Spinal Cord Injury Paper

However, there are additional guidelines in terms of assessing the patient for prolonged catheter use. There should be frequent assessment and evaluation of the patient’s need for continued use. It is important to note that in addition to determining the patient’s need for catheterization, prior to insertion the nurse should also complete the following:

When I started my placement , Mrs . X who was suffering from Parkinsonism and dementia was on Indwelling urinary catheter for the management of urinary incontinence. Adhering to the results from the literature review I planned for initiating several steps to control incontinence in Mrs. X. My mentor was always with me with full support and guidelines. Fluid management was the first step started. An input output chart was kept and well maintained. Then steps wre also taken to manage constipation. Exercises were the last method practiced and the final result was really appreciable as she got a great reduction in the incontinence rate.

Bernard, M.S., Hunter, K.F., & Moore, K.N. (2012). A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urologic Nursing 32(1)

Joint Commission released national patient safety goals for hospitals in January of 2016. These patient safety goals were “established to help accredited organizations address specific areas of concern in regards to patient safety” (Facts about the National Patient Safety Goals, 2015). National patient safety goal 07.06.01 focuses on the prevention of catheter associated urinary tract infections (CAUTI) in hospitalized patients. Evidence based practice should be implemented to stop these common infections occurring in patients nationwide. Indwelling urinary catheters are only recommended in certain patients, for example to prevent further breakdown of sacral wounds or pressure ulcers in incontinent patients, for comfort in end of life care

First, neurological disorders can occur, as seen with Alzheimer’s disease and Parkinson’s disease, which can lead to neurogenic bladder (“Neurology/Neurogenic Bladder,” 2017). Next, physiological disorders can occur as seen with enlarged prostate in men or shortening of the urethra in women (Jaipaul, 2017). Anticipating the above changes appropriately will aid in understanding what leads to urinary retention in older adults, the resulting need of catheterizations, and the CAUTIs that can follow. Having a foundation to build on, it would be beneficial to explore what nurses can do prevent urinary tract infections in patients who require catheterization.

The three questions addressed were: Who should receive urinary catheters, what are the best practices for those who require urinary catheters and for preventing CAUTI’s acquired from urinary obstruction. This updated guideline offers recommendations for the appropriate use of indwelling catheters utilizing appropriate indications for usage, proper techniques for insertion of indwelling catheters, proper techniques for indwelling catheter maintenance, quality improvement programs, administrative infrastructure and surveillance including identifying those at risk for CAUTI (Gould et al, 2009). The strengths of this guideline are that many questions and scenarios are examined in this document and answered in explicit detail. Any healthcare professional can refer to the document to answer most practice based questions that are posed to them regarding indwelling urinary catheters. One weakness identified is the lack of an alternative explored for the external catheterization for female patients, for example the Purewick solution. However, the Purewick was not released until January 2016 and this guideline was last updated in 2009. Integrative Review

Focus on enhancing quality of care has exaggerated on a nationwide scale. Decreasing preventable damages within the health care settings is being on focus furthermore. From this there has been an immediate connection between repayment to quality through pay-for-reporting and pay-for-execution programs. Around 25% of the hospitalized patients have an indwelling catheter in place (Saint, Kowalski, Forman et al., 2008) and there is a 3% to 7% has the probability to get urinary tract infections in such cases. The infection could cause the signs of bladder distress, trouble in urination, and high temperature in such patients. Analysis shows that 48% of patient who has indwelling catheter complains of pain from the catheter, 42 % experience inconvenience from the catheter and 61% found that their daily activities are exceptionally constrained by these catheters (Saint, Lipsky, Baker, McDonald, & Ossenkop, 1999). Urinary tract infections may prompt bacteremia (infection

The patient and their families must be aware of the infection, the source of infection, signs and symptoms, treatments, and measures to apply at home to decrease their risk of receiving an infection. Because geriatric patients are incontinent they may need a catheter in place to help remove their urine. Nurses must perform aseptic technique, wearing proper gloves when inserting or removing device. Another way to help reduce the risk of elderly urinary tract infections would be to avoid or remove catheter soon as possible. Once patients are cleared for discharge they must be aware of the steps to take to insure proper bladder

Now that I have shared a brief overview of the spinal cord and some statistics about spinal cord injuries, we will look at the past research that has led to the treatments most commonly used today. In 1990, a steroid called dexamethasone was discovered in human trials to preserve some motor and sensory function if administered at high doses within 8 hours of injury. Surgery used to remove fluid, tissue, or bone fragments, or to stabilize fractured vertebrae by fusing bones or inserting hardware has also proven to be one of the most thorough measures to prevent further harm. I received both of these treatments after my accident, and they are the same that have been used for the past decade. Until recently, doctors had no way of limiting such disabilities, aside from stabilizing the cord to prevent added destruction, treating infections, and prescribing rehabilitative therapy to maximize any remaining capabilities.

A catheter is used in an event of an individual that has either had trauma or surgery and as a result has temporary urinary retention (Patton & Thibodeau, 2013)

A Foley catheter is a thin, sterile tube inserted into the bladder to drain urine ( ). There are many types of catheters such as a straight, indwelling, and condom catheters. A straight catheter is one that does not stay inside the person. It is removed immediately after urine is drained. An indwelling catheter is one that stays inside of the bladder for a period of time. And last, a condom catheter is one that has an attachment that fits onto the penis. This catheter is changed daily or as needed. For the purpose of this document, the care that is going to be performed will need to be performed on a patient/resident with an indwelling catheter.

The National Patient Safety Goal NPSG 0.7.06.01 entitled “ Use proven guidelines to prevent infection of the urinary tract that are caused by catheter.” was selected (The Joint Commission, 2015). Gould, Umsheid, Agarwal, Kuntz, Pegues and Healthcare Infections Control Practices Advisory Committee (2009) reported that in an acute care hospital, a urinary catheter is the most commonly used medical devices (as cited in Acker, 2014). What is a urinary catheter. A urinary catheter is a thin tube inserted into the bladder to drain urine. A collection system bag is connected to the catheter

Ask the patient to lay on their back. The patient's legs should be spread and their feet should be together. The patient laying on their back relaxes the bladder and urethra, making easier to insert the catheter.  You can even assist the patient getting into the supine position.

Five criteria must be met which includes authority, information, objectivity, ease of navigation and privacy and security policies. The website used for my research was www.christopherreeve.org. The website met the five criteria. Authority was displayed in several ways. The author, Judith Lubinsky is qualified as an expert in the spinal cord injury field. Judith is responsible for web production and social media for the website. The contact information and credentials for the author was clearly stated. Information is updated daily to keep readers informed of any changes. The information posted is accurate and appropriate for the intended audience. The author provides an unbiased comprehensive review of spinal cord injuries and management. The sponsor for the website is The Christopher and Dana Reeve Foundation. The source of funding does not have an impact on the information provided. The website provides easy navigation with reliable information, treatment options, clinical trials and ways to get involved. The website provided clear privacy and security

The overuse or misuse of indwelling urinary catheters (IUC) is a concern in the emergency department (ED) despite the well-known risks and complications. Although the medically indicated guidelines for use are specific, professionals often ignore the guidelines and insert an IUC without applying evidence-based practice strategies to manage urinary output.