Elimination Assessments

Page 3: Urinary Assessment

  • Focus on assessing urinary function and health.

Page 4: Subjective Urinary Assessment

  • History of Present Illness: Previous urinary tract infections (UTIs), kidney stones, past surgical procedures.

  • Family History: Conditions like hypertension, diabetes, and bladder cancer.

  • Symptom Inquiry:

    • Dysuria (painful urination)

    • Frequency of urination

    • Incontinence

    • Nocturia (nighttime urination)

    • Anuria (absence of urination)

    • Urgency to urinate

  • Urinary Characteristics:

    • Hematuria (blood in urine)

    • Appearance: clear vs. cloudy

    • Odor

  • Medication History

Page 5: Communication in Urinary Assessment

  • Effective questioning about:

    • Usual urinary patterns

    • Recent changes in urinary habits

    • Past or present voiding difficulties

    • Family history of urinary disorders

Page 6: Physical Assessment - Urinary System

  • Inspection:

    • Check for herniation/prolapse in women, edema, urethral issues.

  • Palpation:

    • Assess costovertebral angle tenderness for pyelonephritis or stones.

    • Check bladder distention and prostate gland.

Page 7: Continued Urinary Assessment Techniques

  • Percussion:

    • Blunt percussion of kidneys to assess tenderness

    • Dull sound = residual urine; Tympanic sound = empty bladder

  • Auscultation:

    • Listen for renal artery bruits indicating turbulent blood flow.

Page 8: Relevant Anatomy for Urinary Update

  • Herniation issues such as bladder into the anterior vaginal wall, drooping uterus, and rectal bulging can impact urinary function.

Page 9: Practice Question - Urinary Assessment

  • Question: Which finding necessitates providing bathroom access?A. Tenderness over the kidneyB. Ingestion of 8oz of waterC. Abdominal bruit presentD. Dull sound over bladder

Page 10: Assessing Urine Characteristics

  • Characteristics:

    • Color, odor, clarity, sediment

  • Output:

    • Minimum of 30mL/hour

    • Continency vs. incontinence

    • Presence of catheter

Page 11: Implications of Urine Color

  • Color Guides:

    • Colorless or pale yellow: Excess fluid, diabetes insipidus.

    • Yellow to milky: Infections, vaginal creams.

    • Bright yellow: Vitamin excess.

    • Pink to red: Blood, certain foods, medications.

    • Blue/green: Medications or infections.

    • Orange to amber: Dehydration, bilirubin presence.

    • Brown to black: Old blood, certain medications.

Page 12: Urinalysis (UA) Overview

  • Process: Clean catch vs. sterile specimen collection.

  • Assessment Parameters:

    • Color, clarity, odor, pH, specific gravity, and tests for proteins, glucose, ketones.

    • Microscopic exams for hematuria, pyuria, etc.

  • Sample Requirements: Minimum of 10mL for testing.

Page 13: Urinalysis Collection Methods

  • Clean Catch Method: Vital for accurate results.

  • Foley Catheter: Collect immediately after insertion.

  • Sterile Specimen via Catheter: Necessitated in incontinent patients.

  • Pediatric Collection: Via catheter until voluntary control is achieved.

Page 14: Interpreting Urinalysis Findings

  • Common Indicators:

    • Hematuria: Infections, stones, or tumors.

    • Proteinuria: Glomerular damage or malignancy.

    • Specific Gravity: Hydration levels.

    • Abnormalities in patients with UTIs: Leukocytes, hematuria, nitrites, and more.

Page 15: Renal Function Testing

  • BUN (Blood Urea Nitrogen): Normal: 10-20 mg/dL; elevated indicates dysfunction.

  • Creatinine Levels: Male: 0.6-1.2 mg/dL; Female: 0.5-1.1 mg/dL.

  • GFR (Glomerular Filtration Rate): Normal: 90-120 mL/min; low indicates kidney issues.

Page 16: 24-hour Urine Collection

  • Purpose: Diagnose kidney problems through total volume collection.

  • Procedure: Start at a specified time; keep on ice and discard first morning urine.

Page 17: Diagnostic Tests for GU

  • Tests Include:

    • X-rays, Ultrasound, CT, MRI for organ structure.

    • Intravenous Pyelogram: Visualizes blood flow through urinary tract.

    • Cystoscopy for enhanced visualization.

    • Biopsy implications for suspected malignancies.

Page 18: Cystoscopy Insights

  • Procedure Overview: Utilizes a cystoscope for internal visualization.

  • Considerations: NPO after midnight, monitor for retention, potential UTI, manage discomfort, and watch for blood in urine post-procedure.

Page 19: Nursing Considerations for Contrast Usage

  • Allergy Assessment: Verify iodine allergies.

  • Nephrotoxicity Monitoring: Increase fluids post-procedure and watch for adverse reactions.

Page 20: Tests That Can Detect

  • Conditions Include:

    • Urinary Tract Infections, Pyelonephritis, CAUTI, Urolithiasis, Cancer, Hydronephrosis.

Page 21: Case Study Example

  • Scenario: Assess an 84-year-old post-cystoscopy patient.

  • Questions to Ask: Fluid intake, urine appearance, family history, pattern changes.

  • Assessments: Check for bladder distension, use percussion.

  • Diagnostics Considerations: Urinalysis, ultrasound, BUN, creatinine tests.

  • Interventions: Warm compresses, fluid management, bathroom assistance, anticipation of symptomatic improvement.

Page 22: Introduction to GI Assessment

  • Focus on assessing gastrointestinal function and health.

Page 23: Subjective GI Assessment

  • Key Symptoms: Abdominal pain, dyspepsia, gas, nausea/vomiting, changes in bowel habits, stool characteristics, nutritional history.

Page 24: Oral Cavity Assessment

  • Components: Inspection of the soft palate, oral cavity, lips, gums, tongue, pharynx.

Page 25: Abdominal Assessment Techniques

  • Inspection Findings: Color changes, hernias, lesions, ascites, peristaltic activity, discoloration, bruises, striae, and shape evaluations.

Page 26: Abdominal Auscultation

  • Sound Types: Regular (5-35 sounds/min), hyperactive (>35 sounds), hypoactive (<5 sounds), absent sounds (confirming full 5 mins).

  • Vascular Sounds: Listen for bruits indicating vascular issues.

Page 27: Continued Abdominal Auscultation

  • Vascular sounds detection for aortic and renal areas indicative of stenosis or obstruction.

Page 28: Abdominal Percussion Techniques

  • Purpose: Assess organ size and density, detect solid masses, indicate normal/abnormal conditions.

Page 29: Abdominal Palpation Techniques

  • Approach: Light palpation for tenderness, deep if indicated. Order of assessment should be consistent: inspection, auscultation, percussion, palpation.

Page 30: GI Assessment Changes with Aging

  • Observations: Muscle tone decreases, saliva and enzyme levels decline, motility changes in intestines.

Page 31: Practice Question - GI Assessment

  • Scenario: What action follows abdominal observation in a client with diarrhea?A. Percussion for liverB. Auscultation for bruitsC. Light touch for tendernessD. Help to bathroom.

Page 32: Stool Assessment Characteristics

  • Normal Parameters: Volume varies, color ranges, odor characteristics, shape distinctions.

  • Abnormal Indicators: Black stools, narrow shapes, presence of blood/mucus.

Page 33: Bristol Stool Chart Overview

  • Types of Feces: Various stool types from Type 1 (hard lumps) to Type 7 (liquid).

  • Diagnostic Indicators: Types indicate constipation to diarrhea issues.

Page 34: GI Diagnostics - Stool Tests

  • Common Tests: FOBT, C. diff testing, stool cultures.

  • Nursing Considerations: Ensure contamination prevention and proper collection techniques.

Page 35: GI Diagnostics - Imaging Studies Overview

  • Types: Ultrasound, fluoroscopy, CT, MRI.

  • Considerations: Pre-procedure preparations (NPO, hydration) and contrast precautions.

Page 36: GI Diagnostics - Endoscopic Procedures Overview

  • Procedures: Upper GI and lower GI evaluations, specimen collection, sedation considerations.

Page 37: Practice Question - Stool Collection

  • Correct Procedure Statements:A. Avoid contamination from toilet bowl.B. Do not include toilet paper.C. Encourage prior bathroom visit.D. Use bedpan for sample collection.E. Clean commode before collection.F. Labs require 45mL sample.

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