Question

Two days after the creation of an ileal conduit, the nurse notes that the client's urine appears cloudy but is not malodorous. The nurse should: A. Document the finding B. Obtain an order for an antibiotic C. Irrigate the stoma with saline D. Limit the protein intake

Short answer

Answer: A. Document the finding

Step-by-step solution

Define and understand an ileal conduit

An ileal conduit is a surgical procedure that reroutes the urine flow from the kidneys to the surface of the abdomen through a stoma. It is usually performed after the bladder has been removed or has ceased to function.

Analyze the given information

From the given information, we know that: 1. It's two days after the creation of an ileal conduit. 2. The client's urine appears cloudy but not malodorous (smelly).

Understand the possible reasons for cloudy urine

There are several reasons why urine might look cloudy: 1. Dehydration: Concentrated urine can appear cloudy. 2. Infection: Bacteria or white blood cells in the urine might cause cloudiness. 3. Mucus secretion: The ileal conduit may secrete mucus, giving a cloudy appearance to the urine.

Evaluate the options

Now let's evaluate each option: A. Document the finding: This is a reasonable step since the nurse is simply documenting the observation. B. Obtain an order for an antibiotic: This implies that the nurse suspects an infection. However, there is no evidence of infection in this case (urine isn't malodorous). C. Irrigate the stoma with saline: This would be appropriate if there is a blockage. Still, nothing indicates a blockage in the urine flow. D. Limit the protein intake: This would be an appropriate option if the patient is on high protein intake, which could cause cloudy urine. However, there is no information about the client's protein intake.

Choose the best answer

Based on the analysis of the information provided and the possible reasons for the cloudy urine, the most appropriate action for the nurse to take is: A. Document the finding The cloudy appearance of the urine could be a temporary situation or the result of mucus secretion from the ileal conduit, which is not harmful. However, the nurse should continue monitoring the client's condition, and if additional symptoms appear or persist, further steps should be taken accordingly.

Key concepts

Ileal Conduit Care

Caring for an ileal conduit involves understanding the surgical procedure and its purpose. An ileal conduit is a urinary diversion system created after the bladder is removed or is not functioning. It diverts urine from the kidneys to the abdomen through a stoma. Proper care includes:

• Regularly inspecting the stoma for any signs of infection or irritation. It should appear pink and moist.
• Ensuring the skin around the stoma remains clean and dry to prevent irritation or infections.
• Changing the stoma bag or appliance regularly to avoid leakages.
• Hydration is key, as it helps prevent kidney stones and infections.

Being attentive to these aspects can prevent complications and ensure the ileal conduit functions properly. Always follow healthcare provider instructions and ask for guidance if unsure about any procedures.

Cloudy Urine Causes

Cloudy urine can be concerning, but it is not always indicative of a serious problem. In patients with an ileal conduit, cloudiness might result from:

• Mucus secretion from the conduit. This is normal because the ileum, part of the small intestine used to create the conduit, naturally secretes mucus.
• Dehydration, which concentrates urine and can make it appear cloudy. Drinking enough fluids is essential to maintain clear urine.
• Possible infection. While the urine isn't malodorous, cloudiness alongside other symptoms like fever might warrant further investigation.

Urine appearance can change based on diet and hydration levels. Document any persistent changes and report them to healthcare providers for appropriate action.

Postoperative Care

Postoperative care after creating an ileal conduit focuses on recovery and prevention of complications. In the immediate period after surgery:

• Monitor the patient's vital signs regularly to track recovery.
• Encourage gentle movement to promote circulation and decrease the risk of blood clots.
• Pain management is crucial for comfort and can aid in faster rehabilitation.
• Nutritional support, focusing on a balanced diet, can aid healing.

Observing for signs of infection or complications is critical. Patients should be educated on the importance of reporting unusual symptoms such as fever, chills, or unusual stoma appearance to their healthcare provider.

Nursing Documentation

Accurate nursing documentation is vital in managing patient care, particularly in postoperative contexts like ileal conduit creation. It involves:

• Recording observations promptly. This includes the description of urine, the condition of the stoma, and any changes in the patient's health status.
• Detailing the patient's response to treatments and medications.
• Noting any patient-reported symptoms or feelings of discomfort.
• Updating the patient's care plan as their condition evolves.

Documentation not only ensures continuity of care but also provides essential information for other healthcare professionals involved. Careful and precise records support valid clinical decisions and effective patient care delivery.