N1 U3
black stool indicates
-upper GI tract bleeding (including the esophagus, stomach, and duodenum) -iron -pepto bismol (Bismuth subsalicylate)
J-pouch/ileoanal reservior
A reservoir is created from the distal small bowel (called the ileum), which is then joined to the anal canal. This pouch serves as a storage place for the stool that the patient is able to pass through the usual route, eliminating the need for a permanent external bag (ostomy).
A. What is the normal amount of urine output in a 24 hour period? B. What could change this output?
A. 1000-1800cc or close to what is taken in B. fluid intake or IV fluids meds (diuretics or opioids) infections
What are the functions of the kidneys?
Basic functions include: -filtration -reabsorption -secretion removal of waste and excess water from body, regulation of fluid, electrolytes, and acid base balance
What does "patency" mean?
Being open, expanded or unobstructed
What are signs and symptoms of a UTI? What nursing interventions/treatments would be implemented for a patient with a UTI?
Can happen anywhere in the urinary tract Signs/Symptoms: hematuria, pyuria frequency, dysuria, urgency, cystitis, nocturia, fever, vomiting, diarrhea, malaise, cloudy urine, confusion in the elderly, elevated WBC counts, darker urine, stronger smell Diagnosis: UA (urinalysis), C&S Interventions/Tx: medications: antibiotics, pyridium; remove catheter, increase fluid intake, good peri-care, cranberry juice, no bubble baths, urination after sex, breathable clothing (Nursing Interventions - Fundamentals p. 1032)
How will specific gravity change with dehydration? Overhydration?
Dehydration: # INCREASES specific gravity will go above 1.025 and urine will be concentrated with more solutes and a darker color. -Increase fluid intake. -Diuretic therapy -diabetes insipidus -renal disease. Overhydration: # DECREASES specific gravity will go below 1.015 and there will be less solutes and a lighter color -Decrease fluid intake -increase fluid loss (diuretics).
What is hemodialysis? How often will a patient have hemodialysis? What are specific assessments for patients on hemodialysis? What is a normal urine output for a patient on hemodialysis?
Dialysis- diffusion of solutes across a membrane from an area of higher concentration to lower concentration used to remove excess fluid and waste products in renal failure Hemodialysis- removes electrolytes, waste products and excess water by diffusion and filtration. A machine filters the patient's blood because the kidneys are no longer able to rid the body of wastes Assessment- BEFORE dialysis, assess vascular access site for a palpable pulsation, an audible bruit, or sings of inflammation. Report absence of pulsation, thrill or bruit. AFTER, assess for bleeding at the site. Report adverse affects of muscle cramping, headache, nausea and vomiting, altered level of consciousness, seizures or hypotension. Take VS, lab values, BUN (measures amount of nitrogen in the blood), electrolytes, serum creatine, weight; output Usually undergo 2-3 sessions per week for a total of 9-12 hours.
Where does most absorption of nutrients and electrolytes occur?
Duodenum and Jejunum
What is the BRAT diet?
It is used for diarrhea. It is bananas, rice, applesauce, and toast.
What nursing interventions should you implement for a patient with an indwelling urinary catheter?
Keep bag below the bladder regular peri-care and catheter care when draining bag clean tip with alcohol wipes document color clarity amount
What is a midstream "clean catch" urine sample?
A urine/voided specimen collected after the first few millimeters of urine are voided to clear the "stagnant" urine in the ureter a sterile container is used to collect the urine, but it is a "clean" technique.
In administering an enema, what position would you place the patient and why?
Left Sims - it follows gravity and the natural curve of the rectum and sigmoid colon.
What type of enema is used to treat fecal impaction?
Oil-retention enema
Opiods!
Opioids cause constipation!!! ALWAYS give laxatives(1st) / stool softeners (combination if needed) -pt. needs to be on a bowel program
What types of foods help prevent constipation?
Soluble fiber: apples, bananas, barley, oats and beans. Insoluble fiber helps speed up the transit of food in the digestive tract and prevent constipation. Whole grains, most vegetables, wheat bran and legumes. Pg 1085 Fundamentals: "High fiber foods include fresh or cooked fruits and vegetables with their skins, whole-grain breads and cereals, and fruit and vegetable juices."
How many large volume enemas can be given in succession?
Up to 3
What causes anuria? What nursing interventions should you implement for this cause?
absence of urine, less than 100cc/24hr. Causes: renal failure, kidney failure, shock and severe dehydration, hypovolemia Interventions- increase fluids
What causes polyuria? What nursing interventions should you implement for this cause?
increased amounts of urine (greater than 2000ml/24hr) not always abnormal if they are on a lot of fluids or on a diuretic because it increases urine production Might be seen with head injury: brain loses control of kidneys and has a lot of fluid output could be the onset of diabetes :Interventions:
What is the guaiac hemoccult FOBT and why is it done?
the most common type of fecal occult blood test. It looks for blood in a stool sample can detect blood that can't be seen by the human eye.
Review pre- and post-procedure orders and nursing interventions for EGD and colonoscopy..
Pre-Procedural Nursing Implications: (1) Endoscopic procedures are invasive, and therefore require a formal, signed consent form. (2) The patient must be educated about the procedure, the significance of any preparation, and any post-procedural sequelae. (3) Upper GI endoscopy (esophagoscopy, gastroscopy) requires that the patient be fasting. Sedatives are administered prior to the procedure to relax the patient and facilitate passage of the scope. (4) If the patient wears dentures, have a denture cup available. The physician may require the removal of the dentures prior to oral insertion of the scope. (5) Colon endoscopy (proctoscopy, sigmoidoscopy, and colonoscopy) requires that the bowel be free of stool to enhance visualization. This is normally accomplished with laxatives and cleansing enemas. Post-Procedural Nursing Implications. (1) Accidental perforation of the esophagus or colon may occur during endoscopy. If pain or bleeding occur following the procedure, notify the professional nurse. Note the following: (a) Mouth or throat pain. (b) Rectal pain. (c) Abdominal pain. (d) Bleeding from rectum. (e) Bleeding from mouth or throat. (2) Withhold foods, fluids, and p.o. medications until the patient is fully alert and gag reflex has returned. (3) Take vital signs per ward SOP
amonia dermatitis
(diaper rash) reddened skin that may be excoriated, caused by skin bacteria reacting to urea in urine
barium x-ray
-Fleet barium goes through large intestine and creates an image of the bowel in an x-ray. -A barium X-ray is a radiographic (X-ray) examination of the gastrointestinal (GI) tract. Barium X-rays (also called upper and lower GI series) are used to diagnose abnormalities of the GI tract, such as tumors, ulcers and other inflammatory conditions, polyps, hernias, and strictures -drink chalky swallow, -drink lots of fluids to get it flushed out -bowel movements: white colored stool normal the first few times of passage. Make sure to drink lots of fluids to flush barium out of system.
What is the minimum amount of hourly urine output?
30cc/hr; less than that and you should suspect kidney failure/problems
urine normally consists of:
96% water
Define fecal incontinence. What are the signs/symptoms? What assessments are to be done? What are nursing interventions and/or treatments? What would be good prevention for this problem?
:is the inability to hold fecal material in the rectum. Assessment: neurological, mental, emotional testing/history, surgical hisotry, stool pathology, pain characteristics, acute or traumatic brain injury (per Heather) S/S: loss of stool/feces without control Tx: bowel training/bathroom training, fiber (starting in small amounts), exercise/activity, hydration, peri-care, emotional support, bowel diary (Try not to use briefs with incontinent pads - it holds moiture in and promotes skin breakdown!) Prevention: keep abdominal floor muscles strong, (more?)
What is a colostomy? What type of output would you expect? What are complications?
A colostomy is an opening of part of the colon onto the abdominal skin surface via a stoma. Stool is soft in consistency. (Fundamentals P.1073)
How much fluid is administered in a large volume enema?
A large-volume enema is 500-1000mL
What is a paralytic ileus?
A paralytic ileus is an intestinal blockage due to lack of peristalsis in the intestines because the intestines are "paralyzed." Food won't move through, so it gets blocked and additional waste aggregates, causing a greater blockage
What is Valsalva's maneuver? If the vagus nerve is stimulated, what could happen?
A person voluntarily relaxes the external anal sphincter assisted by a deep breath against the closed glottis to move the diaphragm down, contracting abdominal muscles to increase pressure and contracting the pelvic floor muscles. If the vagus nerve is stimulated, a drop in blood pressure could cause a syncopal episode due to a decrease in cerebral blood flow and cerebral perfusion
vagal response/stimulation
A sudden drop in heart rate and blood pressure leading to fainting, often in reaction to a stressful trigger. (passing out when having a bowel movement) (hypotension) an automatic response within our bodies that occurs as a result of stimulation of our vagus nerve.
How do you determine proper placement of an NG tube?
Air bolus, check pH of gastric residual, X-Ray
What are foods that loosen stool (some are diuretics!)? For what conditions would you want to loosen the stool?
Alcohol, beans, beer, chocolate, fried foods, prune or grape juice, raw fruits and vegetables, spicy foods, spinach. You might use this diet for people with constipation or intestinal blockage.
Abdominal X-Ray
An X-ray of the abdomen will show if there is any gas in the intestinal tract, as well as its location. Both of these pieces of information will help your physician to make a diagnosis. Upper GI Series: This test is done with barium, and can illuminate any problems in the small intestine.
What is an ileostomy? What are different types of ileostomies? What type of output would you expect from an ileostomy? What are complications of ileostomies?
An ileostomy is an opening of the ileum onto the abdominal skin surface via a stoma. Stool is liquid and contains large amounts of electrolyte (Fundamentals P.1073)
What is an indwelling or Foley catheter? What is a Straight or Intemittent catheter? How do they differ for men and women?
An indwelling or Foley catheter has an extra port. There is the tube to remove urine and another smaller port to inflate a balloon that keeps the catheter from falling out of the bladder; A straight catheter (Intermittent catheter) is only a tube and no port (because there is no balloon to inflate) and is used for "in and out" or intermittent catheterization procedures. Men- insert 8" and then another 1"; may have a curved catheter tip (coude) Women- insert 2-3" in and then another 1".
What are foods that would thicken the stool? For what type of condition would this be appropriate?
Applesauce, bananas, bread, cheese, high-fiber foods, marshmallows, pasta, peanut butter, rice, tapioca. You might use this type of diet for patient's with an ileostomy.
Review assessment of the abdomen - normal and abnormals.
Assess subjective data: ask the patient questions. INSPECTION: observe contour and symmetry (asymmetry is not normal); AUSCULTATION: all four quadrants: listen for a minute each. Hypoactive: low motililty or possible return of peristalsis (if person didn't have bowel sounds before). An absense of bowel sounds may indicate constipation, a blockage or paralytic ileus. Hyperactive bowel sounds may indicate diarrhea is heard more than once every five seconds. PERCUSSION: used to identify air, fluid or solid masses in the abdomen. PALPATION: determine firmness, softness, distention, of the abdomen, noting possible masses or areas of firmness that should be soft. (There is a lot more information in the Health Assessment book-chat 23).
What are normal and abnormal assessments for a stoma?
Assess the stoma for color: ideally a healthy pink. A dusky pink or bluish tint (cyanosis) suggests inadequate circulation to the stoma. (Should be pink, warm and moist.) Assess the position: assess the stomal mucosa - it must remain on the abdominal surface. If the stoma retracts, feces may potentially enter the abdominal cavity and cause peritonitis. Prolapse (protrusion) should be reported to the surgeon. Report abnormal findings, such as a rash, purulent drainage, ulcerated skin or bulging around the stoma. Inspect the stoma for bleeding and discharge. Some bleeding may occur because the stoma tissues are fragile. Monitor color and consistency of ostomy output. (Fundamentals p. 1090)
What are important nursing assessments and interventions for patients with urinary incontinence?
Assessment: skin integrity, neurological status, severity and causes Interventions: bladder training, pelvic muscle management, education, self-care assistance
What foods cause odor?
Beans, Cabbage-family, cheese, eggs, fish, garlic, onions
What are foods that may cause gas?
Beans, beer, vegetables in the cabbage family, carbonated beverages, cucumbers, dairy products, onions, radishes
What can be done to diagnose urinary retention?
Bladder scan urine or blood samples. post-void residual (PVR) cystoscopy. ultrasound and CT scan. urodynamic tests. electromyogram
What is bladder training?
Bladder training is a way of learning to manage urine incontinence It is generally used for stress incontinence, urge incontinence or a combination of the 2 types. Generally, it is a way to keep a schedule for voiding. Maybe the patient goes every two hours...
Review the similarities and differences between ulcerative colitis and Crohn's disease.
Both types of Inflammatory Bowel Disease Both are disorders of the Lower GI tract (even though, technically, Crohn's can occur anywhere in GI tract) Both disturb normal activity of the GI tract Both cause pain Both have etiologies that are not understood (both are thought to have a genetic disposition) Treatments are similar: NPO, low-residue diet, TPN if needed Crohn's typically involves the small intestine Ulcerative Colitis is typically in the rectum and then the cecum Colitis- affects only the inner lining of colon or rectum Crohn's Disease - inflammation can occur anywhere in the digestive tract from mouth to anus
Urinary Elimination
Bowel Elimination Follows Nursing I Unit 3
What are foods that may block an ileostomy?
Celery, coconut, coleslaw, mushrooms, corn, nuts, popcorn, raisins, raw vegetables and fruits, seeds, stringy meats
What is colostomy and ileostomy, sigmoidostomy? What nursing assessments and interventions are specific to these bowel diversions?
Colonoscopy: opening of a part of the colon onto the abdominal skin surface, creating a stoma -soft stool Ileostomy: opening of the ileum onto the abdominal skin surface via a stoma. -liquid stool Sigmoidostomy: opening of a part of the sigmoid colon onto the abdominal skin surface, creating a stoma -formed stool Inspect stoma and skin, cleanse with warm water and pat dry, measure stoma periodically, empty/irrigate/cleanse routinely, apply coritocsteroid aerosol spray and antifungal powder as indicated.
What are normal results for a urinalysis?
Color/Clarity: light straw to amber yellow acid base: pH: 4.6-8 specific gravity: 1.015-1.025 leukocyte: negative ketones: none glucose: none WBC: 0-5 RBC: 0-3 bacteria/yeast: none-few cast: none-occasional (casts are precipitates of proteins).
Define constipation. What are the signs/symptoms? What assessments are to be done? What are nursing interventions and/or treatments? What would be good prevention for this problem?
Constipation: infrequent, sometimes painful passage of hard stools. S/S: Difficult/less frequent bowel movments, hypoactive bowel sounds, loss of appetite, N/V, abdominal distension, fullness or bloating, urge to defecate but inability, generalized malaise. Assessments: Subjective data; palpation, possible x-rays or other imaging Tx/Interventions: Increase fluids (add prune juice, flavored water, a little coffee), increase fiber, increase activity, provide stool softeners, monitor I&O, monitor pain level, constipation relievers (metamucil, colace, mag citrate, Culcolax), Laxatives and enemas are a last resort. Prevention: would include activity and a diet with food high in fiber and appropriate fluid intake.
What are the reasons for NG tube insertion?
Decompress the stomach gastric lavage (wash) gastric gavage (feed)
Review bowel obstruction signs/symptoms, nursing interventions, treatments.
Defined- intestinal contents unable to move through bowel S/S: abdominal pain, vomiting (may smell like feces), high pitched gurgling bowel sounds, diminished or absent bowel sounds, abdominal distension, signs of decreased blood volume (orthostatic hypotension, tachycardia, tachypnea, decrease in urine output) Nursing Interventions: health promotion (increase fiber intake, maintain fluid intake, exercise), assessing (assess pts who complain of abdominal pain or if they don't eat, inspect for distension & listen to bowel sounds) Treatments: surgery, GI decompression (tube inserted through nose and a weighted tip or balloon at the end of the tube goes into the intestine by gravity) pg.672 med surg
How are renal calculi diagnosed? What nursing interventions/treatments would be ordered for a patient with renal calculi?
Diagnosed: KUB XRAY: identifies calculi in the kidneys, bladder, and ureters IVP(intravenous pyelogram) Renal ultrasound Start IV and insert dye to look for obstruction in kidneys. CT scan or MRI Cystoscopy is used to visualize and remove calculi from bladder and ureters Treatment: Sometimes pass on their own provide pain meds lithotripsy (shock wave) surgical removal stents food and fluid management make sure to strain urine to catch stones.
Define diarrhea. What are the signs/symptoms? What assessments are to be done? What are nursing interventions and/or treatments? What would be good prevention for this problem?
Diarrhea: Frequent watery stools. S/S: abdominal cramping, nausea (with or without vomiting), painful burning sensation at the anus, soreness and inflammation of skin around anus (resulting in breakdown of perineal tissue), hyperactive bowel sounds Assessment: liquid stool, brown, green or yellow, N/V, hyperactive bowel sounds, palpate for tenderness, stool sample to check for blood, get subjective data from patient. DON'T use fiber for an acute attack; but fiber in the diet as a prophylactic is good. Treatment: frequent peri-care, ointment/skin barriers, I&O, educate patient, reduce anxiety, increase fluids, monitor frequency and character of BMs, use BRAT diet, reintroduce solids slowly, antidiarrheal agents (for C-diff, sometimes fecal microbiota transplantation). Prevention: would be avoidance of foods that thin stool, avoidance of higher-fiber foods during an acute attack, (more?)
What is diverticulitis?
Diverticulitis: an acute inflammatory bowel disease characterized by inflammation or infection of diverticula (blind pouches) in the bowel mucosa. (Diverticula are pouch-like herniations that can occur anywhere along the intestinal tract. They tend to occur at weakened areas of the intestinal wall and most commonly appear in the sigmoid colon.) Possible causes: low-fiber diet: often leads to constipation, which increases pressure on the colon wall and traps bacteria-rich stool in the diverticula decreased colon motility: slows the passage of GI contents and increases the risk of food and bacteria trapped in diverticula; aging, sedentary lifestyle and postponing bowel movements S/S: pain in the LLQ, may be intermittent at first, but progressively steady; fever, weakness and fatigue, changes in elimination (alternating between constipation and diarrhea), anemia, rectal bleeding Test: CT or ultrasound, x-rays, CBC, WBC, hematocrit and hemoglobin (may indicate bleeding), colonoscopy, barium enema to detect diverticula Treatments: liquid diet progressing to a soft diet in a few days, low-fiber, stool-softeners, (laxatives are to be AVOIDED), IV antibiotics to treat severe infection, oral antibiotics for mild infections, pain meds, surgery with colon resection if needed **After recovery, a high-fiber diet is recommended
How do you change the appliance or pouch on an ileostomy or colostomy?
Emptying the ostomy pouch is a clean, not sterile, procedure. Rinse the pouch with clean, warm tap water after emptying. A large (60ml) syringe works well for this purpose. Air is eliminated by compressing the pouch and reapplying the clip to close the pouch. Then, the pouch is checked for leaks from the stomal area and the condition of the stoma is assessed. Cleanse the abdominal skin around the stoma, inspect the stoma's appearance, gently dry the abdominal skin and apply a new ostomy pouch. See Procedure 33-3 in Fundamentals p. 1108-1112 Changing an Ostomy Pouch(Fundamentals p. 1091)
Define fecal impaction. What are the signs/symptoms? What assessments are to be done? What are nursing interventions and/or treatments? What would be good prevention for this problem?
Fecal Impaction: bowel that will not move through the intestines. assessment: small amount of liquid stool when pt complains of constipation and can't go. S/S: abdominal pain, distended abdomen, constipation, c/o rectal or abdominal fullness, N/V, loss of appetite, abdominal and rectal pain; colon keeps absorbing water, so stool becomes harder and harder, sometimes a rectal exam will allow the feeling of a mass of stool Interventions/Tx: reduce anxiety and embarrassment, suppositories, laxatives, enema (oil immercion), other water enemas, manual digital removal, increase fluids, add fiber and increase physical activity. Inspect, Ausculatate, Percuss and Palpate. Get subjective symptoms from patient. Prevention: would be the same things as for constipation: activity and a diet with food high in fiber and appropriate fluid intake.
Define flatulence. What are the signs/symptoms? What assessments are to be done? What are nursing interventions and/or treatments? What would be good prevention for this problem?
Flatulence is the accumulation of gas in the GI tract. S/S: distention, feeling of fullness, bloating, cramping (When larger than usual quantities are produced, they are most often the result of increased colonic motility secondary to intestinal irritation.) Treatment: remove foods that cause gas: broccoli, cabbage, onions, legumes (beans); remove carbonated drinks, chewing gum, sucking candy Prevention: see treatment above!
If an NG is connected to suction, is it low or high suction and intermittent or continuous? Why?
Fundamentals P.1094 Low suction is 20 to 40 mmHg high suction is 80 to 100 mmHg. Intermittent suction provides suction for a preset interval of time, followed by intervals of no suction. With continuous there is a greater risk for damage of the gastric mucosa because the NG tip will get stuck to the gastric wall. According to the book it should be set at the lowest intermittent pressure possible while still having results. According to the instructors- it should be set at 80-100 mmHg intermittent (which they called low?!).
What GI assessments would you expect on a patient following a procedure with general anesthesia?
Gastrointestinal tract motility may be reduced after surgery with delay in gastric emptying. These alterations are induced partly by surgery, partly by the residual effects of anesthetic agents, and particularly by opioids administered for post-operative pain relief. Post-operative ileus reduces the rate of mobilization and may also reduce or delay absorption of drugs administered by the gastrointestinal tract. Furthermore, post-operative nausea and vomiting may ensue and also be responsible for delayed mobilization, subjective discomfort and delay in administration of oral agents post-operatively.
What is a low-residue diet? For what conditions would this be used?
Goal is fewer and smaller BMs each day. CAN have refined flours/breads, well cooked (soft) or canned fruits and vegetables, potatoes without skin, mild cheeses, milk and eggs, plain yogurt (no berries, nuts). No fresh vegetables, no raw or fresh fruits (including lettuce-like veggies), no rich desserts, no tough meats. This is for people with Crohn's, IBS, Ulcerative Colitis and like-issues.
What does the nurse assess with urine?
Health hisotry color, odor, amount, pH, specific gravity, glucose, ketones, RBC, bacteria/yeast, I&O normal pattern of urination and recent changes in urine dysuria (painful urination) norturia (bedwetting urinating more than once at night) hematuria (blood in urine) polyuria (pus in urine, foul smelling) abdominal suprapubic or flank pain
What types of diets would you use for patients with an: ileal conduit a neobladder, a Koch pouch
Ileal conduit: No special diet, unless you were on a special diet before. Drink 8-10 glasses of water a day unless specified otherwise. Neobladder: Kock Pouch: Chew everything very well until almost mush.
What types of diets would you use for patients with an: ileostomy, a J-pouch, colostomy, PEG tube, transverse colostomy, etc?
Ileostomy: rice, pasta, cheese, bananas, applesauce, smooth peanut butter, pretzels, yogurt, and marshmallows. ... J-pouch: There are several foods that are generally easy to digest and may even help to create bulk and firm up stool. If a j-poucher is having a hard time with diarrhea or loose stool, backing down her diet from new or untried foods and adding some of these foods back into her diet may help to firm up the stool. Applesauce Bananas Hard-boiled eggs Hot breakfast cereals Mashed potatoes Oatmeal Peanut butter (creamy only) Plain pasta Toast (white bread or other types without seeds or nuts as tolerable) White rice Yogurt (with live cultures) Colostomy: Eat slowly and chew your food well. Drink 8 to 10 (8-ounce) glasses of liquids every day. Eat mostly bland, low-fiber foods. Read the "Recommended foods" section for more information. When you add foods back to your diet, introduce them one at a time. Read the "Adding foods to your diet" section for more information. PEG tube: Transverse colostomy: Sigmoid colostomy: High carb/fresh fruits vegies foods that prevent furthering of hardened stool
What are the different types of urinary diversions? What are specific nursing assessments and interventions you will need to perform on these patients? (More interventions?)
Ileum conduit- urine is collected in a drainage bag applied over the stoma on the abdomen Neobladder- after removal of the urinary bladder, a pouch is surgically created from a portion of the small bowel Assessment: color, assess skin around, drainage, leakage Interventions: keep skin clean, educate patient (more?)
Define urinary retention.
Inability to completely empty the bladder of urine Pt is either unable to perceive the feeling of bladder fullness or unable to relax the bladder neck and external urethral sphincter to allow urine to pass from body. -Often requires a bladder scan.
When assessing the abdomen, what 4 things do you do and in what order? Why?
Inspection auscultation percussion palpation Once you palpate, you can change the dynamic in the abdomen and cause sounds you wouldn't have heard or cause changes in motility.
It can cause constipation and stools to be light or white in color. Barium may be scattered throughout the GI tract for several days. It can cause x-rays of the urinary tract to show opacifications where they shouldn't; as well as artifact on an abdominal CT scan.
It can cause constipation and stools to be light or white in color. Barium may be scattered throughout the GI tract for several days. It can cause x-rays of the urinary tract to show opacifications where they shouldn't; as well as artifact on an abdominal CT scan.
What causes urinary retention?
Loss of bladder tone secondary to excessive stretch of the detrusor muscle fibers Accumulation of urine in the bladder also leads to stasis of urine which leads to UTIs and calculi development Urethral blockage Bladder Distention enlarged prostate general anesthesia
What are causes of abdominal distension what would you inspect auscultate and/or palpate upon assessment?
Many things can cause abdominal distention, from flatulence to constipation, lactose intolerance, IBS, ascites, appendicitis (many things)! You would assess the same things as in #6 of the bowel review guide. Assess subjective data: ask the patient questions. INSPECTION: observe contour and symmetry (asymmetry is not normal) AUSCULTATION: all four quadrants: listen for a minute each. Hypoactive: low motililty or possible return of peristalsis (if person didn't have bowel sounds before. An absense of bowel sounds may indicate constipation, a blockage or paralytic ileus. Hyperactive bowel sounds may indicate diarrhea is heard more than once every five seconds. PERCUSSION: used to identify air, fluid or solid masses in the abdomen. PALPATION: determine firmness, softness, distention, of the abdomen, noting possible masses or areas of firmness that should be soft. (There is a lot more information in the Health Assessment book-Chpt 23.)
What is micturition reflex?
Micturition means urination. Reaction of bladder to stretching, leading to bladder contraction and perceived need to void; an involuntary spinal reflex.
What nursing interventions should you implement after an indwelling urinary catheter has been removed?
Monitor urine output: especially the first one after taking the catheter out asses area for irritation, assess for pain, bladder training assess pt's perineum and meatus for any signs of redness or irritation then provide perineal care encourage pt to drink plenty of liquids to distend the bladder expect urine within the 6-8hrs if patient hasn't voided within 8hrs, bladder scan!
What could a nurse assess from the color of a patient's feces?
Normal feces is brown, formed and moderately soft. If the feces is white or gray: bile might not be getting into the intestine (no bile present), or there may be barium in the feces from getting dye before a procedure. If the stool is light it may be due to antacids, also. If the stool is red, it could be due to blood , could be hemorroids, or a lower GI bleed. If the stool is black and tarry, an upper GI bleed may cause blood to coagulate with the stool. Old blood is coffee-ground-like. Iron will cause the stool to be darker, as will Pepto Bismol.
List 10 things that could lead to altered bowel function
Nutrition, fluid intake, activity and exercise, body position, lifestyle, pregnancy, medications, surgery, ignoring the urge to defecate, and fecal diversion (a surgically altered root for feces)
Review diagnostic procedures and labs specific to the GI system.
Occult blood test stool cultures/ova and parasites colonoscopy sigmoidoscopy X-ray studies
What are movements that assist with the transportation of waste products through the GI tract called?
Peristalsis
What is peritoneal dialysis? How often will a patient have peritoneal dialysis? What are specific assessments for patients on peritoneal dialysis? What is a normal urine output for a patient on peritoneal dialysis?
Peritoneal dialysis: a catheter is placed through the peritoneal wall into the cavity. It is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. It is done every day! Patients can do an overnight exchange (8-12 hours) or some may do five exchanges throughout the day. Dialysate is infused into the peritoneal cavity by means of the catheter and it runs out into the drainage bag. CAPD: continuous cycle peritoneal dialysis= 7days/week for 4-8 hrs; CCPD-continues cycle peritoneal dialysis-24hrs 7days a week done while pt is sleeping APD: automated peritoneal dialysis-30min exchange repeated over 8-10hrs while client is sleeping; Assessment vs, glucose level (watch for hyperglycemia), record I&O. Note fluid color, Signs of infection, check access sight for wetness and leakage; Output is a minimum of the dialysate plus at least 30ml/hr.
What is enuresis?
Repeated inability to control voluntary urination. Factors: small bladder capacity sound sleeping bowel dysfunction stress and anxiety at home or school UTI's family history Nocturnal enuresis (bed wetting during the night)
What is the function of the bladder?
Stores urine detrusor muscle contracts to help excrete urine if urge to void is strong (when 300-400ml is in bladder)
Define all types of urinary incontinence.
Stress urge reflex functional total (See table p. 1022-1024 in Fundamentals and p. 739 Med Surg)
What can be done to treat urinary retention?
Surgery for obstruction reposition patient Intermittent catheter encourage pt to strengthen muscles (Kegals)
This part of the GI tract absorbs primarily fluid and electrolytes and stores waste products.
The Large Intestine
What are pre-procedure and post-procedure orders for barium X-rays?
To x-ray the upper GI with barium contrast dye: the patient has to drink barium liquid. To prep for a lower GI exam: the patient will get a barium enema.
What is the treatment of choice to promote evacuation of hardened stool?
Treatment of choice: activity and high-fiber diet. Other interventions: Increase fluids, enemas, digital removal
Review diagnostic procedures and labs specific to the urinary system.
UA, C&S, 24Hr Urine, Blood Tests: CBC, Blood Chemistry: MGA, BMP, CMP, CHEM 7, CHEM 12 Basic Panel: BUN, Creatinine, Ca, K Na, Cl Glucose, CO2
When would a straight cath be performed?
Urine retention - insert the catheter to release the urine then remove and dispose of it.
What is a suprapubic catheter?
a narrow-lumen tube (catheter) that a physician inserts into the bladder just above the pubic symphysis It is used for longer-term catheterization It is associated with fewer infections than a regular indwelling catheter
How much fluid should a person have per day?
approximately 2000 mL per day is necessary to meet cellular needs and have enough left over to promote a soft stool consistency. (Pg 1085): Fluid intake between 1500 - 2000 mL per day promotes a normal bowel elimination pattern."
How does the nurse assess a patient for urinary retention?
ask pt questions about normal voiding rouitine. assess urine output: note color, quantity, odor.. percuss and palpate in the suprapubic area of the abdomen or even higher if bladder is filled with excess urine bladder scan
What causes oliguria ? What nursing interventions should you implement for this cause?
decreased amount of urine, less than 30cc/hr. (or <500ml in 24 hrs) Causes- severely decreased fluid intake or any disease/injury that leads to an excesses loss of body fluids Interventions:
Know how to irrigate a colostomy pouch.
https://www.mskcc.org/cancer-care/patient-education/colostomy-irrigation-instructions-sigmoid-descending-colostomy Important Points Try to irrigate at the same time each day. Don't irrigate if you have diarrhea. Don't irrigate if you notice a bulge (hernia) around your stoma. If you notice a bulge or hernia, call your doctor. Check with your doctor before irrigating while you are getting chemotherapy or radiation therapy. Irrigation is not recommended during these treatments. The amount of returns will vary from irrigation to irrigation.
List 3 major risks of catheterization
infection to the bladder ureters and eventually the kidneys if there is a break in sterile technique trauma to the internal tissues microorganisms can migrate from the meatus up the outside of the catheter toward the bladder.
Solutes found in urine:
organic solutes: urea, ammonia, uric acid, creatine inorganic solutes: sodium, chloride, potassium, sulfate, magnesium, phosphorus
hemocult test
turns blue if positive
kock pouch
type of continent ileal reservoir created surgically by making an internal pouch with a portion of the ileum and placing a nipple valve flush with the stoma. Also called a K-pouch, a continent ileostomy is a connection of the end of the small intestine, called the ileum, to the skin of your abdomen. A surgeon makes it so that waste can leave your body, because it can't leave the usual way.
clay colored stool indicates
you may have a problem with the drainage of your biliary system, which is comprised of your gallbladder, liver, and pancreas. Bile salts are released into your stools by your liver, giving the stools a brown color.
