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 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 Desire to urinate @ 250-450mL for adults Void an average of 5x/day Discomfort at 400-600 Bladder capacity Infants average 250-500 Infants have shorter urethras No control Immature Kidneys Preschoolers Voluntary Control 2-5 yrs School Age Maturity Enuresis Primary Secondary Impaired micturation Men- enlarged prostate Womenchildbearing/hormonal ∆ Mobility Kidneys lose ability to concentrate urine Bladder loses muscle tone Privacy When & Where Gender Food and Fluid Intake Medications Muscle Tone Pathologic Conditions Surgical and Diagnostic Procedures Polyuria Oliguria Anuria Frequency Nocturia Urgency Dysuria Hesitancy Incontinence Retention Neurogenic Bladder Hematuria 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 Detailed history Physical assessment GU Assessment Hydration Urine exam I&O Characteristics Color Clarity Odor Routine Clean catch/midstream 24 hour Serial Double voided Pediatric How Equipment Use a sterile specimen cup Procedure Cleanse Start/Stop Place cup Start Done when patient has an indwelling urinary catheter Use aseptic technique to obtain specimen Use sterile aseptic technique to transfer to container Done to test renal function & urine composition ALWAYS DISCARD THE 1ST SAMPLE Collect urine for 24 hours Used to evaluate hematuria Collected over a period of time Done to check urine for glucose Collect 2nd specimen Often difficult Use terms they understand Need to use special collection devices Urinalysis Tests for kidney function C&S Definition 1st voided specimen in the morning Examine within 2 hours Can do at bedside with reagent strips BUN SerumCreatinine Creatinine Clearance Urine Sodium Sugar & acetone determination 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 Promote Fluid Intake Encourage normal Voiding Habits Assisting with Toileting Prevent UTIs Bladder Training Kegals Maintaining Skin Integrity External Devices Crede’s Manuever Urinary Catheterization 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 Personal Routine Characteristics of stool Routines to promote normal elimination Use of artificial aids Nutrition/fluid history Activity Medical Interventions Color Consistency Odor Shape 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 Hyperactive – Borborygmus – over 35 Loud, high-pitched, rushing, tinkling or growling sound indicating increased GI motility Hypoactive – less than 5 sounds per minute Absent bowel sounds may indicate paralytic ileus Paralytic Ileus – any direct manipulation of bowel in surgery cause temporary stop of peristalsis. Feces cannot be mixed with urine or water Wear disposable gloves Use tongue depressor to collect specimen and put in container Seal and label 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 Symptom, not a disease Signs Proper Diet Adequate fluid intake Take time for defection Routine Daily physical activity Privacy in hospital Administering laxatives and enemas Avoid Valsalva manuever 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 Oil retention enema Cleansing enema Digital removal of fecal mass 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 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 Mucus in stools Cannot control the urge Possible skin breakdown Possible excessive fluid loss Antibiotics Enteral nutrition Food allergies & intolerance Surgeries Diagnostic testing C. diff Communicable foodborne pathogens Good Handwashing Encourage fluids Monitor for dehydration Maintain I & O Administer antidiarrheal medications 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 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 Avoid gas producing foods Carminative enema Return Flow enema Rectal Tube MOBILITY 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 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 Large Volume 500 to 1000ml Hypotonic or isotonic Small Volume Hypertonic solutions Under 200ml 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 Low enema - 3 inches Used to clean rectum and sigmoid Maintains left lateral position Carminative – used to expel flatus Solution releases gas which distends rectum and stimulates peristalsis Return Flow Enema Used to expel flatus Infuse 200-300 fluid then lower bucket Oil Retention – Softens feces and lubricates Cleansing Fluid & Electrolyte Imbalance Tissue Trauma Vagal Nerve Stimulation Dependence 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 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 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
