Fecal and Urinary Elimination / Transferes/ Feeding Flashcards
Describe the process of urination
urine collects until pressure stimulates special sensory nerves called stretch receptors. This transmits an impulse to the control center which in turn instructs the sphincter muscles to relax causing the urge to void. If the time or place is not appropriate, mictriration occurs which will remove the urge until the stretch increases.
Name some factors that influence urination and give and example of each
Developmental - lack of urinary control
Older age - kidney function has minimal decrease unless affected by disease which creates high risk for toxicity/ increase in bladder urinary urge/ nocturia - awakening at night with the urge
Psychosocial - privacy, position, sufficient times, site/sound of running wateer
fluid/foods - will influence frequency and colour
meds - diuretics
muscle tone/ activity level = important
- What characteristics of urine would a nurse assess? What can you tell about hydration from these characteristics?
• The quantity or urine produced within 24 hours (normal 1200ml – 1500ml).
o It is considered normal if the output is generally similar to fluid intake.
o If the output is less than 30ml/h this may indicate decreased blood flow to the kidneys and should be reported immediately.
o An increase of urine production may indicate an excessive fluid intake, a possible hormonal imbalance such as inadequate antidiuretic hormones, or an inability of the kidneys to concentrate urine.
• The colour and/or clarity of the urine (normal is straw, amber, transparent).
o If it is dark amber it is concentrated
o Cloudy urine can be caused by white blood cells, bacteria, pus, or contaminants (including prostatic fluid, sperm, vaginal drainage)
o Some foods/drugs can cause a change in colour
o Pink, bright red or rusty brown colours can be red blood cells in the urine or a hematuria.
o Menstrual blood can also discolour urine but should not be confused with a hematuria.
• The odour will assist will determining infection or glucose levels; a fetid odour is possible infection whereas a sweet odour reflects a high glucose level. Urine normally has a faint aromatic scent.
• Sterility is used to determine bacterial contamination. Urine in the bladder is sterile.
• PH levels in urine are normally 4.5-8.
o If the urine is less than 4.5 it is a possible indicator of alkalosis, urinary tract infection or a diet high in fruits and vegetables
o Urine with a PH of more than 8 is an indicator of starvation, acidosis, diarrhea or a diet high in protein foods or cranberries.
• Specific gravity is used to determine the concentration of urine. Normal is 1.010 to 1.024
o Less than 1.010 is diluted
o More than 1.024 is concentrated
• Glucose in urine indicated high blood glucose and may represent poorly controlled or undiagnosed diabetes.
• Ketone bodies are not normally found in urine. Their presence could indicate uncontrolled or undiagnosed diabetes, starvation, or an ingestion of excess acetylsalicylic acid.
• Blood should not be present in urine. Clients who have blood in the urine may have a UTI, kidney disease, or bleeding from the urinary tract
- Give a short description of 5 common bowel elimination problems
“constipation may be defined as fewer than three bowel movements per week and the passage of small, dry, hard stool that is difficult to eliminate.” (Kozier, 2014 p.1272)
“fecal impaction is a mass or collection of hardened feces in the folds of the rectum. Impaction occurs from prolonged retention and accumulation of fecal material. In sever impactions, the feces accumulate and extend well up into the sigmoid colon and beyond.” (Kozier, 2014 p 1273)
“diarrhea refers to the passage of three or more loose (mushy) or watery feces per day or more frequently than is usual for the person.” (Kozier, 2014 p.1274)
“bowel incontinence, also called fecal incontinence, refers to the loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter.” (Kozier, 2014 p. 1275)
“flatulence is the presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines.” (Kozier, 2014 p. 1275)
- Give 5 examples of special diets and explain the need for these diets
- [NPO] nothing by mouth: food and fluid are prohibited. This diet may be used prior to anesthesia to prevent aspiration of stomach contents. This should be used infrequently to minimize nutritional and dehydration risks. Alternate methods of feeding/hydration include parenteral feeding.
- A clear fluid diet: the client is limited to water, tea, coffee, clear broths, ginger ale or other carbonated beverages, strained and clear juices and plain gelatin. It provides carbohydrates but no nutrition and is a short term diet option for someone with certain types of surgery, or infections of the gastrointestinal tract.
- Full Fluid Diet: contains only liquids or foods that have been turned to liquid at body temperature. They are eaten by patients with gastrointestinal disturbances or those who cannot tolerate solids/semisolid foods.
- Soft Fluid Diet: is easily chewed and digested. It is often ordered for clients who have difficulties chewing and/or swallowing. It is a low-fibre diet containing few uncooked foods. Variations include the pureed diet where water is added and the food is blended to a semisolid state.
- [DAT] Diet as Tolerated: This is ordered when the patients appetite, ability and tolerance for certain foods is fluid or changing. This may be given postoperative where day one the client may tolerate a liquid diet only and progress over time to a solid food diet.
Before moving any client what does the nurse assess?
Before moving any client the nurse should assess:
• Documentation/outcomes of previous transferes
• Space for transfer
• Number of assistants needed
• Body size
• Ability to follow direction
• Tolerance/muscle strength/joint mobility
• Level of comfort
• Presence of orthostatic hypertension
• Equipment required, if any
What determines the number of people needed for a transfer?
The number of people required for a transfer is determined by the physiotherapist. A nurse can increase but never decrease the number of prescribed persons required.
What does the nurse assess when a client needs some assistance with walking?
When a client needs assistance walking the nurse must assess: • Orientation or mental state • Amount of assistance required o Activity tolerance o Strength o Coordination & balance • Safety of environment • Signs of orthostatic hypertension • Need for additional devices
Name 3 assistive devices that clients can use for ambulation and explain each one. Give some examples of when and where these devices would be used.
• Canes: three types available…
i. Standard or straight leg cane
ii. Tripod or crab cane
iii. Quad cane with four feet
• Walkers:
i. standard walker: The patient must be able to pick It up to use it. Therefore requires partial strength in both hands and wrists; strong elbow extensors and strong shoulder depressors. The patient must also be able to bear partial weight on both legs.
ii. Four-wheeled and two-wheeled (roller walkers do not need to be picked up but are less stable and used by patients too weak or unstable to pick up and move the walker with each step.
• Crutches: are either temporary or permanent
the client’s weight is born by the muscles of the shoulder girdle and upper extremities. Exercises to strengthen the upper arms and hands are recommended.
i. Axillary crutch (underarms with hand bars)
ii. Forearm crutch (crutch extends only to forearms) – usually used for patients with weak extensor muscles of the arms
List the different types of urine specimens and how they are different from each other.
Clean voided - client able to do self-void in a cup
clean catch or midstream - used to determine UTI
timed - some exams require collection over a specified time frame
Indwelling catheter - used from a closed drainage system
Identify each urine test and describe what each means in relation to care
specific gravity - indicates concentration or amount of waste present (dehydration/excessive glucose)
Urinary PH - tests acidity or base - are kidney
responding correctly to imbalances
Glucose - glucose in urine - uncontrolled diabetes
Ketones - by-product of the breakdown of fatty acids - poorly controlled diabetes
Protein - are normally too large to pass the glomerular mebrane - indicates possible damage
Occult blood - when blood is not visible it is occult
Metabolic substances - evaluates renal function
factors affecting bowel elimination
privacy - important for most people
timing - encourage when urge is recognized
nutrition and fluids - type, consistency
exercise - regular exercise to promote regular
positioning - sitting, leaning forward
Constipation
constipation - movement of fecal matter through large intestine is slow = extra water absorbed leading to hard dry stools
Presentation fewer than 3 movements/week; hard dry lumpy stool; straining or pain during defecation; sensation of incomplete bowel evacuation; abdominal pain, cramps, distension; anorexia, nausea; passage of stool large enough to block toilet
Fecal Impaction
fecal impaction - mass or collection of hardened feces in the folds of the rectum caused by prolonged retention.
presentation; diarrhea or anal seepage; anorexia, nausea
Diarrhea
presentation: 3+ loose or watery stools/day or more frequently than normal; abdominal cramps; nausea
causes - medications, allergies, osmotic salts, disease
Bowel Incontenence
Loss of voluntary control of fecal/gaseous
presentation: partial - can’t control flatus or prevent minor soiling
major - control feces of normal consistences
possible crohn’s
Flatulence
excess gas leading to the stretching and inflation of intestines
Colostomy or ileostomy
artificial opening of the intestinal or urinary tract to bypass a blockage
what psychological implications might a person with either a colostomy or ileostomy face?
impaired body images, decreased sexual functions, dyadic adjustments (relationship)
What is the proper position for putting someone on a bed pan? How do you provide privacy?
cover w/ a bed linen to help maintain comfort and dignity
roll on side, place regular bedpan so that buttock rests on smooth round rim
roll onto back
place the bed in a semi-fowler position if permittable
cover with bed linen for privacy
do not leave on the bedpan for more than 15 minutes
When someone is incontinent why is it so important to cleanse the skin thoroughly?
to prevent perennial skin irritation and breakdown.
Clients should be taught that repeatedly ignoring the sensation of needing to defecate can result in which of the following?
a. Constipation
b. Diarrhea
c. Incontinence
d. Hemorrhoids
a. Constipation
Mr. Dejardin, a 45 year old woman who is clinically obese, presents to the emerg with complaints of right-sided back pain. In removing her bedpan you note white, pasty stool. What would be the MOST appropriate action?
a. Encouraging her to increase her fluid intake
b. Encouraging her to increase her fibre intake
c. Documenting findings and notifying the appropriate member ojf the HCT.
d. Obtaining a thorough dietary history for the past 72 hours
c - document and advise appropriate HCT member. due to obesity she is at risk for gallbladder disease. the white pasty stools suggest a bile duct obstruction. The right side pain is consistent with this.
John O’Reilly has been ordered a barium swallow before a loser GI computed Tomography (CT Scan). What action should the nurse take after the procedure?
a. Maintaining John’s NPO status until the barium is expelled
b. Assessing his abdomen for distension
c. Encouraging fluids and ambulation
d. Using special precautions with his bodily waste
c. fluids and ambulation to promote a bowel movement and the elimination of the barium
In assessing a new colostomy, the nurse notes that the stoma is pale and grey. Which is the most appropriate action?
a. REmoving the appliance and examining the skin beneath the adhesive
b. notify the surgeon
c. document and continue monitoring
d. Irrigating the colostomy
b. notify the surgeon. the colour suggests a decrease in circulation to the area. The reason for this must be determined immediately
John is 65 years old with chronic alcoholism. He is admitted with a peptic ulcer. on emptying his bedpan the nurse notes black and tarry stool. What is the MOST probable explanation?
a. side effect of iron supplements
b. experiencing upper GI bleed
c. side effect of taking ASA
d. ingestion of beets
b Upper GI bleed as a result of his peptic ulcer. the colour is the effect of digestive enzymes in the blood.
