ADULT CARE EXAM 3 (part 2)

bowel and urinary lectures

Constipation

• how many poops times a week counts as constipation?

• what are the poop characteristics like?

• less than 3x per week

• hard and dry

Impaction

• poop collected and wedged in rectum

Risk factors

• unconcious

• immobility

• confusion

Manifestations

• lost appetite

• oozing liquid stools

• abdominal distention + cramping

• nausea/vomiting (bc the distention triggers vomit reflex)

• rectum pain

Intervention

• impaction removal

  • sims position > stick finger in butthole > pull out pieces of poop

Diarrhea

Concerns for

• dehydration, electrolyte imbalance

• skin breakdown

Incontinence

• physical condition resulting in inability to control feces and farting

Caused by

• impaction

• bowel or neuro conditions

• CDIFF

• laxative abuse

Considerations

• harms body image + causes possible social isolation

Flatulence

Caused by

• opioids

• immobility

• surgery

Manifestations

• pain, cramping, “fullness”

Hemorrhoids

• dilated engorged veins of rectum

Caused by

• straining

• pregnancy

• heart failure + chronic liver disease

  • bc these cause blood backup into veins = distended engorged veins

Diagnostic and lab testing

• fecal specimen

• fecal occult blood test (exL guiac stool test)

• colonoscopy

Bristol stool scale

• has hard lumps that are difficult to pass

• lumpy sausage shaped

• cracked surgace

Acute care management

• medications

• positioning

• health promotion

• bowel diversions (aka ostomies): temporary or permanent artificial opening of abdomen connected to opening of ileum or colon

Types of ostomies + their associated stool textures

• ileum =

• transverse colon =

• sigmoid colon =

• end colon =

• liquid stools (literally brown water)

• thick liquid or soft stool

• formed stool

• formed stool

Ostomy care

• assess stoma

  • should be what color?

• assess surrounding skin for skin breakdown = bad

• when to empty pouch?

• when to change to a new pouch?

• patient teaching: disturbed body image and psychosocial changes

• tbh can refer to a wound ostomy nurse

Nutritional considerations for ostomies

• post-op

• colostomies

  • regular diet with proper fiber to meet stool soft

• ileostomies

  • dehydration risk (bc the stools r liquid)

  • encourage rehydrating with glass of water after voiding

• food blockage from indigestible fiber

  • AVOID corn, popcorn, cabbage, raw mushroom, fresh pineapple

  • chew food thoroughly

• pink/red

• when 1/3 or ½ full

• once or twice a week

Using bed pan

• Patient in ____ position while HOB is raised to ___

• ROLL patient onto bed pan (NEVER lift them onto it)

• Make sure patient comfy

• sitting

• 45 degrees

Medication therapy for constipation

To promote poop

• what drugs are stronger than laxatives?

• do suppositories or oral meds work faster?

To prevent diarrhea

• anti-mobility and anti-diarrhea drugs

Enemas

• clean the enema with:

  • normal saline (safest option)

  • tap water

  • hypertonic solution

  • soapsuds

• administering the enema:

  • BE CAUTIOUS using on patient with _____ bc stimulates vagus nerve —> risks bradycardia, dropped BP, fainting

  • process: sims position > explain procedure and length of time to retain the solution BEFORE he/she can poop > observe the results

• Types

  • oil retention enema: used to soften stools

  • carminative enema: used to relieve gas

  • kayexalate enema: used to remove K from body

• cardiac disease

if enemas fail to work, u gotta remove the enema with ur fingers (digital removal)

• LAST RESORT

• loosen the fecal matter by massaging around it

• you can use enema afterward

Nasogastric tubes

Used for different things

• lavage (flushing out the stomach)

• enteral feedings

• suctioning gastric content

• decompression (to relieve abdominal distention/gas buildup)

Types

• ____: used for drug administration OR enteral feeding

• ____: used for suctioning OR decompression

• fine bore or small bore (10-12 for women; 14-16 for men)

• large bore (above size 20)

Health promotion and patient teaching

• poop same time everyday

• good diet

• reccomend 150 mins of exercise weekly

• maintain skin integrity if u have fecal incontinence

General

• low cardiac output > low kidney perfusion > accumulated waste that circulates through blood

• typical daily urine output is ____

• urine output < 30ml/hr indicates possible issue with either of what 3 things?

• 1200-1500mL

• blood volume, kidney, or circulation

Terminology

• ___: low urine output

• ___: high urine output

• ___: no urination

• ___: painful urination

• ___: urge to pee often at night

• ___: blood in pee

• ___: you have the urge to pee, but it wont come out; common in men with BPH

• oliguria

• polyuria

• anuria

• dysuria

• nocturia

• hematuria

• hesitancy

Factors influencing urination

• etc etc etc

• fever (bc fluid was lost to sweating)

• SX of fluid imbalance (polyuria, oliguria, etc etc)

Aging considerations affecting urination

• decreased kidney size

• decreased GFR

• altered hormone levels

• loss of bladder muscle elasticity/strength

• BPH @ men

• constipation can cause urinary retention (bc urethra and colon located next to eachother. thus distended colon = compressed urethra = cant pee)

Assessment

• physical exam

  • if smth is wrong with urinary system = lower abdominal pain or flank pain

• lab tests

  • if urine is foamy = ____

  • if urine smells sweet/fruity = ____

• protein in urine

• glucose in urine

Urine specimen collection methods

• Midstream clean catch urine culture

• Random urinalysis (UA)

  • NEVER take specimen from urine bag if patient has foley catheder UNLESS you JUST changed the bag bc otherwise its contaminated

• Creatinine clearance: 24 hr urine sample that measures amt of creatinine present in urine within 24 hrs

  • patient needs to pee in cup each time within the 24 hrs. if they forget even ONCE, nah gotta redo the whole thing…

• Dipstick: used to test if ____ is present in urine from UTI

• acetone

• intermittent catheder (IC): used to drain bladder and removed ASAP

  • GOLD STANDARD bc reduced infection risk!

  • material of catheder: plastic or red rubber

• indwelling catheder (foley): remains in place for weeks, providing continous drainage for chronic retention

  • high infxn risk

  • material of catheder:

    • latex (up to 3 weeks)

    • pure silicone or teflon (up to 3 months)

Perineal and catheder care

• perform perineal or catheder are every shift OR after each bowel movement

• cleanse catheder w/soap and warm water around the catheder —> down and away the entire length of tube > rinse off soap

• DONT advance the catheter further into the bladder (so avoid pushing/pulling on catheter)

Catheter removal

• remove it as soon as its no longer needed

• prevent urethral trauma by FULLY deflating balloon BEFORE removing catheter

• dribbling and temporary dysuria is NORMAL after catheter removal

• ASSESS urinary function by noting urine output from their FIRST void after removal

  • if anuria within ____ hrs post-removal ——> notify HCP

• 4 hrs

Alternatives to catheters

• condom catheter: used for incontinent or comatose men

• supra-pubic catheter: surgical placement of catheter through abdomen into urinary bladder

Alterations in urinary elimination

• urinary retention

• urinary incontinence

• UTI

• urinary diversion

Urinary retention

• bladder unable to fully empty

Manifestations

• lower abdomen tenderness

• no relief after urination

• dribbling or leakage

• restless

• sweating

Interventions

• warm bath to induce micro-urination

• void every 2-3 hrs

• ____ pushing down on lower abdomen when attemping to void

• ____: same technique as trying to pop your ears while pinching nose

  • DONT do this is pateint has cardiovascular disease (bc stimulates vagus nerve → bradycardia, drop in BP, fainting)

• credes method

• valsava meneuver

Urinary tract infection

• usually from indwelling catheters

• often caused by Ecoli

Risk factors

• women at higher risk

• older patients

• urinary retention

• immunocompromised (including diabetic ppl)

• obesity (bc pt cant self clean well)

• CV issues

• pregnancy

• having multiple sexual partners

Manifestations

• in older adults, they often display ______

• fever, chills, n/v

• dysuria

• increased frequency

• hematuria

• cloudy urine

Nursing interventions

• antibiotics and pain management

• clean catheder 3x mimimum everyday and after each bowel movement

• void ever 2-4 hrs

• hydration!!!

• altered LOC and NO FEVER! (bc usually fever is common SX)

UTI cysticytis VS UTI pyleonephritis

Cysticytis UTI

***this is how typical uti begins before traveling up to ur kidneys***

• UTI of the lower portion of bladder

• SX: increased frequency, urgency, hematuria

Pyleonephritis UTI

***this is a progressed uti***

• UTI of the kidneys

• SUPER BAD; can develop into sepsis > kidney failure > death

• SX: flank pain, fever, chills, n/v, fatigue

Urinary incontinence

• involunary leakage of urine

Risk factors

• females with multiple vaginal birth pregnancies

• older adults

• urinary retenton

• diabetes

• neurological disorders (ex: parkinsons, CNS injury)

• confusion, dementia, depression

Urinary diversions

• Continent urinary reservoir (Indiana pouch)

  • basically ostomy but for urination that pt inserts catheder into when they need to pee

• Orthotropic Neobladder:

  • new bladder made from intestines

  • most “normal” option bc allows pt to still pee through urethra

• Urostomy (or Ileal Conduit)

  • piece of intestine turned into a “pipe” for urine to constantly flow out of

  • person has no control so kinda messy

• Nephrostomy:

  • tube inserted directly into kidney to completley bypass the bladder