Notes chapter 15 Flashcards
Elimination includes the ?
Urinary system and the gastrointestinal system
Elimination is essential for?
Body function properly
-both system help the body detoxify and eliminates waste products
Give me some steps Before the skills / Procedure?
1.check the health care provider order and review facility policy
2.Introduce yourself and title or role
3.Identify the patient by checking his or identity bracelet and request the patient name and birth
4.explain procedure
5.educated patient before
6.evaluate the patient (idea )
- Hand hygiene
8.assembly equipment and complete necessary charge
- Prepare the patient’s procedure -close the door for privacy -raise the bed -position
Give some steps During skills/procedure ?
-Promote patient involvement as much possible (encourage patient and increase patient knowledge condition and care)
-Determine the patient tolerance of the procedure being alert for sign and symptoms of discomfort and fatigue
Give some steps after the procedure?
-assist the patient to a position of comfort and place needed item within easy breach
-raise the side rails and lower the bed to the lowest position-remove glove and all protective barriers such as gown, goggles, mask
-perform hand hygiene after removing gloves
-document a patient’s response to the procedure expected or unexpected outcome and all the patient teaching
-reported any unexpected
Urinary elimination is ?
Natural process that clear the body of waste material and helps maintain electrons balance
The urinary tract can be affected by ?
problem with the kidney , the ureters ,the bladder the urethra or surrounding organs
Patient at risk for problem with urine elimination includes *? l
Undergone surgical procedure of the bladder ,the prostate , or the vagina , urologic trauma,urethral stricture or tumor ,neurologica
Urinary Catheters are used to maintain?
urine flow ,to divert urine flow to facilities healing postoperative, to introduce medications by irrigation and dilate or prevent narrowing of some portion of the urinary tract
Catheterization ?
Of the bladder which is usually responsible of the nurse ,involves introducing rubber or plastic tube a urinary catheter through the urinary meatus and the urethra into the urinary bladder
What type of catheter is this -has a tapered tip and is used when enlargement of the prostate gland is suspected. -The curved style is used to assist the health care provider in the insertion of a urethral catheter in a male patient with prostate enlargement ?
Coude catheter
What type of catheter has a -balloon near its tip that is inflated after insertion to hold the catheter in the urinary bladder for continuous drainage?
Foley catheter
What type of catheter is this are used to drain urine from the renal pelvis of the kidney?
Malecot and dePezzer (mushroom)
What type of catheter has multiple openings in its tip to facilitate intermittent drainage?
Robinson catheter
What type of catheter is inserted through the abdominal wall above the symphysis pubis to create a urinary diversion in cases of obstruction , strictures , or injury to the bony pelvis , the urinary tract or surrounding organs?
The cystostomy , the vesicostomy , or the suprapubic catheter
Self Catheterization is it stereo technique or clean technique ?
clean technique
Routine catheter care is important aspect of ?
indwelling urinary drainage system
-least every 8 hours to prevent urinary tract
If potency of the catheter itself become interrupted by ?
mucus, blood ,cloth or sediment ,Catheter irritation
-this procedure requires a physician order
Indwelling Urinary Drainage System Care?
-explain the procedure
- answer the patient’s question and instruct
-Discourage the use of lotions or powder during perineal care
-encourage a using bag during the day and bedside training night
-instructions for patient to wear loose fitting
Incontinence?
inability to control urine or bowel elimination can be a psychologically distressing and socially disruptive problem , especially among older adults
Urinary incontinence can occur?
because pressure in the bladder is too great or because the sphincters are too weak
-Fecal incontinence may result from?
diarrhea or constipation muscle damage or weakness damage , a rectocele , or even inactivity Patients with
Bladder Training?
Is the achievement of voluntary control voiding it often involve developing the use of muscle in the perineum
Kegel exercise use for *?
-improve perineal muscle tone and sphincter control is part of bladder train
-trying to stop the flow of urinary during voiding - before meal
A nasogastric ( NG ) tube?
is a flexible , hollow tube that is passed into the stomach via the nasopharynx
Insertion and Maintenance nasogastric tubes ?
It can be used to remove gas , fluids , or toxic substances from the stomach; to diagnose gastrointestinal problems to obtain secretions or to administer fluids and nutrients into the stomach
-also can help prevent vomiting
There are various types of NG tubes, including?
percutaneous endoscopic gastrostomy (PEG) Button, and jejunal tubes
-physician determines which tube is best suited for the patient .
Gastric Gavage used to? .
deliver fluids or nutrients (gastric gavage) -the NG tube can be attached to a feeding pump, or the feeding can be allowed to flow in by gravity via a bag or a syringe
Tube feedings usually are started slowly and gradually increased , or they may be diluted and gradually strengthened , to prevent? .
dumping syndrome.
-Dumping syndrome is caused by too rapid an infusion of highly concentrated feedings
-The symptoms are similar to those of shock and can be very disturbing to the patient
Gastric lavage often is used?
in cases of poisoning stop gastrointestinal bleeding
(washing out of a body cavity, such as the colon or stomach, with water or a medicated solution.)
The purpose of gastric decompression is to ?
remove the air and fluids that build up when gastrointestinal motility is slowed
Patient With Gastric Tube ?
-Deficient Nutrition : Related to insufficient intake
-Compromised Swallowing Ability: Related to neuromuscular impairment
-Potential for Aspiration Into Airway : Related to inability to swallow effectively
-Frequent , Loose Stools: Related to altered intake associated with tube feedings -Infrequent or Difficult Bowel Elimination : Related to altered intake associated with tube feedings
Bowel Eliminates?
-Elimination of bowel wastes (defecation ) is a basic human need and is essential for normal body function
-bowel movement at least every 1 to 3 days
CARE OF THE PATIENT WITH HEMORRHOIDS?
Hemorrhoids are swollen and inflamed veins in the anus and lower rectum -They may result from straining during bowel movements or from increased pressure during pregnancy or with heavy lifting
Flatulence*?
-the presence of air or gas ( flatus ) in the intestinal tract , (typically occurs when a person consumes gas )
- producing liquids and foods such as carbonated beverages , cabbage , or beans ; swallows excessive amounts of air ; or is constipated
-It also can be caused by decreased peristalsis ,
- may cause distention of the stomach and abdomen
An enema and what is the primary reason *?
is the instillation of a solution into the colon via the anus
-The primary reason for an enema is promotion of defecation (the discharge of feces from the body) in a patient with constipation
A fecal impaction?
is a collection of feces in the rectum in the form of a mass that becomes so large or hard that the patient is unable to pass it voluntarily
An ostomy by definition * ?
an artificial opening -The site of the opening is called a stoma
Ostomies can be created because ?
of trauma to the intestine , severe inflammation or diseases such as cancer that involve part of the intestine
-They can be temporary or permanent depending on the reason
-located along the intestine
An ileostomy?
is an opening in the ileum ( the distal part of the small intestine ).
-ileostomy is needed when the entire colon must be removed or bypassed
Standard Steps Select Skills ?
- All nursing skills must include basic steps for the safety and well-being of the patient and the nurse
-Before the skill
-During the skill
-Completion of procedure
Skills for Urinary Tract Disorder Urinary elimination ?
-Catheter
-Maintaining adequate urinary drainage
-Routine catheter care
-Bladder training
-Managing incontinence
-Discontinuing an indwelling catheter
Self Catheterization? .
-Used for the patient who experienced spinal cord injury or other neurologic disorders that interfere with urinary elimination .
-Intermittent self- catheterization promotes independence function for the patient and eliminates the need for an indwelling urinary drainage system
How do we measure to place the NG Tube?
From the tip of the nose - to the earlobe to the xiphoid process
Nasogastric Suctioning -Gastric lavage:? ,
-commonly called stomach pumping or gastric irrigation , it is the process of cleaning out the contents of the stomach .
It has been used for over 200 years as a means of eliminating poisons from the stomach . Such devices are normally used on a person who has ingested a poison , overdosed on a drug.
Nasogastric Suctioning Gastric decompression? :
Is to remove the air and fluids that build up when gastrointestinal motility is slowed .
It is used frequently after surgery to help with the distention that may occur and to prevent nausea and vomiting .
Nasogastric Tube Removal?
Cannot be delegated to unlicensed personnel
Enema ? .
-Installation of a solution into the colon via the anus
- A cleansing enema stimulates peristalsis by introducing large volumes of fluids to distend the bowel
-An oil retention enema is used to soften the stool and lubricate the bowel to make defecation easier
Ostomies Colostomy? :
The surgical creation of a stoma on the abdominal wall to where the colon is normally attached
Ostomies ileostomy?
Is an opening in the ileum (the distal part of the small intestine
Ostomies Urostomy ? :
the diversion of urine away from a diseased or defective bladder through a surgically created opening or stoma in the skin?
Colostomy Bag?
Closed bags may need changing 1 to 3 times a day.
Skin barrier (Wafer ): the piece of the pouching system that sticks to your body.
Pouch Drainable bags These are best if your stools are very liquid. You empty them through an opening at the bottom.
Ostomy Care?
involves the removal of diseased. portions of the gastrointestinal or urinary system and creation of an artificial opening in the abdomen to allow for the elimination of body wastes.
A new pouch (a 1-piece system, or 2-piece system that has a wafer)
A pouch clip.
Scissors.
A clean towel or paper towels.
Stoma powder.
Stoma paste or a ring seal.
Skin wipes.
A measuring card and a pen.
-Difficulty digesting foods ( lactose intolerance ) can cause watery stools.
-Certain foods can increase gas ( cabbage , cauliflower , apples ) , have a laxative effect ( figs , chocolate ) , or increase the risk for constipation (pasta ,cheese , eggs )
Fiber requirement
Fiber requirement : 25 to 38 g /day
Fluid requirement ?
2 L / day for females and 3 L / day for males from fluid and food sources
Medications
Laxatives:
Cathartics:
Laxatives: Soften stool
Cathartics: Promote peristalsis
Ostoimes , Colostomis , Ileostomies are created?
Ostomies are created in either the large intestine or the small intestine
-Colostomies end in the colon ,
- ileostomies end in the ileum
End stomas are a result?
of colorectal cancer or some types of bowel disease.
Loop colostomies help resolve a medical emergency and are temporary .
a loop of bowel is supported on the abdomen with a proximal stoma draining stool and a distal stoma draining mucus . It is usually constructed in the transverse colon ?
In a loop colostomy
consist of two abdominal stomas : one proximal and one distal The proximal stoma ?
Double -barrel colostomies
is an intestinal obstruction caused by reduced motility following bowel manipulation during surgery , electrolyte imbalance , wound infection , or by the effects of medication ?
Paralytic ileus
Frequent use of laxatives
Advanced age Inadequate
fluid intake Inadequate
fiber intake
Immobilization due to injury
Sedentary lifestyle
Pregnancy Medication effects
CAUSES OF CONSTIPATION
Viral gastroenteritis Bacterial gastroenteritis Antibiotic therapy Inflammatory bowel disease Irritable bowel syndrome?
CAUSES OF DIARRHEA
Use of a lighted instrument by the provider to visualize and collect tissue samples for biopsy or remove polyps from the colon or lower small bowel ?
Colonoscopy
Use of a lighted instrument by the provider to visualize and collect tissue for biopsy or remove polyps from the sigmoid colon and rectum?
Sigmoidoscopy
: Use of a lighted instrument to visualize, treat and obtain specimens from the bladder and urethram ?
Cystoscopy
Test for bladder muscle function by filling the bladder with C*O_{2} or 0.9% sodium chloride and comparing pressure readings with reported sensations?
Urodynamic testing:
: Visualizes the inside of the bladder ?
Cystourethroscopy
: Measures the rate and degree of bladder emptying?
Uroflowmetry
: Measures the strength of pelvic muscle contractions?
Electromyography
