Fundamentals CH 21, 37-38, 11-17
Cliches to Avoid
"Everybody is afraid of surgery. Why should you be any different?"
Cliches to Avoid
"Everything will be all right."
A client has been recently diagnosed with type 1 diabetes mellitus. He is seen in the emergency room every day with high blood sugar. The client apologizes to the nurse for bothering them every day, but he cannot give himself insulin injections. What should the nurse's response be?
"Has someone taught you how to take them?"
A nurse is discussing cataract treatment with a client. Which of the following statements by the nurse would be most therapeutic?
"Have you ever thought of laser surgery?"
A patient reports constipation. Which of the following assessment questions should the nurse initially ask when completing the patient's health history, including bowel habits?
"How do you handle stress?"
A nurse finds that a client has infiltration around the IV line that needs to be removed. What explanation should the nurse give to reduce the client's anxiety?
"I know that you are anxious, but removal will be painless and the IV location needs to be changed."
The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. Which of the following is the most appropriate response by the nurse to decrease the client's anxiety?
"I will start an IV that will add fluids directly to the blood stream."
A nurse is caring for a client with depression. The nurse finds that the client is withdrawn and does not communicate with others. Which of the following is the most appropriate response by the nurse?
"Is that a new shirt you're wearing?"
A nursing student is preparing to administer morning care to the patient. What is the most important question that the nursing student should ask the patient?
"May I help you with a bed bath now or later this morning?"
A nurse on the rehab division states to her head nurse, "I need the day off and you didn't give it to me!" The head nurse replies, "Well, I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate," In the act of sending the message, which statement would be considered more effective?
"My Tyler, I would like to discuss my schedule with you. I requested the 8th of Auguest off for a doctor's appointment. Could I make an appointment?"
The nurse enters the patient's room and examines the patient's IV fluids and cardiac monitor. The patient states, "Well, I haven't seen you before. Who are you?" Which of the following is the nurse's best response?
"My name is John Smith. I'll be caring for you until 11 pm."
The public health nurse is leaving the home of a young mother who has a special needs baby. THe neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's best response to the neighbor?
"New mothers need support."
A nurse pays a house visit to a client who is on total parenteral nutrition. The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse?
"Tell me more about how it feels to eat with your family."
A female client reports to her primary care physician with aggravated chest pain. The physician orders a stress test. The client tells the nurse that she doesn't want to take the test and feels she should instead continue with the medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse?
"Tell me more about how you are feeling."
A nurse visits a female victim of sexual assault for the fourth visit. The client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse?
"Tell me more about the aspects that makes you feel as if it happened yesterday."
A client reports to the primary health care facility with complaints of chest pain. After the investigations and initial treatment, the client anxiously inquires if he had a heart attack. What should be the nurse's reply?
"The physician wants to monitor you and control your pain."
When the preoperative patient tells the nurse that he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is
"The thought of having surgery is keeping you awake."
A nurse has developed a strong rapport with the wife of a patient who has been receiving rehab following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require home and will require care that can only be provided in a facility with constant nursing care. The patient's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond?
"This must be very difficult for you to hear. How do you feel right now?"
A nurse has developed strong rapport with the wife of a patient who has been receiving rehabilitation following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require care that can only be provided in a facility with constant nursing care. The patient's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond?
"This must be very difficult for you to hear. How do you feel right now?"
The daughter of an elderly female patient has asked the nurse why a urine speciman was collected from her mother earlier that morning. How can the nurse best respond to the daughter's query?
"We want to test your mother's urine to make sure she doesn't have a urinary tract infection."
A client comes to the clinic complaining of abdominal pain. Which question would be most appropriate for the nurse to ask initially to facilitate the assessment?
"What activities exaggerate the pain?"
A nurse is assessing a patient's nutritional intake prior to admission based upon information that indicates the patient has lost 10 pounds over the last 2 months. An appropriate therapeutic communication technique to gain information is which of the following?
"What factors have contributed to your weight loss over the last few months?"
A patient scheduled to have hip replacement surgery states, "I am so scared of the surgery and of the anesthetic." What is the best response by the nurse?
"What questions do you have about the surgery?"
A 76-year-old patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the most appropriate comment or question to elicit additional information?
"What specific complications have you experienced?"
You are the charge nurse responsible for the evening shift. During rounds, you hear the patient care tech yelling loudly to a patient regarding his transfer from the bed to chair. When entering the room, which of the following is your best response?
"When your patient is safe and comfortable, meet me at the desk."
A nurse is examining a 3-year-old child with conjunctivitis. During the examination, the child starts crying and refuses to sit still. Which of the following statements is appropriate for the nurse tell the child?
"Would you like to see my flashlight?"
Using Judgmental Comments
"You aren't acting very grown up. How do you think your husband would feel if he saw you crying like this?"
therapeutic touch
"unruffling," or clearing, congested areas of energy in the body and redirecting this energy
4 basic components of the assertive response or approach
(1) having empathy, (2) describing one's feelings or the situation, (3) clarifying one's expectations, and (4) anticipating consequences
Phases of the Helping Relationship
(1) the orientation phase, (2) the working phase, and (3) the termination phase
The eyes carry other nonverbal messages
(Exs: a stare during anger, open wide in fear, etc)
Nocturnal enuresis
(night time bedwetting) usually subsides by age 6.
Urinary incontinence
, any involuntary leakage of urine, is one of most common chronic health problems. Of those who seek treatment, 80% are cured or have their symptoms improved notably
Your ability to communicate effectively will influence your sharing, problem solving, goal attainment
, team building, and effectiveness in critical nursing roles
If a group member dominates the group process,
, then the leader or other group members must confront the member to promote the needed collegial relationship
Large Intestine -• Functions
- Absorption of water - Manufacture of some vitamins
Effects of aging
- Decreased bladder muscle tone may reduce capacity of bladder to hold urine, resulting in increased frequency of urination.
Large Intestine -• Functions
- Formation of feces - Expulsion of feces from the body
Be considerate of the receiver
- select a message that appeals to the pt's interests and that requires minimal effort and time to decode
Do not ignore an uncomplaining pt
- they may view communication as intimidating
24-hour urine specimen
-Collect all urine voided in 24-hour -Post a sign on patient's door not to discard urine -Initiate a collection at a specific time, which is recorded, by asking patient to empty their bladder -Send urine to the lab
Which of the following are included in the nursing plan of care to prevent adverse effects when caring for a patient w/ a nasogastric tube in place for gastric decompression?
-Irrigate w/ saline -Measure the length of exposed tube - Measure the pH of the aspirated tube contents - Administer frequent oral hygiene
Small intestine -duodenum, jujunum, ileum
-Responsible for digestion of food and absorption of nutrients into bloodstream
Treating UTI's
-Short-course antibiotic regimen Teach patient to: Drink 8-10, 8 oz glasses water day Observe urine for color, amount, odor and frequency Dry perineal area from front to back
Which activities take place during the working phase of the nurse-patient relationship?
-The patient participates actively in the relationship -The patient genuinely expresses his or her concerns to the nurse.
Ostomy care
-keep patient as free of odors as possible, empty ostomy appliance frequently.
Diarrhea
-passage of more than three loose stools a day -in infants-overfeeding or too much con syrup in formula.
Stomach-hollow, J shaped
-stores food during eating, churns food to aid in digestion, pushes partially digested food
WARMTH AND FRIENDLINESS
. pleasant greeting, friendly smile, acceptance, and interest)
Patient teaching for colostomies
...
basic components of assertive behavoirs:
1. having empathy 2. describing one's feelings or the situation 3. clarifying one's expectations 4. anticipating consequences
Diagnostic Tests
1—fecal occult blood test
Toilet training
2 to 3 years old, enuresis
Diagnostic Tests
2—barium studies (should precede UGI)
Peristalsis Contractions occur every
3 to 12 minutes.
Diagnostic Tests
3—endoscopic examinations
Normal pH of urine
6.0 w/ range of 4.6 to 8.
A patient has a nursing diagnosis of Impaired Urinary Elimination related to maturational enuresis. You recognize that your patient is which of the following?
A child older than 4 years of age who has involuntary urination
If frequency of urination changes, it may indicate illness.
A habitual low fluid intake or decrease in sensation of thirst associated w/ aging may cause less urination. Inaccessibility of toilet facilities owing to travel, work circumstances, illness or limitations in mobility may lead to infrequent urination
A nursing instructor is discussing differences between helping relationships and social relationships with a group of nursing students. Which statement is characteristic of a helping relationship?
A helping relationship is characterized by an unequal sharing of information
A nursing instructor is discussing differences between helping relationships and social relationships with a group of nursing students. Which statement is a characteristic of a helping relationship?
A helping relationship is characterized by an unequal sharing of information.
In which of the following situations would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a patient's new onset of chest pain
In which of the following situations would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a patient's new onset of chest pain.
The nurse has entered a patient's room and observes that the patient is hunched over and appears to be breathing rapidly. What type of question should the nurse first implement in this interaction?
A yes/no question.
Nonverbal Communication
AKA body language -transmission of info w/o the use of words
Intrapersonal Communication
AKA self-talk
Data must be collected to evaluate the effectiveness of a plan to reduce urinary incontinence in an older adult patient. Of the information below, which is least important for the evaluation process?
Age of the patient
If a patient was instructed to avoid foods that may have a laxative effect, the nurse would advise the patient to avoid which of the following foods?
Alcohol
A bowel-training program includes which of the following?
Allowing ample time for evaluation.
Open-Ended Question or Comment
Allows a wide range of possible responses
Clarifying Question or Comment
Allows nurse to gain an understanding of a pt's comment to avert misconception Do not overuse
An elderly patient who has had a colostomy for over 10 years states, "I won't need any teaching about colostomies. I understand how to change the bag and care for my colostomy, but I'm not sure how to best clean my stoma?" What does this statement indicate?
An incongruent relationship
Paralytic ileus
Anesthesia also inhibits peristalsis by blocking parasympathetic impulses.
Which one of the following enemas would be used for a patient with intestinal parasites?
Anthelmintic enema
Which of the following terms describes a condition in which 24-hour urine output is less than 50 mL?
Anuria
Dispositional Traits
Are characteristic or customary ways of behaving
Goals of the Helping Relationship
As the pt's needs and goals change, so do the nursing care interventions
Normal fresh urine has an aromatic odor.
As urine stands, it often develops an ammonia odor because of bacterial action.
Measuring Urine Output
Ask patient to void into bedpan, urinal, or specimen container in bed or bathroom.
A nurse has drafted an SBAR communication before contacting the primary care provider of a patient whose condition has worsened. How should the nurse best conclude this communication?
Ask the care provider to come and assess the patient*
A nurse has drafted an SBAR communication before contacting the primary care provider of a patient whose condition has worsened. How should the nurse best conclude this communication?
Ask the care provider to come and assess the patient.
(see full question) The nurse has been closely monitoring a patient who has recently had her indwelling urinary catheter removed. In the six hours since the catheter was removed, the patient has yet to void. How should the nurse first respond to this assessment finding?
Assess the patient's bladder by palpation and bedside ultrasound.
Which of the following is an appropriate nursing action to promote regular bowel habits?
Assisting the patient to as normal position as possible to defecate
A nurse is asking a client health-related questions during a medical assessment. The client has developed lesions on the skin and warts around the mouth. Which of the following factors affect oral communication?
Attention and concentration
Types of channels
Auditory Visual Kinesthetic
A message can be sent to the receiver through the following channels:
Auditory Visual Kinesthetic (touch)
Which of the following accurately describes a guideline when inserting an indwelling catheter?
Avoid irrigation unless needed to relieve an obstruction.
In the provision of care and the establishment of the therapeutic relationship, the nurse must first
Be aware of one's own personality
Developmental Level
Be aware of the pt's age Knowing how each age group commonly perceives health, illness, and body functions should guide your interactions w/ your pts
Validating Question or Comment (Re: what heard or observed)
Be careful not to overuse - pt may think you are not listening
Using Comments That Give Advise
Be careful!
Assertiveness Skills
Be respectful, not aggressive!
Mrs. D, an alert, ambulatory, older nursing home resident, voids frequently, and has difficulty making it to the bathroom in time The priority treatment option for Mrs. D would most likely involve which of the following?
Behavioral techniques
FACTORS INFLUENCING COMMUNICATION -Environment
Best when the environment facilitates an easy exchange of info
When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. Which of the following could cause this variation in color of the urine?
Blood
When the nurse performs a Hemoccult test on a stool specimen, blood in the stool will change the color on the test paper to
Blue
An elderly woman who is incontinent of stool following a cerebrovascular accident will have the following nursing diagnosis
Bowel incontinence related to loss of sphincter control as evidenced by inability to delay the urge to defecate
Which of the following statements should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence?
Boys may take longer for daytime continence than girls
During removal of a fecal impaction, which of the following could occur b/c of vagal stimulation?
Bradycardia
Which class of laxative acts by causing the stool to absorb water and swell?
Bulk-forming
Which of the following would the nurse incorporate into the teaching plan for a patient to promote healthy urinary functioning?
Caffeine-containing beverages should be monitored to prevent excess intake.
FACTORS INFLUENCING COMMUNICATION -Environment
Calm and nonthreatening -Minimize distractions and ensure privacy
Gait
Can ID well-being, sadness, etc
Intrapersonal Communication
Can also help you mentally prepare for a pt/family interaction
Directing Question or Comment
Can be used to obtain more info about a topic brought up earlier in the interview or to introduce a new aspect of the current topic
Avoid stereotyping a person according to occupation
Can give you ideas as to abilities, talents, interests, and economic status, but it stereotyping and should be avoided
Touch
Can have many meanings (i.e. affirmation, intimacy, aggression, etc) Can be a powerful therapeutic tool when used at the right time Be sensitive to touch! Many situations require touching the pt while implementing nursing care (i.e. essential and inevitable) Become comfortable/sure
Posture
Carries nonverbal messages
Mode of Dress and Grooming
Carry nonverbal messages healthy people with high self-esteem tend to pay attention to details of dress and grooming
Gestures
Carry numerous messages (Ex: thumbs up means victory)
Your patient complains of excessive flatulence. When reviewing dietary intake, which food would you identify as responsible?
Cauliflower
A student nurse studying human anatomy knows that the following is a structure of the large intestine:
Cecum
Assessing a Problem With Voiding
Check adequacy of patient's self-care behaviors
A patient scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema?
Cleansing enema
Left side lying or knee chest position
Cleansing enemas
When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of which of the following inappropriate communicaiton techniques?
Cliche
During an assessment of a newly admitted patient the nurse asks the patient many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question?
Closed question
Which of the following direct visualization tests uses a long, flexible, fiber-optic-lighted scope to visualize the rectum, colon, and distal small bowel?
Colonoscopy
When caring for a patient, nursing care will be most effective when the nurse-patient interactions are focused on which of the following circumstances?
Common understanding
A nurse touches the patient's hand while discussing his diagnosis. This action is a(an)
Communication channel
Evaluating
Communication facilitates the revision of parts of the care plan
Bladder
Composed of three layers of muscle tissue called detrusor muscle
A nurse communicating with a patient states, "I will be changing your dressing." She is wearing sterile gloves and a mask. She is conveying a(an)
Congruent relationship
The nursing instructor informs a student nurse that a patient she is caring for has a chronic neurologic condition and the condition decreases the patient's peristalsis. What nursing diagnosis is the most likely risk for this patient?
Constipation
Ignoring the urge to defecate on a continual basis leads to
Constipation and hard stool
A student nurse is attempting to improve her communication skills. Which of the following is an appropriate therapeutic communication skill?
Control the tone of voice to avoid hidden messages
When documenting patient care, the nurse understands that the most important reason for correct and accurate documentation is which of the following?
Conveyance of information
Sociocultural Differences
Culture, economic condition, and overall lifestyle influence a pt's preferred mode of communicating
Keep conversation as natural as possible
DOn't sound overeager, be alert and relaxed
Ostomy care
Dark or purple-blue stoma is compromised circulation or ischemia
When a person has a fever or diaphoresis, how would the urine output be described?
Decreased and highly concentrated
Verbal Communication
Depends on language
During discharge teaching, the nurse should:
Determine the progress made in established goals
7 Goals of the Helping Relationship
Determined cooperatively and are defined in terms of the pt's needs (Exs: increased independence for the pt, etc)
Which of the following symptoms are known side effects of antibiotics?
Diarrhea
Effects of aging
Diminished ability of kidneys to concentrate urine may result in nocturia.
Measuring Urine Output
Discard urine in toilet unless specimen is needed. -Record the total amount voided during each shift and 24-hour period on the patient's permanent record.
The nurse is preparing to auscultate the bowel sounds of a patient with a nasogastric tube in place to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube?
Disconnect the nasogastric tube from suction during the assessment of bowel sounds.
Skin care
Disposable washclothes should be used for critically ill.
Which of the following would be a common nursing diagnosis for the patient w/ an ileostomy?
Disturbed body image
Failure to Listen
Do not become defensive in response to pt's comments (i.e. a huge barrier to open and trusting communication)
Giving False Assurance
Do not do this! (You do not know that everything is going to be ok!)
A client is admitted to the healthcare facility with complaints of pain on urination that is secondary to a urinary tract infection (UTI). The nurse documents this finding as which of the following?
Dysuria
Group Dynamics
Each group member uses talents and interpersonal strengths to help the group to accomplish its goals
Assessing
Effective communication techniques, as well as observational skills, are used extensively during this phase
A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?
Empathy
Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached?
Empathy
A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. Which of the following is the most appropriate intervention?
Encourage family discussions of feelings.
Open-Ended Question or Comment
Encourages free verbalization
Nursing care for a patient with an indwelling catheter includes which of the following?
Encouraging a generous fluid intake if not contraindicated by the patient's condition
Developmental Level
Ex 10 year old won't know what an infection is
Intrapersonal Communication
Ex: "Calm down, you've been in challenging situations before and always survived. You can handle this
Certain gaits are associated w/ illness
Ex: pts recovering from recent abdominal surgery usually walk slightly bent over and slowly and might need the assistance of handrails or a helping person
Inspection and palpation of the Anus and Rectum
Examine anal area for cracks, nodules, distended veins, masses or polyps, or fecal mass
Silence
Excessive talking tends to place the focus on the nurse rather than on the pt
Kidney functions:
Excrete waste product (urine)
While assessing a client, the nurse notices that the client seems to be distracted from the questions being asked. The nurse attempts to identify factors that may be affecting the communication. Which of the following would the nurse identify as an internal influencing factor?
Experience
Assessing a Problem With Voiding
Explore its duration, severity, and precipitating factors
Sounds
Exs: crying, moaning, gasping, etc
FACTORS INFLUENCING COMMUNICATION -Values
Exs: nurses who believe teaching pts is important vs not AND a pt's motivation or lack of
Urostomy-
External stoma or outlet must be catherized at regular intervals to drain the urine that has collected in this reservoir.
When assessing a patient's nonverbal communication, the nurse will assess which of the following as the most expressive part of the body?
Facial expressions
As the nurse prepares to assist Mrs P with her newly created ileostomy, she is aware of which of the following?
Fecal drainage will be liquid
An elderly client who is wheelchair bound following a cerebrovascular accident is being assessed by the nurse. The nurse notes the client has seepage of stool from the anus. The nurse knows this is indicative of
Fecal impaction
Kidney functions:
Filter and excrete blood constituents not needed; retain those that are needed
A Helping Relationship
Focuses on the "whole" pt
Diagnosing
Following the formulation of the nursing diagnoses, you'll communicate findings to others
Which one of the following is a recommended food for an older adult who is constipated?
Fruit
Regular exercise improves
GI motility and muscle tone
A nurse who is preparing to administer an injection to the client, states, "This injection will not be painful." The nurse has used which communication technique?
Giving false reassurance
During a nursing staff meeting, the nurses determine that they will make sure all vital signs are reported and charted within 15 minutes following assessment. THis is an example of:
Group Identity
After surgery, Ms. Young is having difficulty voiding. Which nursing action would most likely lead to an increased difficulty with voiding?
Having Ms. Young ignore the urge to void until her bladder is full
Communication is the
Heart of nursing
Gestures
Helpful w/ pts who have hearing and language deficits
Verbal Communication
Helps nurses assess what the pt knows and feels -Nurses use extensively
Food and fluid-types and amounts affect elimination
High-fiber diet and daily fluid intake of 2-3,000 mL facilitates bowel elimination
Group Dynamics
How individual group members relate to one another during the process of working toward group goals
Position-help patient assume usual voiding positions.
Hygiene-Assist w/ perineal cleaning if needed.
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. Which of the following is the characteristic of empathy?
Identifying with the client's feeling
Giving False Assurance
If you inadvertently do use false assurance, then you should explain w/ an apology and implement effective communication techniques
A patient has developed edema in her lower legs and feet, prompting her physician to prescribe furosemide (Lasix), a diuretic medication. After the patient has begun this new medication, what should the nurse anticipate?
Increased output of dilute urine
A nurse is providing instruction to the patient regarding the procedure to change his colostomy bag. During the teaching session, he asks, "What type of foods should I avoid to prevent gas?" The question the patient has asked allows for which of the following?
Information clarification
Inspection and palpation of the Anus and Rectum
Insert gloved finger into anus to assess sphincter tone and smoothness of mucosal lining
Inspection and palpation of the Anus and Rectum
Inspect perineal area for skin irritation secondary to diarrhea
Ostomy care
Inspect stoma frequently. Should be dark pink; red and moist
Skin care
Intensive care patients have limited mobility d/t medical condition, postoperative status, or urinary catheter use. Risks increase greatly.
The nurse and the physical therapist discuss the therapy schedule and goals for a patient on a rehab unit. What type of communication is occuring between the nurse and the therapist?
Interpersonal
The nurse and the physical therapist discuss the therapy schedule and goals for a patient on a rehabilitation unit. What type of communication is occurring between the nurse and the therapist?
Interpersonal
Organizational Communication
Involves individuals and groups Communication occurs to achieve established goals Ex: Committee meetings
A Helping Relationship
Involves professional relationships, professionalism, confidence, and expertise
USING THERAPEUTIC COMMUNICATION IN THE HELPING RELATIONSHIP
Involves purposeful communication
Reflective Question or Comment
Involves repeating Encourages the pt to elaborate on thoughts and feelings
Hand-off Communication: SBAR Technique
Involves the accurate presentation of all pt-related info to another caregiver
A Helping Relationship
Involves trusting and valuing, appearing confident and competent, and focus
Touch
Is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, anger, etc
Colostomy Care
Keep patient as free of odors as possible; empty appliance frequently.
Colostomy Care
Keep the skin around the stoma site clean and dry.
Mrs. D, an alert, ambulatory, older nursing home resident, voids frequently, and has difficulty making it to the bathroom in time. The nurse planning her care is aware of which of the following?
Kegel exercises performed at regular intervals throughout the day may be helpful
A patient's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the patient in anticipation of administering a cleansing enema?
Left side-lying
The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be
Liquid consistency
A nurse is administering a prescribed solution of cottonseed oil to a client during an enema. What is the outcome of the use of cottonseed?
Lubricates and softens stool
Kidney functions:
Maintain composition and volume of body fluids
Using Questions Containing the Words Why and How
May be intimidating to pts "Why were you not tired enough to sleep last night?"
Touch
Means different things to different people Age and sex influence
Colostomy Care
Measure the patient's fluid intake and output.
When communicating with patients nurses need to be very careful in their approach. This is particularly true when communicating using
Medical terminology
Gender
Men and women communicate and interpret differently -Validate that both you and your pt are accurately receiving the message the other is trying to communicate
Silence
Might ID complete understanding, that the individuals are thinking, etc
"Why were you not tired enough to sleep last night?" Using Questions That Probe for Info
Might cut off communication "Let's get to the bottom of this" - may destroy communication
Urinary incontinence
More problem for women b/c urethra shorter. Strong psychological factors, such as marked fear may result in involuntary urination
FACTORS INFLUENCING COMMUNICATION -Environment
Music, art, stuffed animals, etc might assist in placing the pt at ease
Group Communication Small-Group Communication
Must communicate to achieve their goal Exs: staff meetings, patient care conferences, etc The more people involved, the more complex it becomes
nurse
Must understand and implement proper communication techniques
Group Dynamics
Mutual respect
A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a
Neurogenic bladder
When caring for a client with fecal incontinence, the nurse provides an absorbent pad to protect clothing and bed linens. The nurse knows that fecal incontinence is the result of which of the following reasons?
Neurologic changes that impair muscle activity
The nurse encourages a client to participate in the communication process by using an opening remark based on observations and assessment. Which approach would be most effective for the nurse to use to promote trust?
Neutral
Urethra
No part of female urethra outside body, unlike male. Male urethra functions in excretory system and reproductive system
Diagnostic Tests
Noninvasive procedures take precedence over invasive procedures
During an annual performance review with an employee, the nurse manager does not maintain eye contact and seems concerned about the time and the next appointment. This use of communication is considered
Nonverbal
Measuring Urine Output
Note amount of urine voided and record on appropriate form.
Assessing a Problem With Voiding
Note patient's perception of the problem
Interpersonal Communication
Nurses communicate w/ pts, family members, and members of the HCT
Evaluating
Nurses rely on cues they receive from their pts to verify whether patient objectives or goals have been achieved
Dispositional Traits
Nurses who consistently demonstrate these communicate effectively
Sequencing Question or Comment
Nursing assessment is facilitated when events leading to a problem are placed in sequence
General Physical Appearance
Observe for changes in appearance Can help you detect illness or evaluate the effectiveness of care or therapy
Reasons for Catheterization
Obtaining a urine specimen when usual methods can't be used
Interpersonal Communication
Occurs b/t two or more people w/ a goal to exchange messages
Closed Question or Comment
Often a barrier to effective communication
Nurses continue to report the occurrence of negative communication w/ physicians
Often cited as a contributor to poor job satisfaction and jeopardizes nurse retention (i.e. rude, intimidating, etc)
Assessing
One-to-one communication is used w/ pts to obtain thorough nursing histories and PEs
During an assessment of a newly admitted patient the nurse asks the patient many questions. The nurse begins the assessment by asking, "How many times have you been hospitilized this year for your back pain?" This is an example of which type of question?
Open-ended question
Mr. Edmondson has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of type 2 diabetes. The nurse has asked Mr. Edmondson, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?
Open-ended question
Mr. Edmonson has always prided himself in maintaining good health and is shocked at his diabetes 2 diagnosis. The nurse asks Mr. Edmondson, "How do you think your diabets is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?
Open-ended question
Outcome Identification and Planning
Oral and written communication is needed to inform others of what needs to be done to meet the set objectives or goals
A client has a urinary tract infection. The client is told to take phenazopryridine (Pyridium) to decrease urinary discomfort. The client should be instructed that her urine will turn
Orange
A patient taking a urinary analgesic should be cautioned that her urine might change to what color?
Orange-red
During an interaction with a critically ill patient's family, the nurse uses the communication technique of silence. The technique assists the family to:
Organize their thoughts
A nurse enters the patient's room and introduces himself stating, "Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and I will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on." He then gives the patient a printed card with this information. In the helping relationship, what does this represent?
Orientation phase
When caring for a psychiatric patient, a formal contract is made with the patient during which phase of the nurse-patient relationship?
Orientation phase
When explaining the action of a hypertonic solution enema, the nurse incorporates which of the following as basis for action?
Osmosis of water into colon
A patient walking to the bathroom with a stooped gait is noted with facial grimacing. It is important that the nurse assess the patient for which of the following?
Pain
A client with colorectal cancer is complaining to the nurse of constipation. Which of the following signs or symptoms accompany constipation?
Pain on defecation
Ostomy care
Pale stoma may be anemia.
Outcomes for Normal Bowel Elimination
Patient has a soft formed bowel movement every 1 to 3 days without discomfort
Outcomes for Normal Bowel Elimination
Patient should seek medical evaluation if changes in stool color or consistency persist
Skin care
Patients w/ fecal incontience and impaired mobility 37.5 X more likely to develop pressure ulcers
During a home visit, the nurse learns that the client ensures a daily bowel movement with the help of laxatives. The client feels that deviation from a bowel movement every day is unhealthy. Which nursing diagnosis would the nurse most likely identify?
Perceived constipation
You are the guest speaker at a women's club. Most of the women are over the age of 40 years. The women have asked you to speak on health promotion topics. In the area of urinary urgency, you instruct the women to
Perform Kegel exercises
A nurse is caring for a client with an abdominal injury at a health care facility. The client tells the nurse that he passed blood-stained stool. Which of the following nursing actions is appropriate when a client reports blood in the stool?
Perform a screening test on stool samples
Stretch receptors in bladder stimulated as urine collects.
Person feels desire to void when bladder fills to about 150 to 250 mL.
Measuring Urine Output
Place calibrated container on flat surface and read at eye level.
Specimens from infants and children
Plastic disposable collection bags are available for collecting urine specimen from infants and young children who have not achieved voluntary bladder control
Intrapersonal Communication
Positive vs. negative
Measuring Urine Output
Pour urine into appropriate measuring device.
Control tone of your voice
Practice makes perfect!so you are conveying what you want to say and not a hidden msg
Which of the following is a nursing priority when caring for a male patient with a condom catheter?
Preventing the tubing from kinking to maintain free urinary drainage.
• Assist patient as soon as they first feel the Urge to void
Privacy-most adults and children cannot urinate in presence of another person, provide privacy
Documenting Communication
Promotes continuity of care given by nurses and other HCPs via progess notes and care plans
Closed Question or Comment
Provides limited choices of responses (i.e. "yes" or "no")
A laboratory test of a client's urine indicates the presence of pus in the urine. Which of the following terms is used to describe this type of urine?
Pyuria
A Helping Relationship
R/t the components of care, concern, trust, and growth
A nurse at a health care facility provides continence training to a client. During the training, the nurse plans a trial schedule for voiding that correlates with the time when the client is usually incontinent. Which of the following is a possible reason for the nurse's action?
Reduces potential for accidental voiding
Silence
Reflect on what has been shared and observe the pt
A nurse is caring for a client with myasthenia gravis. The client is having difficulty forming words and his tone is nasal. Which of the following is an effective communication strategy for this client?
Repeat what the client has said to verify the meaning.
Listening is a skill!
Requires attention and concentration
Outcome Identification and Planning
Requires communication among the pt, nurse, and others as mutually agreed-upon outcomes are developed and interventions are determined
When collecting a urine specimen for routine urinalysis from a patient, the nurse keeps in mind which of the following?
Results may be altered if a sample is left standing at room temperature for a long time.
A barium enema should be done before an upper GI series b/c of which of the following?
Retained barium may cloud the colon
Which of the following terms denotes a patient's inability to void even though the kidneys are producing urine that enters the bladder?
Retention
Verbal Communication
Reveals aspects of the person's intellectual development, educational level, and geographic and ethnic origin
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which of the following activities would the nurse be carrying out?
Reviewing health changes
Skin care
Routine skin cleansing and incontinence care intervention reduce patient's chance of developing UTI, incontience associated dermatitis, pressure ulcer, fungal infection, C-diff
Space and Territoriality
Seeking the pt's permission before touching areas w/in a pt's private zones
Goals of the Helping Relationship
Selected nursing interventions will help the person move toward the goal
A group of nursing students are working together on a presentation for their clinical instructor. One student in the group participates by arguing and attempting to block each step of the process of creating this presentation. The student's behavoir is causing frustration for the group of students and slowing their progress. Which of the following best describes the role of this individual student is playing in relationship to the group dynamics?
Self-serving
A nurse is interviewing a patient for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the patient's past medical history. The nurse is the
Sender
Sigmoid colon contains feces.
Sigmoid colon empties into rectum.
SBAR
Situation, Background, Assessment, Recommendations -consistent method for hand-off communication
SBAR - stands for
Situation, Background, Assessment, and Recommendations
Facial Expressions
Some mask their feelings, making it more difficult to determine what the person is really thinking
Urinary incontinence
Sometimes increased abdominal pressure such as occurs during coughing and sneezing forces involuntary escape of urine.
Bladder
Sphincter guards opening between urinary bladder and urethra
Mr. B is 60 years old and alert. He is timid and reluctant to talk about his urinary retention problem. Which part of this plan could create stress for Mr. B and possibility increase his inability to urinate?
Staying w/ him while voiding
Changing the Subject
Stops conversation -May occur when feeling uncomfortable about the topic -Leads to ignoring the pt
A nurse uses a catheter to collect a sterile urine specimen from a client at a health care facility. If a catheter is required temporarily, which type of catheter should the nurse use?
Straight catheter
Group Dynamics
Success or failure of a group is largely a function of its members' behavior
Inappropriate Comments or Questions
Suggest that there is no cause for anxiety or concern, or they offer false assurance Tend to be interpreted as a lack of real interest in what has been said
Using Leading Questions
Suggests what response the speaker wishes to hear "You aren't going to smoke that cigarette, are you?"
A nurse is using a bladder scanner to assess the bladder volume of a patient with urinary frequency. In which of the following positions would the nurse place the patient?
Supine
A patient with urine retention related to a complete prostatic obstruction requires a urinary catheter to drain the bladder. Which type of catheter is most appropriate for a patient that has an obstructed urethra?
Suprapubic catheter
Skin care -Measurable outcomes
Surgical site infection Urinary tract infection Pressure ulcer Skin integrity
Hand-off Communication: SBAR Technique
TJC has mandated a National Patient Safety Goal that requires organizations to "implement a standardized approach to hand-off communications, including an opportunity to ask and respond to questions"
Space and Territoriality
Take cues from pts
Which of the following guidelines should a nurse use when choosing a position in relation to a patient during a verbal interaction?
Take note of the patient cues when choosing a position and act on these cues.
Which of the following guidelines should a nurse use when choosing a position in relation to a patient during a verbal interaction?
Take note of the patient's cues when choosing a position and act on these cues.
Silence
Take time to wait for the pt to initiate or to continue speaking
The nurse is providing teaching to a patient who is being discharged to home with an indwelling urinary catheter in place. What information is important for the nurse to discuss with the patient?
The catheter can be connected to a smaller leg bag for ambulation.
During a visit to the pediatrician's office, a parent inquires about toilet training her 2-year-old daughter. The nurse informs the mother that one factor in determining toilet-training readiness is when:
The child can recognize bladder fullness.
Assessing
The data collected verbally and nonverbally are analyzed and then passed on to the appropriate people through oral and written communication
Outcome Identification and Planning
The formal written plan of care is a form of communication
Implementing
The implementation of the plan of care is then documented in the pt's record
Mr. Cheng, a hospitalized patient w/ diabetes mellitus, has developed a UTI. He is 80 years old and has an indwelling catheter in place. Which factor is most likely the cause of his UTI?
The indwelling catheter
The physician has ordered an indwelling catheter inserted in a hospitalizated male patient. The nurse is aware of which of the following considerations?
The male urethra is more vulnerable to injury during insertion
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?
The needle causes pain when it goes in, but I will be by your side throughout and will help you hold your position."
Touch
The nurse could use touch to indicate concern and respect for the pt
The nurse enters the room of a patient with cancer. He is crying and states, "I feel so alone." Of the following statements, which is the most therapeutic?
The nurse holds the patient's hand and asks, "What makes you feel so alone?"
The nurse has enetered a patient's room after receiving morning report, rapidly assessed the patient's airway, breathing, and circulation and greeted the patient by saying, "good morning." The patient made no reciprocal response to the nurse. How should the nurse best respond to the patient's silence?
The nurse should ask appropriate questions to understand the reasons for the patient's silence.
The nurse has entered a patient's room after receiving morning report, rapidly assessed the patient's airway, breathing, and circulation and greeted the patient by saying "good morning." The patient has made no reciprocal response to the nurse. How should the nurse best respond to the patient's silence?
The nurse should ask appropriate questions to understand the reasons for the patient's silence.
A nurse and an elderly client with chronic back pain are in the working phase of the nurse-client relationship. Which of the following activities occur in the working phase?
The nurse tries to avoid retarding the client's independence.
Upon assessment of the urine in a patient's indwelling urinary catheter drain bag, the nurse notes the urine to be dark yellow. This assessment finding indicates which of the following?
The patient is underhydrated.
When the nurse communicates with a newly admitted patient, the nurse must pay particular attention to nonverbal behaviors. The nurse considers which of the following as nonverbal communication?
The patient's tone of voice
Implementing
The pt informs you of his or her ability or inability to meet targeted objectives
Implementing
The pt's verbal and nonverbal messages are assessed during each nurse-pt interaction
Outcomes for Normal Bowel Elimination
The relationship between bowel elimination and diet, fluid, and exercise is explained
A dialysis nurse is teaching a patient to care for the dialysis access that was inserted in the patient's right arm. The nurse assesses the patient's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the patient's hospitalization. What phase of the working relationship is best described in this scenario?
The working phase
A dialysis nurse is teaching a patient to care for the dialysis access that was inserted in the patient's right arm. The nurse assesses the patient's fears and concerns related to dialysis, the dialysis acess, and care of the access. The information is taught over several sessions during the course of the patient's hospitilization. What phase of the working relationship is best described in this scenario?
The working phase
In order to provide effective nursing care, the nurse should engage in what type of communication with the patient and significant others?
Therapeutic communication
Using Questions Requiring Only a Yes or No Answer
They cut off discussion "Did you have a good day?"
Nurses should recommend avoiding the habitual use of laxatives. Which of the following is rationale for this?
They will cause chronic constipation
Urinary catheterization is the most common cause of hospital acquired infection.
True
A nurse tells a client that she will come back in 10 minutes to re-assess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing?
Trust
Which of the following factors is most important in the development of rapport between nurse and patient?
Trust
Changes in stool characteristics or frequency may be one of first clinical manifestations of disease.
Tumor-stool narrower or ribbon-like
A nurse is performing a physical assessment of a patient's abdomen. What is the normal sound that should be heard using the technique of percussion?
Tympany
Effects of aging
Urine retention and stasis=more likelihood of urinary tract infection
A nurse is caring for an elderly client. What strategy should the nurse include in order to facilitate effective communication?
Use active listening during communication.
Humor
Use appropriately and effectively! Is a learned skill Can be destructive Be aware of cultural differences
Evaluate the pt's language proficiency
Use medical interpreters prn
Secondary Skin infections (SSIs)
Use preoperative skin asepsis Alcohol free solution to reduce bacterial counts or MRSA and Acinetobacter
Closed Question or Comment
Used to gather specific info and allow the nurse and pt to focus on a particular area
Sequencing Question or Comment
Used to place events in a chronologic order or to investigate a possible cause-and-effect relationship b/t events
Implementing
Verbal and nonverbal communication are used to teach, counsel, support, etc pts and families during the implementation phase
Mr T is nervous about a colonoscopy scheduled for tomorrow. The nurse describes the test by explaining that it allows which of the following?
Visual examination of the large intestine
Treating UTI's
Void immediately after intercourse Drink two glasses of water before and after sex Wear underwear w/ cotton crotch and avoid tight clothes Drink 10 oz cranberry or blueberry juice that may prevent bacteriuria (bacteria in urine)
Effects of aging
Voluntary control affected by physical problems and inability to reach toilet in time.
Documenting Communication
We continually assess pt's needs and conditions - requires accurate documentation
Which of the following factors is related to developmental changes in bowel habits for elderly clients?
Weakened pelvic muscles lead to constipation
Care provided to a patient following surgery and until discharge represents which phase of the helping relationship?
Working phase
Rapport:
a feeling of mutual trust experienced by people in a satisfactory relationship
To be an effective caregiver
a nurse must be an effective communicator
The sender or source (encoder) of the message
a person or group who initiates or begins the communication process
This communication process is initiated based on
a stimulus i.e. a pt need that must be addressed - Ex: pain)
Common characteristics of the assertive nurse
ability to remain calm; the freedom to ask for help when necessary; the ability to give and accept compliments; honesty in admitting mistakes and taking responsibility for them; etc
Common characteristics of the assertive nurse
ability to share honestly one's thoughts, feelings, and emotions
OPENNESS AND RESPECT
accepting, non-prejudice, non-judgmental,
message
actual physiologic product of the source
The message
actual physiologic product of the source (Ex: conversation, gesture, memo, etc)
Enema
add enema to solution to container. Release clamp and allow fluid to progress through tube before reclamping.
Nutritive enemas
administer fluids and nutrition rectally.
self-serving roles
advance the needs of individual members at the group's expense
Self-serving roles
advance the needs of individual members at the group's expense (Exs: attention seeker, dominator, etc)
Ileostomy
allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma
Postvoid residual (PVR)
amount of urine remaining in the bladder immediately after voiding.
All interviews should begin w/
an explanation of the purpose of the interview
In many cultures, eye contact suggests respect
and a willingness to listen and to keep communication open (i.e. cultural variations)
being aware of your cultural beliefs and prejudices-Assists in understanding nonverbal communication
and enables the delivery of accurate nursing care to the pt and family
Allow ample time for the pt to respond
and explore other sources of needed info
Communication is the means used to establish rapport
and helping-trust relationships
Be aware of your own personal cultural beliefs
and identify prejudices or attitudes that could be a barrier to good communication
Most stomas protrude ½ -1 inch from abdominal surface
and initially appear as-swollen and edematous.
Focus on the whole pt
and not the pt's diagnosis
Feces excreted from rectum through anal canal
and out opening called anus.
Be knowdgedable about the topic of interest
and provide accurate info. If unfamiliar, best to tell patient and direc tthem to other resources.
Be aware of both the nonverbal messages you send
and the nonverbal messages you receive from pts
Exercise helps keep elimination
and urine production optimal.
Each person has a sense of how much personal or private space is needed
and what distance b/t individuals is optimum
horizontal violence
anger and aggressive behavior between nurses, or nurse-to-nurse hostility
Urinary incontinence
any involuntary loss of urine that causes a problem
Transient incontinence
appears suddenly and lasts for 6 months or less, treatable factors, secondary to acute illness, infection, as a result of medical treatment, use of diuretics, etc.
Nurses who are competent, honest, skilled communicators
are viewed as effective and compassionate caregivers
Some Asian and Native American cultures view eye contact
as an invasion of an individual's privacy
Process of emptying the bladder
as urination, micturition or voiding
Urine
assess for color, odor, clarity, and sediment
Skin
assess for color, texture, turgor, and excretion of wastes
RESPECTING PERSONAL SPACE
assess thru observations; be sensitive to this so that pt feels comfortable
Working phase
assistance to perform acitivities of daily living nursing roles of teacher and counseler
Stress can make people void smaller amounts
at less frequent intervals.
Valsalva maneuver-
attempt to forcefully exhale, bearing down to defecate, contraindicated in people with cardiovascular problems.
Indwelling catheters (retention or Foley catheters)
balloon inflated so catheter doesn't slip out once it's inserted into bladder
Nephron
basic structural and functional unit of the kidneys
Skin care
basin tap water source of cross-contaimination. Lower microbial counts in prepackaged bath vs. basin tap water.
Diagnosing
becomes a permanent part of the pt's record
Empty contents of ostomy bag into
bedpan, toilet or measuring device.
Be flexible
best to follow patient's lead and then return to subject you wanted to discuss
Iron salts
black stool
Instructional obstruction
blockage prevents normal flow of intestinal contents through intestinal tract
Occult blood-
blood hidden in stool specimen or cannot be seen on gross examination (can be seen w/ screening tests)
Warning signs of colon cancer
blood in stools, change in bowel elimination pattern, rectal or abdominal pain, sensation of incomplete emptying after bowel movement.
Hematuria
blood in the urine
Levodopa
brown or black urine
Fecal impaction
build up of stool
Communication skills
building blocks of professional relationships b/t nurse and pt, nurse and nurse, and nurse and other health-team members
Urinating or voiding is largely involuntary reflex act,
but its control can be learned
Alcohol has diuretic effect
by inhibiting release of antidiuretic hormone
A full bladder, a dull headache, anxiety, concern, and fear
can all negatively influence communication (Be sensitive to these)
Pathogens introduced into the bladder
can ascend the ureters and cause bladder and kidney infections.
Absorbent products for incontinence
can cause skin breakdown and put patients at risk for UTI.
Toilet training shouldn't begin until child
can hold urine for 2 hours, recognize feeling of bladder fullness, communicate need to void and control urination until seated on toilet.
Pelvic floor muscle training (PFMT)
can improve voluntary control of urination and reduce or eliminate problems w/ stress incontinence by strengthening perineal and abdominal muscle tone.
Nephrotoxic
capable of causing kidney damage
CDC reported HAIs in intensive care units
caused by MRSA as high as 60% in 2004 -healthcare workers reportedly wash/sanitize hands less than 50% of the time
Chronic renal failure
caused by diabetes, hypertension, and glomerulonephritis
Functional incontinence
caused by factors outside the urinary tract
Infants
characteristics of stool and frequency depend on formula or breast feedings
Kidneys
check for costovertebral tenderness
health function of bathing:
cleaning skin, controling infection, stimulating tissue and muscles, removes endogenous flora
Clean-catch
collected during midstream -catch-patient voids and discards a small amount of urine, continues voiding in sterile specimen container to collect urine. First small amount of urine voided helps to flush away organisms near meatus and shows organisms most characteristic of urine body produces.
Document stoma
color, consistency, amount of output
Weakening of the pelvic floor muscles
common cause of urinary continence problems and women and men.
Culture
common lifestyles, languages, behavior patterns, traditions, and beliefs that are learned and passed from one generation to the next.
intrapersonal communication aka self talk
communication that happens within the individual
Gossip and Rumor
communication via the grapevine can ruin reputations blocks teambuilding Do not engage in!
Termination phase
conclusion of initial agreement is acknowledged -might be change of shift time, when patient is discharged, or when nurse leaves on vacation or outside employment
Suppository-
conical or oval solid substance shaped for easy insertion into a body cavity designed to melt at body temperature.
Lean meat, processed cheese, eggs, pasta
constipating foods
Older adult
constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes
Enuresis
continued incontinence of urine past the age of toilet training
Ventililator associated penumonia (VAP)
contributes to significant morbidity; 40% mortality rate; $40,000 per case to treat
Most children develop urinary control
control between ages 2 to 5.
Medulla and a subsidiary center in the spinal cord
control reflex to defecate
Common characteristics of the assertive nurse
confident, open body posture; eye contact; use of clear, concise "I" statements
Ileal conduit-
cutaneous urinary diversion.
Stoma complications-
cyanotic, blue
A patient's recent diagnosis of colorectal cancer has required a hemicolectomy (removal of part of the bowel) and the creation of a colostomy. The nurse would recognize that the patient's stoma is healthy when it appears:
dark pink and moist.
The home care nurse is caring for a patient with an ileal conduit. Upon assessment of the patient's stoma, the nurse recognizes a normal stoma site as appearing:
dark pink and moist.
Orientation phase
data-gathering patient and nurse meet and learn to identify each other by name
Indwelling catheters and pregnancy
decrease bladder muscle tone/cause muscle atrophy
Child, adolescent, adult
defecation patterns vary in quantity, frequency, and rhythmicity
Hospitals have an established code of conduct and policies
defining and addressing acceptable and unacceptable behavior
The group's ability to function at a high level
depends on each member's sensitivity to the needs of the group and its individual members
Antihelmintic enemas
destroy intestinal parasites.
Hospitals educate all staff about the code of conduct
develop reporting systems, use mediators when necessary, and document all efforts to address unacceptable behavior
Endoscopy-
direct visual exam of body organs or cavities- -using fiber-optic endoscope
Proactive behavior includes learning how to react professionally and protectively "in the moment,
documenting and reporting the incident, and insisting that this abuse is addressed
PRIVACY
drawing the curtains
Cathartics and laxatives
drugs that induce emptying of intestinal tract
Constipation
dry, hard stool, persistently difficult passage of stool and/or incomplete passage of stool
Upon assessment of a patient with multiple sclerosis, the nurse notes that the patient is difficult to understand d/t an inability to produce speech sounds related to poor respiratory control and impaired movement of the lips and tongue. The nurse will document this finding on the patient's chart as:
dysarthria
SBAR requires
education and practice
Combine high-fiber foods
eight 8 oz glasses water daily and exercise to prevent constipation.
Urine from the nephrons
empties into the kidneys
Reflex incontinence
emptying of the bladder without sensation of need to void
Chronic kidney disease
end result of irreparable damage to kidneys
The nursing student is nervous and concerned about the work she is about to do at the clinical facility. To allay anxiety and be successful in her provision of care, it is important for her to:
engage in self-talk to plan her day and decrease her fear
People who habitually urinate infrequently develop more urinary tract and kidney disorders than those who urinate
every 3 to 4 hours d/t stagnation of urine in bladder, which is medium for bacterial growth.
Termination phase
examine w/ patient for attainment of goals, may be positive or negative emotional reaction from patient
An esophagogastroduodenoscopy
examines the esophagus, stomach, and upper duodenum through an optic scope.
Verbal Communication
exchange of info using words (i.e. spoken and written)
verbal communication
exchange of information using words, including both spoken and written
Cathartics (castor oil, etc)
exert a stronger effect on the intestines than laxatives
A helping relationship
exists among people who provide and receive assistance in meeting human needs
helping relationship
exists among people who provide and receive assistance in meeting human needs
Percussion of the abdomen
expect resonant sound or tympany - Areas of increased dullness may be caused by fluid, a mass, or tumor
Communication often begins w/
eye contact
When assessing a patient's nonverbal communication, the nurse will assess which of the following as the most expressive part of the body?
facial expressions
noise
factors that distort the quality of a message, can interfere with communication
Noise
factors that distort the quality of a message—can interfere w/ communication (Exs: TV, pain
Rapport
feeling of mutual trust experienced by people in a satisfactory relationship
Dullness sound in abdomen may be caused by
fluid, a mass, or a tumor.
PATIENT VERSUS TASK FOCUS
focus on the pt and pt needs, not on the nurse or an activity in which the nurse in engaged)
group-building or maintenance roles
focus on the well-being on people doing the work
task-oriented goals
focus on the work to be done
Task-oriented roles
focus on the work to be done (Exs: coordinator, delegator, etc)
Foods high in water increase urine production;
foods high in sodium decrease urine formation
Enema
for adult enema ranges from 750 to 1,000 mL.
Use sterile technique
for catheter insertion and monitoring for the site
hand hygiene
fundamental practice to reduce healthcare-acquired infections
Onions, cabbage, beans, cauliflower:
gas-producing foods
CARING
genuine (cared about and cared for)
Ventililator associated pneumonia (VAP)
good oral care programs signifiant reductions
Elavil
green or blue-green urine
Antibiotics
green-gray color
Assessing data about voiding patterns
habits, past history of problems
SBAR a consistent method for
hand-off communication that is clear, structured, and easy to use
Anger and aggressive behavior b/t nurses, or nurse-to-nurse hostility,
has been labeled horizontal violence (i.e. bullying, criticizing, blaming, or bickering)
dehydrated pt
has dry skin, eyes that may be sunken
Cheese and eggs
have a constipating effect
Caffeine-containing beverages
have a diuretic effect, increasing urine production
Fruits and vegetables
have a laxative effect on the system
Bathing serves 3 functions:
heatlh, social acceptance and comfort
Cleansing enemas
help establish regular bowel function during bowel training program
Carminative enemas
help expel flatus from the rectum
Therapeutic communication is essential and remains a vital part of a
helping relationship
group dynamics
how individual group members relate to one another during the process of working toward group goals
EMPATHY
identifying w/ the way another person feels - be sensitive, but objective
Empathy
identifying with the way another person feels
Hemorrhoids
if veins become abnormally distended can occur
Be truthful
if you aren't sure about something say
SBAR
improves hand-off communication
SBAR enables nurses to communicate
in a collegial, collaborative manner w/ the focus on pt safety
Nerve centers for urination
in brain and spinal cord
Be aware of cultural variations
in nonverbal communication
One third to one half of food waste is excreted
in stool within 24 hours
listen to themes
in the patients communication
Communication is a reciprocal process
in which both the sender and the receiver of messages participate simultaneously
Bowel incontinence
inability of anal sphincter to control discharge of fecal and gaseous material. Usually caused by organic disease
Functional obstructions
inability of intestinal musculature to move the contents thru the bowel d/t muscular dystrophy, diabetes, Parkinson's, manipulation of bowel during surgery
High fiber foods
increase bulk in fecal material (which increase pressure on intestinal wall, a stimulus for peristalsis)
Stress incontinence
increase in intra-abdominal pressure
CONFIDENTIALITY
indicate w/ whom the info that the pt gives will be shared and the right to specify who might have access to the info
Diverticulitis
inflammation of diverticulum from obstruction by fecal matter, resulting in abscess formation
Enema
insert enema tip into anus, directing tip toward umbilicus. Do not force entry of the tube. Goes about 2-3 inches in. Introduce solution slowly over period of 5 to 10 minutes.
Urethral meatus
inspect for signs of infection, discharge, or odor
Avoid words that might have diferrent
interpretations
Flatus
intestinal gas
Urinary cauterization
introduction of a catheter (tube) through urethra into bladder for purpose of withdrawing urine
Enema
introduction of a solution into the large intestine usually to remove feces
Catheterization involves risk for
introduction of microorganisms into bladder and UTIs.
Fecal incontinence
involuntary or inappropriate passing of stool or flatus
*The final phase of SBAR communication
involves making a recommendation, in the case of a patient whose condition is worsending, may involve recommending that primary care come to assess patient
Urinary diversion
involves the surgical creation of an alternate route for excretion of urine
A Helping Relationship
is dynamic (person providing assistance and person being helped are participants)
The ability to communicate w/ pts and w/ other nurses
is essential for effective use of the nursing process
A Helping Relationship
is purposeful and time limited (goals to be met in a time period)
Anuria
kidney shutdown or renal failure
Renal failure
kidneys fail to remove metabolic end products from blood and are unable to regulate fluid, electrolyte, and pH balance
Nurse should not assume patient who works in healthcare
knows everything about their condition
1500 mL chyme enters
large intestine daily (liquid or watery)
Prunes, brain, chocolate, spicy foods, alcohol, coffee
laxative effect
OPTIMAL PACING
let the pt set the pace; let the pt know if time is limited
Auscultation of the abdomen
listen for bowel sounds in all quadrants - Note frequency and character, audible clicks, and flatus - Describe bowel sounds as hypoactive, hyperactive, absent or infrequent
People feeling ill often demonstrate
little interest in personal appearance
Suprapublic catheter-
long term continuous drainage, inserted surgically
Working phase
longest help patient meet physical and psychosocial needs
ICUs compliance hand hygeine
lowest b/c of increased of excessive staff workloads
Oil-retention enemas
lubricate the stool and intestinal mucosa making defecation easier.
If cultrually appropriate
maintain eye contact
The receiver must then
make a decision about an accurate response
Be clear and concise
makes statements simple stay on one subject at a time
Bowel training program
manipulate factors w/in person's control (food and fluid intake, exercise, time for defecation) and produce elimination of a soft, formed stool at regular intervals w/out a laxative
Nurses who stay focused and professional and approach physicians in a collegial
manner will be better prepared to avoid negative communication
Nasogastric tubes
may be inserted to decompress or drain the stomach of fluid or unwanted stomach contents such as poison or medications and air, when peristalsis is absent.
Newly occurring infrequent voiding
may be kidney or circulatory disorder
Anticoagulants
may cause blood in the urine (hematuria)
Sedatives and tranquilizers
may diminish awareness of need to void
Diuretics (treatment of hypertension)
may prevent reabsorption of water and electrolytes, more excretion of dilute urine
Trauma or illness
may result in patient's need for nursing assistance w/ voiding.
Specific gravity
measure of concentration of dissolved solids in urine. Normal range is 1.015-1.025.
Factors associated w/ urinary retention
medications, enlarged prostate, vaginal prolapse.
channel
medium sender has selected to send the message
The channel
medium the sender has selected to send the message
A rigid, stiff appearance
might be a good indicator of tension and pain
channel
might target any of the receiver's senses
Depressed or tired people
more likely to slouch
European Americans and African Americans require
more personal space b/t two people who are speaking
Catheter-associated urinary tract infections
most common hospital acquired infections in the U.S. and the reason why catherization should be avoided whenever possible. Use aseptic technique with catherization.
Facial Expressions
most expressive part of the body -convey anger, joy, etc
The message sent
must be simple, clear, and easy to understand
The receiver (decoder)
must translate and interpret the message sent
receiver (decoder)
must translate and interpret the message sent
Infection control practioners and staff
need to take ownership of hand hygeine interventions and knowlede plans
1 million
nephrons in each kidney
Peristalsis is under control of the
nervous system.
Palpation of the abdomen
note any muscular resistance, tenderness, enlargement of organs, masses
Working phase
nurse provides whatever assistance needed to achieve each goal provides referrals
Interventional patient hygeine (IPH)
nursing action plan directly focused on forifying patients' hosts defensives through the use of evidence-based care (oral care, skin cleansing, incontinence management, and hygeine)
Inspection of the abdomen
observe contour, any masses, scars, or distention
Sterile specimens
obtained by catheterizing the patient's bladder or by taking the specimen from an indwelling catheter already in place
interpersonal communication
occurs between two or more people with a goal to exchange messages
small-group communication
occurs when nurses interact with two or more individuals
organizational communication
ocvurs when individuals and groups within an organization communication to achieve established goals
SBAR Has been adopted by a significant number
of hospitals
Nephrons remove the end products
of metabolism and regulate fluid balance
Gurgling can be heard upon auscultation
of the abdomen for bowel sounds.
Upper gastrointestinal (UGI) series involves fluoroscopic examination
of the esophagus, stomach, and small intestine after ingestion of barium sulfate.
source (encoder)
of the message is a person or group who initiates or begins the commucation process
Stool
once excreted feces are called
Mass peristalsis sweeps occur
one to four times each 24-hour period.
The key to assertiveness is
open, honest, and direct communication
eye contact absence often indicates anxiety or defenselessness
or avoidance of communication
Pyridium
orange to orange-red urine
Overflow incontinence
overdistention and overflow of bladder
Nurses need to control their
own facial expressions Any sign of repulsion or disgust could greatly impact the pt's self-image and recovery
Be attententive to your
own verbal and nonverbal communication, signal you are listening by using appopriate facial expressions
Dysuria
painful or difficult urination.
Diuretics
pale yellow urine
Urinary bladder
palpate and percuss the bladder or use bedside scanner
Stoma
part of he ostomy that is attached to the skin, formed by suturing the mucosa to the skin.
Orientation phase
patient given orientation to health care facilities, its services, admission routines
Silence
patient might be angry and use silence to display this emotion
Silence
patient might be comfortable and content in nurse-patient relationship
Silence
patient might be thinking
HONESTY, AUTHENTICITY, AND TRUST
patients should be able to trues nurses are who they say they are (professional helpers) and they can be trusted to meet their needs
Autonomic bladder
people whose bladders are no longer controlled by brain b/c of injury of disease void by reflex only.
With infants, assess the number of wet diapers
per day that the infant produces. Newborns should have minimum of six wet diapers per day. With older adults, bladder tone could be a problem.
Colostomy
permits the formed feces in the colon to exit through the stoma
A Helping Relationship
person providing assistance professionaly accountable for outcomes of relationship and means used to attain them
sugesstions for dealing w/ angry patient
physical restraints should be used as a last resort (require written order, documentation and time frame for use)
Toddler
physiologic maturity is first priority for bowel training
Aspirin, anticoagulants
pink to red to black stool
language
prescribed way of using words so people can share information effectively
Glycosuria
presence of sugar in the urine
Mechanical obstruction
pressure on intestinal walls d/t tremors, stenosis, adhesions, hernias.
Cleansing enemas
prevent involuntary escape of fecal material during surgical procedures
Diuretics
prevent reabsorption of water and certain electrolytes in tubules
Defecation
process of bowel elimination; a bowel movement
communication
process of exchanging information and generating and transmitting meanings between two or more individuals
cabbage
produces gas in the system
COMFORTABLE ENVIRONMENT
promote ease - Exs; furniture, lighting, and temp; relaxed and unhurried)
Cleansing enemas
promote visualization of intestinal tract by radiographic or instrument exam
Medicated enemas
provide medications absorbed through rectal mucosa
The nursing process
provides the guidance and direction needed to communicate w/ pts effectively
Pyuria
pus in the urine.
Address by a formal name such as Mr., Mrs., Ms., or Dr.
rather than slang terminology such as "honey" or "sweetie"
A colonoscopy visualizes the
rectum, colon, and bowel using a lighted scope.
Anticoagulants
red urine
SPECIFIC OBJECTIVES
related to having a purpose for an interaction (Ex: to perform a head-to-toe physical assessment at the beginning of each shift); be flexible at all times; follow the pt's cues to work toward meeting all needs
Cleansing enemas
relieve constipation or fecal impaction
Urinary catherization would be used for:
relieving urinary retention, obtaining a sterile specimen, emptying bladder before, during or after surgery
sugesstions for dealing w/ angry patient
remain w/ an anxious person unless your safety is at risk
sugesstions for dealing w/ angry patient
remove yourself from a dangerous situation and call for help
Diuretics cause increased urine production
resulting in the need for increased urination and possibly urge incontinence.
Orientation phase
roles of both people in relationship clarified -agreement of contract about relationship established (goals, ways information about patient will be handled)
Ventililator associated penumonia (VAP)
second most frequent hospital associated infection
USING NURSING OBSERVATIONS
seeing and interpreting are useful for validating info
If catheter is forced through urethra,
sepsis and trauma can result.
helping relationship
sets the climate for the participants to move towards common goals Sometimes called the nurse-patient relationship (i.e. the nurse is the helper, and the pt is the person being helped)
SBAR May be used for
shift report, conversations w/ physicians, and transfer of pts
Urine output
should almost equal fluid intake -. Patient should maintain fluid and electrolyte balance. Patient should maintain skin integrity
A urine specimen from a patient with an indwelling catheter
should be obtained from the catheter itself.
Stoma
should be red, bleeding
Patients who need to use a bedpan
should have the head of the bed elevated 30 degrees unless contraindicated.
Visual—
sight, observations, and perception
Physical examination of urinary system
skin hydration, urine • Correlation of these findings with results of procedures and diagnostic tests
Feces
solid waste products that have reached the distal end of colon and are ready for excretion (in sigmoid colon)
Schedule
some patients have normal urination schedule and some do not-support patient's usual urination pattern
Freshly voided urine
specimen is pale yellow, straw-colored, or amber, depending on its concentration.
Auditory
spoken words and cues
cliché
stereotyped, trite, or pat answer
cliche
stereotypical, trite, or pat answer
Routine urinalysis
sterile specimen not required patient void into clean bedpan, urinal or receptacle avoid contamination w/ feces
Cholinergic medications
stimulate contraction of detrusor muscle, producing urination
Put skin protectant on skin around
stoma.
Use soap and water to clean around
stoma.
Infant
stool differs if being breast-fed or formula. Breastfed babies more regular stool.
Ventililator associated penumonia (VAP)
strong relation to VAP and dental plague, bacterial colonization of oropharnyx
SBAR Provides
subjective and objective data
Equipment that gives person better access to toileting facilities
such as a walker, cane wheelchair and Velcro closings on clothing can be used.
Acute renal failure-
sudden decline in kidney function and may cause dehydration, anaphylactic shock, obstruction.
Analgesics and tranquilizers
suppress CNS, diminish effectiveness of neural reflex
Ileal conduit-
surgical resection of small intestine, with transplantation of ureters to isolated segment of small bowel
Ostomy
surgically formed opening from the inside of an organ on the outside
Mixed incontinence
symptoms of urge and stress incontinence present
COMPETENCE
take responsibility for strengths and weaknesses so pt receives optimal care)
Most common types of solutions for cleansing enemas are:
tap water, normal saline, soap solution and hypertonic solution.
Kegel exercises
target the inner muscles that lie under and support the bladder.
Paralytic ileus
temporary stoppage of peristalsis, lasts 24-48 hours, direct manipulation of bowel during abdominal surgery inhibits peristalsis causing this condition.
Speak clearly, distinctly, and in terms
that the pt understands
Confirmation of the message provides feedback (i.e. evidence)
that the receiver has understood the intended message
A sigmoidoscopy examines
the distal sigmoid colon, rectum, and anal canal through a flexible or rigid sigmoidoscope.
When collecting stool using the technique "timed specimen,"
the nurse should consider the first stool passed by the patient as the start of the collection period.
Messages might be influenced by
the person's previous knowledge, past experiences, feelings, or sociocultural level
A 3-year-old child is being admitted to the medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which of the following communication techniques to elicit the most information from the parents?
the use of questions that direct comments to clarify
Secondary Skin infections (SSIs)
third leading cause of HAIs -increase hospital stay by 7-10 days -twice as likely to die
an elderly pt who has aphasia and is agitated d/t pain from an abscessed tooth might be unable
to communicate w/ the nurse
It is a mistake to permit negative behavior by a physician
to discourage any future communication
Urethra conveys urine from bladder
to exterior of body
Do not pretend
to listen
The purpose of the interview
to obtain accurate and thorough info
interviewing techniques
to obtain needed information while remaining flexible in approach
a glance is often an attention-getting method
to open conversation
Cleansing enemas
to remove feces from the colon
Kinesthetic
touch
nonverbal communication aka body language
transmission of information without the use of words
Urethra
transport urine from bladder to exterior of body.
Hyperreasonance occurs when excess fluid
trapped in the intestines
Which of the following factors is most important in the development of rapport between nurse and patient?
trust
Nocturia
urination during the night
Urge incontinence
urine lost during abrupt and strong desire to void
sugesstions for dealing w/ angry patient
use a calm, assertive approach w/ a verbally abusive patient
Regarding medical terminology
use lay terminology when speaking w/ pts
Stoma
use toilet tissue to wipe feces off
Giving enema
use warm water solution and check temperature with a bath thermometer. If bath thermometer not available, warm to room temp or slightly higher and test on inner wrist. Warming prevents chilling patients. Cold solution could cause cramping.
Intermittent urethral catheters (straight catheters)
used to drain bladder for shorter periods
Urostomy-
uses section of intestine to create an internal reservoir that holds urine
The nurse is caring for a patient who speaks Chinese, and the nurse does not speak Chinese. An appropriate approach for communication with this patient includes:
using a caring voice and repeating messages frequently
The nurse is caring for a patient who speaks Chinese, and the nurse does not speak Chinese. An appropriate approach for communication with this patient includes:
using a caring voice and repeating messages frequently.
Avoid "elderspeak" when communicating w/ older adults
using speaking patterns and words that mimic "baby talk" that imply that the older person is not competent -A form of ageism
People in good health and w/ a positive attitude
usually hold their bodies in good alignment
Language development is directly correlated
w/ the pt's neurologic competence and cognitive development
When possible, sit
when communicating w/ a patient -Don't cross arms or legs
Urinary retention
when urine produced normally but is not excreted from the bladder.
Antacids
white discoloration or speckling in stool
"I" statements — "I feel . . ." and "I think .
— play an important role in assertive statements
Indirect Visualization Studies
• Abdominal ultrasound • Magnetic resonance imaging • Abdominal CT scan
Nursing Measures for the Patient With Diarrhea
• Answer call bells immediately. • Remove the cause of diarrhea whenever possible (e.g., medication).
Methods of Emptying the Colon of Feces
• Cleansing • Retention • Return-flow
Diseases Associated With Renal Problems
• Congenital urinary tract abnormalities • Polycystic kidney disease • Urinary tract infection
Diseases Associated With Renal Problems
• Diabetes mellitus • Gout • Connective tissue disorders
Preventing Food Poisoning
• Do not eat ground meat uncooked. • Never cut meat on a wooden surface.
Preventing Food Poisoning
• Do not eat seafood that is raw or has a strong unpleasant odor. • Clean all vegetables and fruits before eating.
Patient Guidelines for Stool collection
• Do not place toilet tissue in the bedpan or specimen container. • Notify nurse when specimen is available.
Patient teaching for colostomies
• Drink 2 quarts of water daily • Teach about medications
Bowel Training Programs
• Eliminate a soft, formed stool at regular intervals without laxatives • When achieved, discontinue use of suppository if one was used
Reasons for Catheterization
• Emptying bladder before, during, or after surgery • Monitoring critically ill patients
Methods of Emptying the Colon of Feces
• Enemas • Rectal suppositories • Oral intestinal lavage • Digital removal of stool
Types of Direct Visualization Studies
• Esophagogastroduodenoscopy • Colonoscopy • Sigmoidoscopy
Colostomy Care
• Explain each aspect of care to the patient and self-care role. • Encourage patient to care for and look at ostomy.
Nursing Measures for the Patient With Diarrhea
• If there is impaction, obtain physician order for rectal examination. • Give special care to the region around the anus.
Patients at Risk for UTIs
• Individuals with indwelling urinary catheter • Individuals with diabetes mellitus • Elderly people
Patient teaching for colostomies
• Initially encourage patients to avoid foods high in fiber • Avoid foods that cause diarrhea or flatus
Colostomy Care
• Inspect the patient's stoma regularly. - Note the size, which should stabilize within 6 to 8 weeks.
Bowel Training Programs
• Manipulate factors within the patient's control • Food and fluid intake, exercise, and time for defecation
Preventing Food Poisoning
• Never buy food with damaged packaging. • Never use raw eggs in any form.
Individuals at High Risk for Constipation
• Patients on bed rest taking constipating medicines • Patients with reduced fluids or bulk in • their diet
Individuals at High Risk for Constipation
• Patients who are depressed • Patients with central nervous system disease or local lesions that cause pain
Large Intestine
• Primary organ of bowel elimination • Extends from the ileocecal valve to the anus
Preventing Food Poisoning
• Refrigerate leftovers within 2 hours of eating them. • Give only pasteurized fruit juices to small children.
Reasons for Catheterization
• Relieving urinary retention • Obtaining a sterile urine specimen
Patients at Risk for UTIs
• Sexually active women • Women who use diaphragms for contraception • Postmenopausal women
Types of Colostomies
• Sigmoid colostomy • Descending colostomy
A nurse is caring for a client with urostomy following bladder blockage due to cancer. Which of the following should the nurse use to maintain the integrity of the peristomal skin?
• Skin barrier products • Antibiotic ointments • Steroid ointment
Bladder
• Smooth muscle sac • Serves as a reservoir for urine
Patient teaching for colostomies
• Teach about odor control (intake of dark-green vegetables) • Resume normal activity including work and sexual relations
Which of the following activities takes place during the working phase of the nurse-patient relationship?
• The patient participates actively in the relationship. • The patient genuinely expresses his or her concerns to the nurse.
Promoting Regular Bowel Habits
• Timing • Positioning • Privacy • Nutrition • Exercise - Abdominal settings - Thigh strengthening
Types of Colostomies
• Transverse colostomy • Ascending colostomy • Ileostomy
Indirect Visualization Studies
• Upper gastrointestinal (UGI) • Small bowel series • Barium enema
Diseases Associated With Renal Problems
• Urinary calculi • Hypertension
Patient Guidelines for Stool collection
• Void first so that urine is not in stool sample. • Defecate into the container rather than toilet bowl
