Bladder & Bowel Function studentppt

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Dorothy Woodard
Kozier & Erb: Chap 48 (skip p. 1334 – 1331, 1332-1337)
& 49 (skip ostomies)
Evolve Case Studies: Urinary Patterns & Constipation
Real Nursing Sillls: Urinary Elimination (Only Applying
Condom Cath, Caring for the Client with Cath,
Removing Cath, Emptying Bag); Bowel Elimination
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Identify criteria for assessment of the bladder function
Recognize variations from normal urinary elimination
Describe nursing measures for dealing with urinary
problems
Compare & contrast the procedures & rationale for
collection of urine specimens
Identify the purpose(s) of each diagnostic test listed in
the content
Recognize normal values of selected diagnostic tests
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Desire to urinate @
250-450mL for adults
Void an average of
5x/day
Discomfort at 400-600
Bladder capacity
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Infants average 250-500
Infants have shorter
urethras
No control
Immature Kidneys
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Preschoolers
 Voluntary Control 2-5 yrs
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School Age
 Maturity
 Enuresis
 Primary
 Secondary
Impaired micturation
 Men- enlarged prostate
 Womenchildbearing/hormonal ∆
Mobility
Kidneys lose ability to
concentrate urine
Bladder loses muscle tone
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Privacy
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When & Where
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Gender
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Food and Fluid Intake
Medications
Muscle Tone
Pathologic Conditions
Surgical and Diagnostic Procedures
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Polyuria
Oliguria
Anuria
Frequency
Nocturia
Urgency
Dysuria
Hesitancy
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Incontinence
Retention
Neurogenic Bladder
Hematuria
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Accumulation of urine
Bladder lacks response
Pressure builds
Sphincter opens
Dribbles small amts
Uncomfortable
Causes
 Frequency
 Voiding more
than q2h
 Causes
 Involuntary
leakage of urine
 More prevalent
with increasing
age
 Types
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Detailed history
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Physical assessment
 GU Assessment
 Hydration
 Urine exam
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I&O
Characteristics
 Color
 Clarity
 Odor
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Routine
Clean catch/midstream
24 hour
Serial
Double voided
Pediatric
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How
Equipment
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Use a sterile specimen
cup
Procedure
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Cleanse
Start/Stop
Place cup
Start
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Done when patient has
an indwelling urinary
catheter
Use aseptic technique
to obtain specimen
Use sterile aseptic
technique to transfer to
container
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Done to test renal
function & urine
composition
ALWAYS DISCARD
THE 1ST SAMPLE
Collect urine for 24
hours
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Used to evaluate
hematuria
Collected over a period
of time
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Done to check urine for
glucose
Collect 2nd specimen
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Often difficult
Use terms they
understand
Need to use special
collection devices
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Urinalysis
Tests for kidney
function
C&S
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Definition
1st voided specimen in
the morning
Examine within 2 hours
Can do at bedside with
reagent strips
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BUN
SerumCreatinine
Creatinine Clearance
Urine Sodium
Sugar & acetone
determination
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Clean catch or aspiration
of urine from catheter
Done to determine
presence of bacteria
Need 24-72 hours for
growth
Also checks to see what
antibiotic bacteria is
sensitive to
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Promote Fluid Intake
Encourage normal Voiding Habits
Assisting with Toileting
Prevent UTIs
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Bladder Training
Kegals
Maintaining Skin Integrity
External Devices
Crede’s Manuever
Urinary Catheterization
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Identify criteria for assessment of bowel function
Identify the procedure for collecting a stool
specimen
Recognize normal values of selected diagnostic tests
In a client situation, recognize variations from
normal bowel elimination
Describe nursing interventions utilized for managing
bowel problems
Age
Diet and fluid intake
Physical activity
Psychological factors
Personal habits
Position during
defecation
Pregnancy
Surgery and anesthesia
Medications, laxatives,
and cathartics
Diagnostic tests
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Personal Routine
Characteristics of stool
Routines to promote
normal elimination
Use of artificial aids
Nutrition/fluid history
Activity
Medical Interventions
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Color
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Consistency
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Odor
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Shape
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Originate from air and
fluid moving in small
intestine
Occur irregularly 5-35
times per minute
Auscultate starting in
RLQ
Normal sounds are highpitched and gurgling
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Hyperactive – Borborygmus – over 35
 Loud, high-pitched, rushing, tinkling or growling
sound indicating increased GI motility
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Hypoactive – less than 5 sounds per minute
 Absent bowel sounds may indicate paralytic ileus
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Paralytic Ileus – any direct manipulation of bowel
in surgery cause temporary stop of peristalsis.
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Feces cannot be mixed
with urine or water
Wear disposable gloves
Use tongue depressor to
collect specimen and put in
container
Seal and label
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Stool for occult blood
(GUAIAC)
 Home or bedside
 Measures microscopic
amounts of blood in feces
 Screening tool for colon
cancer
 Stool smeared on filter
paper and use test solution
 Ova and Parasites –
specimen to lab
immediately
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Symptom, not a disease
Signs
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Proper Diet
Adequate fluid intake
Take time for defection
Routine
Daily physical activity
Privacy in hospital
Administering laxatives
and enemas
Avoid Valsalva manuever
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Collection of hardened
feces wedged in rectum
or sigmoid colon that
cannot be expelled
Clinical manifestations
include: several days
without BM despite urge,
seeping of liquid stool,
loss of appetite,
abdominal distention and
pain
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Oil retention enema
Cleansing enema
Digital removal of fecal
mass
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Explain Procedure
Drape client, place linen saver, bedpan
Don clean gloves and lubricate index finger
Gently insert finger into rectum
Gently begin to loosen mass by massaging around it and into
it
Work feces downward and remove small pieces
Wash hands and assess vital signs
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Increase in the number of
stools and the passage of
liquid, unformed stools
Rapid movement of
intestinal contents
through colon, unable to
absorb fluid and nutrients
May have increased
mucus secretion
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Mucus in stools
Cannot control the urge
Possible skin
breakdown
Possible excessive fluid
loss
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Antibiotics
Enteral nutrition
Food allergies &
intolerance
Surgeries
Diagnostic testing
C. diff
Communicable foodborne pathogens
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Good Handwashing
Encourage fluids
Monitor for dehydration
Maintain I & O
Administer antidiarrheal
medications
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Inability to voluntarily
control the passage of
feces and gas.
Very embarrassing and
can harm body image
Caused by conditions
impairing anal sphincter
control or conditions that
cause frequent, watery,
loose stools
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Gas accumulates in
lumen of intestine
Escapes by belching or
passing of flatus
Reduction of motility
caused by opiates,
general anesthesia,
abdominal surgery,
immobility
 Bloating
 Abdominal
distention
 Cramping pains
 Excessive
passage of gas
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Avoid gas producing
foods
Carminative enema
Return Flow enema
Rectal Tube
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MOBILITY
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A solution introduced in
the rectum and colon
Promotes defecation by
stimulating peristalsis
or softening stool
Instillation breaks up
fecal mass and
stretches intestinal wall
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Hypotonic – water moves from colon to
interstitial spaces. Tap Water – should not be
repeated over and over because possible water
overload
Isotonic –Normal Saline – Safest
Hypertonic –Pulls fluid out of interstitial spaces
to colon
Soapsuds – Mild castile soap irritates the colon
and volume of liquid stimulate peristalsis
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Large Volume
 500 to 1000ml
 Hypotonic or isotonic
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Small Volume
 Hypertonic solutions
 Under 200ml
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High enema
 Raise container 12 – 18 inches above anus
 Given to cleanse as much colon as possible
 Position changes from left lateral to dorsal recumbent
to right lateral during administration
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Low enema - 3 inches
 Used to clean rectum and sigmoid
 Maintains left lateral position
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Carminative – used to expel flatus
 Solution releases gas which distends rectum and
stimulates peristalsis
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Return Flow Enema
 Used to expel flatus
 Infuse 200-300 fluid then lower bucket
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Oil Retention – Softens feces and lubricates
Cleansing
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Fluid & Electrolyte
Imbalance
Tissue Trauma
Vagal Nerve
Stimulation
Dependence
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Skill in Kozier & Erb
Prepare Equipment
Don gloves and insert rectal tube
 3-4 inches for adult
 2-3 inches for child
 1-1.5 inches for infant
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Slowly administer solution – height of bag
determines rate of flow
Encourage client to retain enema as long as
possible
If client c/o fullness or pain, lower bag to slow or
clamp off tubing for 30 seconds, then restart
Assist client to defecate
Record and report
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Used to relieve gas
Lubricate tube
Insert into rectum about 4 inches
Tape in place
Leave in place no longer than 30 minutes
Reinsert every 2 – 3 hours prn
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