Urinary elimination

pure silicon

long term use-2 or 3 months.

dysuria

lower UTIs have pain or buring dduring urniation as urine flows over inflamed tissues -fever, chills, nausea, comiting, and malaise

oil retention enemas

lubricate the rectum and colon -feces absorb oil and become softer and easier to pass

a client with an ileostom

maintain a daily fluid intake of at least 3 L to prevent blockage -pouch needs to be changed before it starts leaking. -The client can eat anything -no need to buy new clothes

abnormal characteristics of stool: excess fat

malabsorption syndrome, enteritis, pancreatic disease, surgical resectinon of intestine

selecting size of catheter

men-16-18 Fr women- 14-16 Fr children-8-10 Fr

abnormal characteristics of stool: frequency

more than 3x a day; less than once a week

abnormal characteristics of stool: shape

narrow, pencil shaped: obstruction, rapid peristalsis

abnormal characteristics of stool: odor

noxious change-blood in feces or infectin

risk factors for developing colon cancer

obesity inactivity >50 family history of colon cancer ethnic background: Jew of eastern European descent race: African Americans diet: high intake of animal fats, and low in fruits and veggies smoking and alcohol intake diabetes

A client reports passing narrow pencil-shaped stools over the past few days. Which conditions should the client be evaluated for? Select all that apply.

obstructions and rapid peristalsis

plastic catheterizaiton

only for intermittent use

A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in small amounts and is more frequent when she coughs. The nursing assessment reveals that the client is obese, has had three pregnancies, and has already gone through menopause. The nurse understands that she is at increased risk of developing urinary tract infection. What nursing interventions are helpful to prevent a urinary tract infection in the client?

1. emphasize cotton wear 2. promote complete emptying of bladder by double voiding 3. emphasize the importance of perineal hygiene

preventing infection in patients with catheters

1. follow hand hygiene 2. don't touch the spigot or get it contaminated 3. only use sterile technique to collect specimens from a closed drainage bag 4. drain all before exercise 5.empty q8h 6.tape and secure appropriately

A client who presents with dribbling of urine is diagnosed with stress incontinence. What else should the nurse include in the assessment of this client? Select all that apply.

1. height and weight-obesity 2. menopausal status-decrease in estrogen production, pelvic muscles weaken, leading to stress incontinence 3. pregnancy puts pressure on the bladder osteoarthritis does not

elimination changes that result from inability of the bladder to empty properly may cause?

1. incontinence 2. frequency 3. urgency 4. urinary retention 5. UTI

A client is experiencing difficulty in voiding. Which nursing interventions may help to stimulate the micturition reflex in the client? Select all that apply.

1. induce sound of running water. 2. stroke the inner aspect of the sensory nerves and promotes micturiton reflex 3. pour warm water over perineum 4. help the client assume normal voiding position

After reviewing a patient's laboratory reports, the nurse concludes the patient has cholecystitis. Which laboratory finding enabled the nurse to reach this conclusion?

2. Increased amylase levels Cholecystitis causes inflammation of the gallbladder. Increased amylase levels are observed in patients with cholecystitis due to obstruction of the bile duct. Increased bilirubin levels indicate hepatobiliary disease. Increased alkaline phosphatase levels indicate hepatobiliary carcinomas and bone tumor. Increased carcinoembryonic antigen levels indicate cancer or inflammation of the gastrointestinal tract.

A nurse is caring for a client admitted with diarrhea. What could be the possible causes of diarrhea in the client? Select all that apply. 1. Use of opioid drugs Correct 2 Use of antibiotics Correct 3 Food allergies Correct 4 Prolonged stress 5 Hypothyroidism

2. Use of antibiotics 3. Food allergies 4. Prolonged stress

A client has an alkaline phosphate level of 200 units/L. What can be interpreted from this laboratory value? The client has a normal level. The client has a transfusion reaction. The client has hepatobiliary carcinoma. The client has pancreatitis.

Alkaline phosphatase levels are indicative of hepatic and bone health. An increase in serum levels of the enzyme indicates hepatobiliary carcinoma. The normal level of alkaline phosphatase is 30-120 units/L. Bilirubin levels are elevated in transfusion reactions due to destruction of hemoglobin. Serum amylase levels indicate pancreatic function. Text Reference - p. 1098

When assessing a 55-year-old client who is in the clinic for a routine physical, the nurse instructs the client about the need to obtain a stool specimen for guaiac fecal occult blood testing (gFOBT): 1 If client reports rectal bleeding. 2 When there is a family history of polyps. 3 As part of a routine examination for colon cancer. 4 If a palpable mass is detected on digital examination

As a part of the routine examination for colon cancer This is used as a dignostic screening tool for colon cancer by the American Cancer Society

Which of the following medications listed in a client's medication history possibly causes gastrointestinal bleeding? Select all that apply. Aspirin Cathartics Antidiarrheal opiate agents Nonsteroidal antiinflammatory drugs (NSAIDs) New Choice

Aspirin Nonsteroidal antiinflammatory drugs (NSIADs) =side effects are rectal bleeding

A client reports having the urge to void but urine starts leaking before she reaches the bathroom. Which treatment strategies would be helpful for the client? Select all that apply. Scheduled toileting Absorbent products Electrical stimulation Clothing modification Antimuscarinic agents

Scheduled toileting Absorbent products Clothing modification Functional incontinence is characterized by the inability to reach the bathroom in time. Scheduled toileting involves teaching the client to void at specified times so that there is no urgency. Use of absorbent products helps prevent soiling of clothes. Clothing can be modified to make it easier to remove when there is an urgency to void. Electrical stimulation is helpful for clients with stress incontinence. Antimuscarinic agents are helpful for clients with urge incontinence. Text Reference - p. 1060

An alcoholic develops chronic pancreatitis. Which laboratory parameter is helpful in diagnosing pancreatitis?

Raised serum amylase

A client is admitted for lower gastrointestinal (GI) bleeding. What color of stool does the nurse anticipate the client to have?

Red-colored stool indicates lower GI bleeding.

A client is suffering from chronic constipation but has no other symptoms. Which medication would provide the most relief for the client's constipation? a. castor oil b. mineral oil c. polycarbophil d. docusate sodium

The drug of choice for managing chronic constipation in a client who is hemodynamically stable is a bulk-forming substance such as polycarbophil. Castor oil causes cramping, as well as an imbalance in fluid and electrolytes and should be avoided for long-term use. Mineral oil causes nutritional deficiency and on aspiration causes pneumonia, and should be avoided. Docusate sodium is suitable for short-term therapy.

A nurse is reviewing the records of a client who had chronic constipation. The record states that the client has type 3 stools according to the Bristol Stool Form Scale. What would be the characteristic of the stool? 1. like a saugage but with cracks on the surface 2. like a sausage or snake, smooth and soft 3. soft blobs with clear-cut edges 4. sausage shaped but lumpy

Type 3 stools are like a sausage but with cracks on the surface. Type 4 stools are like a sausage or a snake, and are smooth and soft. Types 5 stools are soft blobs with clear-cut edges. Type 2 stools are sausage-shaped but lumpy. Text Reference - p. 1092

The nurse is taking a health history of a newly admitted client with a diagnosis Rule/out bowel obstruction. Which of the following is the priority question to ask the client?

When was the last time you moved you bowels - lack of bowel movement is a sign of bowel obstruction and is a medical emergency

leakage around the catheter

a change in lumen size or use of antipasmodic meds is necessary

abnormal characteristics of stool: color

absense of bile=white or clay iron ingestion or upper gastrointestinal bleeding=black or tarry red=lower GI bleeding, hemorrhoids pale with fat=malabsorption of fat transulent mucus=spastic constipation, colitis, excessive straining bloody mucus: blood in feces, inflammation, infection

during emotional stress the digestive process is

accelared, and peristalsis is increased

Factors affecting bowel elimination

age fluid intake psychological factors position during defecation pregnancy meds, laxatives and cathartics diet physical activity pain surgery and anthesia diagnostic test

colonoscopy

an endoscope exam of the entire colon uses a colonoscope inserted into the rectum prep: similar to barium enema; clear liquids the day before and then some form of bowel cleanser such as GoLytely. Enemas till clear

amylase

an ezyme produced in the pancreas, and helps the digestion process

computerized tomography scan

an x-ray film examination of the body from many angles uses a scanner analyzed by a computer -preparation is usually NPO -the patient needs to lie very still; if claustrophobia use light sedation

barium enema with air contrast

an x-ray film examn uses an opawue contrast medium and air that outlines the colon and rectum to examine the lower GI tract prep: NPO after midnight, bowel prep such as magnesium citrate

Upper gastrointestinal barium swallow

an xray exam using a opaque contrast medium- structure and motility of the upper GI tract and pharynx, esophagus, and stomach prep: NPO After midnight the night before the exam remove all jewelry or other metallic objects after the test patient needs to increase fluids to facilitate passage barium

upper endoscopy

and endoscopic examination of the upper GI tract allows more direct visualization through a lighted fiber optic tube that contains a lens, forceps, and brushes for biospy

Before collecting a stool sample for occult blood, the nurse instructs the nursing assistive personnel to:

ask to void Emptying the urinary bladder before collecting the stool sample prevents contamination of the specimen.

why you only use sterile water to inflate the balloon

because saline crystallizes, resulting in incomplete deflation of the balloon at the time of the removal

white-gray-glay colored

biliary obstruction or a lack of bile production

barium enema, colonoscopy and flexible sigmoidoscopy require what bowel prep

bowel preparation with magnesium citrate

The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to: Use the double-voiding technique. Perform Kegel exercises. Use Credé's method. Correct Keep a voiding diary.

credes method pressure is put on the suprapubic area with each attempted void. the maneuver promotes bladder emptying by relaxing the urethral sphincter

ultrasound prep

depends on organ to be visualized nd includes NPO or no prep

when is amylase elevated

elevated in pancreas abnormalities of the pancreas -inflammation or tumors -cholecystitis -necrotic bowel -diabetic ketoacidosis

he nurse is analyzing the fecal characteristics of a client. Which substances indicate an abnormality? Select all that apply. Excess fat Blood Mucus Bile pigment Dead bacteria

excess fat, blood, mucus The presence of excess fat is an abnormal finding and indicates liver dysfunction. The presence of blood and mucus in the stool are an abnormal finding and are associated with internal bleeding, infection, and inflammation. Bile pigment and dead bacteria are normal constituents of the fecal matter.

What foods help bowel movement

fiber, vegetables, fruit, whole grains gas-producing foods: onions, cauliflower, and beans

TYPE 6 stool

fluffy pieces with ragged edges a mushy stool

fluid intake and movement of bowels

fluid liquefies intestinal contents, easing its passage. reduced fluid intake slows passage and results in hardening of stool

condom catheter

for incontinent or comatose men who still have complete and spontaneous bladder emptying. never use standard adhesive tape

hypertonic -low volume

for patients who cant tolerate large amounts of fluid -not dehydrated or young infants

promotion of omfort

frequent or unpredictable voiding, dysuria, and painful distention are sources of discomfort -comfort: clean, dry clothing -protective pad analgesics act on the urthral and bladder mucosa-relieve dysuria inflamed urthra, local discomfort: sitz bath

Diseases of the GI tract associated with stress

gastric and duodenal ulcers Crohns disease ulcerative colitis IBS

cause of hemorrhoids

hemorrhoids are dilated, engorged veins in the lining of the rectum. 1.increased venous pressure from straining at defecation 2. pregnancy 3.heart failure 4. chronic liver disease

A client who has malabsorption syndrome asks the nurse about the process of nutrient absorption. What response should the nurse give the client? Select all that apply.

ileum: absorbs fat and bile salts the jejunum absorbs carbs and proteins nutrients are absorbed into the blood vessels

Age related factors affecting bowel elimination

infant: -smaller stomach capacity -less secretion of digestive enzymes -rapid peristalsis -unable to control defacation because of lack of neuromuscular development older adults: loss muscle tone in anal and perineal sphinter never impulses to the anal region slow

anticholinergic drugs: atropine Glycopyrrolate

inhibits gastric acid secretion and depresses gastrointestinal motility -useful in hyperactive bowel disorders -cause constipation

removal of indwelling catheter

insert syringe into the balloon injection port. slowly withdraw all the solution remains (partially inflated balloon traumatizes the urthral canal as the catheter is removed. After deflation-inform pt that they will feel *burning* sensation. pull smoothly and slowly noting the first voiding after removal and document the time and amount of voiding for the next 24 hr -if amounts small-frequent assessments made -if 4 hours have elasped without voiding or pt feels discomfort-necessary to reinsert the cath

abnormal characteristics of stool: blood, pus, foreign body, mucus, worms

internal bleeding, infection, swallowed objects, irritation, inflammation

cystitis

irritated bladder causes a frequent and urgent sensation of the need to void. urine is cloudy bc of bacterial and white cells

A client is being assessed for a possible urinary tract infection (UTI). Before sending a urinalysis specimen to the laboratory, a nurse collects a small amount of urine to perform a dipstick test. If the client has a UTI, which component should be detected in the urine? 1.protein 2. glucose 3. ketones 4. leukocytes

leukocytes A dipstick test is performed in the health care provider's office to test for different components. In this case, the health care provider tests white blood cells or leukocytes, which indicate an infection. Protein is detected in clients with nephropathy. Glucose is detected in clients with diabetes mellitus. Ketones are detected in clients with poorly controlled diabetes, starvation, and dehydration.

TYPE 3 stool

like a sausage but with cracks on the surface

TYPE 4 stool

like a sausage or snake-smooth and soft

abnormal characteristics of stool: consistency

liquid: diarrhea, reduced absorption hard: constipation

Factors to decrease UTI

-avoid the routine use of catheters;only when indicated -collaborate with heatlh care providers to remove catheters when medical indications no longer exist -suggest noninvasive continent devices such as condom catheters to reduce the risk -need to be patient advocate by taking an active role in monitoring duration of treatment

NG tubes

-lavage for active bleeding -poisioning and gastric dilatation -compression through inflated baloon for controlling esophageal and gastric bleeding -enteral feeding with patients who have difficulty swallowing -decompression by removing secretions and gaseous substances

What are the pre-test and post-test procedures should a nurse follow while managing a client who is scheduled for a cystoscopy? Select all that apply.

-monitor intake andoutput -inform the client that he may have voiding difficulty post procedure -inform the client that he may pass red-tinged urine post procedure Fluid intake and urine output should be monitored post cystoscopy to determine obstruction or trauma to the urinary system. After the procedure, the client may have difficulty voiding or have red or pink urine because of trauma to the urethral or bladder mucosa. Fluids should be encouraged to promote urine formation and prevent infection. Cystoscopy can be used as a therapeutic procedure and may have untoward effects.

tap water enemas

-stimulates evacuation -never repeated due to potential water toxicity

The nurse is teaching kidney function to a group of nursing students. Which of the following statements apply to kidney function? 1.The kidneys produce several substances vital for maintenance of blood pressure. 2 The kidneys produce several substances vital to bone mineralization. 3 A nephron is a functional unit of the kidney and helps in urine formation. 4 The kidneys filter waste products of metabolism and excrete them in the urine. 5 The kidneys produce several substances vital to white blood cell (WBC) production

1, 2, 3, 4 The kidneys produce several substances vital for maintenance of blood pressure. Correct 2 The kidneys produce several substances vital to bone mineralization. Correct 3 A nephron is a functional unit of the kidney and helps in urine formation. Correct 4 The kidneys filter waste products of metabolism and excrete them in the urine. 5 The kidneys produce several substances vital to white blood cell (WBC) production

A student nurse is learning to auscultate the abdomen for bowel sounds. What should the student nurse know about the bowel sounds before starting to auscultate? Select all that apply. 1.Normal bowel sounds occur every 5-15 2.Each bowel sound lasts one to several seconds. 3.An increase in pitch or a tinkling sound indicates bowel distention. 4.Hypoactive sounds may occur in small intestine obstructions. 5. Hyperactive sounds may occur in a paralytic ileus.

1,2,3 Bowel sounds can be assessed by auscultating the four quadrants of the abdomen. It is considered normal if the bowel sounds occur every 5-15 seconds. Each bowel sound may last one to several seconds. In bowel distention, an increase in pitch or a tinkling sound can be heard. Hypoactive sounds are less than 5 sounds per minute and may occur in paralytic ileus. Hyperactive bowel sounds or 35 or more sounds per minute occur when there is an intestinal obstruction.

A client's midstream urine sample is being collected for laboratory investigation. Arrange the steps that a nurse should follow after the sample has been collected in the container.

1. Replace the cap on the container. 2. Clean urine from the exterior surface of the container. 3. Attach a label on the side of the container. 4. Attach a laboratory requisition to the specimen bag. 5. Remove gloves and perform hand hygiene.

mrs. grayson had stress incontinence for the past 2 years. embarrassed about her problems n not spoken about it, would like to regain urinary control, weights 200 pounds and 5''1

1. Teach Mrs. Grayson supportive measures to reduce intraabdominal pressure such as losing weight and avoiding heavy lifting. Other measures that will help her include initiating a bladder and habit training program, maintaining a toileting schedule, having her use double voiding, and encouraging her to reduce caffeinated beverages from her diet. 2. Mrs. Grayson is experiencing urinary tract infection (UTI). Residual or retained urine in her bladder causes the urine to become more alkaline and is an ideal site for microorganism growth. Encourage Mrs. Grayson to increase her fluid intake to 2200 to 2700 mL/day. Teach her to empty her bladder completely. Ensure that she continues to use good perineal hygiene. 3. Strategies to teach Mrs. Grayson to prevent infection include maintaining good hand hygiene, cleaning from front to back of perineum, performing catheter care, taking care not to raise bag higher than bladder (preventing reflux of urine). Instruct Mrs. Grayson to maintain an adequate fluid intake and a closed urinary drainage system. Also tell Mrs. Grayson to prevent kinks in catheter tubing.

A client who has malabsorption syndrome asks the nurse about the process of nutrient absorption. What response should the nurse give the client? Select all that apply. 1 The ileum absorbs fat and bile salts. 2 The duodenum absorbs iron and vitamins. 3 The jejunum absorbs carbohydrates and proteins. 4 Nutrients are absorbed into the blood vessels. 5 Plant fiber undergoes absorption in the small intestine.

1. The ileum absorbs fat and bile salts 3. The jejunum absorbs carbs and proteins 4. nutrients are absorbed into the blood vessels Fats and bile salts undergo absorption in the ileum, whereas the carbohydrates and proteins undergo absorption in the jejunum. Nutrients that cross the mucosal barrier of the intestine are absorbed into the lymph fluids or blood vessels. Iron and vitamins are absorbed in the ileum and not the duodenum. Plant fiber is not digested in the small intestine; the undigested fiber is emptied into the cecum.

An older adult presents with urinary frequency due to cystitis. What nursing instructions are helpful to this client? Select all that apply.

1. advise cranberry juice 2. encourage pt to increase fluid intake 3. discourage intake of caffeine Cranberry juice decreases bacterial infections of the bladder and urinary frequency due to cystitis. Clients should be encouraged to increase fluid intake to at least six to eight glasses a day unless medically contraindicated. Bacterial growth is minimal in diluted urine. Incomplete urination tends to increase the frequency, and also increase the risk of infection. Coffee, tea, cola, and alcohol intake should be discouraged since these have a diuretic effect and may increase urinary frequency. Routine use of indwelling catheters should be avoided as it may cause urinary infection. Restricting fluid intake does not decrease urinary incontinence severity or frequency.

Mr. Ryan Kelter is a 33-year-old Caucasian who lives in an acute rehabilitation center. He was injured in a motorcycle accident that caused a spinal cord injury (SCI). As a result of the SCI, he has neurogenic bladder that prevents him from fully emptying his bladder. Because of this, he needs to be straight catheterized several times a day. Beth is the student nurse assigned to Mr. Kelter. She understands the importance of keeping him on his bladder schedule to prevent a urinary tract infection (UTI). 1. Beth enters Mr. Kelter's room after lunch to perform straight catheterization. List in order the steps Beth takes to perform straight catheterization on Mr. Kelter. A. Lubricate the catheter. B. Clean penis with dominant hand. C. Apply sterile gloves. D. Advance catheter into penis. E. Apply fenestrated drape. F. Hold penis with nondominant hand. G. Ask patient to bear down. H. Coil catheter in dominant hand. 2. Beth should advance the catheter ________ to _______ inches or until urine flows out of it. 3. As Beth inserts the catheter into Mr. Kelter's penis, she feels resistance. She should use more force to guide the catheter through his urethra. A. True B. False

1. apply sterile gloves 2. apply fenestrated drape 3. lubricate the catheter 4. hold penis with non dominant hand 5. clean penis with dominant hand 6. coil catheter in dominant hand 7.ask patient to bear down 8.advance catheter into penis Answer: 7 to 9 Rationale: In an adult male the catheter should be advanced 7 to 9 inches (17-22.5 cm) or until urine flows out of it. Answer: B Rationale: When resistance is felt while inserting a catheter, withdraw the catheter and do not force it. If there is resistance to the catheter insertion, have the patient take slow, deep breaths while slowly inserting the catheter. When urine appears, advance the catheter another 2.5 to 5 cm (1 to 2 inches).

indications for catheter usage

1. intermittent catheterization →relieving discomfort or bladder distention, providing decompression →obtaining sterile urine specimen when clean catch specimen is unobtainable →assessing residual urine after urination -managing patients with spinal cord injuries, neuromuscular degeneration or incompetent bladders long term 2. short term indwelling catheterization -obstruction of urine outflow-prostate enlargement -surgical repair of bladder, urethra, surrounding structures -measurement of urinary output in critically ill -prevention of urethral obstruction from blood clots after genitourinary surgery -continuous or intermittent bladder irrigation 3. long term indwelling catheterization -severe urinary retention with recurrent episodes of UTI -skin rashes, ulcers, or wounds irritated by contact with urine -terminal illness when bed linen changes are painful for patients

helping patient with stress urinary incontinence to gain control over urination

1. learning exercises to strengthen the pelvic floor 2. intitating a toilet schedule on awakening, at least q22h during the day n evening, before bed, and q4h at night 3. avoiding overfilled bladder 4. minimize tea, coffee, caffeine drinks and alcohol 5. taking prescribed diuretic meds in the morning 6. following a weight-control program if obestiy is a problem that is causing increased abdominal pressure kegal and bladder retraining

What is the primary purpose of a soft, high-fiber diet immediately following a myocardial infarction (MI)?

1. maintain bowel health to decrease flatulence Dietary fiber is used to stimulate the wall of the intestinal tract to move the stool through and out of the rectum, without a client needing to bear down to force the stool out of the rectum. The Valsalva maneuver (straining with a closed glottis) causes bradycardia and decreases cardiac output, and should be avoided after an MI. Fiber does not get digested, it only aids in adding bulk to the stool. Fiber helps in lowering cholesterol but this action is not the primary purpose of it following an MI. Fiber does not decrease gas production.

A nurse is caring for a client who has undergone a surgery on the pharynx. The client has a small bore nasogastric tube. What are the purposes of a small bore nasogastric tube?

1. medication administration 2. enteral feeding

catheter care

1. need health care order 2. maintains a closed urinary drainage system 3. hang plastic bag on the bed frame or wheelchair 4. never on the bed rail 5. look for kinks and blockage in tubing 6. perineal hygiene ->3 times a day to prevent buildup of secretions or encrustation ->soap and water is effective 7. patients with catheters receive special care 3x a day and after defecation or bowel incontinence 8. daily intake of 2000-2500 mL

The patient is to have an intravenous pyelogram (IVP). Which of the following apply to this procedure? (Select all that apply.) Note any allergies. Monitor intake and output. Provide for perineal hygiene. Assess vital signs. Encourage fluids after the procedure.

1. note allergies 2. encourage fluids after the procedure The dye used in the procedure is iodine based. Assessing for history of any allergies can predict allergy to the dye used. Fluid intake dilutes and flushes the dye from the patient.

Alkaline phosphatase increases with

1. obstructive heptaolilary disease 2. hepatobiliary carcinomas 3. bone tumors 4. healing fractures

Correct order for irrigating a nasogastric tube (NG):

1. perform hand hygiene and apply clean gloves 2. clamp and disconnect the NG tube 3. insert tip of syringe into NG tube and slowly inject 30 mL of saline 4. slowly aspirate the syringe 5. reconnect the NG tube to suction

A nurse is caring for a client who has undergone a surgery on the pharynx. The client has a small bore nasogastric tube for enteral feeding. After an assessment, the health care provider orders removal of the tube. The nurse follows all the steps of the procedure to remove the tube. Arrange the steps of the procedure in the correct sequence.

1. perform hand hygiene and clean gloves 2. turn off suction and disconnect NG tube from the drainage bag or suctin 3. Remove tape of fixation device from bridge of nose and unpin tube from gown 4. stand on the clients right side if right-handed, left side if left-handed 5. hand the client facial tissue; place clean towel across chest 6. intruct client to take and hold a deep breath 7. clamp or kink tubing securely and pull tube out steadily and smoothly into towel in other hand 8.clean nares and provide mouth care 9. dispose of tube and drainage equipment in the proper container

A client is advised to have a barium swallow test. What instructions should the nurse provide to the client to prepare the client for the test? Select all that apply 1 Remove all jewelry before the test. 2 Don't eat anything after midnight. 3 Lie very still during the procedure. 4 Have a clear liquid diet 24 hours before the test. 5 Prepare the bowel using GoLytely

1. remove all jewelryt before the test 2. dont eat anything after midnight Barium swallow tests examine the structure and motility of the GI tract by using a contrast media like barium. The client needs to remove all jewelry or metallic objects from the body as they may interfere with the x-ray taken. The client should fast before the test, because the stomach and intestines should be empty for visualizing. It is not necessary to lie still during the procedure or to have a clear liquid diet for 24 hours before the test. Bowel preparation with GoLytely is performed for investigations like enteroclysis, colonoscopy, flexible sigmoidoscopy, and barium enema.

A client who is a smoker complains of involuntary passage of urine after a strong sense of urgency to void. What nursing interventions are helpful to this client? Select all that apply.

1. smoking cessation 2. antimuscarinic agents 3. behavioral interventions Urge incontinence is characterized by an involuntary passage of urine following a strong urge to void. Smoking can irritate the bladder and worsen the incontinence; therefore, the client should be instructed to quit smoking. Antimuscarinic agents help to prevent the involuntary contraction of the bladder muscles and prevent passage of urine. Behavioral interventions are helpful in making lifestyle changes to adjust for incontinence. Crede's method is helpful for clients with overflow incontinence. Intermittent catheterization is used when a client has urinary retention with overflow incontinence.

A nurse is caring for a client admitted with diarrhea. What could be the possible causes of diarrhea in the client? Select all that apply. 1.Use of opioid drugs 2.Use of antibiotics 3.Food allergies 4.Prolonged stress 5.Hypothyroidism

1. use of antibiotics 2. food allergies 3. prolonged stress Use of antibiotics may cause diarrhea by disrupting the normal flora of the intestine. Food allergies and prolonged stress cause increased peristalsis resulting in diarrhea. Use of opioid drugs and hypothyroidism cause constipation by decreasing peristalsis.

A nurse is taking care of a client who is bedridden. The nurse implements dietary modifications to relieve constipation. The client requests a bed pan. The nurse provides the client with a bed pan and ensures that the client is in a comfortable position to defecate. Arrange the steps for placing the bedridden client on a bedpan, in the correct sequence.

1.Ensure the client is positioned high in the bed. 2.Raise the client's head about 30 degrees. 3. provide support of upper torso 4.Ask the client to raise the hips by bending the knees and lifting the hips upward. Incorrect 5.Place a hand palm up under the client's sacrum, 6.resting the elbow on the mattress Slip the pan under the client.

An elderly male client has been admitted to the hospital for a urinary tract infection. Which of the following physiological changes in the urinary system should the nurse teach the client about? Select all that apply.

1.Urinary retention increases risk of urinary infection. 2.Prostate enlargement may lead to urinary retention. 3.Ineffective bladder contraction leads to urinary retention. Urinary retention increases risk for bacterial growth and development of urinary infection. Prostate enlargement may lead to urinary retention by obstructing the flow of urine. Because the bladder cannot contract effectively, an older adult often retains urine after voiding. The older adult often experiences nocturia. Prostate enlargement increases urinary frequency due to incomplete voiding.

total bilirubin: 0.3-1 mg/dL

1.increased in hepatobiliary diseases (affecting the liver and bile, bile ducts, and gallbladder 2. increased in obstructions of bile ducts, 3. increased in certain anemia 4. increased in certain transfusion reactions

how much should an adult need to drink a day

1100-1400 mL

After a transurethral prostatectomy a patient returns to his room with a triple-lumen indwelling catheter and continuous bladder irrigation. The irrigation is normal saline at 150 mL/hr. The nurse empties the drainage bag for a total of 2520 mL after an 8-hour period. How much of the total is urine output?

1320 The output is determined by calculating the amount of irrigation solution and subtracting that from the total output: 150 × 8 = 1200. Total output is 2520. 2520 - 1200 = 1320 urine output., 1320 mL, 1320 mL, The output is determined by calculating the amount of irrigation solution and subtracting that from the total output: 150 × 8 = 1200. Total output is 2520. 2520 - 1200 = 1320 urine output."

when does a child develop neuromuscular control of defecation

2-3 yrs

enteroclysis

24 hours of clear liquid diet and colon cleansing such as GoLytely or enemas until clear

balloon size

3 ml (peds) 75 ml (large postoperative volume 5-30 ml most common 5 allows for optimal drainage

A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in small amounts and is more frequent when she coughs. What should the nurse teach the client about her disorder? Select all that apply 1. due to local irritation 2. nervous system disorders 3. weakness of muscles around urethra 4. stress incontinence 5. intra-abdominal pressure exceeds urethral resistance

3. weakness of muscles around urethra 4. stress incontinence 5. intra-abdominal pressure exceeds urethral resistance Involuntary voiding of urine on coughing occurs due to weakness of muscles around the urethra. It is also called stress incontinence. Stress incontinence occurs in older women when intra-abdominal pressure exceeds urethral resistance. Involuntary voiding occurs only when abdominal pressure rises above the urethral pressure. Local irritating factors and nervous system disorders usually lead to urge incontinence.

A client presents with acute abdominal pain. The nurse suspects the presence of bowel necrosis in this client. What does the nurse expect to find in the laboratory test report? A. the bilrubin level is increased b. the serum amaylase is increased c. carcinoembryonic antigen level is increased d. the alkaline phosphatease levels are increased

B The presence of amylase indicates the function of the GI tract. Bowel necrosis is associated with increased serum amylase, due to pancreatic stimulation. Serum bilirubin levels indicate the functioning of the liver. Carcinoembryonic antigen indicates GI inflammation. Alkaline phosphatase becomes elevated when bone tumors are present.

Carcinoembryonic antigen

CEA elevated in the presence of cancer or inflammation of the GI tract or hepatobiliary organs

A primary health care provider instructs the nurse to insert an indwelling urinary catheter in a client for 3 weeks. What type of catheter is the best choice for this client to prevent infection and promote comfort?

Catheters made of latex are suitable for clients who require catheterization for 3 weeks. These catheters are used for the short-term and may prevent infection if protected from contamination. Silicon and Teflon catheters are appropriate for clients who require catheterization for 2-3 months. Plastic catheters are appropriate for intermittent catheterization. Text Reference - p. 1062 latex

Since removal of the patient's Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first? 1 Check for bladder distention 2 Encourage fluid intake 3Obtain an order to recatheterize the patient 4Document the amount of each voiding for 24 hours

Check for bladder distention The patient may experience urinary retention after catheter removal. If amounts voided are small, checking for bladder distention is necessary.

A client complains that he is not able to pass urine completely. Even after voiding, the client does not feel that the bladder is empty. What tests can be done to assess the postvoid residual (PVR) in the client?

Correct 1 Portable noninvasive bladder ultrasound device Postvoid residual can be assessed using a portable noninvasive bladder ultrasound device. It helps to determine the amount of urine left in the bladder after voiding. A cystoscopy helps to visualize the structures of the urinary tract. An x-ray of the abdomen may show the condition of abdominal organs, but is not helpful in determining the residual urine left in the bladder. An intravenous pyelogram may help to determine the function of the kidneys, but does not help in determining postvoid residual.

The nurse is caring for a client with abdominal pain who is scheduled for a barium enema with air contrast. What information should the nurse give to the client before this procedure? Select all that apply. 1.The procedure will help in the examination of lower GI tract. 2.The client will have to be nil per os (nothing by mouth; NPO) after midnight. 3. No metallic objects are allowed during procedure 4.Light sedation is required for the procedure. 5.The client needs to lie very still during the procedure.

Correct 1 The procedure will help in the examination of lower GI tract. Correct 2 The client will have to be nil per os (nothing by mouth; NPO) after midnight. An x-ray film examination uses an opaque contrast medium and air that outlines the colon and rectum to examine the lower GI tract. Preparation includes nil-per-osl (NPO) after midnight, a bowel preparation such as magnesium citrate, and in some instances, enemas to empty out any remaining stool particles. Metallic objects do not interfere with the procedure; therefore, they do not need to be removed. Sedation is not required as it is not a painful procedure. There is no need for the client to lie very still as the procedure is not affected with client's movement.

The nurse recognizes which client needs to use a fracture pan for a bowel movement? a. client who is obese b. client experiencing confusion c. the clinet on bed rest d. a client recovering from hip surgery

D A fracture pan is used for a client with back or lower-extremity health issues. Because a fracture pan is shallow in comparison to a regular bedpan, the fracture pan prevents disturbing the client's body alignment. Text Reference - p. 1104

A client is scheduled for a plain film x-ray of the kidney, ureter, and bladder. What preliminary preparations should this client take?

For getting a plain film of kidney, ureter, and bladder there is no specific preliminary preparation that needs to be done.

MRI

NPO 4-6 hours before examinatin no metallic objects

prep for upper endoscopy

NPO after midnight the night before examn patient removes ally jewlry and other metallic objects light sedation

barium enema with air contrast prep

NPO after midnight, a bowel prep with magnesium citrate, some instances an enema to remove remaining stool particles

aspirin

NSAID used to relieve pain prostaglandin inhibitor interfers with the secretion of protective mucus and thereby increase the risk of gastric bleeding

The nurse receives a prescription to obtain a post-void residual for a client via catheterization. What is the best way to obtain this measurement?

Intermittent catheterization is used when evaluating the residual urine following urination. The investigation requires measurement of urine remaining in the bladder after voiding. Intermittent catheterization prevents the risk of infection. Long-term catheterization is done in clients with urinary retention. It may also be done for clients with recurrent episodes of urinary infections, skin breakdown, and terminal illness. Short-term catheterization is required for obstructive conditions, surgical repair of bladder and urethra, prevention of urethral obstruction, and bladder irrigation. There is no such thing as medium-term indwelling catheterization. Text Reference - p. 1061

MRI

NPO 4-6 hours before no metallic objects

A client who visited the hospital for routine laboratory tests has been found to have an increased serum carcinoembryonic antigen. Which conditions are suspected in the client and require further assessment? Select all that apply. a. bowel necrosis b. diabetic ketoacidosis c. inflammation of GI tract d. inflammation of hepatobiliary organs e. transfusion reaction

c. inflammation of GI tract D. inflammation of hepatobilary organs *Carcinoembryonic antigen* increases in inflammatory disorders of the gastrointestinal tract and with inflammation of the hepatobiliary organs. Therefore, the client requires evaluation for these disorders. *Serum amylase* is a marker for GI function. *Bowel necrosis* and *diabetic ketoacidosis* are associated with increased serum amylase and not carcinoembryonic antigen. A transfusion reaction is associated with increased serum bilirubin due to destruction of hemoglobin, and not carcinoembryonic antigen.

nonsteroidal antiinflammatory drugs

cause GI irritation that increases the incidence of bleeding with serious consequences to older adults

iron

causes discoloration of the stool (black) nausea vomiting constipation abdominal cramps

foods that can create an environment in the bladder more prone to infection

citrus juices-orange, grapefruit, pineapple

high enemas

cleanse entire colon

low enemas

cleanse rectum and sigmoid colon

colonoscopy

clear liquids day before and then some form of bowel cleanser such as Golytely. enemas until clear are common

An elderly African American reports a change in bowel habits with rectal bleeding and a sense of incomplete bowel evacuation. What disorder does the nurse suspect in this client? 1. infection 2. colon cancer 3. irritable bowel syndrome 4. inflammatory bowel syndrome

colon cancer Age and race are two factors that can indicate whether a client is at an increased risk of developing colon cancer. In this case, the client is an elderly African American. Statistics show that African Americans have a higher risk of developing colon cancer. In addition, the client's presentation of change in bowel habits, rectal bleeding, and sense of incomplete evacuation of bowel are warning signs of colon cancer, and the nurse should evaluate the client for this condition. Infections are usually present with diarrhea which may be associated with blood. Irritable bowel syndrome and inflammatory bowel disorders are associated with abdominal pain. Text Reference - p. 1100

normal characteristics of stool

color-brown odor-pungent consistency- soft, formed freq- infant 4-6 times adult-2-3 times a week amount-150g/day shape-resembles diameter of rectum constituents- dead bacteria, fat, pile pigement, cells lining intesting mucosa, water, undigested food

black or tarry stools

consumption of iron

medicated enemas

contain drugs -ex: kayexalate-used to treat patients with dangerously high potassium levels

enteroclysis

contrast material is introduced to jejunum, allowing entire small intestine to be studied -prep 24 hours of clear liquid diet and colon cleansing such as GoLytely or enemas until clear

food that helps urinary infection

cranberry, apple, and prune juices

Bristol Stool Scale TYPE 1

seperate hard lumps, like nuts (hard to pass)

A nurse is caring for a client with malabsorption syndrome. What changes in bowel elimination is the client likely to report? Select all that apply. Pale stools Black, tarry stools Clay-colored stools Increased flatulence Fat and mucus in stools

pale and fat/mucus in stools A client with malabsorption syndrome is unable to digest fats. Therefore, oily fat and mucus present in the stools give the stools a pale color. Black or tarry stools can be caused by consumption of iron preparations. One of the most common causes of increased flatulence is swallowing air from activities such as chewing gum, drinking carbonated beverages, eating rapidly, or sucking through straws. Biliary obstruction or a lack of bile production may cause the stools to become white, gray, or clay-colored.

Physical activity and bowel elimination

physical activity promotes peristalis and immobilization depress it.

suprapubic cath

placement of cath rthrough the abdominal wall into the bladder. must remain in pt at all times. monitor I&O carefully, urine charcterisitics, nd observe for signs of infection.

antibiotics

produce diarrhea by disrupting the normal bacterial flora in the GI tract

carminative enemas

provide relief from gaseous distention -improve ability to pass flatus.

self catheterization

pt with chronic disorders-spinal injuries teach pt the structures of urinary tract, clean vs sterile, importance of adequeate fluid intake, freqency of self-catherization 4-6 times a day with volumes of 400-500mL

habit training

pt with functional incontinence helps improve voluntary control -pateint establishes the pattern by documenting episodes of incontinence and scheduling voiding opportunities just before the urge time interval. goal: keep pt dry

soapsuds

pure castile soap in tape water or normal saline -acts as an irritant to promote bowel peristalsis -caution with older adults and pregnant

A nurse is teaching a group of people regarding colon cancer. Which factors should the nurse explain as warning signs of colon cancer? Select all that apply. Rectal bleeding Obesity and inactivity Change in bowel habits Older than 50 years of age Having a family history of colon cancer

rectal bleeding change in bowel habits sensation of incomplete bowel evacuation

lower GI tract present stools

red stools

A client is advised to have a barium swallow test. What instructions should the nurse provide to the client to prepare the client for the test? Select all that apply. a.Remove all jewelry before the test. b.Don't eat anything after midnight. c,Lie very still during the procedure. d.Have a clear liquid diet 24 hours before the test. e.Prepare the bowel using GoLytely.

remove all jewelry before the test dont eat anything after midnight Barium swallow tests examine the structure and motility of the GI tract by using a contrast media like barium. The client needs to remove all jewelry or metallic objects from the body as they may interfere with the x-ray taken. The client should fast before the test, because the stomach and intestines should be empty for visualizing. It is not necessary to lie still during the procedure or to have a clear liquid diet for 24 hours before the test. Bowel preparation with GoLytely is performed for investigations like enteroclysis, colonoscopy, flexible sigmoidoscopy, and barium enema.

A client is advised to undergo dialysis. Which conditions are the indications for dialysis? Select all that apply.

renal failure that does not respond to conservative therapy worsening or uremic symptoms associated iwth renal failure severe electrolyte and fluid imbalance Dialysis is performed to decrease the fluid overload, and eliminate the metabolic toxins. It is indicated in renal failure that does not respond to medications and dietary changes. If the uremic symptoms associated with renal failure worsen, dialysis is performed to prevent complications. Severe electrolyte and fluid imbalance which does not respond to simple therapies would need dialysis for correction. Multiple sclerosis with damage to the nerve that controls bladder may result in incontinence. It can be managed by catheterization. Decreased blood urea nitrogen is not an indication of dialysis as it does not indicate renal impairment.

A client's urinalysis shows the presence of casts. Based on this laboratory data, what should the nurse suspect? 1. protein-calorie malnutrtion 2. renal injury 3. end stage renal disease 4. renal stone formation

renal injury The increased presence of granular casts is always an abnormal finding and is usually indicative of renal injury. Protein-calorie malnutrition is characterized by the presence of ketone bodies in the urine, not casts. Increased levels of urea and creatinine indicate end-stage renal disease. The presence of excess crystals predisposes a client to the development of renal stones, not casts.

normal saline

safest due to equal osmotic pressure -volume stimulates peristalsis

magnesium citrate

saline purgative, fast acting and suitable for managing poisoning.

Bristol Stool Scale TYPE 2

sausage-shaped but lumpy

The nurse who works in a medical surgical unit observes that women have a higher incidence of urinary tract infections than men. Why is this?

shortened urethra absence of prostatic secretions proximity of urethral meatus to anus The increased susceptibility to urinary tract infection among females is due to their short urethra, making the upward transmission of microorganisms easier. Women also lack prostatic secretions, which have antibacterial properties. The proximity of the urethral meatus to the anus among females leads to the spread of microorganisms from the anus to the urethra. The presence or absence of testosterone does not have any impact on urinary function. It is responsible for sex characteristics. Kidney structure does not vary between men and women.

how to pick catheter size?

sizse of pt urthral canal. french system: larger catheter larger the guage number

A client needs a bowel preparation before a procedure. Which medication is appropriate in managing this client? Psyllium Polycarbophil Methyl cellulose Sodium phosphate

sodium phosphate Sodium phosphate is meant for acute emptying of the bowel and is suitable for managing the client with acute constipation. Psyllium, polycarbophil, and methyl cellulose as they are bulk- forming agents are the drugs of choice for managing chronic constipation, rather than acute constipation.

TYPE 5 stool

soft blobs with clear-cut edges (passed easily)

The nurse is reviewing laboratory results for a client and notices the urine tested positive for ketones. What underlying factors may lead to the presence of urinary ketone bodies? Select all that apply. 1. epilepsy 2. starvation 3.dehydration 4. hyperthyroidism 5. uncontrolled diabetes mellitus

starvation, dehydration, and diabetes Ketones are produced as a by-product when the body uses fat for energy production. When a client is not taking in adequate amounts of carbohydrate, such as in starvation, the body uses other sources for energy. Dehydration can also lead to ketonuria. A client with uncontrolled diabetes mellitus breaks down fatty acids for energy. Epilepsy and hyperthyroidism are not associated with the presence of ketone bodies in urine. Epilepsy is a disease that affects the nervous system, and hyperthyroidism affects the endocrine system.

intermittent cateterization

straight single-use cathether long enough to drain the bladder- 5 to 10 minutes after finished immediately withdraw cat increases risk for infection and trauma pt with spinal cord injuries or MS

restorative care

strengthening pelvic floor muscles bladder retraining habit training self-cath maintence of skin integrity promotion of comfort

bisacodyl and castor oil

suiable for preparing the bowel for carrying out diagnostic procedures

docusate calcium

suitable for short term therapy for relieving straining during defecation

alternative to urethral catheterization

suprapubic catheterization condom catheter

Histamine antagonists

supress the secretion of hydrochloric acid and interfere with the digestion of some foods

the health care provider has ordered a cleansing enema for a client with constipation which enema can be administered?

tap water normal saline soapsuds solution low-volume hypertonic

ultrasound

technique uses high-freq sound waves to echo off body organs creating a picture

Spastic constipation presents with stools with

translucent mucus

bladder retraining

treating pt with stress incontinence and decreased urge to void goal is reduce voiding frequency and perhaps the bladder capacity

kegal excercises

treating stress incontinence, OAB, mixed cause of urinary incontinence -pt need to be alert and motivated -continued use -learn the technique while voiding-->then practice not voiding

latex catheters

up to 3 weeks, be aware of allergies

maintenance of skin integrity

urine on skin causes encrustations that fosters breakdown 1. washing with mild soap and water to remove 2. body lotion keeps skin moisturized 3. petroleum-based ointments provide barrier to the urine

TYPE 7 stool

watery, no solid pieces. Entirely liquid

barium enema with air contras

x ray film examination uses an opaque contrast medium and air that outlines the colon and rectum to examine the lower GI tract