Comprehensive Nursing Lab 4: Elimination, Assessment, and Reproductive Health

What is elimination?

The removal/excretion of physiological waste products from the body.

What are the two major types of elimination?

Urinary and gastrointestinal (bowel) elimination.

What is urine elimination called?

Micturition/urination.

What is bowel elimination called?

Defecation.

What factors can affect elimination?

Age, diet, fluid intake, activity, medications, illness, stress, and surgery.

What is the correct order for an abdominal assessment?

Inspection → Auscultation → Percussion → Palpation (IAPP).

Why is auscultation performed before palpation?

Palpation can alter bowel sounds.

What are you looking for during abdominal inspection?

Contour, symmetry, distention, skin changes, scars, lesions, and visible masses.

What are bowel sounds?

Sounds produced by movement of gas and intestinal contents through the GI tract.

What is peristalsis?

Coordinated muscular contractions that move food and intestinal contents through the GI tract.

What is the normal character of bowel sounds?

Irregular, gurgling sounds that vary in frequency.

Where do you begin auscultating bowel sounds?

Right lower quadrant.

What should you do if bowel sounds aren't heard immediately?

Continue listening according to the required assessment period; don't immediately document them as absent.

Should the patient empty their bladder before an abdominal assessment?

Yes, when appropriate, because a full bladder can cause discomfort and interfere with assessment.

What information should be included in a nutrition history?

Food preferences, appetite, typical food/fluid intake, dietary restrictions, supplements, weight changes, and factors affecting eating.

Why are food preferences important?

They help identify dietary patterns and develop individualized nutrition care.

What measurements are commonly used to assess nutritional status?

Height, weight, BMI, and changes in weight over time.

What does BMI assess?

Weight relative to height as a screening measure of body size.

What can an unexpected weight change indicate?

A possible nutritional, metabolic, or health problem.

What is enteral nutrition?

Nutrition delivered directly into the gastrointestinal tract through a feeding tube.

How is initial feeding-tube placement confirmed?

X-ray/radiographic confirmation.

Why shouldn't you use the 'whoosh test' to confirm tube placement?

Auscultating air injected through the tube is not a reliable method for determining tube location.

What is gastric residual volume (GRV)?

The amount of gastric contents remaining in the stomach when assessed through a gastric feeding tube.

What does gastric residual help assess?

Gastric emptying and tolerance of enteral feeding.

What is a continuous tube feeding?

Formula delivered continuously, usually by an enteral feeding pump.

What is an intermittent tube feeding?

Formula given at scheduled intervals rather than continuously.

What is a bolus feeding?

A larger amount of formula administered over a relatively short period.

What is an important position during tube feeding?

Keep the patient's head of bed elevated, generally 30-45°, as appropriate.

Why is the head of bed elevated during tube feeding?

To reduce the risk of aspiration.

What is aspiration?

Entry of food, fluid, or gastric contents into the airway/lungs.

What counts as intake?

Fluids taken orally, enteral feedings, IV fluids, liquid medications, and other measurable fluids.

What counts as output?

Urine, emesis, liquid stool, and other measurable fluid losses.

What is the purpose of measuring I&O?

To assess fluid balance.

What is the most important output measurement to accurately monitor?

Urine output.

What should you do when measuring urine output?

Measure it accurately and document the amount according to facility policy.

What is a capillary blood glucose test?

A blood glucose measurement obtained from a finger-stick blood sample.

Why is the side of the fingertip often used?

It generally causes less discomfort than puncturing the center of the fingertip.

What should you do before obtaining a finger-stick glucose?

Verify the patient, explain the procedure, perform hand hygiene, prepare equipment, and follow the facility procedure.

What is an ostomy?

A surgically created opening that allows body waste to exit through the abdominal wall.

What is a stoma?

The visible portion of the intestine brought through the abdominal wall.

What should a healthy stoma generally look like?

Moist and pink to red.

What stoma finding should be concerning?

A stoma that is pale, dusky, blue, purple, brown, or black.

What is a Foley catheter?

An indwelling urinary catheter that remains in the bladder to continuously drain urine.

Where should the drainage bag be kept?

Below the level of the bladder and off the floor.

Why keep the drainage bag below the bladder?

To promote drainage and prevent backflow of urine.

Should the catheter tubing have dependent loops?

No. Keep tubing positioned to allow unobstructed urine flow.

What does UA stand for?

Urinalysis.

What does C&S stand for?

Culture and sensitivity.

What is the purpose of a urine culture?

To identify microorganisms that may be causing an infection.

What does sensitivity testing determine?

Which antimicrobial medications are effective against the identified organism.

What is a 24-hour urine collection?

Collection of all urine produced over a complete 24-hour period for laboratory analysis.

What happens if urine is accidentally discarded during a 24-hour collection?

Follow facility/lab instructions; the collection may need to be restarted because the specimen is incomplete.

How does aging affect bowel elimination?

Decreased activity, dietary changes, medications, and physiologic changes can contribute to constipation.

How does aging affect urinary elimination?

Older adults may experience changes in bladder capacity, urgency, frequency, and continence.

Why is developmental stage important when assessing elimination?

Normal elimination patterns vary across the lifespan.

What should the nurse do after collecting assessment data?

Analyze the data to identify health strengths and health concerns.

What is a nursing diagnosis based on?

The patient's assessment data and identified responses to health conditions.

What makes documentation effective?

Accurate, objective, specific, measurable medical terminology.

Should the nurse document assumptions?

No. Document objective findings and relevant patient-reported information accurately.

What are the major skills you need to demonstrate for Lab 4?

Tube feeding, glucose testing, I&O, ostomy care, Foley care, elimination devices, weighing, and specimen collection.

What are normal bowel sounds according to your Lab 4?

Approximately every 5-20 seconds.

What are hyperactive bowel sounds?

Sounds occurring more frequently than every 5 seconds.

What are hypoactive bowel sounds?

Sounds occurring less frequently than every 20 seconds.

Are normal bowel sounds regular?

No. They are irregular.

What does peristalsis mean?

Rhythmic muscular contractions that move GI contents through the digestive tract.

What are striae?

Stretch marks.

What is ascites?

Abnormal accumulation of fluid in the abdominal cavity.

What does elimination mean?

Removal and excretion of physiological waste products by the kidneys and intestines.

What two major types of elimination are covered in Lab 4?

Urinary and bowel elimination.

Why is elimination assessment important?

Elimination can provide an indirect gauge of general health.

What characteristics of urine should the nurse assess?

Color, appearance/clarity, odor, sterility, pH, specific gravity, protein, nitrites/nitrates.

What types of questions should be included in a urinary elimination history?

Ask about the patient's normal urinary pattern and changes/problems with urination.

What is urinary incontinence?

Involuntary leakage of urine.

What is frequency in urinary terms?

Urinating more frequently than usual.

What is dysuria?

Painful or difficult urination.

What is urgency?

A sudden, strong need to urinate.

What is important when collecting any urine specimen?

Follow the ordered collection method, provide appropriate patient instructions, label the specimen correctly, and handle/store it appropriately.

Why must specimens be handled and stored properly?

To prevent changes in the specimen, including multiplication of microorganisms that could affect results.

When should a culture specimen ideally be collected in relation to antimicrobial therapy?

Before antimicrobial treatment is started, when possible.

Does a nurse always need a physician's order to collect a specimen?

No, an order is not always required.

For female urinary cleansing, which direction should the meatus be cleaned?

Front to back, not back to front.

How does a 24-hour urine collection begin?

At the designated start time, the patient voids and that initial urine is discarded.

Is the urine voided at the exact start time included?

No.

What happens after the initial void is discarded?

Collect all urine for the next 24 hours.

What happens at the end of the 24-hour period?

The patient voids, and the final urine is included in the collection.

What happens if urine is accidentally missed during a 24-hour collection?

The collection may need to be restarted according to facility/lab protocol.

Why is urine kept on ice during some 24-hour collections?

To preserve the specimen and limit chemical/microbial changes during the collection period.

What is intake?

The amount of fluid entering the patient's body.

What is output?

The amount of fluid leaving the patient's body.

What is the goal of I&O?

Total intake and output should be roughly equal over time, depending on the patient's condition.

What unit is used for I&O?

mL.

Should food itself be recorded as a fluid intake?

Solid food is tracked separately, generally as a percentage eaten, rather than as I&O fluid.

What should you do if a fluid measurement isn't already in mL?

Convert it to mL.

What should you do with I&O totals?

Add them and document the totals.

How many ounces is one cup for your Lab 4 calculations?

8 oz.

How many mL is one cup?

240 mL.

How many ounces is the water pitcher?

32 oz.

How many mL is the water pitcher?

960 mL.

Why might a patient have difficulty eating?

Problems involving the mouth, teeth, gums, swallowing, appetite, ability to feed themselves, finances, or medical conditions can interfere with nutrition.

What should a nurse assess when oral problems may affect nutrition?

The mouth, teeth, and gums.