The nurse is changing an external urinary catheter on a male patient. Which observation by the nurse requires additional attention?
a. The patient urinates at least every 4 hours.
b. The patient's urine is dark yellow and clear.
c. The skin of the penis under the catheter is dusky.
d. The patient applies the catheter indepen-dently.
C
Regardless of the location, dusky skin is cause for concern because it is a clinical indicator of tissue hypoxia. If the tissue is hypoxic, the perfusion is probably inadequate to meet tissue oxy-gen demand and increases the risk of skin breakdown. Urinating at least every 4 hours is a desir-able outcome. Clear urine is a desirable outcome because it indicates urine that is free of sediment and not infected. The dark yellow color can indicate dehydration. Ability to perform self-care for a urinary catheter depends on the physical abilities and motivation of the patient, but it is generally a desirable outcome.
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