21.8 Applying the Nursing Process to Catheterization
21.8 Applying the Nursing Process to Catheterization
Open Resources for Nursing (Open RN)
When preparing to insert an indwelling urinary catheter, it is important to use the nursing process to plan and provide care to the patient. Begin by assessing the appropriateness of inserting an indwelling catheter according to CDC criteria as discussed in the “Preventing CAUTI” section of this chapter. Determine if alternative measures can be used to facilitate elimination and address any concerns with the prescribing provider before proceeding with the provider order.
Subjective Assessment
In addition to verifying the appropriateness of the insertion of an indwelling catheter according to CDC recommendations, it is also important to assess for any conditions that may interfere with the insertion of a urinary catheter when feasible. See suggested interview questions prior to inserting an indwelling catheter and their rationale in Table 21.8a.
Table 21.8a Suggested Interview Questions Prior to Urinary Catheterization
| Interview Questions | Rationale |
|---|---|
| Do you have any history of urinary problems such as frequent urinary tract infections, urinary tract surgeries, or bladder cancer?
For males: Do you have any history of prostate enlargement or prostate problems? For females: Have you had any gynecological surgeries? |
Previous medical conditions and surgeries may interfere with urinary catheter placement. Information about a male patient’s prostate will assist in determining the size and type of catheter used. (Recall that using a catheter with a Coude tip is helpful when a male patient has an enlarged prostate.) If a patient has a history of previous urinary tract infections, they may be at higher risk of developing CAUTI. |
| Have you ever had a urinary catheter placed in the past? If so, were there any problems with placement or did you experience any problems while the catheter was in place? | Questioning the patient about placement and prior catheterizations assists the nurse in identifying any problems with catheterization or if the patient has had the procedure before, he/she may know what to expect. |
| Do you have any questions about this procedure? How do you feel about undergoing catheterization? | The nurse should encourage patient involvement with their care and identify any fears or anxiety. Nurses can decrease or eliminate these fears and anxieties with additional information or reassurance. |
| Do you take any medications that increase urination such as diuretics or any medications that decrease urgency or frequency? If so, please describe. | Identifying medications that increase or decrease urine output is important to consider when monitoring urine output after the catheter is in place. |
| Have you had any orthopedic surgeries that may affect your ability to bend your knees or hips? Are you able to tolerate lying flat for a short period of time? | The patient may not be able to tolerate the positioning required for catheter inse