Scc/ Test 3

Front 1

What are some factors affecting urinary output

Back 1

type and amt. of intake, hydration, medications, functional status of kidneys and anesthesia

Front 2

What are some factors affecting voiding

Back 2

developmental, psychosocial, medications, muscle tone, pathologic conditions, surgical and diagnostic procedures, mobility, mental status, communication

Front 3

The kidneys produce urine at a rate of about?

Back 3

50-60ml. per hr.

Front 4

The kidneys produce how much urine per day?

Back 4

1500-1600ml.

Front 5

Loss of elasticity in the bladder wall effects whom,

Back 5

older adults and childbearing may have weakened the pelvic muscles,

Front 6

what kind of substances can increase urine production by acting as a diuretic

Back 6

caffeine, such as coffee, tea, cola, and chocolate. Consuming lg. amt of alcohol

Front 7

a diet high in salt causes what?

Back 7

water retention and decreases urine production

Front 8

what are diuretics sometimes called

Back 8

water pills

Front 9

what do diuretics treat

Back 9

blood pressure, fluid retention, and edema by increasing elimination of urine

Front 10

what is referred to as kidney stones

Back 10

renal calculi

Front 11

describe renal calculi

Back 11

(kidney stones) or tumors, which obstruct the normal flow of urine

Front 12

Disorders of the urinary system taht affect urinary elimination include the following:

Back 12

infection or inflammation of the bladder, ureters, or kidneys, renal calculi, hypertrophy,

Front 13

diseases invloving other systems can indirectly affect urinary function. what are some ex.

Back 13

Cardiovascular and metabolic disorders decrease blood floow through the glomeruli and thus impair filtraton and urine production. any condition that affects the nervous system, neurogenic bladder, systemic infection, mobility and communication problems, cognitive changes that alter perception of the urge to void

Front 14

what occurs as a result of impaired neurological function. The person cannot perceive bladder fullness nor control the urinary sphincters. The bladder becomes flaccid or spastic, causing frequent involuntary loss of urine

Back 14

neurogenic bladder

Front 15

Anesthetic agents do what to the glomerular filtration

Back 15

decrease blood pressure and glomerular filtration, thus decreasing urine formation. Spinal anesthesi decreases teh pt. awareness of the need to void

Front 16

to assess urinary elimination you will use what kind of data

Back 16

nursing history, physical examination, and diagnostic and lab. reports

Front 17

assessment of the urine includes what

Back 17

measuring urine output and conducting a variety of bedside tests

Front 18

physical assessment for urinary elimination includes examination of

Back 18

kidneys, bladder, urethra, and skin surrounding the genitals

Front 19

what term is referred to as the absence of urine. this term is used when urine output is less than 100mL in 24hrs

Back 19

Anuria

Front 20

what is excessive urination. what term is referred to as being caused by excessive hydraion, diabetes mellitus, diabetes insipidus, or kidney disease

Back 20

polynuria

Front 21

What term is referred to urine output of less than 400mL in 24hrs

Back 21

Oliguria

Front 22

What term is referred to blood in the urine. May be due to trauma, kidney stones, infection, or menstruation

Back 22

Hematuria

Front 23

What term is referred to a sudden, almost uncontrollable need to urinate

Back 23

Urgency

Front 24

What term is ref. to as the need to urinate at short intervals

Back 24

frequency

Front 25

what are some types fo urinary incontinance

Back 25

urge incontinence, stress incontinence, mixed incont., overflow incont., functional incont., transient inconti., adn unconscious (reflex) incont.

Front 26

what is the inability to empty the bladder completely.

Back 26

urinary retention

Front 27

What do etiologies include in urinary retention

Back 27

obstruciton, inflammation and swelling, neurological problems, medicaitons, and anxiety

Front 28

What are some risk factors for urinary tract infect. (UTI)

Back 28

sexually active women, women who use spermicidal contraceptive gel, older women, men w/ an enlarged prostate, people w/ kidney stones, anyone who has an indwelling catheter, people who hae diabetes mellitus, people who have a history of UTI

Front 29

What are some signs and symptoms of UTIs

Back 29

urinary frequency, urgency, foul smelling urine, pyuria, dyuria, dysuria, hematuria, bladder spasms, edema, chills, fever, back pain, nausea and vomiting

Front 30

how is a clean catch specimen done

Back 30

a client must cleanse the genitalia before voiding and collect the sample in midstream

Front 31

for many ambulatory clents who need no assistance w/ uriantion. be sure to inform them that their i&o is being monitored and explain how they can help what would you then do

Back 31

place a specimen "hat" under the toiletseat to collect urine, or have male clients void into urinal periodically measure and empyt

Front 32

what is an indwelling catheter

Back 32

also known as a foley or retention catheter, is a flexible plastic tube that is inserted through the urethra into the bladder. It is held by a balloon that is inflated in the bladder above the detrusor muscle

Front 33

How would you collect a freshly voided sample,

Back 33

collect the urine in the same manner as when yoiu are measuring intake and output. pour the urine into a specimen container labeled w/ the pt. name, date, and the time of collection transport asap if there is a delay most agencies recommend refrigeration

Front 34

How would you collect a sterile urine specimen

Back 34

by inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter. to obtain a specimen from an indwelling catheter, insert a needle into the specimen port of the catheter and withdraw urine

Front 35

How would you collect a 24hr. collection

Back 35

to begin have the pt. void and record the time. discard this 1st voiding but collect all urine for the next 24hrs be sure to inform the pt and all staff about the collectionpost signs in prominent locations such as the client's b.r., entry door, to remind staff

Front 36

A routine urinalysis UA is one of the most commonly ordered lab. test is is used as what

Back 36

an overall screening test as well as an aid to diagnosing renal, hepatic, and other diseases requires a freshly voided sample include "dipstick" testing and /or microscopic analysis

Front 37

What are some testing tools for urinary elimination

Back 37

dipstick, specific gravity, urinalysis, blood studies

Front 38

What test can determine pH adn specific gravity adn the presence for protein, glucose, ketones, and occult blood in the urine

Back 38

bedside testing (dipstick)

Front 39

who may you delegate the bedside urine testing to

Back 39

unlicensed assistive personnel (UAP) if you know that the knowledge and skill to perform the procedure. ask the UAP to report the test results to you and to save the urine sample in case you should need to repeat the test.

Front 40

specific gravity is what

Back 40

an indicator of urine concentration, can be measured w/ a reagent strip is usually tested in the lab. but it is a nursing responsibility in some settings

Front 41

when yu want to be precise and accurate for urine concentration, you should use a refractometer it does what

Back 41

measures the extent to which a beam of light changes direction when it passes through the urine(the refractive index) if concentration of solids is high the light is refracted more

Front 42

blood urea nitrogen and creatinine levels are commonly measured to assess what

Back 42

renal function and hydration

Front 43

NANDA diagnoses specific to urinary elimination include the following:

Back 43

Impaird urinary elimination, urinary incontinence(functional, overflow, reflex, stres, total, urge), risk for urge urinary incontinence, urinary retention, readiness for enhanced urinary elimination

Front 44

client will resume his normal urination pattern by oct. 20, 2007 is an example of what

Back 44

planning/goals

Front 45

what is a uti

Back 45

occurs when microogranisms usually e.coli which normally lives in the colon, enter the urethra and begin to multiply.

Front 46

an infection limited to the urethra is called

Back 46

urethritis

Front 47

occours when bacteria travel up the urethra into the bladder, causing a bladder infection

Back 47

cystitis

Front 48

If the cystitis is not treaded promptly the infection may progress where

Back 48

superiorly (upward) to the ureters or kidneys (pyelonephritis)

Front 49

what is the involuntary loss of urine associated w/ a strong urge to void. it is often referred to as overactive bladder

Back 49

urge incontinence

Front 50

what is an involuntary loss of urine w/ increased intraabdominal pressure.

Back 50

stress incontinence

Front 51

what term is used is involuntary urination after about 5 to 6 yrs. of age, when control is usually established

Back 51

enuresis

Front 52

Nocturnal enuresis aka what and what is it?

Back 52

(bed wetting)common in preschoolers and should not be considered a problem untl after age 6

Front 53

Describe Stress Urinary Incontinence

Back 53

Loss of less than 50mL of urine occurring w/ increased abdominal pressure (coughing, laughing, sneezing...),
related to: weakened pelvic muscles/structural supports,
increased intra abdominal pressure
overdistention

Front 54

Interventions for stress urinary incontinence

Back 54

pelvic floor strentghthening exercises (kegal),
schedule regular voiding to reduce bladder pressure, limit coffee/ tea, weight loss, incontinence pads, boifeedback training

Front 55

define biofeedback training

Back 55

learning how to control that muscle and feel when it is tightened and wehn it is loosened

Front 56

Describe Total urinary incontinence

Back 56

continual and unpredictable loss of urine
related to: neurological dysfunction
anatomic abnormalities such as fistula,

Front 57

Interventions for total urinary incontinence

Back 57

schedule fluid intake, schedule regular voiding times, asses skin regularly adn use barrier creams, use adult briefs, use catheterization

Front 58

describe functional urinary incontinence

Back 58

inability of usually continent person to reach toilet in time to avoid unintentional loss of urine
Related to: environmental factors, neuromuscular limiation, sesory impairment psychological factors

Front 59

what are some interventions for functional incontinece

Back 59

modify environment,
orientation cues, clothing, raise toilet seat, lighting call light, schedule voidings assess for uti

Front 60

describe urge incontinence

Back 60

involuntary passage of urine occuring soon after a strong sense of urgency to void
related to: decreased bladder capacity, medications(diuretics, anticholinergics), irritation of bladder stretch receptors (infection, alcohol, caffeine, concentrated urine, overdistended bladder) constipation

Front 61

what are the interventions of urge incontinence

Back 61

voiding schedule (avoid overdistention), limit coffee/tea/alcohol, treat infections, pelvic floor strengthening, modify clothing(limit belt, zipper, they want to get in there), review use of anticholinergic meds (delayed voiding, practice delaying, postpone voiding, rather than the urge to go, they go during a schedule time),

Front 62

describe reflex urinary incontinence

Back 62

involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached
related to: tissue damage (radiation, radical pelvic surgery), neurological impairment (paralysis)

Front 63

what are the interventions of reflex urinary incontinence

Back 63

determine schedule for emptying bladder, self catheterization or collection devices (teach client clean technique not sterile)

Front 64

What are some contributing factors of a UTI

Back 64

residual urine, pH(in order to prevent we try to acidify it ex. cranberry juice), instrumentation, contaminated hands, poor perineal hygiene, catheterization(the longer its in the longer its prone to infection), intercourse, kinked catheter drainage tubing, back flow of urine(also bags need to be set lower)

Front 65

What are the symptoms of a UTI in the bladder?

Back 65

pain, burning(dysuria), frequency, urgency, hematuria(blood in urine), cloudy urine, fever, chills, N/V, malaise

Front 66

What are symptoms of a UTI in the kidney?

Back 66

CVA tenderness, chills and fever

Front 67

what are the interventions of a UTI

Back 67

medication, antibiotics, analgesics, education to prevent recurrence (good hygiene, lots of fluids)

Front 68

For clients who have loss of bladder tone, collaboratively you may do what?

Back 68

administer cholinergic medications, use Crede's maneurver(apply manual pressure over the bladder to promote emptying), and perform urinary catheterization.

Front 69

what is an example of a cholinergic medication which managies urinary retention?

Back 69

bethanechol chloride (Urecholine) which promotes bladder emptying

Front 70

independent nursing measures to assess and promote urination include the following:

Back 70

monitor i&o, assess fro risk factors for urinary retention(ex. prostatic hypertrophy pelvic surgery, meds),inspect and palpate for bladder distention, place pt. in normal voiding position, provide privacy, pour water over the perineum, run water nearby or place the pt. hand in warm water, measure post voiding residual urine

Front 71

Drugs which have anticholinergic properties do what?

Back 71

can cause urinary retention

Front 72

drugs which have cholinergic properties can do what?

Back 72

stimulate urination

Front 73

what does urinary antispasmodics do?

Back 73

decreases spasmolytic action on smooth muscle of GU tract, decreases the pain of bladder spasms, these drugs are anticholinergic, could cause confusion, blurred vision ex. flavoxate hydrchloide, urispas, ditropan, oxybutynin

Front 74

what does urinary analgesics do?

Back 74

exert a local anesthetic effect on urinary mucosa, relieve urinary tract pain, available otc, colors urine red-orange, stains clothes, take w/ meals, should seek treatment for underlying condition causing pain, ex. pyridium, azo standard

Front 75

Bethamechol, and Urecholine is an ex. of whak kind of drugs?

Back 75

drugs that stimulate urination

Front 76

Flavoxate hydrochloride, urispas, oxybuynin, ditropan is what kind of drugs

Back 76

urinary antispasmodics

Front 77

Phenazopyridine hydrochloride is what kind of drugs?

Back 77

Urinary analgesics

Front 78

when providing care for a pt. w/ an indwelling catheter what are some nursing goals?

Back 78

prevent uti(means that it can't be opened at any point), maintain free flow of urine, prevent transmission of infection(observe universal precautions), promote normal urine production, maintain skin and mucosal integrity

Front 79

for women who cannot assume a dorsal recumbent position, you can you use which position?

Back 79

side-lying position and lit the superior buttock to expose the urethral meatus

Front 80

why would perform a bladder irrigation?

Back 80

to maintain patency of a urinary catheter, to wash out the bladder or to instill medications into the bladder.

Front 81

an intermittent irrigation is most commonly used for what?

Back 81

medication instillation

Front 82

when would you use a continuos irrigation?

Back 82

used to maintain patency when blood, clots, or debris are anticipated.

Front 83

when would you use a routine intermttent irrigation?

Back 83

are sometimes ordered to ensure patency; however these should be avoided adn irrigation done only as necessary.

Front 84

procedure collecting a clean catch urine specimen

Back 84

don clean gloves, wash the perineum or the end of the penis w/soap and water, then w/ antiseptic solution, have the pt. begin voding. after the stream begins, collect a 30-60mL specimen, maintain sterility. do not touch the inside of the container or the container lid., place the lid on container label and transport it to the lab in a timely manner

Front 85

procedure inserting a catheter

Back 85

take an extra pair of sterile gloves an extra sterile catheter into the room, be sure that you have good lighting especialy for female, work on rt. side of the bed if you are a rt.handed;the left side if you are lt.handed,drape the pt for privacy, perform perineal care before the procedure wash your hands open the kit, don sterile gloves and maintain sterile technique, once you have touched the pt. w/ your nondominant hand, do not remove that hand from teh pt., lubricate the catheter tip before insertion, insert 5-7.5cm (2-3in.)for women,17-22.5cm(7-9in)for men until urine flow, drain the bladder; collect needed samples; measure urine, and connect drainage bag as needed

Front 86

procedure intermittent bladder or catheter irrigation

Back 86

establish a sterile field under the specimen removal port or the irrigation port on a three-way catheter, because of the risk of infection never disconnect the drainage tubing rom teh catheter, use sterile irrigation sol.,warmed to room temp, instill teh irrigation sol. slowly, repeat the process as necessary

Front 87

procedure continuos bladder irrigation

Back 87

drape the pt, exposing the irrigation port of the indwelling catheter, using aseptic tech. insert the connecting tubing into the irrigation sol. container, prime the tubing, removing all air, don clean procedure gloves, pinch the irrigation port of the catheter; remove any plug, and connect the irrigation tubing to the port., regulate the flow of tthe irrigant appropriately, monitor for urine output

Front 88

applying an external (condom) catheter

Back 88

application of a condom catheter is a clean procedure, the penis should be clean and dry prior to catheter application, when applying the condomn, stabalize the penis w/ your nondominant hand, leave a gap of 2.5-5cm(1-2in), between the condom and the tip of the penis to prevent skin irritaion, it is important use only the tape supplied in the applicaiton kit to secure the catheter (for condomn cath. that contain adhesive material on the inside fo the condom, grasp the penis and gently compress the condom onto the shaft), be certain that the tubing from the end of the catheter to the bedside drainage (or leg) bag is free from kinks

Front 89

define urinary catheterization

Back 89

it is the introduction of a pliable tube (catheter) into the bladder to allow drainage of urine.

Front 90

why is urinary catherization performed?

Back 90

to obtain a sterile urine specimen, empty the bladder for surgical or diagnostic purposes, prevent or treat bladder overdistention and urinary retention (eg after surger) wehn other measures fail, measure the urine that remains in the bladder after the pt. voids. this is commonly referred to as post-void residual vol. and is measured as part of the diagnostic workup for a pt. w/ urinary retention or incontinene

Front 91

which type of catheter is the cause of most commom nosocomial infections

Back 91

indwelling catheter

Front 92

which type of catheter is a single lumen tube that is inserted for immediate drainage of the bladder. after the bladder is empty or the sample obtained the catheter is removed and the pt. resumes voiding independently

Back 92

straight catheter

Front 93

This is used for continuous bladder drainage. Usually a double lumen tube: one is used for urine drainage, and the second lumen is used to inflate a balloon near the tip of the catheter. for most pt. you use a 5mL balloon; for children 3mL; and fro achieving hemostasis after a prostatectomy a 30mL.

Back 93

indwelling catheter

Front 94

this is used for continuos urine drainage when the urethra must be bypassed.

Back 94

suprapubic catheter; it is inserted through an incision above the symphysis pubis it is often sutured in plae but may occasionally be a double lumen catheter held in place by a balloon.

Front 95

what are the supplies used for inserting an indwelling catheter

Back 95

they are usually prepackaged; included in the kit are sterile gloves, swabs or cotton balls, a solution for cleansing the urethral meatus, sterile lubricant, a sterile indwelling catheter, a syringe filled w/ sterile water to inflate the retention balloon, drainage tubing, and a drainage collection bag.

Front 96

what are most common catheter sizes

Back 96

#12,#14, or #16

Front 97

pediatric catheter kits contain which sizes?

Back 97

#8 or #10

Front 98

what is the appropriate position when inserting a urinary catheter

Back 98

dorsal recumbent for both men and women

Front 99

for women who are unable to assume a dorsal recumbent posion, consider which position?

Back 99

sims' posion or a lateral position

Front 100

what are some factors that affect defecation?

Back 100

development, diet(particularly fiber, fluids), activity (walking), psychological (having to go on a bed pan), habits, medication (antibiotics, which changes the colonization), anesthesia and surgery (manipulation of the bowel; could cause parilytic ilues the bowel stop, pain (if it hurts they don't go)

Front 101

what is the process by which the bowel eliminates waste?

Back 101

defecation

Front 102

what is feces made up of?

Back 102

is a mixture of fiber and undigested food, shed epithelial cells, inorganic material (eg.ca.and phophate), bacteria, and water. small amt. of fat may be present

Front 103

a person can increase the pressure to expel feces by contracting trhe abdominal muscles while maintaing a closed airway. this is called

Back 103

valsalva maneurver.
although it assists clients w/ heart disease, glaucoma, increased intracranial pressure or a new surgical wound should be caustioned to avoid teh valsalva maneurver because it raises b/p, increases pressure w/in the abdom. cavity, and is associated w/ an increased risk for cardiac arrhythmias

Front 104

what are some assessments you can make when assessing the bowel elimination?

Back 104

normal bowel habits, risk factors, stool assessment

Front 105

what is considered to be a normal defecation pattern?

Back 105

there is a wide renage of "normal", the frequency of bms may range from several times per day to once a week. as long as the person passes stools w/out excessive urgency(needing to rush), w/ minimal effort and no straining, w/out blood loss, and w/out the use of laxatives, you can regard bowel function as normal

Front 106

describe some abnormalities in stool assessment?

Back 106

old blood will be dark/blackish-melena (red towards the rectum), iron may cause black colored stools, white clay colored-no bile-bile gives stool its pigment, pale w/ fat-malabsorption, mucus or bloody mucus, worms,

Front 107

describe normal bile?

Back 107

feces is usually brown in color because bile salts, which aid in the digestion of fat, are excreted in teh feces. bile is normally golden yellow, but the action of bacteria in teh GI tract change the color to brown. bacteria are also responsible for the odor of feces

Front 108

whom you can you find stress ulcers?

Back 108

very ill people

Front 109

what is a personal and sociocultural factor affecting bowel elimination?

Back 109

privacy is important, clients working in fast paced jobs may have difficulty even consciously recognizing he need to defecate, some are acutely embarrassed by the thought and wait until they are entirely alone, parents and caregivers may hold off because of fear fo leaving the children alone, stress has a major influence on motility of the GI tract.

Front 110

Nutrition, hydration and activity level are all factors affecting bowel elimination give some ex of each?

Back 110

fiber. high fiber promotes peristalsis, low fiber such as pasta slow peristalsis, dietary supp. can also affect bowel function.
fluids. a minimum of 6-8glasses of fluid per day is required to promote healthful bowel function. different types of fluids have varying effects on sensitive individuals. for instance consuming lg. amt of milk may cuase constipation in some, coffee promotes peristalsis in many clients and may even cause lose stools in sensitive clients,
activity, seems to stimulate peristalsis and bowel elimination.

Front 111

several diagnostic tests may be perfomed to assess for bowel elimination problems what name 3?

Back 111

direct visualization studies, indirect visualization studies, adn laboratory studies

Front 112

these are studies for diagnostic and treatment purposes conducted by gastroenterologist.

Back 112

direct visualization studies the nurse prepares for the test, monitor the pt. tolerance of the procedure, provide pain medication or sedation to keep the pt. comfortable during exam, and provide reassurance to the pt. as the test proceeds

Front 113

these studies are radiographic views fo the lower GI tract. the simplest is an abdominal flat plate, an anterior to posterior x ray view of the abdomen used to detect gallstones, fecal impaction, and distended bowel.?

Back 113

indirect visualization

Front 114

When would the laboratory studies be used to assess bowel elimination

Back 114

stool specimens may be analyzed to detect blood, infection, or parasite infestation.

Front 115

how is a lab study performed to assess stool

Back 115

the client must void first and then defecate in a clean, dry bedpan, bedside commonde or a special container placed under the toilet seat. A small sample is obtained and sent to the lab for analysis or analyzed at bedside.

Front 116

how do you handle stool specimens

Back 116

wear clean gloves when you handle the container ro manipulate stool specimens. tongue blade to transfer teh stool specimen to the container provided by the lab. do not contaminate the outside fo the specimen container. in most case you will need approx. 2.5cm (1in) of formed stoo or 20-30mL of liquied stool. If blood, mucus, or purulent material is present, be sure to include this w/ the sample, transport the specimen to lab asap. usually you will need to refrigerate the specimen until it can be received by the lab

Front 117

you may be called on to assess stool for the presence of blood what test would you perform

Back 117

blood may be visible to the eye or occult(hidden), yoiu can perform he test for occult blood at the bedside or in lab. the test is called guaiac test, hemoccult, or fecal occult blood test.

Front 118

for fecal occult blood test done in the home the pt. should restrict what kind of things?

Back 118

certain foods for 3days before stool testing; for ex. red meat, ckn, fish, horseradish, and some raw fruits and veg. may result in a false positive reading, should not take salicylates (aspirin eg), steroids, iron preparations, or anticoagulants for 7 days before the test, the test should not be done if a woman is having her period or if the person has bleeding hemorrhoids or hematuria

Front 119

assessing for pinworms describe the process and define what a pinworm is

Back 119

pinworms (an intestinal parasite) are small, white, threadlike worms that live in the cecum. they come to the anal area to deposit eggs during the night and migrate back up, in assessing a child you can spread the buttocks while the child is sleeping and examine the anus to see whether any pinworms are visible to the naked eye. you can test for the eggs w/ tape, in the morning, as soon as the pt. awakens, press clear cellophane tape against teh anal opening. remoe the tape immediately, and place it on a slide, you may also need to do perianal swabs this test may need to be repeated on consecutive days

Front 120

procedure for testing stool for occult blood

Back 120

use a clean , dry container, take are taht the sample is not contminated by urine or menstual blood, be careful not to contaminate the outside of the collection container w/ feces, test two small stool samples from separate areas fo the lg. sample, spread each sample thinly, one at a time, onto the windows of the hemoccult slide, place teh correct number and size of drops of developer sol. into the window of the opposite side on the hemoccult slide, record a positve result if the slide windows turn blue

Front 121

procedure placing and removing a bedpan

Back 121

determine wheter the pt. will need to use a regular bedpan or a fracture pan, don clean procedure gloves, help the pt. to achieve a postion on the bedpan that will be most helpful in facilitating urinary or bowel elimination. place the pt. in semi fowler's posion whenever possible modify the position based on the pt. condition, provide clean washcloths and towels for the pt. to perform personal hygiene when elimination is complete. assist if the pt cannot perform these tasks independently

Front 122

procedure for administering an enema

Back 122

determine the pt. ability to retain the enema sol., if the pt. is immobile, have a bedpan or bedside commode available, warm the sol., lubricate teh tip of the enema tubing generously, insert the tubing only about 7.5-10 cm (3-4in) into rectum, hold the container at the correct ht. above the level of the hips, instil teh sol. at a slow rate, encourage the pt to take slow, deep breaths and hold the sol. for 5-15 min. depending on the type of enema, assess the pt. for cramping or inability to retain the sol, doc. the results

Front 123

procedure for removing stool digitally

Back 123

trim and file your nails, obtain baseline vital signs and determine wheter the pt. has a history of cardiac problems or other contraindications, determine whether the procedure will be accompanied by suppository insertion or enema admin. (eg. will an oil retention enema be given first), use only one or two fingers, and remove stool in small pieces, allow the pt. periods of rest, and monitor for signs of vagal nerve stimulation, teach the pt. lifestyle changes necessary to prevent stool retention

Front 124

Common nursing diagnoses related to bowel elimination include the following:

Back 124

bowel incontinence, constipation, risk for constipation, perceived constipation, diarrhea, toileting self care deficit

Front 125

what are some planning goals for bowel elimination

Back 125

maintian/ restore normal bowel elimination pattern by .....
maintain/ regain normal stool consistecy by ....
prevent (assoc.risks)(eg. fluid &elec. imbalance,
skin breakdown (prevent skin breakdown, bowel incontinence)

Front 126

what are some nursing interventions for bowel elimination

Back 126

promoting normal or regular defecation, privacy, positioning, timing of defecation, fluids and nutrition, exercise, medications (enemas)

Front 127

Clients most likely to experience constipation are those who?

Back 127

have decreased activity or are on bedrest, are receiving opiods or other medications that slow peristalsis, and have decreased fluid and fiber intake

Front 128

some examples of constipation as discussed in notes

Back 128

infrequent bowel movements, difficult evacuation of stool, inability to defecate at will and hard feces. the longer stool stays in the intestine the more water is absorbed and the harder teh stool.

Front 129

The strategies to prevent and treat constipation are identical to the activities that promote regular bowel elimination they include the following:

Back 129

increase teh intake of high fiber foods, increase fluid intake, increase physical activity, provide privacy for using the toilet, assist the pt. to a seated or squatting position whenever possible. a semi-fowler's position is preferred for a client on bedrest. allow the pt. uninterrupted time to use the toilet especially after meals, when mass peristalsis occurs

Front 130

What are some causes of constipation

Back 130

medications NARCOTICS (frequent side effect sometimes a stool softener w/ be prescribed w/it or a lax), ASA, antihistamines, aluminum antacids, hypnotics, tranquilizers, irregular bowel habits/ changes in routine schedule, bedrest-decreased mobility, elderly-slowed peristalsis, neurological conditions that block nerve impulses, illness such as hypothyroidism, hypoocalcemia, hypokalemia, depression, eating disorders, low fiber diets, stress, laxative abuse

Front 131

constipation can cause harm in a number of ways what are some ex.

Back 131

straining can cause increase in intraocular pressure and intracranial pressure, people who have had an MI-dysrythmias stimulation of vagus nerve, surgery and childbirth-hemorrhoidectomy and sutures, hemorrhoids

Front 132

Preventing and intervening constipation include:

Back 132

teaching pt., fluids (1500mL/24hr), fiber (fruits/veg), activity (walking), stool softeners to prevent constipation, sometimes laxatives especially if on narcotics, laxatives or enams to treat (they may become impacted), privacy, positioning (left side), bedside commode

Front 133

Fecal Impaction is caused by what?

Back 133

unrelieved constipation, hardened feces collects and becomes so wedged in the rectum that it cannot be passed. it is the presence of hardened fecal mass in the rectum.

Front 134

define an enema

Back 134

is the introduction of solution into the rectum to soften feces, distend teh colon, and stimulate peristalsis adn evacuation of feces.

Front 135

What are the types of enemas

Back 135

classified as cleansing, retention, or return-flow

Front 136

this enema promote removal of feces from the colon may be used to: treat severe constipation or impaction, clear teh colon in prep. for visualization procedures such as colonoscopy, empty the colon when starting a bowel training program

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cleansing enemas

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this type of enema introduces a solution into the colon that is meant to be retained for a prolonged period.

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retention enemas

Front 138

list the most common forms of retention enemas

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oil retention enamas, carminative enamas, medicated enemas, nutritive enamas

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this enama is also known as a harris flush, may be ordered to help a pt. expel flatus and relieve abdominal distention

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return flow enema

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what may a nurse assess for impaction

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debilitated, confused, unconscious, dehydrated client-most common, look for oozing of diarrhea as a sign, but that may not be present, loss of appetite, nausea, abdominal distention, cramping, rectal pain

Front 141

what is some examples of treatments of impaction from our notes?

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perform a digital exam to check for an impaction, oil fleets enema to soften may help some, usually have to manually remove an impaction-very uncomfortable/ try to prevent

Front 142

if fecal impaction does not respond to use of stool softeners and enemas, you will need to digitally remove feces from the rectum. how is this accomplished

Back 142

by breaking up the hardened mass into pieces and manually extracting the pieces. you may admin. an oil retention enema at least 30 min. prior to digital removal to soften the stool and decrease the pt. discomfort during the procedure aside from discomfort the pressure generated in teh rectum may stimulate the vagus nerve, slowing the heart rate for that reason you must have a dr. order

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this is the inability to control the discharge of feces and flatulence

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bowel incontinence

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what are some things you can do to manage bowel incontinence

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monitor pattern of BM, provide bedpan at regular intervals, change clothing bed linens to prevent skin irritation and embarrassment, provide propmt hygiene care, monitor skin for evidence of breakdown, review diet, consider a bowel training program, you may use incontinence pads (never place the plastic side of the pad next to the pt. body), never refer to incontinence pads as diapers

Front 145

describe when and what a fecal incontinence pouch is

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may be used for pt. w/ incontinene to protect perineal skin or to collect large samples of feces. the pouch collects fecal drainage, keeping feces away from the skin this is commonly used approach for clients w/ uncontrolled diarrhea

Front 146

describe diarrhea

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increase in number of stools, liquid unformed, stool is going through the bowels quickly and water is not absorbed, count as output when you are doing I&O.

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difficulty starting or maintaining a urinary stream

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is called urinary hesitancy

Front 148

why might diarrhea occur

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as a result contaminated food, a viral infection, or dietary change, or as a side effect of a medication.

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loss of bladder control, leakage is known as

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dribbling

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what are the primary concern in diarrhea

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water and potassium loss, pts are at risk for fluid electrolyte imbalance., infants, young children, and the frail elderly are most vulnerable and may require hospitalization adn intravenous fluid replacement therapy. also, exposes skin to very irritating substances which cause breakdown

Front 151

Nursing interventions on diarrhea focus on

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treating the diarrhea itself, as well as its associated problems (cramping, fluid and electorlyte imbalances, and impaired skin integrity)

Front 152

what are some causes of diarrhea

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antibiotic use, infections C.Diff, enternal nutrition, allergies, food borne pathogens, medication, lactose intolerance, illnesses such as colitis

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What are some nursing interventions on treating diarrhea,

Back 153

monitor frequency, amt., color, and consistency of stools to determine severity of diarrhea, monitor I&O, body wt, and vital signs to assess for fluid losses, assesss skin turgor and mucous membranes for evidence of fluid imbalance, monitor serum electrolyte levels to detect imbalances, assess the perineal area for alterations in the skin integrity, provide assistance w/ hygiene to protect the skin, encourage your pt. to sip liquids often to replace the losses, avoid a sudden lg. intake of fluid or food, because this may trigger mass peristalsis, teash the client about or provide a clear liquid diet, including electrolyte replacement fluids, if your client has an appetite advise a BRAT diet:bananas, rice, applesause,toast,also highly spiced foods or lg quanties of raw fruits and veg. may cause diarrhea in some pts. tell pts to keep track of what triggers, several med. espcially antibiotics, may also, change of med may be required to manage diarrhea

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medication is usually reserved for use w/ chronic diarrhea-diarrhea that has persisted for more than 1month, why is it that you would instruct pt. to avoid using otc drugs unless instructed by physician

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antidiarrheal medications are not recommended for acute diarrhea. in most cases diarrhea is a response to infection or unusual foods and serves as a mechanism to rid the body of the pathogens or troublesome food.

Front 155

what are the primary antidiarrheal drugs prescribed

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opiates (eg. paregoric) and opiate derivatives, although they slow peristalsis and inhibit diarrhea, they may cause drowsiness;advise especially elderly to use w/ caution

Front 156

chronic pressure on the veins within the anal canal, as w/ prolonged sitting or retained feces, can cause what

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hemorrhoids (distended blood vessels within or protruding from the anus)

Front 157

describe hemorrhoids

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dilated veins-can be internal and/or external, may bleed, may be painful, avoid constpation