GI ELIMINATION Flashcards
Elimination
Excretion of waste products from kidneys and intestines
Defecation
Process of elimination of waste
Feces
Semisolid mass of fiber, undigested food inorganic matter
Incontinence
Inability to control urine or feces
Void
Urinate
Micturate
To urinate
Dysuria
Painful or difficult urination
Hematuria
Blood in the urine
Nocturia
Frequent night urination
Polyuria
Large amounts of urine
Urinary frequency
Voiding at frequent intervals
Urinary urgency
The need to go now
Protienuria
Presence of large protien in the urine
Hesitancy
Difficulty initiating urination
Dribbling
Leakage of urine despite voluntary control of urination
Retention
Accumulation of urine in bladder without he ability to completely empty
Residual
Urine remaining post void > 100 ml
Bowel elimination process
Fecel material reaches rectum
Stretch receptors initiate contraction of sigmoid colon/rectal muscles
Internal and sphincter relaxes
Sensory impulses cause couldn’t are “bearing down”
External sphincter relaxes
Valsalva maneuver
Increasing the pressure in order to expel feces by contracting the abdominal while maintaining a closed airway (holding our breath)
Who would you not want to valsalva?
Post op, like abdominal surgery or mom who just had a c section
Patients who just had aneurysm
People who just got a stroke
What factors affect bowel elimination?
Age
Personal factors
Sociocultural factors
Nutrition and hydration
Activity and medications
Surgery and procedures
Pregnancy
Pathological conditions
What can activity stimulate?
Peristalsis
Who would have weak abdominal muscles?
Sedentary people
What do patients with limited activity often experience?
Constipation
What kind of meds almost always affect the GI tract
ORAL MEDS!!
What can bowel manipulation lead to?
Paralytic ileus
Paralytic ileus
When there is no sensation no nerve stimulation or muscle contraction so that mean the food gets stuck there because there is no movement.
So it can lead to bowel obstruction.
It can be corrected through medicine or increasing fluid.
What can pregnancy cause?
Bowel eliminating issues
Because of morning sickness
Eating schedule
Slowing of intestinal motility
What kind of pathological disorders can affect bowel elimination
Neurological disorders (affect the lower GI tract)
Cognitive conditions
Pain or immobility
What are some examples of neurological disorders that affect innervation of lower GI tract?
C spine injuries, lumbar spine, thoracic spine or anywhere on the spine
How can cognitive conditions effect bowel elimination?
It limit the ability to sense the “urge”
What can pain or immobility lead to?
Sluggish peristalsis
What is the general overall goal for the patient when it comes to bowel elimination?
To have soft formed, regular bowel movements
And to be free of nausea, vomiting and bloating
How can we promote regular defecation?
Privacy
Correct position
Timing
Fluid intake
Proper diet
Exercise
What can we do as nurses to give the patient privacy?
Close the door, Go chart, turn your back, clean up or go organize the patients stuff
What is the correct position?
Seated up right
*when you give the patient a bed pan do not leave them flat in the bed they won’t have a good bowel movement
When is a good time for patients to go to the bathroom?
Typically after meals and some patients may need assistance
How much fluid intake should we promote to the patients?
6-8 ounce glasses
What is a proper diet considered?
Fresh fruits, vegetables, whole grains, fiber
How can we promote exercise?
3-5 times a week
ROM for patients on bed rest
Positioning encourage exercise
even if they are just getting up and walking to the nurses stations
Severe constipation
Separate hard lumps
Dehydration, lack of fiber and exercise
(Whopper candies)
Mild constipation
Lumpy and sausage like
Not enough water, fiber, or exercise
(Babe Ruths)
ideal
Sausage shape w cracks
Probably get enough excercise, drink plenty of water and good diet
(Snickers)
Ideal pt 2
Smooth, soft sausage
Good diet, enough fluids, and exercise
( Swiss rolls)
Lacking fiber
Soft blobs w clear edges
Not a good fibrous diet
Eat more veggies and fruit
(Marshmallows)
Mild diarrhea
Mushy consistency
Can be caused by stress, laxative abuse, pregnancy, irritable bowel syndrome, etc
(Pudding)
Severe diarrhea
Liquid consistency
Factors that lead to this cdiff, lactose and tolerant, laxatives
(Choco milk)
How can kidneys maintain fluid balance in the body?
Regulating the amount of make up of the fluids inside and around the cells
This is is controlled by hormones
What are the hormones involved?
Antidiuretic hormone (ADH) -produced by pituitary gland
Aldosterone - produced by adrenal gland
When our adh is low what happens?
More volume less solute
What happens when our adh is high?
More solute less volume
What does aldosterone works to?
Specifically to control sodium in the body
Helps control of secretion of potassium
What does the ADH hormone adjust to?
What we need to get rid of and what we need to keep
Normal urinary patterns
The kidneys produce 50-60 ml per hour or 1500 ml per day
How many times a day should voiding take place?
About 5-6 or maybe even more depending on fluid intake
Specific gravity
Measure of dissolved solutes in a solution
What happens when urine solutes increase?
The specific gravity increases
( the darker the urine)
What is the normal specific gravity?
in urine 1.002 to 1.003
When fluid intake increase
Urine becomes more diluted and lighter in color (lower specific gravity)
When fluid intake decreases
Urine becomes darker and specific gravity rises
What are some colors urine can be?
Dark yellow
Red/pink
Brown
Orange
Milky white
Blue
Green
Purple
What can cause dark yellow urine?d
Dehydration
What can cause red/pink urine?
Blood
What can cause brown urine?
UTI
What can cause orange urine?
Some medications, beta karatin like carrots ( would have to be a lot)
What can cause milky white urine?
Yeast infection, UTI, pus that is in the urinary tract (severe UTI)
What causes blue urine?
Some medications , methyl blue (used during certain testing)
What can cause green urine?
Medications
Purple *****
Purple bag syndrome when there is colonized bacteria in a folly catheter indication that it is time to change the folly if you see a patient who’s urine is purple
What are some bladder incontinence devices?
Condemn catheter
Pure wick
Foley catheter
Condemn catheter
Only for males
Probably used if we do not want to use a foley, older adults at risk for infection we would want to use a condemn catheter first
Pure wick
Specifically for a female
Sits between the labia
Absorbs urine draws it away
Folly catheter
Can be inserted in both male and female
Helps keep it inside bladder and collects urine as well
Coude Catheter
Requires a specific order because it is a certain type of urinary catheter
For someone who is having a large prostate means urine doesn’t travel as easily down the urethra
What are some different collection devices for urine?
Urinal (not often seen in hospital)
Bed side commode
Hat( looks like old nurses hat)
Where can the hat be used?
In bedside commode or the toilet to help monitor urine and stool
How can we promote normal urination
Privacy
Position
Facilitate routines or patterns
Promote fluid intake and nutrition
Assist with hygiene
What are some characteristics to pay attention to of urine?
Color
Clarity
Odor
What should our urine look like?
Light yellow like freshly squeezed lemons
Color of the urine
Color can indicate some form of intake or lack of fluids
Clarity
It will be cloudy is pathogen is present
Odor
Pathogen can change odor as well as intake
Specimen collection
Collection devices- depend on how much help the patient needs
Sterile collection process
Collection from Dooley collection bag
What do you include when documenting fluid intake?
Semi-liquid foods
Ice chips
Fluids
IV fluids
Tube feeding
Irrigations instilled and not immediately removed
What are some examples or irrigation instilled and not immediately removed?
Hemodialysis, peritoneal dialysis
What are example of output fluids that should be recorded ?
Fluid loss via emesis (throwing up)
Urine output
Diarrhea
Drainage from suction or wounds
What should we teach the patient and family members?
Intake and output!!
Ex. “Hey if you bring something to eat and drink let us know so we can record that”
What do we need to use to make sure we get accurate counts of fluids?
Use measured collection devices!!
What is important to do when dealing with patients we have to accurately record intake and output?
Use cups with measurements on them
Label which one is for input and what is for output
Avoid styrofoam cups but will not be as accurate
