A nurse is assisting with the care of a client in a medical-surgical unit.
Vital Signs
05:00
Temperature 36.6 C (97.9 F)
Heart rate 100/min
Respiratory rate 22/min
Blood pressure 160/98 mm Hg
Oxygen saturation 96% on oxygen 2 L/min via nasal cannula
14:00
Temperature 36.8 C (98.3 F)
Heart rate 90/min
Respiratory rate 18/min
Blood pressure 138/88 mm Hg
Oxygen saturation 97% on oxygen 2 L/min via nasal cannula
Which of the following actions should the nurse take to decrease the risks for a urinary tract infection for this client? Select all that apply.
A.
Encourage the client to drink 3,000 mL of fluid daily.
B.
Change the indwelling urinary catheter tubing every 3 days.
C.
Place the drainage bag on the bed when transporting the client.
D.
Empty the drainage bag when it is half-full.
E.
Review the need for the indwelling urinary catheter daily.
F.
Use soap and water to provide perineal care.
The correct answer and Explanation is :
To decrease the risks for a urinary tract infection (UTI) in a client with an indwelling urinary catheter, the nurse should take the following actions:
A. Encourage the client to drink 3,000 mL of fluid daily.
E. Review the need for the indwelling urinary catheter daily.
F. Use soap and water to provide perineal care.
Explanation:
A. Encourage the client to drink 3,000 mL of fluid daily.
Adequate fluid intake helps to flush the urinary tract and dilute urine, reducing the risk of infection by decreasing the concentration of potentially harmful bacteria in the urine. Encouraging the client to drink 3,000 mL of fluid daily can help maintain urinary tract health and reduce the risk of developing a UTI.
E. Review the need for the indwelling urinary catheter daily.
An indwelling urinary catheter can be a significant source of infection. Regularly reviewing the need for the catheter helps ensure it is only used when absolutely necessary and is removed as soon as it is no longer needed. This reduces the duration of catheterization, which is a key factor in decreasing the risk of UTIs.
F. Use soap and water to provide perineal care.
Proper perineal care is essential to prevent bacteria from the surrounding area from entering the urinary tract. Using soap and water to clean the perineal area helps to remove bacteria and reduces the risk of infection. It is important to follow proper hygiene practices to maintain cleanliness and reduce the risk of UTIs.
Incorrect Options:
B. Change the indwelling urinary catheter tubing every 3 days.
Routine changes of the catheter tubing every 3 days are not recommended. The primary focus should be on maintaining sterile technique during catheter insertion and ensuring proper hygiene rather than frequent tubing changes.
C. Place the drainage bag on the bed when transporting the client.
The drainage bag should be kept lower than the level of the bladder to prevent backflow of urine and potential contamination. Placing the drainage bag on the bed can lead to backflow, increasing the risk of infection.
D. Empty the drainage bag when it is half-full.
The drainage bag should be emptied when it is about one-third full to avoid overfilling and potential backflow. Waiting until the bag is half-full could increase the risk of infection due to possible contamination.
By implementing the correct measures, the nurse can effectively decrease the risk of UTIs in clients with indwelling urinary catheters.