Preparation Notes for Elimination & Growth

Chronic Kidney Disease and Urine Output
  • In chronic kidney disease (CKD), urine output is typically decreased.
Stool Specimen Collection for Blood Testing
  • Perform hand hygiene before starting.
  • Use clean gloves during the procedure.
  • Collect stool using a tongue blade.
  • Steps for testing:
    • Smear stool on two panels of a testing card.
    • Add developer solution to each smear and control panel.
    • Results must be read within 30 to 60 seconds.
  • Interpretation:
    • A blue color change indicates a positive result for blood (guaiac positive).
Infant Developmental Milestones
  • Fine & Gross Motor Skills: Understanding of motor skill development is crucial for age-appropriate assessments.
  • Key Milestones:
    • 2-3 months: Decreased head lag.
    • 3 months: Can hold objects briefly & begins to reach for them.
    • 4-6 months: Developed head control; can grasp objects voluntarily by 5 months.
    • 7 months: Bears weight on feet and transfers objects between hands.
    • 8 months: Sits without support.
    • 10 months: Moves from prone to sitting position.
    • 11 months: Places objects into a container and walks while holding onto something.
    • 12 months: Stands momentarily without assistance and tries to build a two-block tower, although usually unsuccessful.
Understanding Constipation
  • Definition: Constipation can be defined as decreased stool output or hard, dry, lumpy stool, which is often painful.
  • Patient Teaching:
    • Increase fluids: This helps to soften stool by pulling water into the bowel.
    • Increase fiber: High fiber promotes stool bulk and peristalsis.
    • Increase activity: Physical activity encourages bowel movements.
Understanding Diarrhea
  • Patient Education:
    • Rest the bowel - avoid spicy or unusual foods.
    • Follow the BRAT diet: Bananas, rice, applesauce, and toast.
  • Risks Associated:
    • Fluid volume deficit due to excessive fluid loss.
    • Skin integrity issues - irritation and potential for excoriation from frequent stools.
Ostomies
  • Types:
    • Ileostomy: Surgical opening in the ileum, produces watery stool.
  • Care Guidelines:
    • Empty collection bag when it's one-third full.
    • Educate patients on measuring stoma size and cutting the wafer appropriately (1/8 inch wider than stoma).
    • Prevent moisture exposure to skin to avoid breakdown.
Urinalysis

  • Blood in Urine (Hematuria):

    • Considered abnormal with 3 or more RBCs per high-powered field.
    • Causes include UTIs, renal stones, malignancies, coagulopathy, and vigorous exercise.

  • White Blood Cells (WBCs):

    • >5 WBCs per high-powered field is considered abnormal, indicating possible infection or other issues.

  • Urinalysis Patterns:

    • Leukocyte Esterase: Positive in urinary tract infections (UTIs).
    • Urine may appear concentrated (dark yellow) in cases of dehydration with elevated specific gravity.
    • Diseases:
    • Acute Tubular Necrosis (ATN): Urine can be dark yellow with muddy brown casts, indicating tubular damage.
    • Nephrotic Syndrome: Urine may appear foamy due to high protein levels, absent leukocyte esterase and casts.