Exam 3 Flashcards
November 25th
Nursing interventions for acute urinary problems
keep elimination habits similar
medication to stimulate detrusor muscle contractions
catheterization
How can medications influence urination
diuretics (increase urine)
sedatives (incontinence)
can change urine color
Types of catheter lumen materials
plastic- intermittent only
latex- 3 weeks max
silicon/teflon- long term (2-3 mos)
What does nil per os mean
nothing by mouth; NPO patients
How often do you perform mouth and nares care for NG tube
every 2 hours
What are indications for an intermittent catheter used
one time use
to relieve bladder distention to if clean catch sample is not a possibility
assess residual urine (if no bladder scan)
What type of urine specimen collection cannot be delegated
sterile specimen (catheter)
What are delegated tasks related to catheterization
report if pt has pain, leakage, or abnormal urine
empty drainage bag
perineal care
What are some ways to prevent CAUTI
keep closed drainage system
empty urine bag when 1/2 full
clean spigot
perineal care every 8hrs
Salem Sump characteristics
double lumen
air vent “pigtail”
for decompression/ lavage
decreased risk of gastric mucosa damage
main lumen connects to suction
Characteristics of elderly bowel movements
-decreased peristalsis, weakened anal sphincters, esophageal emptying slows
-decreased ability to thoroughly chew food
When would you start over a 24 hours urine collection
if contaminated or missed collection
When might NPO diet be necessary
after surgery, blockage, bleeding
Why is it critical to change ostomy bag?
for skin integrity (ileostomy enzymes/acids)
assess stoma
prevent odors
increase self esteem/comfort
Part of small intestines that absorbs water, fat, iron, and bile
ileum
What is a urostomy
continuously drains urine into collection pouch
urine drains from ureter –> intestine –> stoma
What are restorative care interventions for urinary problems
pelvic floor muscle training
lifestyle changes
voiding schedule
bladder retraining (mentally)
Nursing interventions for impaired bowel movements
establish toileting routine
encourage fluid intake
review dietary intake (need fiber)
enema to promote bowel cleansing
Why might a patient have a disturbed body image r/t bowel movements
bowel divisions (colostomy)
refusal to learn how to use it
What are some possible consequences of a catheter irrigation
irrigation solution doesn’t return
bright red blood (notify provider)
pain from clots of kinked tube
What are catheter irrigations
after bladder surgery
flush that remove clots/sediment from entering catheter
continuous or intermittent
must have closed catheter system to prevent infection
keeps catheter patent
Part of GI tract that allow storage, mixing, and emptying
stomach
Nursing diagnosis for diarrhea and cause
malabsorption. bloating, cramping, loose stools
r/t antibiotics, antidepressants, antacids, oral hypoglycemics
What are nursing interventions for urge urinary incontinence
limit nighttime intake, avoid bladder irritants, strengthen pelvic floor
What are some sociocultural factors that influence urination
Gender (men w/ enlarged prostates & women w/ pelvic prolapse)
Bathroom privacy and school/work environment
Type of hemorrhoid with visible purple thrombosis
external hemorrhoid
Type of hemorrhoid in anal canal with inflammation or distention
internal hemorrhoid
What are complications of NG tube placements
resistance= move steadily
vomiting= clear airway
gag=withdraw slightly on insertion
respiratory distress= remove tube to back nasopharynx
Purpose and steps to Kegel exercises
strengthens pelvic floor muscles
1) stop urination midstream
2) tighten muscles as if lifting a marble (don’t hold breath)
Process of an enema
for diagnostic tests or constipation
doesn’t require sterile technique
pt lays on left side/right knee flexed (Sim’s)
use warm solution
What part of catheter irrigations can be delegated
pain, discomfort, change in urine, leakage
How is urinary issues related to a nursing diagnosis of impaired skin integrity
constant moisture from incontinence can lead to skin breakdown/irritation
becomes an infection risk
How can medications influence bowel movements
opioids slow peristalsis
antibiotics decrease intestinal bacteria=diarrhea
laxatives promote defecation
cathartics control diarrhea
What type of procedure is classified as a urinary diversion
urostomy
What type of patients might require an intermittent catheter
spinal injury
neuromuscular degeneration
incompetent bladder
What should you do if the irrigation solution doesn’t return
reposition patient
check for kinks
use a new syringe to passively return/empty
Nephrostomy
tubes go through skin to the renal pelvis (on back)
drains renal pelvis if ureters are obstructed
Reasons that constipation may occur
improper diet
reduced fluid intake
meds
lack of exercise
Term for unformed stool than can lead to skin breakdown
diarrhea
What is effluent?
fecal material
What type of ostomy has less odor and a liquid consistency
ileostomy
Term for unrelieved constipation; stool cannot be expelled in rectum
Impaction
What can bowel impaction turn to if left untreated
intestinal obstruction
Coudé catheter characteristics
single lumen
stiffer
curved tip, easier to guide, less traumatic
How do you verify NG tube placement
ask patient to talk
X-ray confirmation
aspirate syringe for gastric contents (<5 pH)
What are nutrition changes for an ostomy
low fiber at first
eat slow/chew completely
10-12 water glasses daily
avoid gassy foods
Term for temporary or permanent abdominal wall opening
bowel diversion
(stoma and ostomy)
Urge incontinence
overactive urge to pee; muscles will contract and urine won’t stop once it begins (nocturia)
What is a suprapubic catheter
surgically inserted if flow blockage through urethra
long term intervention
Double Lumen NG Tube characteristics
large bore; 12+ French
for gastric decompression or removing gastric secretions
Salem sump
Functional incontinence
incontinence not related to urinary tract issues
mobility issues, cognitive impairment, environmental barriers
What are symptoms of bowel impaction
oozing liquid stool seeping around mass
loss of appetite
distention
cramping
How does growth and development influence urination
gain voluntary bladder control @ 18-24 months
decreased bladder capacity in elderly
Single Lumen NG Tube characteristics
fine/small bore
for med and enteral feedings
Characteristics of infants bowel movements
-infants have a smaller stomach capacity, less enzymes, faster peristalsis
-can’t control defecation until 2-3 yrs
Part of small intestines that absorbs carbs, proteins, electrolytes
jejunum
What type of urine specimen collection can be delegated
midstream specimen
How do you document I’s and O’s for NG tube
Intake: irrigation solution
Outtake: gastric drainage
What are nursing interventions for stress urinary incontinence
Kegel exercises, stop smoking (prevents coughs), empty bladder completely
What type of ostomy increased risk of electrolyte imbalance
ileostomy
What is the process of discontinuing a NG tube
assess for bowel sounds (disconnect suction)
standard precaution
pt takes deep breath, kink tubing, steadily remove
After: assess abdomen tenderness, N/V, nostrils
Ways to maintain an NG tube
mouth care every 2hrs
NPO
maintain patency= turn frequently
What is collected during 24 hour urine sample
hour 0 (1st void) not collected
all in between collected
hour 24 collect last sample
What are some nursing urinary interventions for elderly
educate on making a void schedule
adequate hydration
empty bladder before/after meals
limit fluids 2 hrs before bed
Part of small intestines the gets fluid from the stomach
duodenum
How do diagnostic tests influence bowel movements
colonoscopies require laxatives to fully empty bowel
will have increased gas and soft stool
Acute urinary retention
sudden onset
from an infection or post surgical (anesthesia/meds)
Stress incontinence
urine leaks because of an incompetent urethral sphincter
high intra abdominal pressure during coughing, laughing, exercise
What is another name for intermittent catheters
straight catheter
single lumen
What is post void residual and how is it measured
urine left in the bladder after voiding
can be seen with a bladder scan
How can fluid and diet intake influence bowel movements
fiber absorbs fluid=softer stool
whole grains, fruits, veggies are high fiber foods
may produce gas which increases colon motility
How can psychological factors influence bowel movements
emotional stress increases peristalsis
possible diarrhea and gas distention
depression slows peristalsis= constipation
Overflow incontinence
bladder is overdistended/ full but cannot fully empty (retention) due to a urethral blockage
What are possible complications of NG tube removal
abdominal pain
sore throat
aspiration
Nursing diagnosis for constipation and cause
no stool for several days, hypoactive bowels, firm abdomen
r/t pain meds, decreased fluids, decreased mobility
How to place in patient
place patient in High Fowler’s
start titling their head back
then tilt forward
swallow so epiglottis blocks trachea
Term for involuntary urine leakage
urinary incontinence
Term for dilated/engorged veins
hemorrhoids
Term for inability to completely empty bladder
urinary retention
How does pain influence bowel movements
hemorrhoids, rectal surgery, and fissures= defecation discomfort
Pathological factors that influence urination
spinal cord injury, enlarged prostate, neurological deficits
Levin Tube characteristics
single lumen
no pigtail air vent
for meds, tube feeding, decompression
Who Is ask risk for bowel impaction
debilitated, confused, unconscious patients
What are nursing interventions for UTI/infection prevention
educate on proper hygiene/UTI symptoms
promote voiding at regular intervals
How can physical activity influence bowel movements
increases peristalsis
maintain muscle tone= able to increase intrabdominal pressure to open sphincter
When would a coudé be beneficial
enlarged prostate
Term for inability to control feces/gas
incontinence
What can lead to increased risk of hemorrhoids
straining, pregnancy, heart failure, chronic liver disease
How does positioning during defecation influence bowel movement
difficult to go if supine
lean forward, extra intrabdominal pressure, gluteal muscles contract
Purpose of NG tube
decompress GI tract (obstruction)
enteral feeding
GI bleed
lavage (poisoning)
Indications for short-term indwelling catheter
2 weeks or less
urine obstruction (ex. prostate enlargement)
after bladder or urethral surgery
prevent obstruction from blood clots after genitourinary surgery
measure urine output of critically ill
How are UTI’s related to iatrogenic procedures
(in hospital procedure)
catheter (CAUTI) or invasive diagnostic procedure due to break in sterile procedure
How does fluid intake influence urination
caffeine and alcohol= diuretic effects
How does pregnancy influence bowel movements
fetus increases= increased rectal pressure
peristalsis slows in 3rd trimester
hemorrhoids from straining
Understand the process of digital removal of stool
if enema fails; used for impaction
liquid stool oozes/abdominal distention
can possibly stimulate vagal n. = bradycardia/hypotension
Who would benefit from a condom catheter
patients with spontaneous bladder emptying (incontinence/nocturia)
How does surgery and anesthesia influence bowel movements
anesthetics temporarily shuts down peristalsis
What type of ostomy is odorous due to bacteria and semi liquid/solid
colostomy
Part of GI tract that digests using chyme and absorbs nutrients
small intestines
Term for when gas accumulates in intestines causing fullness, pain, and cramping
Flatulence
What are the physiological steps of elimination
intestinal contents trigger peristalsis
stool in rectum causes distention
sphincter relaxed
abdominal muscles contract
How do you measure the NG tube
tip of nose –> earlobe –> xiphoid process
How does the French sizing work for catheters
the larger the number the larger the lumen and tube circumference
Indications for long-term indwelling catheter
1 month or more
severe urinary retention & UTIs
skin rashes, ulcers, wounds that are irritated by urine
comfort for terminal illness
What part of the GI tract blocks airway when food enters
epiglottis
What are physical/bodily factors that influence urination
pregnancy
overweight/obese (increased abdominal pressure)
Process of NG tube irrigation
aseptic technique
confirm tube placement
saline syringe into irrigation tube/install
If resistance: check for kinks, pt on left side
aspirate fluid
reattach to suction
Chronic urinary retention
from medication
a progressive blockage (prostate)
neural pathway interruption (stroke, MS, trauma)
Term for bowel diversion of large intestines
colostomy
How does surgery influence urination
pelvic surgery or anesthesia inhibit micturition reflex
Term for bowel diversion of small intestines
ileostomy
Contraindications for NG tube
- head/neck trauma (can lead to intracranial insertion)
- nasal surgery
- Hx of alcoholism (esophageal varices)
What are the benefits of Kegel exercises for men/women
Men: improve fecal/urinary incontinence & erectile dysfunction
Women: improve fecal/urinary incontinence & painful sex
what part of the large intestines absorbs, secrete, and eliminates food blouses
colon
Orthotropic neobladder
creation of a new bladder from part of the intestines
used if there is disease in the bladder or cystectomy
What are possible causes of bowel incontinence
cognitive impairments
C. Diff
food intolerance
What are the components of a triple lumen catheter
urinary drain connected to collection bag
balloon connector
irrigation/instillation
Pathway of the NG tube in the body
enter nares
pass nasopharynx
pass through esophagus
goes to stomach
How can personal habits affect bowel movements
busy schedules don’y allow regular elimination habits
