Urinary Specimen Collection, Incontinence, and UTI's - Fundamentals of Nursing | @LevelUpRN

Summary

In this video, Meris covers key topics related to urinary health, including normal urine characteristics, specimen collection, urinary incontinence, and urinary tract infections (UTIs). She explains expected urine output, specific gravity, and abnormal signs such as cloudy or malodorous urine. Meris also discusses how to collect clean catch and 24-hour urine samples, different types of incontinence, and key risk factors and symptoms of UTIs, particularly in older adults. Practical tips for UTI prevention and patient teaching are provided, making this video essential for nursing students.

Takeaways

• 💧 Normal urine output should range from 0.5 to 1.5 mL per kg per hour, aiming for about 1,500 mL per day.
• ⚠️ Notify the provider if urinary output is less than 30 mL per hour, indicating severe oliguria.
• 🔬 Specific gravity of urine ranges from 1.005 to 1.030, with lower values indicating dilute urine.
• 🌫️ Urine should be clear, and cloudy or malodorous urine is considered abnormal.
• 🧪 A midstream clean catch urine specimen is essential for accurate results and requires specific instructions for patients with different anatomy.
• ⏳ For 24-hour urine collections, the first void of the day should be discarded, and the sample should be kept refrigerated.
• 💪 Stress incontinence is associated with increased intra-abdominal pressure and is more common in patients with weakened pelvic floor muscles.
• 🚻 Urge incontinence involves the inability to reach the bathroom in time, and treatments include physical therapy and medications.
• ❗ People with a vulva are more at risk for urinary tract infections (UTIs) due to a shorter urethra.
• 🧼 Key UTI prevention tips include wiping front to back, wearing cotton underwear, avoiding bubble baths, and increasing fluid intake.

Q & A

What is the normal urine output per hour for a patient?

The normal urine output is 0.5 to 1.5 milliliters per kilogram per hour, with a general goal of 1,500 mL or 1.5 liters per day.

When should a provider be alerted about a patient's urine output?

The provider should be alerted if the patient's urine output is less than 30 mL per hour, as this indicates severe oliguria.

What does a low specific gravity in urine indicate?

A low specific gravity (below 1.005) indicates dilute urine, meaning it is less concentrated.

How can you remember the relationship between dilute urine and specific gravity?

Dilute urine starts with 'L,' and it corresponds to a low specific gravity, which also starts with 'L.'

What are the steps for a clean catch urine specimen for a patient with a penis?

The patient should retract the foreskin if uncircumcised, clean around the urethral meatus, urinate into the toilet, stop, then urinate into the cup, and stop again to finish urinating into the toilet.

What patient education is important for a 24-hour urine specimen collection?

The patient should discard the first void of the day, start collecting urine after that, and keep the container refrigerated.

Who is most at risk for stress urinary incontinence?

Patients who have had multiple pelvic surgeries or multiple pregnancies and deliveries are most at risk due to weakened pelvic floor muscles.

What is the difference between stress incontinence and urge incontinence?

Stress incontinence is urine leakage due to increased intra-abdominal pressure, such as from coughing or sneezing, while urge incontinence is the inability to make it to the bathroom in time when feeling the urge to urinate.

Who is most at risk for urinary tract infections (UTIs)?

People with a vulva are at higher risk for UTIs because they have a shorter urethra, making it easier for bacteria to enter the urinary tract.

What is important patient teaching for preventing urinary tract infections?

Patients should wipe from front to back, wear cotton underwear, avoid bubble baths, empty the bladder regularly, void after intercourse, increase fluid intake, and consider cranberry juice to help with UTI symptoms.

Outlines

00:00

💧 Urine Characteristics and Urinary Specimen Collection

Meris introduces the video by mentioning the topics to be covered: urine characteristics, urinary specimen collection, urinary incontinence, and urinary tract infections (UTIs). She uses flashcards from leveluprn.com to guide the discussion. The normal urine output is explained to be between 0.5 to 1.5 milliliters per kilogram per hour, with an average of 1,500 mls (1.5 liters) per day. A significant point is made about alerting healthcare providers if the patient's urinary output falls below 30 milliliters per hour, indicating severe oliguria. Specific gravity is discussed as a measure of urine concentration, with normal values ranging from 1.005 to 1.030. The video provides a mnemonic to remember the relationship between dilute urine and low specific gravity. Urine clarity is emphasized as a normal characteristic, with haziness, cloudiness, or bad odor being considered abnormal. Different types of urinary specimens are mentioned, including routine urinalysis, clean catch, 24-hour urine specimen collection, and sterile specimens. The clean catch method is detailed, highlighting the differences in collection for patients with penises and vulvas. The importance of midstream clean catch is underscored. The segment ends with a discussion on 24-hour urine collection, emphasizing the need to discard the first void of the day and keep the collection refrigerated.

05:04

🚫 Urinary Incontinence and UTI Prevention

The second paragraph delves into urinary incontinence, focusing on stress incontinence and urge incontinence. Stress incontinence is linked to increased abdominal pressure during activities like coughing or laughing, leading to urine leakage. The risk factors are identified as multiple pelvic surgeries or pregnancies, which can weaken pelvic floor muscles. Urge incontinence is characterized by an inability to reach the bathroom in time upon feeling the urge to urinate. Treatment options range from pharmacological interventions to physical therapy, pelvic floor therapy, and Kegel exercises. Mechanical devices like pessaries are also mentioned. The discussion transitions to urinary tract infections (UTIs), emphasizing their commonality and the importance of patient education. Risk factors are highlighted, particularly for individuals with vulvas due to the shorter urethra, which makes it easier for bacteria to enter the urinary stream. Signs and symptoms of UTIs are listed, including abdominal pain, dysuria, frequency, urgency, burning, and malodorous urine. It's noted that older adults may present differently, with confusion and abdominal pain being significant indicators. The video suggests checking lab values for diagnosis and provides patient education tips to prevent UTIs, such as wiping from front to back, wearing cotton underwear, avoiding bubble baths, emptying the bladder regularly, and voiding after sexual activity. The importance of increased fluid intake and the potential benefits of cranberry juice are also mentioned. The video concludes with a call to action for viewers to like, comment, subscribe, and share the video, and to look forward to the next video on bladder scanners and urinary catheters.

Keywords

💡Urine Output

Urine output refers to the amount of urine produced by the body, typically measured in milliliters per hour. In the video, it is mentioned that normal urine output should be between 0.5 to 1.5 milliliters per kilogram per hour, with a target of 1.5 liters per day. Urine output below 30 milliliters per hour indicates severe oliguria and requires notifying a healthcare provider.

💡Specific Gravity

Specific gravity measures how concentrated urine is. In the video, the normal range is identified as 1.005 to 1.030. Low specific gravity indicates dilute urine, which is less concentrated, while high specific gravity means concentrated urine. The video offers a mnemonic for remembering this: 'dilute' urine with an 'L' has 'low' specific gravity, also with an 'L'.

💡Clean Catch Urine Specimen

A clean catch urine specimen is a method used to collect urine while minimizing contamination. The video explains the process for both people with a penis and a vulva, emphasizing cleaning techniques and proper midstream collection. This method is crucial for obtaining an uncontaminated sample for accurate urinalysis results.

💡24-Hour Urine Collection

A 24-hour urine collection involves gathering all urine produced over a 24-hour period to test kidney function or detect certain conditions. The video highlights important patient instructions, such as discarding the first void of the day and keeping the urine container refrigerated during the collection period.

💡Urinary Incontinence

Urinary incontinence is the inability to control urination. The video discusses two types: stress incontinence, caused by increased abdominal pressure (e.g., from laughing or coughing), and urge incontinence, where the individual feels a sudden need to urinate but can't reach the bathroom in time. Treatments may include medications, physical therapy, and pelvic floor exercises like Kegels.

💡Oliguria

Oliguria is the medical term for producing an abnormally low amount of urine. In the video, it's noted that urine output below 30 milliliters per hour is considered severe oliguria and requires alerting a healthcare provider, as it may indicate kidney dysfunction or other serious conditions.

💡Dysuria

Dysuria refers to painful or difficult urination. The video mentions it as a common symptom of urinary tract infections (UTIs). Patients with dysuria may experience a burning sensation during urination, which is often accompanied by other symptoms like frequent urination and abdominal pain.

💡Urinary Tract Infection (UTI)

A urinary tract infection is an infection in any part of the urinary system, most commonly the bladder and urethra. The video discusses who is most at risk, such as people with a vulva due to their shorter urethra, and key symptoms like dysuria, abdominal pain, and malodorous urine. Patient education includes wiping front to back and increasing fluid intake to prevent UTIs.

💡Pelvic Floor Exercises

Pelvic floor exercises, such as Kegels, strengthen the muscles that support the bladder and other pelvic organs. In the video, they are suggested as a treatment for urinary incontinence, particularly stress incontinence, which can result from weakened pelvic floor muscles after multiple pregnancies or pelvic surgeries.

💡Cranberry Juice

Cranberry juice is mentioned as a natural remedy that can help alleviate symptoms or prevent urinary tract infections. The video highlights the importance of increasing fluid intake, including cranberry juice, to reduce the risk of UTIs, although it is noted that this should be part of a broader approach to managing and preventing infections.

Highlights

Introduction to urine characteristics, urinary specimen collection, urinary incontinence, and urinary tract infections (UTIs).

Normal urine output should be 0.5 to 1.5 mL per kg per hour, with about 1,500 mL per day as the average.

Alert the provider if urinary output drops below 30 mL per hour, indicating severe oliguria.

Specific gravity of urine ranges from 1.005 to 1.030, with low specific gravity indicating dilute urine.

Cloudy or malodorous urine is abnormal and should be assessed further.

Clean-catch urine specimen collection requires different procedures based on anatomy (penis or vulva).

For clean-catch urine specimens, patients should start urinating in the toilet, collect midstream in a cup, and finish in the toilet.

24-hour urine collection requires discarding the first void and keeping the collected urine refrigerated.

Stress incontinence is caused by increased intra-abdominal pressure (e.g., coughing, sneezing) and is common in patients with weakened pelvic muscles due to surgeries or pregnancies.

Urge incontinence refers to the inability to make it to the bathroom in time when feeling the urge to urinate.

Treatment for urinary incontinence includes medications, pelvic floor therapy, Kegel exercises, and devices like pessaries.

People with vulvas are at higher risk for UTIs due to a shorter urethra, making it easier for bacteria to enter the urinary tract.

UTI symptoms include dysuria, frequency, urgency, and malodorous urine. Older adults may present with confusion.

Patient teaching for UTIs: Wipe front to back, wear cotton underwear, avoid bubble baths, and void after intercourse.

Increasing fluid intake and consuming cranberry juice can help decrease UTI symptoms.

Transcripts

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. 

I invite you to subscribe to our channel  and share a link with your classmates and  

friends in nursing school. If you found value  in this video, be sure and hit the like button,  

and leave a comment and let us know  what you found particularly helpful.