Class 7 - Urinary and Bowel Elimination Flashcards
UTI
urinary tract infection
bypassing
a new pathway which is created for the transport of substances in the body
diuresis
increased or accessible production of urine
dysuria
patients with lower UTI’s may experience pain or burning sensation during urination
urgency
sudden and compelling urge to void that cannot be postponed
hematuria
blood in urine
feces
waste matter discharged from bowels after food has been digested
peristalsis
waves of involuntary contraction passing along the walls of the intestines and forcing content onwards
frequency
voiding more than 8 times in 24 hrs
hesitancy
difficulty initiating urination
how much water do you need per day
2 L
residual urine
urine is left in bladder after voiding
incontinence
involuntary loss of urine
voiding/micturition
urination
oliguria
a urine output of less than 400 mL in 24 hrs
flatus
gas in or from stomach or intestines, produced by swallowing air or by bacteria fermentation
sims position
for rectal exams, treatments or enemas. patient lays on their left side, left hip and lower extremity straight, and right hip and knee bent
nocturia
getting up at night to void one or more times
polyuria
voiding large amounts of urine
fibre
the indigestible residue in the diet, provides bulk of fecal matter
impaction
results from unrelieved constipation and can lead to overflow incontinence
stool
feces
laxatives
products that stimulate evacuation of the formed stool from the rectum
factors that influence elimination
- age
- diet
- position
- pregnancy
- Dx. tests
- fluid intake
- activity
- psychological factors
- personal habits
- pain
- medications
- surgery+anesthesia
toileting
- commode
- bedpans (regular or slipper/fracture)
- urinals
- ensure call bell within reach
- maintain privacy
- check on client frequently
- always wear gloves
rectal check/examination
to assess if stool is in rectum
disimpaction
manual removal of stool
-within LPN scope with additional practice, depends on facilities rules
vagal nerve stimulation
anytime there is a disruption in the GI tract. can drop HR and BP, can be fatal
administering rectal suppositories
- wash hands and assemble equipment (suppository, gloves, lubricant, TP, paper towel, toilet/commode/bedpan)
- explain procedure and provide privacy
- sims position, exposing buttocks only
- put on gloves, lubricate suppository, index finger of dominant hand, and anal sphincter
- put toilet tissue in non-dominant hand and lift butt
- instruct client to breath in deeply
- gently insert suppository as client exhales as far lubricated finger will go so it is against rectal wall
- apply pressure to anus for a few seconds
- ask client to try to hold for 15-30 mins
- remove gloves, wash hands
- ensure safe and comfortable
- assist with toileting
- report and record procedure and results
glycerine suppository
- contains no medication
- osmotic laxative (pulling fluid from body into bowel)
- mild action, does not cause irritation
- takes 15-20 mins
dulcolax (bisacodyl) suppository
- contains medication
- increase peristalsis by irritating the rectum (stimulant)
- promotes fluid accumulation in the rectum (osmotic)
- takes 15-60 mins
sodium phosphate “fleet” enema
all the same steps as rectal suppository administration.
- gloves and supplies, wash hands and assemble equipment
- enema, gloves, lubricant, TP, paper towel, under pad, bath blanket, toilet/bedpan/commode
- explain procedure + privacy
- sims position
- remove enema cap and expel air, lube nozzle and anal sphincter
- TP in non dominant hand
- insert nozzle as far as it will go as client exhales
- slowly and firmly squeeze entire contents into rectum
- stop for a few seconds if client experiences discomfort or if fluid is leaking (DONT REMOVE)
- with-drawl nozzle when completely instilled and apply pressure to anus for a few seconds
- remove gloves and dispose of equipment
- ask client to hold enema as long as possible
- ensure safe and comfortable
- assist with toileting
- report and record procedure and results
Hx
history
Ca
Cancer
microlax enema
- must do rectal check first as it only works if there is stool in the rectum
- causes stool to break into smaller pieces; does not irritate bowel wall.
- maintain pressure on the container as you remove
- works in 5-20 mins
what can a nurse diagnosis for bowel care
bowel incontinence, constipation, diarrhea
how much can the bladder hold
up to 1500 mL
how much urine is regular to void every hour
30 mL
what can a nurse diagnosis for bladder care
urinary incontinence, urinary elimination
factors that affect urination
- urge to void @ 150-200 mL
- growth and development
- socio-cultural
- psychological
- personal habits
- muscle tone
- pathological
- surgical procedures
- medications
- Dx. exams
straight catheter
inserted through the urethra, drains bladder and then is removed
indwelling/foley catheter
inserted through urethra balloon inflated to prevent catheter from slipping out - left in bladder - connected to drainage bag
suprapubic catheter
surgically inserted through abdomen above the pubic bone into the bladder
catherization: indications
- before, during and after surgery to keep bladder empty
- observe hourly output with very ill person
- last resort for incontinence to protect skin
- client is too weak to used bedpan, commode, toilet
- collect sterile urine specimen, measure residual urine
closed drainage system
- used for indwelling catheters and suprapubic catheter
- the urinary system must remain STERILE in order to avoid infection
- a UTI is one of the most common causes of delirium in the elderly
catheter care
medical asepsis, standard precautions
- do not allow bag to touch floor
- urine must flow freely - avoid kinks in tubing, ensure client does not lay on it
- keep drainage bag below bladder
- attach drainage bag to bed frame, not rail
- tubing should not loop below drainage bag
guidelines for catheter care
- secure tubing on leg and linen
- check for leaks
- ensure tubing slack when moving client
- move bag to side of bed that client will be turned toward before turning resident
- drainage system remains closed except to change bag
catheter assessment
- colour, amount, quality (odour, sediment, blood)
- taped in place
- pain, burning, urge to urinate, red irritation of meatus
catheter pericare
- morning, hs, after BM
- treat catheter as a urethral extension (cleanse from clean to dirty)
- wash and rinse urinary meatus first
- wash, rinse and dry around catheter away from meatus down catheter tubing for 10cm
- proceed with normal pericare
catheter drainage bag emptying
- wash hands and gather supplies
- clean gloves, paper towel, graduated cylinder
- explain procedure and privacy
- put paper towel under measuring cup on floor
- apply gloves
- open drain, allow urine to drain into cup
- dont let drain touch cup
- close clamp
- assess urine, empty into toilet, clean cylinder
- remove gloves, wash hands, document
switching day/night or night/day catheter
- wash hands and assemble equipment
- leg bag/long sock or night bag, gloves, alcohol swabs, bag caps, specimen container
- explain and give privacy
- apply leg bag below knee and oversock
- ensure drainage cap is closed
- apply disposable gloves
- use alcohol swab and wipe connecting tubing for 30 seconds between the catheter and old drainage bag and the connection to the new bag
- disconnect catheter from old bag tubing
- do not touch ends of any tubes to each other
- place cap on old bag, remove cap from new bag
- connect catheter, cleanse cap with alcohol and store in specimen container. secure catheter to leg (day bag)
cleaning urinary drainage bag
- wash hands and assemble equipment
- disposable gloves, alcohol swabs, detergent, vinegar,
- apply clean gloves
- take drainage to the bathroom
- drain urine into toilet
- re-clamp drainage bag
- remove cap from drainage tubing and place in specimen container
- pour solution into drainage tubing (2 drops of detergent with tuberculin syringe, draw up one week supply in syringe, add tap water so bag is half full- swish together)
- open drain at bottom of bag to drain into toilet
- rinse with tap water until soap is gone
disinfecting the catheter bag
- pour mixture of 1 part vinegar, 4 parts H2O in drainage bag
- swish, rub together
- drain disinfectant but do not rinse
- clean cap and end of tubing with alcohol - recap drainage tubing
- hang up the drainage bag in residents washroom or cloth bag at bedside according to facility policy
- remove gloves, wash hands
external condom catheter
- rubber sheath with a short tube for attaching drainage tubing
- not a sterile procedure
- non invasive
- used by men with incontinence
- promotes comfort and decreases skin irritation
external condom catheter application
- wash hands and assemble equipment
- condom and foam tape; urine collection bag/leg beg and strap (sock to apply, leg bag over), disposable gloves, peri-care supplies
- explain procedure and privacy
- resident in supine position, only penis exposed
- apply gloves, provide peri-care, assess penis
- roll condom over entire length of penis (leave 2-3 cm slack at head of penis)
- apply foam adhesive tape in a spiral motion toward the body
- do not overlap tape or tape head of penis/pubic hair
- connect drainage bag and tubing to end of condom
- remove gloves and wash hands
- at night connect tubing to a larger urine collection bag “night bag”
- throw condoms away after each use
- clean urine bag and tubing daily and discard once a week as per agency policy
removal condom catheter
- wash hands and assemble equipment
- explain procedure and privacy
- apply gloves
- break foam tape in several places
- roll condom off, place cap on drainage tube connector
- wrap condom in paper towel, dispose
- provide peri-care and assess penis
- clean drainage bag
