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201B Exam2 > 201 B Exam 2 GI and GU > Flashcards

201 B Exam 2 GI and GU Flashcards

Gastrointestinal Assessment and Genitourinary Assessment

1
Q

how long does it take for the bowel to return to functional after a GI surgery?

A

1 week to return to functional

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2
Q

what would a surgeon want to know from you about their post-op pt. after bowel surgery before they allow them to eat?

A

-pain levels ↓
-NG tube drainage↓
-BM yet?
-Flatus?
-bowel sounds?
-Ambulating?

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3
Q

in an interview about the GI system what is some subjective data you should look for?

A

last BM
BM description
any nausea
passing gas (flatus)
fullness or bloating/distention

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4
Q

what is some objective data to look for about the GI system?

A

% of meals taken
last BM
character of BMs
intake of fluids
emesis (vomiting)
physical assessment data

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5
Q

what is the order of assessment for the abdomen?

A

inspection, auscultation, palpation (“look, listen, feel”)

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6
Q

nurses only do what kind of palpation of the abdomen?

A

light palpation (deep palpation is only done by a physician)

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7
Q

what are normal bowel sounds?

A

active with irregular gurgling, tinkling every 5-15 sec

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8
Q

what are hyperactive bowel sounds?

A

loud, high-pitched, >every 5-15 sec.

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9
Q

what are hypoactive bowel sounds?

A

faint sounds, < every 5 sec. may not be in all quads,
can be completely absent (ex. after GI surgery)

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10
Q

what are the landmarks of the abdominal area?

A

RUQ
LUQ
RLQ
LLQ

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11
Q

what are the regions of the abdominal area?

A

epigastric region (top)
umbilical region (middle)
suprapubic region
(bottom) aka
hypogastric region

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12
Q

do you palpate the quadrants or the regions of the abdomen?

A

the 4 quadrants are palpated (lightly)

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13
Q

what do we look for when palpating the abdomen? what is normal and abnormal?

A

-normal: soft, non-tender,
pain free
-abnormal: guarding, rigid, tense, firm, tenderness, pain

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14
Q

what are some abnormal abdomen complications that we do NOT palpate?

A

-apendicitis
-acute abdomen (sudden
severe abdominal pain)
-known or suspected
abdominal aortic
aneurysm (AAA)

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14
Q

what is ischemic bowel?

A

the large or small intestine is injured due to not enough blood supply

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15
Q

define illeus

A

loss of forward flow of intestinal contents due to decreased peristalsis, secondary to anesthesia, handling of intestines during surgery, electrolyte imbalance, infection or ischemic bowel

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16
Q

what are interventions for ileus?

A

detection ,
notify MD,
ambulate
hydrate
GI rest
limit opiods
NG tube to suction
oral care

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17
Q

what are the clinical signs of ileus?

A

abdominal pain,
distension
absent bowel sounds
vomiting
constipation
dehydration

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18
Q

large abdomen vs. distension
“inspection”

A

large: uniformly rounded, umbilicus deeply sunken

distended: single rounded curve, umbilicus may flatten or protrude, skin may “glisten” bc stretched

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19
Q

large abdomen vs distension
“auscultation”

A

large: + bowel sounds

distended: varies

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20
Q

large abdomen vs distension “palpation”

A

large: soft, non-tender

distended: firm or rigid, tenderness/pain , guarding

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21
Q

which of these is under voluntary control?

the defecation reflex

the internal anal sphincter

the external anal sphincter

A

the external anal sphincter

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22
Q

feces is what % water and what % solids

A

75% water and 25%

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23
Q

what is the range of normal frequency of bowel?

A

it can vary from 1 to 2 a day to 1 every 1 to 3 days

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24
Q

what are 9 factors affecting bowel elimination?

A
  1. nutrition
  2. fluid intake
  3. activity
  4. lifestyle
  5. position (bed rest)
  6. pregnancy
  7. medications
  8. therapeutics (diagnostic tests , surgery)
  9. age
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25
Q

what are the criteria (2 or more) for constipation?

A

less than 2-3 BM/week
greater than 25% of the time:
-straining
-lumpy, hard stools
-incomplete evacuation

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26
Q

what are some associated signs and symptoms of constipation?

A

-painful BMs
-bloating,
-rectal fullness
-malaise
-loss of appetite

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27
Q

what are the signs of fecal impaction?

A

-no BM in 3-5 days
-passage of liquid/semi-liquid stool around area of impaction

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28
Q

does an enema require a physicians order?

A

yes

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29
Q

what is the purpose (5) of an enema?

A

-to cleanse bowel (for a
procedure or surgery)
-bowel training
-relive gaseous distension
-administer medication
-to treat constipation/fecal
impaction

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30
Q

why is a kayexalate enema given?

A

to reduce high potassium levels if a person is unable to take medicine orally

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31
Q

is a fleet enema considered a medication?

A

yes

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32
Q

what is the volume of a small enema?

A

approx 150 mL

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33
Q

what is an example of a small enema?

A

fleets, oil retention

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34
Q

what is the volume of a large enema?

A

up to 1,000 mL water or saline

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35
Q

what is an example of a large enema?

A

tap H2O or soap suds (to irritate bowel into having a BM)

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36
Q

what position is patient to be in for an enema?

A

left-lateral, Sim’s position

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37
Q

How long recommended to wait after giving enema before trying to have a BM?

A

as long as possible to get max effect (5 min. is goal)

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38
Q

how far is recommended to insert enema meds into rectum?

A

3-4 inches

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39
Q

what is a “Harris flush”?

A

a return flow enema that allows solution and air bubbles to return as you raise and lower the enema bag. Goal is to remove painful gas from patients who have had abdominal surgery

40
Q

what are two adverse effects to watch out for when giving enemas?

A

abdominal pain
excess vagal stimulation

41
Q

what does excess vagal stimulation cause?

A

lower HR (bradycardia)+
lower BP (hypotension)
= syncope

42
Q

is a physicians order required for digital disimpaction?

A

yes

43
Q

what should you assess before performing digital disimpaction?

A

vital signs because of increased risk of vagal stimulation

44
Q

what is occult blood?

A

blood in stool that is not easily visible or detected

45
Q

what is a hemoccult test?

A

chemical test that checks for hidden blood in a stool sample

46
Q

what is a guaiac test?

A

aka fecal occult blood test (FOBT) diagnostic procedure that checks for hidden blood in a stool sample. (Guaiac is chemical that reacts to blood)

47
Q

what is a KUB?

A

it is an X ray test that examines the kidneys, ureters and bladder. used to asses the urinary system and check for causes of abdominal pain

48
Q

what are the structures of the urinary system?

A

-kidneys
-nephrons
-ureters
-bladder
-urethra

49
Q

what is the average urinary volume per void?

A

250-400 mLs

50
Q

what is the adult normal urinary output per day (U/O/ 24hrs) ?

A

1500 mLs/day

51
Q

what is the adult minimum urinary output for 1 hour? for 24 hrs?

A

minimum 30 mLs per hour
minimum 720 mLs per 24 hrs

**these are important. we keep track of these

52
Q

what do casts indicate?

A

they indicate infection or impaired kidney function

53
Q

what to look for when assessing urine?

A

volume per void
color
clarity
odor
any discomfort with voiding?

54
Q

what is the average volume of an adult bladder?

A

500mLs, may distend to hold 2x that amt

55
Q

how does your body know the bladder is full?

A

a full bladder activates stretch receptors and then signals are sent via spinal cord to voiding reflex center

56
Q

define dysuria

A

painful or difficult urination, may be associated with infection or partial obstruction

56
Q

define hesitancy

A

difficult to start a steam or keep it going

57
Q

define urgency in GU assessment

A

a sudden almost uncontrollable need to urinate

58
Q

define frequency in GU

A

the need to urinate at short intervals

59
Q

define hematuria

A

blood in urine, may be due to trauma, kidney stones, infection

60
Q

define nocturia

A

frequent urination after going to bed, assoc with ↑ liquid intake or UT problems or cardiac problems

61
Q

define polyuria

A

excessive urination, caused by excessive hydration, diabetes, or kidney disease

62
Q

define oliguria

A

urine out put of less than 400mL in 24 hr

63
Q

define anuria

A

absence of urine, less than 100mL in 24 hr., assoc. w/ kidney failure or CHF

64
Q

define pyuria

A

pus in urine, caused by lesions or infection in UT

64
Q

what are 8 nursing interventions to promote voiding?

A
  1. privacy
  2. time
  3. assess voiding routine
  4. assist PRN
  5. encourage voiding Q4 hrs
  6. ↓ anxiety, discomfort
  7. analgesics (pros and cons)
  8. sensory stimuli (run water)
65
Q

what is the nephron?

A

the filtration unit of the kidney involved in the formation of urine

66
Q

what is the purpose of the kidneys?

A

-filter metabolic waste, toxins, drugs, hormones, salts and water from blood stream and excrete them as urine.
-help regulate blood volume
-produce red blood cells
-secrete renin
-activate vit D

67
Q

what does the urethra do?

A

transports urine from bladder to body’s exterior

68
Q

what are ureters?

A

narrow tubes that carry urine from kidneys to bladder

69
Q

what does the bladder do?

A

a sac-like organ that receives and stores urine delivered by ureters

70
Q

what inspections are done GU assessment?

A
  1. inspect perineal areas (for excoriation or skin breakdown)
  2. urine
  3. cather?
  4. Urostomy? (permanent) or suprapubic catheter?
71
Q

what is the nursing role in the case of urinary retention?

A

-inspection pf bladder
-palpation of bladder
-use of ultrasonic scanner aka “bladder scanner”

72
Q

is an order required for use of the bladder scanner?

A

no

73
Q

what is CAUTI

A

catheter associated urinary tract infection

74
Q

what are 6 clinical manifestations of a UTI?

A

-dysuria
-increase WBC counts
-fever, chills(rigors)
-*older adults: cognitive impairment
- urine, cloudy, foul smelling,
-pyuria
-symptoms vary w/ individuals

75
Q

what are 2 causes of UTIs?

A
  1. E coli (from GI)
  2. nosocomial -poor catheter technique, catheter care or indwelling too long (Aka CAUTI)
76
Q

geriatric physical changes in GU system

A

about ↓30% function
2/3 nephrons at 80 yrs
↓blood flow to kidneys
↓muscle tone (ureters, bladder and urethra)

77
Q

geriatric GU nursing interventions

A

-assessmet,
-protective devices (briefs,
pads)
-indwelling catheter care
-measurement of I/O
-education
-condom catheter use
-adjust schedule or
environment

77
Q

geriatric specific GU issues

A

nocturia
private about issues
female: loss of muscle tone (caused by menopause or pregnancy)
male: enlarged prostate
blocks urine
urine leakage
retention of urine after
void
↑bladder infections

78
Q

what is a dependent loop?

A

a section of excess drainage tubing in a urine drainage system that forms a low point and can cause urine or liquid to accumulate. It is important to avoid back flow of urine.

79
Q

what is stress incontinence?

A

involuntary loss of urine with increased abdominal pressure in the absence of an overactive bladder

ex: pregnancy, sneezing, obesity

80
Q

what is urge incontinence?

A

involuntary loss of urine with a strong urge to void
(overactive bladder)

81
Q

what is overflow incontinence?

A

leakage of urine with distended bladder

ex: fecal impaction, neurological disorders, enlarged prostate

82
Q

what is functional incontinence?

A

untimely loss of urine with no urinary or neurological cause

83
Q

what is unconscious (reflex) incontinence?

A

loss of urine when person does not know the bladder is full and has no urge to void

ex: CNS disease, bladder inflammation

84
Q

in a case of urinary retention what is a goal amount of urine to be left after voiding (measured by bladder scan)?

A

post voiding residual volume of less than 150 mL
Treas p. 1017 and p.1035 (how to use scanner)

85
Q

for an indwelling catheter it is important that the drainage bag is where?

A

below bladder level

86
Q

when obtaining a urine sample from a closed system what do you never do? why?

A

never disconnect the catheter from the drainage tube to obtain a sample. this would create a portal of entry for pathogens

87
Q

an indwelling catheter bag is attached to where?

A

frame of bed , not side rails

88
Q

for an indwelling catheter, where is the catheter tubing attached?

A

to the body, usually the thigh

89
Q

in catheter care what needs to be cleaned?

A

clean the perineal area and catheter

90
Q

an indwelling catheter is a __________ system

A

closed

91
Q

for an indwelling catheter is is important to always check there are no ________?

A

dependent loops

92
Q

what are three things to do often with urine bag?

A

assess urine
measure output
empty bag

93
Q

a condom catheter cannot be used if there is what?

A

any skin breakdown or irritation

94
Q

the 5 pre-procedure assessments for a condom catheter

A
  1. assess cognitive status
  2. assess pattern of voiding
  3. assess skin
  4. whether penis is retracted and how much
  5. assess for neuropathy
    (Treas p 1051)
95
Q

there are 16 (!) factors affecting urine output, what are they? good luck, someone help me split this up!

A

in alphabetical order
1. body position
2. cognition
3. disease processes
4. fluid/blood loss
5. Hypotension
6. intake/nutrition/IV
7. kidney failure
8. meds
9. muscle tone
10. neurological injury
11. NPO
12. Obstruction
13. pregnancy
14. psychological factors
15. surgery
16. UTIs

201B Exam2 (2 decks)

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