6: Elimination

Question 1

Define elimination

Answer 1

the evacuation of the bladder and bowels

Question 2

What causes individuals to experience alterations in elimination patterns?

Answer 2

• stress
• illness
• medications
• increased intake

Question 3

What are the consequences of bowel obstructions?

Answer 3

• Bowel obstruction can kill. Built up. Food can fament and gas which ruptures bowels leaking bacteria into capillaries.
• this is toxic

Question 4

Define continence

Answer 4

ability to hold on

e.g. birth= stress= incontinent

Question 5

When is a slip/fracture pan used?

Answer 5

for spin and pelvic injured/broken patients. They can lie down and still use it.

the red on with the slant

Question 6

What is a commode

Answer 6

a wheel chair/seat with cut out for bed pan

Question 7

What is an ileostomy?

Answer 7

A bag/appliance is paced externally and a small intestine/bowel brought to the surface. (much more liquid, pungent, stomach acid)

Question 8

What is a Colostomy?

Answer 8

An external bag/appliance is placed and the large intestine/bowel is brought to the surface.

Question 9

What is a fecal diversion device

Answer 9

flexi-seal system
- This is inserted by placed the finger under the tip and insering into the rectum with lots of lubricant. A ballon is inflated once inside to hold it in place.
- Must have liquid poo/need drugs for this
Must not have any rectal trauma

Continence pull up pants
- pull up/nappy that catches drainage

anal plug
- Has a gelatine, plastic looking wrapper that breaks down when inserted into the rectum and the plug springs open.
- Used in situations such as bathing
6hr or less

Question 10

Why is there a peadiatric specific bristol stool chat?

Answer 10

• kids can be secretive about excretion habits

Question 11

What are important personal hygiene practices that can be done in the hospital and what is their benefit

Answer 11

Bathing
Mouth care
Dressing and grooming
shaving/hair remove

these can be both for comfort and infection control.

Consider culture here. E.g. man want to keep beard for culture

Consider how they want their hair styled

consider why they need care e.g. are they right handed and thats what broken?

Question 12

What are some things to be conscious of when doing person hygiene

Answer 12

preferences

• morning or night shower
• frequency of hygiene
• bar soap/liquid soap/ no soap
• frequency of hair washing
• use mosituriser, deodorant
• order of washing
• soaking of dentures vs. washing

We are all different with different preferences.
- Shower/bath
- Morning/night
This is the humanistic element
- What do you use to wash your hair? How often?
- Body soap or bar of soap

Question 13

What are some of the consequences of neglected hygiene

Answer 13

• body odour
• infection
• skin breakdown
• social isolation
• altering body image
• embarrassment

Question 14

Desrice indirect hygiene

Answer 14

not directly doing care but may be setting up for it.

E.g. put shower chair in bathroom, set up towel and they did the rest themselves.

Question 15

Direct care hygiene

Answer 15

you physically do the care

E.g. shave them, clean their denters

Question 16

Nutrition consideration in hospitals

Answer 16

• are they getting all the requirement they need.
• They are sick if ever they need a good diet, its now
• Carbs, protein, fat provide us with energy
  Vitamins, minerals and water support/regulate body processes (cell division, growth and repair of tissues, control use of energy)

Question 17

What are the 6 nutrient classes?

Answer 17

1- water 
2- protein 
3- carbohydrates 
4- fats 
5- minerals 
6- vitamins

Question 18

Food considerations need to be made such as

Answer 18

• thickness
• assisted cutlery
• involve patient when possible

Question 19

Examples of assisted eating

Answer 19

• Nasogastric tub
• Percutaneous endoscopic gastrostomy (PEG)- surgically inserted into the stomach
• Total parenteral nutrition (TPN)- delvers nutrients intravenously

Question 20

What are 4 risks for malnutrition?

Answer 20

• biological (oral cavity pain, difficulty swallowing, stomach ulcers, inflammation, diarrhoea)
• psychological (anorexia nervosa, bulimia, sever stress, anxiety)
• economic (inadequate finances to purchase protein rich foods, fresh fruit and veg)
• geography (living in remote areas= less access)

Question 21

Define viod

Answer 21

pass urine

Question 22

Considerations to undertake when providing a meal

Answer 22

• Before bringing a patient their meal, ask them if they need to open their bowels or void (pass urine)
• Provide hygiene measures before serving the meal tray
• Ask the patient if they would like family or friends to stay during meal-times to encourage conversation/oral intake
• Remove offending objects such as bedpans, old meal trays, urinal bottles and toilet paper rolls
• Ask about their eating habits and provide foods that the patient likes to eat (involve the nutrition team)
• Do not perform other procedures during mealtimes (i.e. don’t perform blood taking or change a wound dressing)
• Make sure foods that are being served are at the correct temperatures
• Provide assistance with eating and drinking as needed (reduce liquid intake directly with meals to encourage food intake)
• Provide plenty of time for the person to swallow their food if you are assisting them
Remove the meal tray after the person has finished eating and provide hygiene as required

Question 23

Factors contributing to dehydration

Answer 23

biological- acute illness, oral cavity pain, nausea/vomiting, movement disorders, urinary incontinence, diarrhoea

psychological- dementia, cognitive impairment, depression, anxiety

Hospital- prolonged fasting, reliance on IV, innaccurate fluid balance

Question 24

Considerations for nur/mid to prevent dehydration

Answer 24

• Correct calculation of a patients daily fluid requirements
• Provide preferred fluids
• Have fluid available and close by at all times during the day
• Make sure water is fresh and looks palatable (i.e. does the patient like lemon in their water)
• Offer fluids at routine times throughout the day
• Provide fluids during activities such as time with the physiotherapist
• Provide assistance with oral intake of fluids
Offer a full glass of fluid with medications