Elimination summer 2013 s

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Elimination summer 2013 s

  1. 1. ELIMINATION P&A
  2. 2. QUICK ANATOMY MOMENT  Kidneys  Ureters  Bladder  Urethra
  3. 3. NORMAL URINE  Volume – approx 250ml-400ml per void  - normal production 30ml/hour -1200-1500cc for average adult per 24 hours - 500-600 newborns  Color light yellow  Clarity clear without sediment  Odor no odor
  4. 4. FACTORS AFFECTING URINATION  Fluid Intake – influences output and frequency  Hypovolemia- loss of fluid  Nutrition – food content, salt, ETOH, caffeine  Body position – work with gravity  Cognition – dementia/confusion, stroke
  5. 5. FACTORS AFFECTING URINATION (CONT.)  Psychological factors – stress, running water, warm water, privacy  Obstruction – anatomical, disease process  Infection – E. coli  Medications – diuretics
  6. 6. ALTERED URINARY FUNCTION  Dysuria  Polyuria  Oliguria  Urgency  Frequency
  7. 7. ALTERED URINARY FUNCTION (CONT.)  Nocturia  Hematuria  Pyuria  Urinary retention
  8. 8. INCONTINENCE  Stress increased abdominal pressure  Functional unable to get to bathroom  Total continuous, involuntary
  9. 9. DIAGNOSTICS  Random specimen - does not need to be sterile - into container or nun’s cap  Clean catch - sterile - three wipes
  10. 10. DIAGNOSTICS (CONT.)  24 hour -kidney function - must include all urine - timing  Catheter sample - sterile - straight cath or indwelling
  11. 11. COLLECTING URINE FROM YOUNG CHILDREN  Catheterization not recommended  Use of collection bag
  12. 12. TESTS  Specific gravity - weight or concentration of urine compared to water - urinometer - normal adult 1.010 – 1.025  Reagant strips - dipped in urine - measures substances in urine such as glucose, proteins & ketones
  13. 13. TESTS (CONT)  Urinalysis - most common - 20cc-30cc sample  Urine C&S - identify microorganisms - 24 to 48 hours - often related to antibiotic use
  14. 14. URINARY HEALTH PROMOTION  Intake  UTI’s  Muscle tone
  15. 15. URINARY CATHETERS  Indications -inability to void, accurate measurement, irrigation, comfort  Types - straight, indwelling (Foley), triple lumen  Risks - infection, trauma
  16. 16. STRAIGHT CATHETERIZATION  Wash hands  Check pt ID  Explain procedure  Position patient  Open kit  Bottom drape  Sterile gloves  Top drape  Pour betadine on cotton balls  Open lubricant  Nondominant vs dominant hands  Insert and advance  Sample if needed  Reposition patient, remove gloves, wash hands document
  17. 17. INDWELLING CATHETERIZATION  Wash hands  Check pt ID  Explain procedure  Position patient  Open kit  Bottom drape  Sterile gloves  Top drape  Test balloon  Pour betadine on cotton balls  Open lubricant  Nondominant vs dominant hands  Insert, advance & inflate balloon  Sample if needed  Reposition patient, strap to leg, remove gloves, wash hands document
  18. 18. INDWELLING CATHETER (FOLEY)
  19. 19. NURSING RESPONSIBILITIES  Placement and removal  Assessment  Sample collection  Troubleshoot  Irrigate when needed
  20. 20. BLADDER IRRIGATION
  21. 21. OTHER TYPES OF URINARY CATHETERS Suprapubic Nephrostomy tubes Condom Catheter
  22. 22. OTHER RELATED URINARY COMPONENTS  Dialysis Hemodialysis Peritoneal dialysis  Bladder scanner
  23. 23. BOWEL ELIMINATION
  24. 24. FACTORS AFFECTING BOWEL ELIMINATION  Nutrition - fiber - lactose intolerant - gluten  Fluid intake - 75% water - ↓fluid intake  Hemorrhoids - enlarged varicose veins  Medication - narcotics - Fe - antacids
  25. 25. ALTERED BOWEL FUNCTION  Constipation - infrequent, painful, hard, dry  Fecal impaction - accumulation in rectum - digital disimpaction  Diarrhea - ↑ motility - medication  Incontinence - involuntary  Distention - inactivity  Disease process - Crohn’s disease, Cystic Fibrosis
  26. 26. DIAGNOSTIC TESTS  Specimen - stool only - procedure  Occult blood - Guaiac or Hemoccult - procedure  Culture - atypical intestinal organisms - procedure, O&P  Radiologic - x-ray image of opaque substance - barium, laxatives, enemas, NPO  Endoscopy - visualization of internal structures -EGD (esophagogastro duodenoscopy) http://www.youtube.com/watch?v=_qrbzpDA98g&feature=related
  27. 27. SPECIMENS
  28. 28. CHECKING FOR OCCULT BLOOD  http://www.youtube.com/watch?v=Pc3MtqUwFwE
  29. 29. COLONOSCOPY  http://www.youtube.com/watch?v=W0fjO0rsCIw
  30. 30. ENEMA  Purpose – cleansing of large bowel  Small Volume - commercially prepared, oil or water, approx. 150cc  Large Volume - warm tap water or saline, - 1000cc for adult, 240cc-350cc for child, 15cc-60cc infant  Return Flow - flatus - 300cc-500cc - repeat as necessary
  31. 31. ENEMA PROCEDURE  Wash hands  ID patient and explain procedure  Fill bag with fluid  Place patient in left lateral position  Place chux  Insert lubricated end of enema tubing 3-4 inches into rectum  Hang/hold enema bag 12-18 inches above patient  Place on bedpan or BSC or eventually bathroom  Make patient comfortable  Wash hands  Document
  32. 32. FECAL DIVERSION  Procedure  Ostomy  Ileostomy  Colostomy - temporary or permanent - irrigation - clothing - unusual circumstances
  33. 33. STOMA
  34. 34. TYPES OF COLOSTOMIES  Ascending  Descending Sigmoid
  35. 35. TYPES OF COLOSTOMIES (CONT.)  Transverse
  36. 36. CARE OF THE COLOSTOMY  Assessment - pink, no pain, flush to skin  Cleaning - soap and water  Bag changing - disposable vs reusable  Emotional support
  37. 37. COVER UP

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