Metro Community College Nursing Program Nancy Pares, RN, MSN Terms used for expelling urine ◦ Urination ◦ Micturition ◦ Voiding Know anatomy and physiology ◦ Kidney, nephron, glomerulus Stage of growth and development Psychological factors Sociocultural factors Personal habits Muscle tone Fluid intake Disease conditions Surgical procedures Medications Diagnostic procedures Urinary retention Lower UTI incontinence Total Functional Stress Urge reflex Urgency Dysuria Frequency Hesitancy polyuria Oliguria Nocturia Hematuria Retention residual Intake and output Color Clarity odor Ph Protein Glucose Ketones Blood Specific gravity Clean voided Midstream Sterile 24 hour Culture and sensitivity Positioning Run water Immersion Privacy and time Adequate fluids Intermittent Indwelling Bladder distention Prevent skin breakdown Obtain sterile speciman Assess residual Relieve obstructed flow Surgical procedure Accurate intake and output Bladder irrigation Keep system closed Keep bag below bladder Don’t let bag touch floor Coil excess tube on bed Check for kinks Encourage fluid intake Cath care x2 daily Empty collection bag every shift Defecation ◦ Reflex occurs when the fecal mass enters rectum Voluntary and involuntary Sphincter relaxation Valsalva maneuver Age Diet Position Pregnancy Diagnostic tests Fluid intake activity Psychological factors Habits Pain Medications surgery Irregular habits Inadequate fluids Lack of exercise Low fiber diet Habitual laxative use No stool Continual oozing Loss of appetite Abdominal distention Cramping Rectal pain Emotional stress Intestinal infection Allergies or intolerances Medications Colon disease Surgical procedures Spinal cord trauma Multiple sclerosis Cerebral vascular accident (CVA) Muscle tone decreased pathological Accumulation of gases Increased with decreased mobility or obstruction Increased venous pressure Excessive straining Pregnancy Congestive heart failure Liver disease Infant---yellow Adults---brown ◦ soft formed Additional notations ◦ Frequency ◦ Shape ◦ constituents Guaic/hemacult Melena Ova and parasites Diet positioning Exercise Digital stimulation Timing of defecation Cathartics/laxatives/enemas privacy Tap water ◦ Stimulates by distention ◦ 750-1000 cc Saline ◦ Stimulates by distention ◦ 1 tsp salt Hypertonic ◦ Draws fluid into the colon (distention) ◦ 4 ounces of fluid ◦ Ex: fleets Soapsuds ◦ Irritates mucosa ◦ Castile soap ◦ 7500-1000 cc Oil retention ◦ Low volume ◦ Softens feces ◦ Must retain for extended time Up and down flush ◦ Aids expulsion of gas ◦ Small amt of fluid introduced, lower bag--repeat Explain procedure Sim’s position Lubrication tube 3-4 in. Insert tube gently toward umbilicus Do not raise container more than 18 in above anus Ask client to retain as long as tolerable Record type and amount of soln and content return Observe for intolerance: