to give quality care to our patients it is indeed very important that urinary catheterization must be performed aseptically to prevent any infection .

RN HEALS MONTHLY JOURNAL JANUARY 2011 IV.RECOMMENDATION In order to prevent any nosocomial infection caused by wrong way of performing urinary catheterization, nurses must be reoriented on the right steps in performing such procedure. Senior nurses in each ward and special areas of R1MC must always remind their nurses in the aseptic way of performing catheterization. This is also important because our nurses are observed by students. Such wrongdoing can be emulated by students that will later on harm their future patients.

Prepared by:

Noted by:

_Bea Kharla F. Mamaradlo, RN_ RNheals Nurse

__Fe S. Maramba, RN Senior Nurse

_____

Noted by:

Approved by:

MS. LIZA P MAMARIL, RN . OIC Assistant Chief Nurse for Training and Research

MR. ROSAURO P CATABAY, RN, MAN OIC Chief Nurse