waste elimination Flashcards
1
Q
urge to void at…
A
400-600 mL
2
Q
bladder holds
A
600-1000mL
3
Q
normal urination amt
A
30mL/hr
4
Q
normal defecation
A
3 or more BM’s per week
5
Q
where is the ileosecal valve
A
between small and large intestine
6
Q
what is the bladder controlled by
A
brain and spinal cord
7
Q
types of output
A
voiding
stools
emesis
gastric/wound drainage
significant diaphoresis
all measured in mL except stools and emesis/incontinence which are estimated
8
Q
types of urine tests
A
urinalysis (cc or sterile)
urine drug screen
urine C&S (cc or sterile)
9
Q
urinalysis pH nl
A
5-8
10
Q
urinalysis specific gravity nl
A
1.010-1.030
lower= over hydration
higher = dehydration
11
Q
urinalysis RBCs nl
A
negative
positive indicates glomerular injury
12
Q
urinalysis protein nl
A
0-8 mg/dL but should be negative
13
Q
urinalysis WBC
A
less than 1phpf but in women 1-5 is nl as well
presence of WBC indicates infection
14
Q
urinalysis casts nl
A
negative
positive indicates renal disease
15
Q
what pan would you use for a pt with hip injury
A
fracture pan
16
Q
rinse bedpan with what
A
cold water
17
Q
stool cultures
A
for C diff.
18
Q
FOBT
A
fecal occult blood test
guaiac or hemoccult
19
Q
ideals for hemoccult test
A
- 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.)
20
Q
hemoccult turns what color when positive for blood
A
blue
21
Q
nl on bristol stool form scale
A
types 4 and 5
22
Q
urinary retention
A
inability to empty the bladder
severe= 2-3 L of urine retained
high post-void residuals
23
Q
bladder scan
A
reads amount of urine in bladder
no radiation, non invasive
24
Q
most common healthcare acquired infection
A
UTI
25
main causes of UTI
non steril catheter placement
improper maintenance of catheter
E coli entering urethra is most causative organism!!!!
26
S&S of UTI
dysuria
urinary frequency
urgency
hematuria
27
complications resulting from UTI
pyelonephritis, bacteremia (sepsis)
28
tx for UTI
antibiotics
29
random urine collection
from normal void or drainage bag
make sure its free from stool or TP but not worried about bacteria
30
collection methods for urine
random
clean catch/midstream
sterile
31
clean catch/midstream urine collection
- clean urethra site
- start voiding into the toilet, THEN stop, THEN void into the container
32
steril urine collection
- from indwellling or straight cath
- completely free from outside organisms
- sample port on chamber of cath
33
how much is usually collected in a urine sample
30-60mL
34
what to label urine sample with
date/time/initials
35
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
36
functional urinary incontinence
decreased ability to toilet independently d/t issues outside of urinary tract
37
transient urinary incontinence
caused by medical conditions, usually reversible
38
overflow
- over distended bladder and chronic retention of urine
- tx: toileting schedule
39
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)
40
urge
overactive bladder
41
reflex
- d/t spinal cord damage between C1-S2
- leaking urine d/t decreased awareness of bladder filling
- toileting schedule or superpubic cath
42
what effect does the backup of urine have on the body
cause bp and hr to go up d/t pressure on vagus nerve
43
kegles
help pt to identify where pelvic floor muscles are by stopping the flow of urine or contracting anus
-
44
ostomy
surgical procedure that changes the way that wastes exit the bod
45
stoma
artificial opening of an ostomy
46
nephrostomy
- tube inserted into renal pelvis
- directly from kidney to drain pouch
- measure urine output
47
urostomy (ileal conduit)
- most common
- done s/p cystectomy (bladder removal)
- ureters rerouted to a portion of the ilium
- no valve= incontinent
48
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
49
cutaneous ureterostomy
- ureters rerouted to stomas created on abdomen
- incontinent
- typically to right side of abdomen
50
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
51
risk factors of constipation
- ignoring the urge to poop
- old age
- medications
- low fiber diet
- neurological conditions
- immobilization and surgery
52
tx for constipation
- prevention: fluid, fiber, and stool softeners
- laxatives
53
msot abused substance in America
laxatives
54
hemorrhoids
dilated engorged rectal veins d/t straining for bowel movements, pregnancy, HF, and liver disease
55
fecal impaction
hardened feces that obstruct the rectum d/t unrelieved constipation
56
risks of fecal impaction
prolonged immobility, confusion, unconsciousness, dehydration, meds
57
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
58
tx for fecal imp.
enemas
manual disimpaction
59
warning with manual disimpaction
possible vagal stimulation (dysrhythmias), bowel perforation
60
diarrhea risks
dehydration, electrolyte imbalance, skin breakdown
61
ileostomy
- incontinent
- done after total colectomy
- stoma is inner RLQ
- output: watery and constant stool
62
continent ileostomy
- kock pouch
- barnett continental intestinal reservoir (BCIR)
- not common
63
types of colostomies
end stoma
loop stoma
double barrel stoma
64
end stoma
- permanent colostomy
- can be done anywhere inside the bowels
65
loop stoma
- temporary
- 7-10 days
- gives bowels a rest
- proximal end of stoma drains stools
- distal end drains mucus
66
double barrel stoma
- temporary
- cut in half and sewn back together later
- proximal end: stool
- distal end: mucus
67
ascending colostomy
- rare
- stoma in RLQ
- output: constant liquid to semi-liquid stool
68
transverse colostomy
- loop or double barrel stomas
- middle to RUQ
- output: liquid to semi-formed stool (unpredictable)
69
descending colostomy
- outer LLQ
- output: stemi-formed to formed stool
- predictable
70
sigmoid colostomy
- most common
- LLQ
- output: normal formed stool (predictable)
71
ostomy assessment
stoma location
type of devise (1 or 2 piece)
stoma appearance
72
stoma appearance
red: good blood flow
moist: good moisture
budded: on top of skin, not below
peristomal skin (liquidy)
drainage: color, consistency, amount
73
change ostomy bandage how often
q 3-4 days
74
provide ostomy care when how full
half way
75
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
76
enema types
cleansing : for feces
Carminative : for gas
77
types of cleansing enemas
- NS
- tap water (hypotonic)
- hypertonic saline
- soap suds
- oil retention
78
NS cleansing enema
- safest
- stimulates peristalsis
79
tap water cleansing enema
- hypotonic
- causes fluid to leave the bowel
- can cause water toxicity
80
soap suds enema
- castile soap in tap water
81
oil retention enema
- mineral oil
- softens stool
82
medicated enema
- carminative
- treats various px
83
barium carminative enema
diagnostic procedure
- radioactive
- looks for cancer
84
enema contraindications
- N/V
- appendicitis
- abd pain
85
86
87
88
