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110 Cards in this Set
- Front
- Back
Structure of Unrinary Tract
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Kidneys, Ureters, Bladder, Urethra
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Kidney
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-pair shaped organ
-on either side of verebrae column bet. 12 thoracic & 3rd lumbar vertebrae |
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Functional unit of the kidney
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the nephron
-each kidney has 1 mil nephron capable of forming unrine |
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Bladder
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-storage compartment of uringe
-behind symphis pubis when empty -in women: infront of uterus & vagina -in men: infront of recturm and above prostate gland - has 3 layers of muscle called Detrusor Muscles |
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Ureters
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narrowed smooth muscles; moves urine fro kidney to bladder
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Urethra
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-exict pathway for uringe
-in women: shorter so increase risk for infections -in men: longer; transport semen & urine |
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Function of kidney
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-regulate fluid volume
-done by 2 process: urine formation & urine excretion |
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Urine formation
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3 processes: filtration, reabsorption, secretion
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Urine excretion
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-involves micturation (voiding)
-adults usually void when bladder has 250-400 ml urine |
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Characteristics of normal urine
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Volume: 250-400 ml
Color: light yellow to dark yellow to dark brown Clarity: clear w/o sediment Odor: aromatic |
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Normal urinary pattern
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-most people void 6-8x daily
-total output in 24 hrs. 1200-1500 ml -max. void = 200 ml -min. void = 500ml |
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Life span consideration adult and older adult
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-middle age men experience urinary incontinence relating to BPH (benign prosthetic hypertrophy)
-women: weakend perineal muscles -cardiovascular changes -decrease bladder capacity -hypertension -coronary artery disease meds. to control hypertension -diruetics -post menopausal due to decrease estrogen levels |
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Factors Affectin Urinary Elimination
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Fluid intake: Intake correlates w/ output
-loss of blody fluid: sweat, vomiting, burns -nutrition -body position -psychological factors : don't remember -obstruction of Urine flow: kidney stones, large prostate -infections -hyperglycemia -hypotension -neurology injury: injury of sacral nerve -decrease muscle tone -pregnancy -surgery -medication -urinary diversions -cardiovascular changes |
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Altered urinary function
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Dysuria, polyuria, oliguria, anuria, urgency, frequency, nocturia, hematuria, pyuria, urinary retention, enuresis, incontinence, stress incontinence, urge incontinence, reflex incontinence, functional incontinence, total incontinence
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Dysuria
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Painful voiding
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Polyuria
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excessive amount of urine, usually around 2500-3000 ml/24 hr
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Oliguria
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decreas amount of urine, usually around 500 ml/24hr
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Anuria
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urine output of less then 100 ml/24hr
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Frequency
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voiding at frequent intervals
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Nocturia
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voiding at night 2 or more times
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Hematuria
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glood in the urine
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Pyuria
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pus in the urine
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Urinary retention
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inability to empty the bladder
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Enuresis
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bed wetting
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Incontinence: 5 types
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involuntary loss of urine
5 types: stress, urge, reflex, functional, total |
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Stress incontinence
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sudden loss of urine ( may be caused by laughing, coughing sneezing)
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Urge incontinence
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inability to hold back urine when feeling the urge to void
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Reflex incontinence
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caused by spinal cord injuries leading to loss of voluntary control of the bladder
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Functional Incontinence
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the patient has normal bladder and sphincter control but can not reach the bathroom
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Total incontinence
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continuous, involuntary, unpredictable loss of urine
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Assessment
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-ask open ended questions such as have you notice any problems w/ voiding
-make sure you clarify do pt. understand terminology you are using -make sure you are culturally sensitive when asking questions |
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Assessment of Elimination
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Questions:
-what is your normal voiding patterns -have you experienced any changes in your usual voiding pattern -have you had any discomfort, pain, frequency incontinence, or difficulty starting the urine stream |
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Assessment: Subjective
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-normal pattern identification
-risk identification -dysfunctional identification |
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Assessment: Objective
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-assessment of urine
-intake and output |
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Physical Assessment
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Inspection: no bladder distention (look above symphis pubis)
Percussion: Hollow sound Palpation: Bladder is naot palpable |
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Diagnostic Test
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-urine specimens: random,
- clean catch (free of microorganisms) -24 hrs. (eeded for accurate measure of kidney excretion) -blood test -radiology procedures -cytoscopy (pt. usually given antibiotic for 2 days after) -urodynamic studies |
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Urinalysis Evaluation
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-urinalysis
-ph -hematuria -casts 9precipitation or clumping of protien substances) -craystals -specific gravity -proteinuria -ketonuria -creatinine -bacteria |
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Specimen for Routine analysis U/A
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-ideally well mixed, first morning (8 hr concentrated) uncentriguged specimen, tested at room temp
-ideally, specimen should be tested w/in 30 min of voiding, w/in 2 hrs. of collected -specimens should not be accepted if left at room temp. for more than 2 hrs. -any fresh random urine specimen is acceptable for chemical analysis -if not possible to test U/A w/in 1-2 hrs, refrigerate asap -refrigeration will < growth of bacteria, primary cause for decomposition of urine after its voided |
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GU Testing - Urine studies
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U/A simplest
-color, turbidity, odor, specific gravity -ph, protien, glucose, ketones (ketoacidosis), bilirubin, blood -microscopically - RBCs, WBC, eptithelial cells, casts |
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GU Testing -Urine studies pH
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-normally, pH of urine range bet. 4.6 and 8
-acidic: values < 7 -alkaline: values > 7 -diets and urinary output: vegetarian : more alkaline, high protein-more acidic -urine specimens become more alkaline: (1) if allowed to stand unrefrigerated, esp. for > 1 hr (2) if urea splitting bacteria are present (3) if specimen is left uncovered -an alkaline urine promote cellular breakdown, therefore, abnormal urinary sediment (such as RBC may be missed on analysis if specimen is not covered & delivered to lab on time or refrigerated |
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Specific Gravity test
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-measure the relative concentration, or density, the weight of a drop of urine as compared to distilled water
-specific graavity of wate is 1.000 -a wider rante (1.001-1.035) is possible in states of fluid restriction or fluid volume excess -if renal function is normal, a change in the specific gravity of urine occurs when there is a need to excrete more or less water to normalize the serum -increase SG =dehydration -decrease SG = overhydration |
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Ketones
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are a byproduce of the incomplete metabolism of fatty acids
-**normally there are not ketones in urine -you may see ketones in a pt. on starvation diet |
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Proteins
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-proteins such as albumin, is not normally present in urine
-protein in urine may occur w/ (a) infecton (b) stress (c)admin of certain meds (d) streuous exercise -random protein does not imply renal disease -persistent protein needs further workup, as 24hr urine collection for total protein -**protein is probable the most significant single finding in detection & dx or renal disease |
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Urine Sediment refers to particles present in urine (1) cells, (2) bacteria, 93) crystals (4) casts
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RBC: 0-3 (if increase possible bleeding going on, UTI infection, bladder trauma)
WBC: 0-5 Bacteria/yeast: none-few 9if increase, then infection) Casts: none-occassional (if increase possible renal disease |
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Urine Culture
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Urine Culture (clean catch/midstream)
-determines # and type of pathogens present -clean catch specimen or catheterized specimen |
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24 hour urine collections
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-collects often ordered for measurement of levels of urinary creatinine or urea nitrogen, Na, Ch, Cal, cathcholamine or other components
-for a composite urine speciment, all urine w/in the designated time frame must be collected -if other voided or cathererized speciments must be obtained while collection is in progress, measure & appropriately document the amounts removed -nurse instructs pt. to empty bladder & discard that urine. Nurse notes the start time. -If pt. has F/C, nurse empties catheter, the tubing & draining bag at the designated start time -urine collection must be free from any contamination-fecal, blood, toilet tissue -24hr after the start time (for 24hr collection) instruct pt to again empty bladder & include ending urine speciment in the collection |
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GU Diagnostic Testing Blood Chemistries
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BUN (blood Uread Nitrogen)
-normal value 10-20 mg/dl -measures ability of kidneys to excrete urea nitrogen (byproduct of liver metabolism of protein) -will > as renal function decreases -not the most reliable test -BUN #'s will Increase as renal function decreases |
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GU Diagnostic Testing Blood Chemistries
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Cr (creatinine)
-normal value 0.6-1.2 mg/dl -indicates kidney ability to excrete creatinine (end product of muscle metabolism) -good indication of renal function -creatinine is a normal by product of muscle metabolism & is excreted by the kidneys (creatinine found in blood, urine, muscle tissue) at faily constant levles, regardless of factors such as fluid intake, diet or exercise -it provides a measure of renal funciton that is relatively independent of the hydration status of the pt or the pt dietary intake -BUN & Creatinine test usually done together |
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Nursing Diagnosis: Stress Incontinence
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-stress incontinence is a state i which a persons experiences a loss of urine of less than 50ml occurring w/ increased abdominal pressure
Defining characteristics: reproted or observed dribbling w/ increased abdominal pressure Related factors: changes in pelvic muscles, increased age |
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Nursing Diagnosis: Urge Incontinence
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A state in which a person experience involuntary passage of urine occuring soon after a stron sense of urgency to void
Defining characteristics: urgency, frequency more than every 2 hours), bladder spasm, nocturia (voiding more than 2x a night), voiding small amounts less than 100ml or large amts 550ml and inability to reach the toilet Related Faxctors: decrease bladder capacity, irritation of the bladder, consumption of alcohol, caffeine, incrased fluids |
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Nursing Diagnosis: Reflex Incontinence
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involuntary ooss of urine
Defining characteristics: no sensation to void, no sensation of bladder fullness Related factors: neurological impairment |
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Nursing Diagnosis: Functional Incontinence
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The inability of a person to reach the toilet in time
Defining Characteristics: amount of time it takes to reach the bathroom Related factors: altered environment, sensory, cognitive, or mobility deficits |
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Nursing Diagnosis: Total Incontinence
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When a person experiencs a continouous and unpredictable loss of urine.
Defining Characteristics: unawareness of incontinence Related Factors: neuropathy, trauma or disease that affets the spinal cord nerves |
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Nursing Diagnosis: Urinary retention
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The state in which a person experiences incomplete emptying of the bladder
Defining Characteristics: bladder distention, small frequent voiding, or absence of urine dribbling Related Factors: blockage, weak detrusor muscles, inhibition of the reflex arc |
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Outcome
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-the client will reestablis control over voiding
-the client will strengthen or maintain control adequate perineal muscle control -the client will verbalize understanding of procedures necessary to promote optimal urinary function |
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Health promotion
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-promote water intake
-prevent urinary tract infections -promote optimal muscle tone -measure to promote voiding eg. positioning |
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Nursing interventions
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-bladder training
-habit training -bladder crede (milking the bladder so pressure will cause pt. to void) -external catheter/protective pants (used to maintain pt. integrity) -urinary catheters (invasive, internal, sterile procecure) **foley Cath. is #1 cause of nosocomical infection *nephrosocmy tube -goes directly into renal pelvis; must never be clamp to prevent kidney damage) |
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Meds: Urinary antiseptics
Nirotfurantoin (Macrobid) |
keep urinary ph in acid range w/ vit. C & cranberry juice; give w/ food; warn pt. drug may discolor urine
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Meds: Sulfonamides
eg. Bactrim, Sepra |
admin. w/ large amount of fluid (med may crystalize) maintain alkaline ph becuase these meds are more soluble in alkaline urine. Avoid food/fluids that acidify urine
-usually given in UTI -give lots of fluid b/c meds. may crystalize |
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Meds: Urinary Analgesic
Pyridium |
for pain or UTI. Teach pt. urine will be red orange
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Meds: Cholinergic
Bethanechol chloride (urecholine) |
never used in pt. w/ any possibility of bladder obstruction; ne4ver give IM or IV ( can lead to circ collapse)
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Antispasmodics: Ocybutynin choloride (Ditropan)
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not used w/ HTN (hypertension, GI/GU obstruction, glaucoma
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Pro-Banthine
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not used w/ narrow angle glaucoma, obstruction
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Meds: Lasix
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Diuretic
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Bowel Elimination
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regular elimination of bowel waste products is essential for narmal body functioning
alteration can cause problems w/ the gastrointestinal an other body systems |
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Structures of the GI Tract
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mouth, esophagus, stomach, small intestine, large Intestine, cecum, colon rectum
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Abdomen: Right Upper quadrant
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liver
lower part of right kidney |
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Abdomen: Left Upper Quadrant
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transverse colon
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Abdomen: Right Lower quadrant
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ascending colon
cecum (cecum is part of ascending colon-softer, wider tube) |
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Abdoment: Left Lower Quadrant
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descending & sigmoid colon
(sigmoid colon-firm narrow tube, normal to have hild tenderness on deep palpation) |
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Digestion: Mouth
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begins in the mouth
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Digestion: Esophagus-reflux
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lower esophageal sphincter or cardi a sphincter betw. esophagus and stomach
-prevents bacward movemnet of fluids from stomach to esophagus -antacids-reduce reflux -fatty food, nicotine will increase reflux |
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Digestion: Stomach
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HCl, mucous, enzyme pepsin, intrinsic factor
-HCl concentration -stomach acidity, acid base balance. foods changes chyme, semi fluid material |
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Digestion: Small Intestine
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chyme leaves stomach, enters small intestine
-mixes w/ digestive enzyme (bile & amylase -travels via small intest. to allow absorption of nutrition and electrolytes -enxymes from pancrease (amylase) and bile form gall bladder released into duodenum -enzymes break down fat, protein, Carb -nutrients absorb by duodenum & jejunum -ileum absorb vits, iron, bile salts *Problem - when food is not broken down into chyme such as stomach removed, gastroplasty or gastritis causes rapid emptying |
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Digestion: Large Intestine
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1. cecum
2. sigmoid colon 3. recturm *responsible for absorption of water; primary bowel elimination |
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Digestion: Colon
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absorption, protection, secretion, elimination
water, Na, Cl, absorbed by colon |
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Functions of GI Tract: Motility, Absorption, defecation
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Motility: Segmentation: alternation contraction and relaxation of smooth muscles. Permits more complete digestion and absorption of nutrients
-peristalsis: propels the intestinal contents along the lenght of the small and large intestine 2. Absopriton - most nof nutrients and electrolyte absorption occurs in the duodenum and jejunum -fluid and electrolyes occur in large intestine 3. Defecation - distenion of the rectal muscles trigger bowel elimination |
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Characteristics of Normal Feces
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frequency - variable
color - brown consistency - soft formed shape - cylindrical amount - 100g - 300g/ day odor -aromatic; pungent |
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Normal Bowel pattern
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-is individualized
- 1-2 bowel movement per day to 1-2 movements every 2-3 days |
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Lifespan considerations
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In older aldults the normal aging process shlow GI motility so frequency of bowel movements normally decrease
-older adults need increase fluid intake and high fiber foods -laxative use high in older adults |
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Factors affecting elimination
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age
diet fluid intake physical activity psychological factors personal habits position during defecation |
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Factors affecting elimination
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pain
pregnancy surgery & anesthesia (slows the GI tract) medication **the most reliable indicatior of functional GI tract is gas |
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Manifestation of altered bowel function
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Constipation: symptom, not a disease.
-Decrease frequency , prolonged or difficult passage of hard dry stools Impaction: results of unrelieved constipation. -Collection of hardened feces, wedged in the rectum Diarrhea: increase in number of stools & the passage of liquid, unformed feces. Incontinence: inability to control passage of feces & gas from the anus. Flatulence: gas accumulates in lumen of the intestines. Distention: accumulation of excessive amounts of air , liquid or solids. Hemorrhoids: dilated, engorged veins in the lining of the rectum **bloody stool usually associated w/ GI bleeding, colorectal cancer, hemorroids |
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Bowel Diversions
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Stoma: portion of intestine brought through the abdominal wall.
Colostomy opening created using a portion of the large intestine. Ileostomy :Opening created using the ileum |
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Assessment
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What is your normal bowel pattern
What things do you do to stay regular Have you had any changes in your normal pattern Do you have problems with nausea, vomiting, constipation or diarrhea Have you had any problems with discomfort or control of your bowel movements. |
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Abdominal Assessment
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Pt should not have a full bladder
Examine the abdominal area in this order: Inspection Auscultation Percussion Palpation Measurement of Abdominal Girth Perirectal Examination *warm stetescope beefore placing on abdomen so as not to alter bowel sounds |
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Abdominal Assessment
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Inspection
Contour: Convex or Flat Symmetry: Symmetrical Auscultation : BS every 5-15 sec in all quardrants. Percussion : Hollow, tympany in LUQ( Stomach) Palpation: Soft Listen to the abdomen before percussion and feeling it because the latter maneuvers may alter the frequency of bowel sounds. |
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Abdominal Assessment: Auscultation Key Points
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Listen for bowel sounds, note frequency & character. Normal sounds consists of clicks & gurgles, frequency estimated at from 5-30 sec. Borborygmi-loud prolonged gurgles of hyper peristalsis (stomach growling)
Bowel sounds may be altered in diarrhea, intestinal obstruction, paralytic ileus, peritonitis. Paralytic ileus: absence of BS greater than 72 Hours |
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Cullen's sine
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bluish discoloration of umblicus seen in inter abdominal bleeding
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Turnern's sign
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bruise like discoloration in flank areas - associated w/ retroperitoneal hemmorrage
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Palpation : Key points
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Light palpation to examine the abdomen
Depress the area 0.5-1 inch This is used to assess skin temperature and moisture Massage in a circular motion to detect abnormal masses, areas of discomfort Deep palpation 1.5-2 inches The purpose of deep palpation is to locate organs, determine the size of the organs and to detect masses |
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Percussion: Key points
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Percussion provides information about the nature of the underlying structure
It is used to outline the size of an organ such as the bladder or the liver Determines whether an organ is air filled, fluid filled or solid |
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Diagnostic Test and Procedures
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Stool Specimens
Hemocult ( guiac) and stool culture Radiological Procedures - Barium Enema - Small Bowel Endoscopic Examinations - Sigmoidoscopy - Colonoscopy - Esophagogastroduodenoscopy |
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Stool Specimens
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Includes inspecting the specimen for consistency and color and testing for occult blood
Tests for fecal urobilinogen, fat, nitrogen, parasites, pathogens, food substances, and other substances; these tests require that the specimen be sent to the laboratory Random specimens are promptly sent to the laboratory Quantitative 24- to 72-hour collections must be kept refrigerated until they are taken to the laboratory Some specimens require that a certain diet be followed or that certain medications be withheld; check agency guidelines regarding specific procedures |
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UPPER GI TRACT STUDY (BARIUM SWALLOW)
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Description
An examination of the upper GI tract under fluoroscopy after the client drinks barium sulfate Preprocedure NPO after midnight prior to the day of the test POSTPROCEDURE A laxative may be prescribed Instruct the client to increase oral fluids to help pass the barium Monitor stools for the passage of barium (stools will appear chalky white) because barium can cause a bowel obstruction DESCRIPTION A fluoroscopic and radiographic examination of the large intestine after rectal instillation of barium sulfate May be done with or without air |
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LOWER GI TRACT STUDY (BARIUM ENEMA)
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DESCRIPTION
A fluoroscopic and radiographic examination of the large intestine after rectal instillation of barium sulfate May be done with or without air PREPROCEDURE A low-residue diet for 1 to 2 days prior to the test A clear liquid diet and a laxative the evening before the test NPO after midnight prior to the day of the test Cleansing enemas on the morning of the test POSTPROCEDURE Instruct the client to increase oral fluids to help pass the barium Administer a mild laxative as prescribed to facilitate emptying of the barium Monitor stools for the passage of barium Notify the physician if a bowel movement does not occur within 2 days |
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UPPER GI FIBEROSCOPY
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DESCRIPTION
Also known as esophagogastroduodenoscopy (EGD) Following sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum; tissue specimens can be obtained PREPROCEDURE NPO for 6 to 12 hours prior to the test A local anesthetic (spray or gargle) is administered along with midazolam (Versed) IV (provides conscious sedation and relieves anxiety) just before the scope is inserted Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle PREPROCEDURE Client is positioned on the left side to facilitate saliva drainage and to provide easy access of the endoscope Airway patency is monitored during the test and pulse oximetry is used to monitor oxygen saturation; emergency equipment should be readily available POSTPROCEDURE NPO until the gag reflex returns (1 to 2 hours) Monitor for signs of perforation (pain, bleeding, unusual difficulty swallowing, elevated temperature) Maintain bed rest for the sedated client until alert Lozenges, saline gargles, or oral analgesics can relieve minor sore throat after the gag reflex returns |
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ANOSCOPY
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Use of a rigid scope to examine the anal canal; client is placed in the knee-chest position with the back inclined at a 45-degree angle
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PROCTOSCOPY AND SIGMOIDOSCOPY
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Use of a flexible scope to examine the rectum and sigmoid colon; client is placed on the left side with the right leg bent and placed anteriorly
Biopsies and polypectomies can be performed |
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Nursing Diagnosis
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Constipation related to:
Immobility Lack of privacy Less than adequate fluid intake Colonic constipation related to: Less than adequate fiber intake Less than adequate fluid intake Chronic use of medication and enemas Perceived constipation related to: Cultural/family health beliefs Impaired thought processes |
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Nursing Diagnosis
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Diarrhea related to:
Stress and anxiety dietary intake Bowel Incontinence related to: Neuromuscular involvement Depression, severe anxiety Pain related to: Hemorrhoid inflammation Toileting self-care deficit related to: Decreased strength and endurance Intolerance to activity |
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Nursing Diagnosis
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Risk for or impaired skin integrity related to:
Fecal incontinence Body image disturbance related to: Presence of ostomy Fecal incontinence |
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Nursing Interventions for Health Promotion
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Client teaching
- Diet - Fluids -Activity and Exercise - Bowel Habits - Colorectal Screening |
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Screening for Colon Cancer
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Risk Factors
Age: over 50 Family history: colon polyps or colorectal cancer History of inflammatory bowel disease (colitis, Crohn’s disease) Living in urban area Diet: high intake of fats, low fiber intake Warning Signs Changes in bowel habits Rectal bleeding Screening Tests Digital rectal examination every year after age 40 Guaiac test for occult blood every year after 50 Proctoscopy every -3-5 years after age 50, after two annual negative exams. |
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Nursing Interventions for altered Bowel Function
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Medication Use
Enemas Rectal Tubes Nasogastric Intubation Fecal Impaction removal Bowel Training Fecal Diversions |
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Goals of Care for clients with elimination problems include the following:
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Understanding “normal” elimination
Attaining regular defecation habits Understanding and maintaining proper fluid and food intake. Achieving a regular exercise program Achieving comfort Maintaining skin integrity Maintaining self-concept |
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Implementation
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Promotion of regular bowel habits
Promotion of normal defecation Squatting position Positioning the bedpan Cathartics and laxatives Antidiarrheal agents Enemas Types: SSE (cleansing), fleets, mineral oil, tape water, oil-retention, carminative, return-flow, medicated Digital removal of stool Bowel training |
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Medications For Constipation
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Laxative
-Bulk: metamucil attract water into the large intestines -Stool softeners: Colace allows water to enter the stool easily -Saline: MOM Increases colon motility through release of cholecystokinine. - Stimulant:- Ducolax_ direct stimulation of the intestine mucosa |
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Medications For Diarrhea
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Diarrhea;
-Absorbents: Pepto Bismal Absorbs excess fluid -Bulk Forming Agents: Psyllium Attracts water to absorb excess fluids - Opiates: Codeine: Increase H2O and electrolyte absorption -Synthetic Agents: Immodium: Decrease intestinal motility -Antispasmodics: Atropine Decreases intestinal Motility |
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Evaluation
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Client will be able to regularly defecate soft formed painless stools.
Client will be able to accomplish normal defecation by manipulating natural components of daily living such as diet, fluid intake and exercise. Client will have minimal reliance on artificial means of defecation such as enemas and laxative use. |