Nursing Fundamentals, Urinary & Bowel Elimination Study Guide

Flashcards reviewing health assessment techniques, urinary and bowel elimination, infection control, and immobility nursing fundamentals.

What is the normal range for urine specific gravity, and what do high versus low values indicate?

Normal specific gravity is $1.005\text{--}1.030$. A high value indicates concentrated urine (e.g., dehydration, fluid volume deficit, SIADH, glycosuria), while a low value indicates dilute urine (e.g., overhydration, diabetes insipidus, renal failure).

What does a positive nitrites result on a urinalysis specifically indicate?

Positive nitrites indicate a bacterial urinary tract infection (UTI) caused specifically by gram-negative organisms such as E. coli.

How are oliguria and nocturia defined clinically in adult patients?

Oliguria is defined as diminished urine output of $<400\text{--}500\,\text{mL}/24\,\text{hr}$ in adults. Nocturia is defined as waking at night to void $\ge 1\text{--}2\times$.

What causes stress incontinence, and what are the key nursing interventions?

Stress incontinence is caused by weak pelvic floor muscles or sphincter leading to leakage with increased intra-abdominal pressure (cough, sneeze, laugh, exercise). Interventions include Kegel exercises, pelvic floor physical therapy, weight loss, avoiding bladder irritants, pessaries, and scheduled voiding.

What underlying mechanism causes overflow incontinence, and how is it managed?

Overflow incontinence occurs when the bladder does not empty fully and leaks small amounts when overdistended. It is managed with intermittent catheterization, Credé maneuver, and treating the underlying obstruction (e.g., BPH medications or surgery).

What is the single greatest risk factor for catheter-associated urinary tract infections (CAUTI), and how should it be managed?

The duration of catheterization is the single greatest risk factor. Nurses should assess the need for continued catheterization daily and remove the catheter as soon as possible.

What is the proper sequence for an abdominal physical assessment, and why does it differ from other body systems?

The sequence is Inspection -> Auscultation -> Percussion -> Palpation. Auscultation is performed before percussion and palpation so that manual manipulation does not alter bowel sounds.

How do colostomies and ileostomies differ in terms of output consistency and risk of fluid/electrolyte imbalance?

Colostomy output depends on location (ascending = liquid, transverse = semi-liquid/pasty, descending/sigmoid = more formed). Ileostomy output is continuous liquid to semi-liquid because it bypasses the colon (where water is normally reabsorbed), placing the patient at a much higher risk for fluid and electrolyte imbalance.

What does a pale, dusky, or black stoma indicate, and what action must be taken?

It indicates ischemia or necrosis of the stoma tissue (a normal stoma should be beefy red/pink and moist). The nurse must notify the healthcare provider immediately.

When should an ostomy pouching system be emptied, and why?

It should be emptied when it is $\frac{1}{3}\text{--}\frac{1}{2}$ full to prevent the weight of the pouch from pulling on the seal and causing leakage.

What patient teaching is essential when administering bulk-forming laxatives?

Bulk-forming laxatives (e.g., psyllium) must be taken with a full glass of water. Without adequate fluid intake, they can worsen or cause bowel obstruction/impaction.

What are the five cardinal signs of local inflammation and their corresponding Latin terms?

The five cardinal signs are Redness (rubor), Heat (calor), Swelling (tumor), Pain (dolor), and Loss of function (functio laesa).

What are the six links in the chain of infection, and which single intervention is most effective across the entire chain?

The six links are: 1. Infectious agent, 2. Reservoir, 3. Portal of exit, 4. Mode of transmission, 5. Portal of entry, and 6. Susceptible host. Hand hygiene is the single most effective intervention across the entire chain.

How is a Healthcare-Associated Infection (HAI) defined, and when does it typically manifest?

An HAI is an infection acquired during treatment in a healthcare setting that was not present or incubating upon admission. It typically manifests $\ge 48\,\text{hours}$ after admission.

What is the main difference in goal between medical asepsis and surgical asepsis?

Medical asepsis (clean technique) aims to reduce the number and spread of microorganisms. Surgical asepsis (sterile technique) aims to eliminate all microorganisms, including spores.

According to the principles of surgical asepsis, what portion of a sterile field is considered contaminated?

The outer $1\,\text{inch}$ edge of a sterile field is considered contaminated.

What PPE, room requirements, and examples are associated with Airborne Precautions?

Airborne Precautions require an N95 or PAPR respirator, a negative-pressure room, and keeping the door closed. Examples include Tuberculosis, measles, varicella (chickenpox), and disseminated herpes zoster.

What parameters define Droplet Precautions regarding droplet size, travel distance, PPE, and room requirements?

Droplet Precautions are used for organisms spread via large respiratory droplets ($>5\,\mu\text{m}$) that travel $\le 3\text{--}6\,\text{ft}$. Required PPE is a surgical mask; room requires a private room or cohort, and the door may stay open.

What three conditions form Virchow's Triad in the development of a Deep Vein Thrombosis (DVT)?

Virchow's Triad consists of: 1. Venous stasis, 2. Hypercoagulability, and 3. Vessel wall damage.

What is a key physical assessment finding for DVT, and what action is strictly contraindicated?

Assessment findings include unilateral calf pain, swelling, warmth, and redness. Massaging the area is strictly contraindicated due to the risk of embolization.

How frequently should an immobile patient be repositioned, and what position is used cautiously for hypotension/shock?

Patients should be repositioned every $2\,\text{hours}$ (or per facility protocol) to prevent pressure injuries. Trendelenburg position is used cautiously for hypotension/shock to increase venous return to the heart.

On which side should a patient hold a cane, and what is the proper stepping sequence?

The cane is held in the hand opposite the weak/affected leg (on the stronger side). Sequence: 1. Move cane forward, 2. Move weak leg forward with the cane, 3. Move strong leg forward past the cane.

What is the correct sequence of steps when ambulating with a walker?

Sequence: 1. Lift/move walker forward a short distance, 2. Move weaker leg forward into the walker, 3. Move stronger leg forward to meet it. Never take a step until the walker is stable on all four feet.