waste elimination Flashcards
urge to void at…
400-600 mL
bladder holds
600-1000mL
normal urination amt
30mL/hr
normal defecation
3 or more BM’s per week
where is the ileosecal valve
between small and large intestine
what is the bladder controlled by
brain and spinal cord
types of output
voiding
stools
emesis
gastric/wound drainage
significant diaphoresis
all measured in mL except stools and emesis/incontinence which are estimated
types of urine tests
urinalysis (cc or sterile)
urine drug screen
urine C&S (cc or sterile)
urinalysis pH nl
5-8
urinalysis specific gravity nl
1.010-1.030
lower= over hydration
higher = dehydration
urinalysis RBCs nl
negative
positive indicates glomerular injury
urinalysis protein nl
0-8 mg/dL but should be negative
urinalysis WBC
less than 1phpf but in women 1-5 is nl as well
presence of WBC indicates infection
urinalysis casts nl
negative
positive indicates renal disease
what pan would you use for a pt with hip injury
fracture pan
rinse bedpan with what
cold water
stool cultures
for C diff.
FOBT
fecal occult blood test
guaiac or hemoccult
ideals for hemoccult test
- 3 different tests on 3 different days
- stop eating red meat 3 days prior
- stop taking NSAIDS 7 days prior (false positive)
- stop taking vit. C and citrus 3 days prior (false neg.)
hemoccult turns what color when positive for blood
blue
nl on bristol stool form scale
types 4 and 5
urinary retention
inability to empty the bladder
severe= 2-3 L of urine retained
high post-void residuals
bladder scan
reads amount of urine in bladder
no radiation, non invasive
most common healthcare acquired infection
UTI
main causes of UTI
non steril catheter placement
improper maintenance of catheter
E coli entering urethra is most causative organism!!!!
S&S of UTI
dysuria
urinary frequency
urgency
hematuria
complications resulting from UTI
pyelonephritis, bacteremia (sepsis)
tx for UTI
antibiotics
random urine collection
from normal void or drainage bag
make sure its free from stool or TP but not worried about bacteria
collection methods for urine
random
clean catch/midstream
sterile
clean catch/midstream urine collection
- clean urethra site
- start voiding into the toilet, THEN stop, THEN void into the container
steril urine collection
- from indwellling or straight cath
- completely free from outside organisms
- sample port on chamber of cath
how much is usually collected in a urine sample
30-60mL
what to label urine sample with
date/time/initials
24 hour urine collecting
- usually looking for kidney problems
- measuring protein, BUN, and creatine
- start clock, first void discarded, THEN all is kept for 24 hours
- keep in steril jug on ice or in refrigerator
functional urinary incontinence
decreased ability to toilet independently d/t issues outside of urinary tract
transient urinary incontinence
caused by medical conditions, usually reversible
overflow
- over distended bladder and chronic retention of urine
- tx: toileting schedule
stress
- involuntary leakage of urine d/t intra abdominal pressure exceeding the strength of urethral sphincter
- seen in prostatectomies in men and pregnancy in women
- tx: pelvic floor exercises (kegles)
urge
overactive bladder
reflex
- d/t spinal cord damage between C1-S2
- leaking urine d/t decreased awareness of bladder filling
- toileting schedule or superpubic cath
what effect does the backup of urine have on the body
cause bp and hr to go up d/t pressure on vagus nerve
kegles
ostomy
surgical procedure that changes the way that wastes exit the bod
stoma
artificial opening of an ostomy
nephrostomy
- tube inserted into renal pelvis
- directly from kidney to drain pouch
- measure urine output
urostomy (ileal conduit)
- most common
- done s/p cystectomy (bladder removal)
- ureters rerouted to a portion of the ilium
- no valve= incontinent
Ureterosigmoidostomy
- ureters connected to sigmoid colon
- urine and stool eliminated via rectum
- can be continent but sometimes isn’t
- not preferred method
- can end up with pH imbalance
cutaneous ureterostomy
- ureters rerouted to stomas created on abdomen
- incontinent
- typically to right side of abdomen
continent urinary reservoir (kock pouch)
internal pouch created from colon and ilium
- ileocecal valve creates one way valve
- continent, must be catheterized
- have to be willing to catheterize 4-6 times per day
risk factors of constipation
- ignoring the urge to poop
- old age
- medications
- low fiber diet
- neurological conditions
- immobilization and surgery
tx for constipation
- prevention: fluid, fiber, and stool softeners
- laxatives
msot abused substance in America
laxatives
hemorrhoids
dilated engorged rectal veins d/t straining for bowel movements, pregnancy, HF, and liver disease
fecal impaction
hardened feces that obstruct the rectum d/t unrelieved constipation
risks of fecal impaction
prolonged immobility, confusion, unconsciousness, dehydration, meds
S&S of fecal impaction
- no BM for several days
- leakage of small amounts of liquid stool
- abd cramping
- anorexia
- possible urinary incontinence d/t pressure on bladder
tx for fecal imp.
enemas
manual disimpaction
warning with manual disimpaction
possible vagal stimulation (dysrhythmias), bowel perforation
diarrhea risks
dehydration, electrolyte imbalance, skin breakdown
ileostomy
- incontinent
- done after total colectomy
- stoma is inner RLQ
- output: watery and constant stool
continent ileostomy
- kock pouch
- barnett continental intestinal reservoir (BCIR)
- not common
types of colostomies
end stoma
loop stoma
double barrel stoma
end stoma
- permanent colostomy
- can be done anywhere inside the bowels
loop stoma
- temporary
- 7-10 days
- gives bowels a rest
- proximal end of stoma drains stools
- distal end drains mucus
double barrel stoma
- temporary
- cut in half and sewn back together later
- proximal end: stool
- distal end: mucus
ascending colostomy
- rare
- stoma in RLQ
- output: constant liquid to semi-liquid stool
transverse colostomy
- loop or double barrel stomas
- middle to RUQ
- output: liquid to semi-formed stool (unpredictable)
descending colostomy
- outer LLQ
- output: stemi-formed to formed stool
- predictable
sigmoid colostomy
- most common
- LLQ
- output: normal formed stool (predictable)
ostomy assessment
stoma location
type of devise (1 or 2 piece)
stoma appearance
stoma appearance
red: good blood flow
moist: good moisture
budded: on top of skin, not below
peristomal skin (liquidy)
drainage: color, consistency, amount
change ostomy bandage how often
q 3-4 days
provide ostomy care when how full
half way
how to make sure seal is good
measure stoma
mark and cut out wafer
apply to skin
flap should be able to come down to show stoma
enema types
cleansing : for feces
Carminative : for gas
types of cleansing enemas
- NS
- tap water (hypotonic)
- hypertonic saline
- soap suds
- oil retention
NS cleansing enema
- safest
- stimulates peristalsis
tap water cleansing enema
- hypotonic
- causes fluid to leave the bowel
- can cause water toxicity
soap suds enema
- castile soap in tap water
oil retention enema
- mineral oil
- softens stool
medicated enema
- carminative
- treats various px
barium carminative enema
diagnostic procedure
- radioactive
- looks for cancer
enema contraindications
- N/V
- appendicitis
- abd pain
