GI/GU Alterations Flashcards
1
Q
high fiber foods
A
whole grains, fruits, bran, vegetables
2
Q
average functional capacity of bladder
A
300-500ml
3
Q
why are females more prone to UTIs?
A
urethra is shorter - bacteria has less distance to travel
4
Q
normal hourly urine output
A
minimum of 30mL
5
Q
anuria
A
no urine output
less than 50 mLs in 24 hours
6
Q
dysuria
A
painful or difficult urination
7
Q
frequency
A
needing to void frequently
8
Q
nocturia
A
need to wake up at night just to void
9
Q
oliguria
A
diminished urine output
less than 400 mLs in 24 hrs
10
Q
polyuria
A
excessive urine output
11
Q
pyuria
A
pus in the urine
12
Q
urinary incontinence
A
involuntary voiding of urine
13
Q
foods high in sodium can cause a pt to:
A
retain water
14
Q
alcohol & foods high in water have a:
A
diuretic effect
15
Q
How do diuretics affect urination
A
increased production of urine
16
Q
What does dark amber urine indicate?
A
concentrated urine - need more water
17
Q
What does clear or very pale urine indicate?
A
diluted urine - too much water
18
Q
what does red urine indicate?
A
hematuria
19
Q
what does brown urine indicate?
A
hematuria or increased bilirubin
20
Q
what does cloudy urine indicate
A
infection, sediment, high urine protein
21
Q
what does foul smelling urine indicate?
A
indication, drugs, dehydration, ingestion of certain foods (asparagus)
22
Q
post-void residual
A
amount of urine left in the bladder after you void, should be close to 0
23
Q
costovertebral angle tenderness
A
could indicate kidney inflammation
24
Q
BUN
A
waste product filtered out of the blood by the kidneys
should be 10-20
25
creatinine
waste product produced in the muscles, filtered out by the kidneys
should be 0.8-1.4
26
is increased RBC ever normal?
only with catheterization or menses
27
possible reasons for increased RBCs
tumor, kidney stones, trauma, cystitis, UTI, bleeding disorders
28
crystals
indicate urine has been sitting for a while - not a usable specimen
29
why is it important to transport urine samples quickly?
room temperature can alter things, more bacteria will grow
30
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
31
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
32
how to preform a sterile urine collection
cleanse port, clamp it for no longer than 30 minutes, collect 10 mLs, remember to unclamp!!
33
why is it important to not leave the catheter clamped?
urine will backflow and cause a UTI
34
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
35
what is a KUB x-ray?
kidneys, ureters, bladder x-ray, depicts size, shape, and position
36
what is a bladder scan
ultrasound that measures bladder volume
37
urinary retention
inability to partially or completely empty the bladder
38
s/s of acute retention
discomfort, feelings of pressure, pain in pelvic region, restlessness, Abd. distention
39
overflow incontinence
bladder is so full that some involuntarily escapes/dribbles out
40
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
41
single-lumen cath
one tube, straight cath
42
double-lumen catheter
indwelling, has two tubes - one with a balloon to hold it in place, one for urine to exit through
43
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
44
why is it important to use the smallest fr cath possible?
minimizes trauma & risk of infection
45
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
46
NEVER an indication for an indwelling cath
incontinence, for you or the patient's convenience
47
what position should females be in for cath insertion
dorsal recumbent position - on back with knees to the side
48
why do we not test the foley balloon?
can cause the tubing to wrinkle - can harm/tear them
49
sterile drapes
block off rectum/anus
50
fenestrated drapes
over the pelvic region
51
how many inches should you lubricate the cath for females?
2-3 inches
52
how many inches should you lubricate the cath for males?
5-8 inches
53
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
54
what should you do if you encounter resistance when inserting a cath ?
don't force it, ask them to relax or bear down
55
how do you properly cleanse the penis for catheterization
use a circular motion, clean from meatus down
56
suprapubic catheterization
surgically inserted into the bladder through the abdominal wall - either sutured to the skin or has a balloon
57
indications for a suprapubic catheter
long term only; tumor in the way of normal urination, meatus damaged by past cath
58
indications for external catheters
incontinence, immobility
59
how often to change a condom cath?
change every 24 hours or if contaminated in some way - changing too often can cause skin breakdown
60
how often to change ext. female caths?
every 8-12 hours or if contaminated
61
UTI s/s
pelvic pain, dysuria, burning urination, frequency, urgency, nocturia, possible back pain if it gets into kidneys
62
urinalysis findings w a UTI
bacteria, sediment, WBC, RBC, positive leukocyte esterase
63
older adult manifestations of a UTI
confusion, incontinence, loss of appetite, nocturia, dysuria, urgency, frequency, sense of being "unwell"
64
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
65
urinary diversions
surgical procedures that divert urine outside of the body though a stoma
66
urinary diversion indications
when pt has an obstruction/tumor blocking part of the urinary tract
67
what should a urinary diversion stoma look like
protrudes 1-3 cm, should be dark pink/red and moist
68
what does a pale stoma indicate
anemia
69
what does a dark purple/bluish stoma indicate
ischemia
70
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
71
expected fluid intake per day
1.5-2L
72
how do laxatives affect the GI tract?
soften stool, promote peristalsis
73
how do antidiarrheals affect the GI tract
inhibit peristalsis
74
how do opiates affect the GI tract
decrease peristalsis, cause constipation
75
how do antibiotics affect the GI tract
decrease normal flora and potentially cause diarrhea
maybe even C Diff
76
what do stool tests look for?
consistency, color, occult bleeding, fat content, different food substances
77
what is bowel training?
having them go the bathroom on a schedule
78
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
79
if a normally continent patient now has diarrhea that they are incontinent to, what should you check for?
fecal impaction - could be leakage
80
enema contraindications
bleeding risk, has thrombocytopenia, rectal irritation, low WBCs, immunocompromised, blood disorder, on chemo
81
how do enemas work?
increase peristalsis, stretches the intestines, irritate the intestinal lining, soften stool
81
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
81
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
82
specific hypertonic enema contraindications
sodium/water retention, renal impairment, on dialysis
83
how to administer a hypertonic enema
slowly insert 4-5 inches (tip is pre-lubricated); instill solution by gently squeezing the bottle
84
diarrhea can cause...
dehydration, F&E imbalances
85
diarrhea typically comes with...
cramping, nausea, vomitting
86
causes of diarrhea
intestinal infections, food allergies/intolerances, tube feedings, IBS, surgical alterations, anxiety, on antibiotics or laxatives
87
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
88
bowel incontinence
loss of voluntary control of defection
89
potential causes of bowel incontinence
loss of sphincter tone, inflammation, neurological conditions
90
bowel incontinence interventions
frequent toileting, skin care, ensure linen is clean, bowel training
91
fecal management system
tube inserted into rectum that directs loose stool in to a collection bag
92
fecal management system indications
end of life care, confined to bed/immobilized, continuous liquid stool,
93
disadvantages of a fecal management system
can leak, they're uncomfortable, can cause skin damage & rectal tissue damage
94
alternative to fecal management system
bag on the outside of their anus - attached with adhesive
95
bowel diversions
a surgical procedure where part of the intestine is brought through the abdominal wall for elimination
96
ileostomy
originates in ileum
liquid contents
output in about 24 hours
97
colostomy
originates in the colon, formed contents, output in 2-5 days
98
if someone has a high output ostomy, what should you monitor?
F&E
99
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
100
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
