Urinary and Bowel Elimination Study Guide

Urinary and Bowel Elimination Toilet Training     Able to hold urine for 2 hours Can feel full bladder and can communicate need to void Usually occurs 18-24 months old Girls usually able to before boys Risk for Urinary Incontinence (Child)  Regression due to hospitalization Urinary System: Child       Bladder usually not palpable when empty Palpated above symphysis pubis to umbilicus Normal pH 5-6 Color Normal: Pale yellow to amber Urethral Orifice: No presence of inflammation Odor Normal: None Urinary System: Health History        Voiding habits Current or past difÏculties Medications Water intake Pain Incontinence Nocturia, dysuria Sterile Specimen from Foley: Steps 1. 2. 3. 4. 5. 6. Clamp for 30 minutes Use an antiseptic swab to clean the access port Attach syringe and aspirate urine into the syringe Release clamp Transfer specimen into container Label per policy and institution Cystoscopy Procedure  What is it o A procedure to view, diagnose, or treat problems of the lower urinary tract  o A scope is inserted through the urethra in order to visualize the bladder, ureteral orifices, and urethra Why is hematuria common post op? o Due to trauma from the procedure Teaching Voiding Habits     Hand washing after voiding When urge-void Privacy Void in usual position UTI Prevention       Drink 8-10 glasses of water per day Observe urine for change in color, odor, frequency Clean front to back Void after intercourse Showers over bath o Bath: sitÝng in dirty water Avoid restrictive clothing Inter Dwelling Catheter (Foley) Care       Drainage bag below level of bladder Push water intake Can shower Empty when 2/3 full or more frequent Teach handwashing Never hang on side rail Inserting an Inter Dwelling Catheter    Is a sterile procedure Discard and restart if sterile field is contaminated Steps o Perform perineal care o Set up sterile field o Clean perineal area with betadine solution o Lube and insert catheter until urine return o Inflate balloon with saline o Secure catheter to leg o Secure collection bag on a non-movable part of bed making sure below level of the bladder Continuous Bladder Irrigation (CBI)     May be ordered when a blood clot or debris threatens to occlude the catheter Bladder irrigation solution should be hung 2.5-3 feet above bladder Assess for decreased urine output or bladder distention o Can indicate that the irrigation solution is not leaving the bladder as expected Know when to stop irrigation o Stopping the flow of the irrigation is the appropriate response until patency can be assessed Types of Urinary Incontinence        Transient o Appears suddenly and lasts 6 months or less Mixed o Urine loss with features of two or more types of incontinence Overflow o Overdistention and overflow of bladder Functional o Caused by factors outside the urinary tract Reflex o Emptying of the bladder without sensation or need to void Total: o Continuous, unpredictable loss of urine Stress o Involuntary loss of urine related to an increase in intra-abdominal pressure Bowel Health      Regular exercise High fiber Avoid antacids and aluminum and iron 2000-3000 mL water daily Avoid opioids Chronic Constipation Teaching   Food that promote peristalsis o Fruits, vegetables, whole grains Food to avoids  o Cheese, lean meat, eggs, pasta Foods that can promote gas and increase discomfort o Onions, cabbage, beans, cauliflower Risk for Altered Elimination   High risk: Bowel surgery, antibiotics, C-diff, contrast for X-rays Low risk: NPO for short time Bowel Obstruction    A blockage prevents the contents of the intestines from passing normally through the digestive tract Requires Immediate intervention Absent bowel sounds Stool Assessment     GI bleed (upper) / black stool Clay color: Absence of bile Pencil shape – Obstruction Fatty – Impaired digestion Constipation   Infrequent bowel movements Priority? To assess frequency of bowel movements Fecal Occult Blood Test Teaching    Definition: Detect presence of blood in stool Avoid o Meat and red coloring, veggies, fruits, aspirin above 325 mg No iron for 3 days prior EGD Care: (esophagogastroduodenoscopy)     Definition of EGD o Procedure that uses a flexible fiberoptic scope to visualize the esophagus, stomach, and upper duodenum Immediate intervention o Monitor the client for signs or perforation, such as pain, difÏculty swallowing, and vomiting blood Expect a hoarse voice or sore throat Nausea common Food Safety Teaching            Never buy food with damaged packaging Take items requiring refrigeration home immediately Wash hands and surfaces often Use separate cutÝng boards for foods Thoroughly wash all fruits and vegetables before eating Do not wash meat, poultry, or eggs to prevent spreading microorganisms to sink and other kitchen surfaces Never use raw eggs in any form Do not eat seafood raw or if it has an unpleasant odor Use food thermometer to ensure cooking food to safe internal temperature Keep food hot after cooking Give only pasteurized fruit juices to small children Enema     Ensure client understands procedure Do not discount fears Client can refuse Do not threaten Enema Types     Cleansing enemas Carminative o Expel flatus (gas) Medicated Oil retention o Lubricate to expel stool Large Volume Enema (750-1000 mL)     Warm solution Recommend amount of fluid Tap water (cannot be given x2) Where to hang? o Max 18 inches o Height determines speed