GI/GU Alterations Flashcards
high fiber foods
whole grains, fruits, bran, vegetables
average functional capacity of bladder
300-500ml
why are females more prone to UTIs?
urethra is shorter - bacteria has less distance to travel
normal hourly urine output
minimum of 30mL
anuria
no urine output
less than 50 mLs in 24 hours
dysuria
painful or difficult urination
frequency
needing to void frequently
nocturia
need to wake up at night just to void
oliguria
diminished urine output
less than 400 mLs in 24 hrs
polyuria
excessive urine output
pyuria
pus in the urine
urinary incontinence
involuntary voiding of urine
foods high in sodium can cause a pt to:
retain water
alcohol & foods high in water have a:
diuretic effect
How do diuretics affect urination
increased production of urine
What does dark amber urine indicate?
concentrated urine - need more water
What does clear or very pale urine indicate?
diluted urine - too much water
what does red urine indicate?
hematuria
what does brown urine indicate?
hematuria or increased bilirubin
what does cloudy urine indicate
infection, sediment, high urine protein
what does foul smelling urine indicate?
indication, drugs, dehydration, ingestion of certain foods (asparagus)
post-void residual
amount of urine left in the bladder after you void, should be close to 0
costovertebral angle tenderness
could indicate kidney inflammation
BUN
waste product filtered out of the blood by the kidneys
should be 10-20
creatinine
waste product produced in the muscles, filtered out by the kidneys
should be 0.8-1.4
is increased RBC ever normal?
only with catheterization or menses
possible reasons for increased RBCs
tumor, kidney stones, trauma, cystitis, UTI, bleeding disorders
crystals
indicate urine has been sitting for a while - not a usable specimen
why is it important to transport urine samples quickly?
room temperature can alter things, more bacteria will grow
how to perform a routine urine specimen
have pt urinate into a clean collection container - make sure there’s no feces, note if they’re on their period
how to preform a midstream urine collection
cleanse meatus, have them void a small amount, then collect 3-5mLs, then have them finish emptying their bladder
how to preform a sterile urine collection
cleanse port, clamp it for no longer than 30 minutes, collect 10 mLs, remember to unclamp!!
why is it important to not leave the catheter clamped?
urine will backflow and cause a UTI
how to preform a 24 hour urine collection
discard the first urine, record start time, collect all urine for 24 hours straight
store on ice
what is a KUB x-ray?
kidneys, ureters, bladder x-ray, depicts size, shape, and position
what is a bladder scan
ultrasound that measures bladder volume
urinary retention
inability to partially or completely empty the bladder
s/s of acute retention
discomfort, feelings of pressure, pain in pelvic region, restlessness, Abd. distention
overflow incontinence
bladder is so full that some involuntarily escapes/dribbles out
interventions for urinary retention
give them privacy, get them in the bathroom in natural position if possible, encourage normal voiding patterns, treat underlying cause, catheterization is last resort to decompress the bladder
single-lumen cath
one tube, straight cath
double-lumen catheter
indwelling, has two tubes - one with a balloon to hold it in place, one for urine to exit through
triple-lumen catheter
indwelling, three tubes - one with a balloon to hold it in place, one for urine to exit through, one that allows fluids to enter the bladder - for irrigation/instilling saline
why is it important to use the smallest fr cath possible?
minimizes trauma & risk of infection
appropriate indications for an indwelling cath
acute retention, accurate I&Os for critically ill pts, some surgeries, healing of open sacral/perineal wounds, prolonged immobility, end of life care
NEVER an indication for an indwelling cath
incontinence, for you or the patient’s convenience
what position should females be in for cath insertion
dorsal recumbent position - on back with knees to the side
why do we not test the foley balloon?
can cause the tubing to wrinkle - can harm/tear them
sterile drapes
block off rectum/anus
fenestrated drapes
over the pelvic region
how many inches should you lubricate the cath for females?
2-3 inches
how many inches should you lubricate the cath for males?
5-8 inches
correct sterile cleaning method for women before cath insertion
one swab on the side, one swab for the other side, one for the middle ALWAYS LAST
what should you do if you encounter resistance when inserting a cath ?
don’t force it, ask them to relax or bear down
how do you properly cleanse the penis for catheterization
use a circular motion, clean from meatus down
suprapubic catheterization
surgically inserted into the bladder through the abdominal wall - either sutured to the skin or has a balloon
indications for a suprapubic catheter
long term only; tumor in the way of normal urination, meatus damaged by past cath
indications for external catheters
incontinence, immobility
how often to change a condom cath?
change every 24 hours or if contaminated in some way - changing too often can cause skin breakdown
how often to change ext. female caths?
every 8-12 hours or if contaminated
UTI s/s
pelvic pain, dysuria, burning urination, frequency, urgency, nocturia, possible back pain if it gets into kidneys
urinalysis findings w a UTI
bacteria, sediment, WBC, RBC, positive leukocyte esterase
older adult manifestations of a UTI
confusion, incontinence, loss of appetite, nocturia, dysuria, urgency, frequency, sense of being “unwell”
pelvic muscle exercises
strengthen muscles that allow the bladder to contract; have them alternate between holding their urine for 5 to 10 seconds and urinating for 5 to 10 seconds
urinary diversions
surgical procedures that divert urine outside of the body though a stoma
urinary diversion indications
when pt has an obstruction/tumor blocking part of the urinary tract
what should a urinary diversion stoma look like
protrudes 1-3 cm, should be dark pink/red and moist
what does a pale stoma indicate
anemia
what does a dark purple/bluish stoma indicate
ischemia
interventions for urinary diversion
regularly inspect stoma, keep peristomal area clean & dry, measure I&Os, empty when 1/3-1/2 full, change bag every 3-7 days
expected fluid intake per day
1.5-2L
how do laxatives affect the GI tract?
soften stool, promote peristalsis
how do antidiarrheals affect the GI tract
inhibit peristalsis
how do opiates affect the GI tract
decrease peristalsis, cause constipation
how do antibiotics affect the GI tract
decrease normal flora and potentially cause diarrhea
maybe even C Diff
what do stool tests look for?
consistency, color, occult bleeding, fat content, different food substances
what is bowel training?
having them go the bathroom on a schedule
fecal impaction
palpable on digital exam - mass of dry, hard feces that cannot be expelled
can cause leakage of liquid stool, fecal matter can cause ulcers if it sits there too long
if a normally continent patient now has diarrhea that they are incontinent to, what should you check for?
fecal impaction - could be leakage
enema contraindications
bleeding risk, has thrombocytopenia, rectal irritation, low WBCs, immunocompromised, blood disorder, on chemo
how do enemas work?
increase peristalsis, stretches the intestines, irritate the intestinal lining, soften stool
how to give a large volume enema
warm the solution, keep it elevated 18 inches about anus, lubricate tube 2-3 inches, gently insert over 4-5 inches, slowly introduce solution over 5-10 minutes, gently remove
when giving a large volume enema, remember to…
do not let go of the tubing at any point, never force entry, remove gently, give it 10-15 minutes to work
specific hypertonic enema contraindications
sodium/water retention, renal impairment, on dialysis
how to administer a hypertonic enema
slowly insert 4-5 inches (tip is pre-lubricated); instill solution by gently squeezing the bottle
diarrhea can cause…
dehydration, F&E imbalances
diarrhea typically comes with…
cramping, nausea, vomitting
causes of diarrhea
intestinal infections, food allergies/intolerances, tube feedings, IBS, surgical alterations, anxiety, on antibiotics or laxatives
diarrhea interventions
identify & eliminate cause, replace lost fluid, monitor I&Os, educate on hand hygiene, frequent toileting, skin care, educate on nutrition, food safety, and hand hygiene
bowel incontinence
loss of voluntary control of defection
potential causes of bowel incontinence
loss of sphincter tone, inflammation, neurological conditions
bowel incontinence interventions
frequent toileting, skin care, ensure linen is clean, bowel training
fecal management system
tube inserted into rectum that directs loose stool in to a collection bag
fecal management system indications
end of life care, confined to bed/immobilized, continuous liquid stool,
disadvantages of a fecal management system
can leak, they’re uncomfortable, can cause skin damage & rectal tissue damage
alternative to fecal management system
bag on the outside of their anus - attached with adhesive
bowel diversions
a surgical procedure where part of the intestine is brought through the abdominal wall for elimination
ileostomy
originates in ileum
liquid contents
output in about 24 hours
colostomy
originates in the colon, formed contents, output in 2-5 days
if someone has a high output ostomy, what should you monitor?
F&E
what foods to avoid with an ostomy
nuts, popcorn, mushrooms, corn, stringy vegetables like celery, foods with skins or casings like sausage - anything that could get stuck, odorous foods
in initial post-op period, avoid high fiber foods
ostomy interventions
inspect stoma, keep peristomal area clean & dry, I&Os, empty when 1/2 full, educate pt on how to care for it themselves
