Elmination

Updated Grades: Grades for the morning group have been updated multiple times to ensure accuracy.
Group Quiz:
- Students have unlimited attempts to complete the group quiz that is due today.
Final Exam Preparation:
  - At the end of class, a PowerPoint presentation with key questions will be presented. This will be beneficial for preparing for the final exam.
  - It is important for students to answer questions during this presentation actively.
  - Topics covered in the PowerPoint will include:
    - End of life
    - Skin integrity
  - Final exam details:
    - Total of 80 questions, each worth 1 point.
    - 20 questions from each subsection (e.g., elimination, pain, mobility).
    - Inclusion of mental health questions which may differ from previous exams.

Weekly Topics Broken Down:
- This week focuses on elimination and related topics.
- Next week will cover pain, with a final lecture class on comfort and pain.
Final Exam Outline:
- Available under weekly materials in the module.
- Students should review it to clarify any uncertainties or 'muddy areas' in understanding.

PowerPoint Presentation:
  - Will include specific questions about:
    - End of life scenarios
    - Mental health topics
    - Inflammatory processes
Class Participation:
- Students are encouraged to either read questions aloud or work as a group to answer them, ensuring active participation and understanding.

Basics of Ostomy Care:
  - Stoma Health Monitoring:
    - A healthy stoma should not show discoloration or cyanosis; if it does, it indicates insufficient blood flow and requires contacting a healthcare provider.
    - Prolapse and recessions of the stoma are other conditions to monitor closely.
  - Pouch Changes:
    - Use appropriate adhesives during pouch changes to avoid pressure on the stoma.
    - Education about ostomy care is crucial, including how to change a pouch
    - Monitor for dermatitis around the stoma area due to adhesive contact.
  - Complications and Management:
    - Potential complications include hernias from abdominal surgeries, which are likely due to weakened muscles post-surgery.
    - Emphasis on teaching patients self-care techniques, such as how to manage flatulence in the pouch.
  - Functional Problems:
    - Address potential issues such as excessive flatulence build-up, which may cause discomfort or leakage.

Kidney Function Tests to Monitor:
  - Glomerular filtration rate (GFR), creatinine, blood urea nitrogen (BUN), and assessments of urine output are crucial for kidney function monitoring.
  - Normal GFR should be around $90 ext{ mL/min}$ .
  - Hemoglobin can indicate anemia common in chronic kidney disease, which leads to urine output changes and waste accumulation leading to uremia.
Acute vs. Chronic Kidney Disease:
  - Acute Kidney Injury (AKI):
    - Rapid, reversible decline in kidney function often caused by infections or dehydration. Symptoms may include increased creatinine levels and potential elevations in potassium.
    - Urine outputs may decrease, leading to symptoms of dehydration or metabolic acidosis.
  - Chronic Kidney Disease (CKD):
    - Gradual loss of kidney function potentially leading to renal failure.
    - Long-term issues often presenting with sustained fluid retention, elevated creatinine, and electrolyte imbalances (potassium mainly).
Important Blood Tests:
- Elevated creatinine indicates renal dysfunction, where levels may be significantly higher in CKD than in AKI.
- BUN values will also likely be higher in both conditions but are crucial for fluid status assessment.

Fluid Intake Recommendations:
- Typical recommendations suggest a minimum of 3 liters of fluid intake per day for adequate hydration.
Diet Impact on Kidney Health:
- Patients should avoid high sodium, protein, and processed sugar to limit stress on the kidneys and prevent worsening conditions like CKD.

Types of Incontinence:
  - Stress Incontinence: Involuntary leakage following activities that increase abdominal pressure, often due to weakened pelvic floor muscles.
  - Urge Incontinence: Related to overactive bladder conditions and may present following neurological damage.
  - Overflow Incontinence: Often related to obstruction and failure to fully empty the bladder, common in men with prostatic enlargement.
  - Functional Incontinence: Occurs when mobility issues prevent reaching the bathroom in time.

Fiber Intake:
- Important for bowel regularity; inadequate fiber can lead to constipation, while excessive fiber without adequate hydration can lead to diarrhea.
BRAT Diet:
- Often recommended for gastrointestinal upset to help firm up stool consistency (bananas, rice, applesauce, toast).
Dietary Modifications for Specific Conditions:
- Maintaining adequate hydration is necessary during illness to prevent dehydration and related complications (e.g. UTIs).
Urinary Tract Infections (UTIs):
- Stress the importance of proper hygiene and dietary choices to prevent UTIs, especially in at-risk populations.

Diverticulitis:
- Inflammation of diverticuli from a diet low in fiber can cause significant issues with digestion and lead to further complications if not addressed with nutritional strategies.
- Older age and low-fiber diets significantly increase risk factors.
Irritable Bowel Syndrome (IBS):
- Characterized by abdominal pain and altered bowel habits; management often includes avoidance of trigger foods and possible psychological support for comorbid depression.
Ulcerative Colitis and Crohn's Disease:
- Autoimmune conditions that lead to chronic inflammation in the GI tract causing ulcers and fistulas, necessitating comprehensive management through diet, medication, and sometimes surgery.
- Regular monitoring of nutrients like Vitamin B12 and D is crucial due to malabsorption issues common in these conditions.

Types of Diversions:
- Urostomy: Surgical diversion of urine, often requiring careful caregiving.
- Ileostomy and Colostomy: Diverting bowel contents into a pouch for collection, particularly when there are issues like cancer or inflammatory bowel diseases.
Post-Surgical Care Considerations:
- Importance of hydration, skin care around stomas, and monitoring for signs of complications like infection, stoma prolapse, or strictures.

Continuous assessment of patients’ outputs and vital signs, emphasizing the connection between hydration and overall health.
Encouraging physical therapy and dietary modifications to promote better elimination health for all patients.
Identifying potential red flags in patient conditions early to prevent complications.