Bowel and Urinary Elimination Flashcards
What is impaction ?
when the stool gets stuck
- have to get a order to get it out
What are hemorrhoids ?
little bubbles that come out of your anus
- lining is swollen
- usually from pressure
How do laxatives work ?
- bring water into poop to make it easier to get out
- or stimulate the muscles to contract to get it out
For administering enema’s what position should they be in ?
left laying in sims position
- pad the bed really good so you don’t dirty the bed
What is the mechanism of action for tap water enema ?
hypotonic
- volume stimulates defecation
- do not repeat because of water toxicity (body soaks up the water really good) and fluid overload
What is the mechanisms of action of normal saline enema ?
isotonic
- volume stimulates peristalsis
- the safest type of enema
What is the mechanism of action of hypertonic/fleet enema ?
hypertonic
- it pulls fluid from the body causing rectal distension
- can cause dehydration
- 120-180 mL is the normal amount
What is the mechanism of action of soap suds enemas ?
it causes intestinal irritation and stimulates peristalsis
- only use castile soap
- carefully with pregnant and elderly pt’s
What is the mechanism of action of oil retention enemas ?
lubrication
- can retain for several hours
What is the mechanism of action of carminative enemas ?
used for gas
- varies by type
- reduces distention
What are the mechanism of action of medication enemas ?
varies depending on the type
- Kayexalate is used to decrease potassium levels
- do not use kayexalate for pt’s with hypokalemia
What type of feces are found in the jejunum ?
wet feces
What is bowel diversion ?
temporary or permanent surgical opening of the ileum (ileostomy) or colon (colostomy) pulled through the abdominal wall to create a stoma
What is the purpose of the ostomy pouch ?
- protects the skin
- contains fecal material
- remains odor free
- comfortable and inconspicuous
What are some nutritional considerations with an ostomy ?
- low fiber foods for the first weeks
- eat slowly and chew food completely
- drink 10 to 12 glasses of water daily
- patient may choose to avoid gassy foods
What is the purpose of the NG tube salem sump ?
decompression
What type of NG tube is for enteral feedings ?
Dobhoff
- small bore
What type of NG tube is for compression ?
Sengstaken-Blakemore
What type of NG tube is for lavage ?
larger bore
How do we measure NG tube lengths ?
- nose to earlobe to xyphoid
- mark length with marker or tape
How do you insert a NG tube ?
- lubricate the whole NG tube
- have pt. take sips of water or swallow while you insert the tube (push tube in while they swallow)
- once you start to put it in don’t stop cause it can activate the gag reflex
- have their head down since it opens up the airwards
What is the best way to check for placement of a NG tube initially ?
X-Ray
How do you maintain the NG tubing ?
- flush with air to check patency per policy (often every 4 hrs)
- frequent checking nasal mucosa and nose where tube is taped
- frequent mouth care (gets dry often and still do mouth care)
- sore throat management (spray/lozenge)
- set up suction as ordered
What is urinary retention ?
an accumulation of urine due to the inability of the bladder to empty
What is a urinary tract infection ?
results from catheterization or procedure
What is urinary incontinence ?
involuntary leakage of urine
What is urinary diversion ?
diversion of urine to external source
What is hemodialysis ?
a machine manually draws out the impurities out of the blood
- machine acts as the filter and then the “clean” blood gets put back into the patient
What is peritoneal dialysis ?
a catheter that is inserted in the peritoneal to remove impurities from the blood
- has to be sterile
What do you do if you unsuccessfully insert a Foley catheter on a patient with a vagina ?
can leave the sterile one in as a landmark and then try again fresh
- can’t just take it out and try again because the urethra has bacteria in it that shouldn’t go into the vagina
What are indwelling catheters for ?
short-term use
- closed drainage system for urine
What are retention catheters ?
commonly used postoperatively because of several lumens to allow for drainage of urine, irrigation of the bladder, and instillation of meds into bladder
What are coude catheters for ?
for pt’s that have prostatic hyperplasia (enlargement)
- curved tip for easy insertion
What are suprapubic catheters for ?
similar to indwelling catheters but put into surgical opening in abdomen rather than urethra
What are condom catheters (external urine) ?
peeing into the condom
- take off each day, clean it, and put fresh one on
- has sticky adhesive
- doesn’t require sterile insertion technique
What type of catheter doesn’t require any drainage system ?
straight catheter
Where would you collect urine specimens when a pt is catheterized ?
from the catheter’s tubing between the bladder and collection bag
- not from bag because it goes through the tubing in the collection bag where it sits in a unclean environment
When getting a urine sample do we use clean or sterile technique ?
use surgical asepsis when obtaining it, and transfer into a sterile cup
What are some characteristics of a standard collection bag ?
- has a large capacity
- has to hung from a non-moveable part of the bed or wheelchair
- have to keep bag below pt’s bladder
What are some characteristics of a leg-bag drain ?
- smaller in size and attaches directly to the pt
- must be emptyied often
