RNSG 1301 Raising the Bar for Success First Semester 2020 – El Centro College | Raising the Bar for Success First Semester 2020

RNSG 1301 Raising the Bar for Success First Semester 2020 – El Centro College Elimination What is the definition of elimination? • Excretion of waste products from kidneys and intestines What are the different types of incontinence? • Urine incontinence – involuntary loss of urine on a continuous/intermittent basis - - - - - - - - - - - - - - - - What is bowel training and who should have bowel training? • Bowel Training Program – program that manipulates factors w/in a person’s control to produce a regular pattern of comfortable defecation w/o meds or enemas • Toddlers b/w 18-24 mos • Pts w/ history of chronic constipation and impaction and those incontinent of stool What is constipation? • Passage of dry, hard fecal material Who is at risk for constipation? • Older adults, those on meds that cause constipation (opioids) What nursing actions should be implemented for a pt. with constipation? • ↑ fiber and fluids, ↑ pt. activity, enema, laxatives & stool softeners, evaluation of meds When would it be appropriate to get a 24 hour urine collection? • When urine samples indicate further testing• Creatinine clearance (renal function) • Nephropathy – high microalbumin (30 mg/24h) How is a 24 hour urine collection performed? • Discard first void then begin 24-h collection (ALL urine in 24h period) • Get venous bl. Sample during period • Send sample promptly to lab @ end of 24h period - - - -- - - - - - - - - - - - - - - - - - - - - - - How do you assess for a urinary tract infection? • Physical exam, labs (urine sample culture & sensitivity (C&S) test) • Presence of bacteria in a midstream clean-catch or sterile specimen • Symptoms: dysuria, urinary frequency/urgency, cloudy urine w/ foul odor • RBCs and nitrates in urine How can the risk of a urinary tract infection be decreased? • Sterile insertion • Proper handling of catheter and drainage device (nonsterile gloves) What and how should urine be evaluated? What is important to document?What and how should a patient’s stool be evaluated? Documentation?What medications/supplements change the color of urine and / or stool? • Red dye (Jello), beets, carrots - red • Meat protein – dark brown • Spinach – green • Cocoa – dark red/brown • Senna – yellow• Bismuth, Fe, licorice, charcoal – black • Barium – milky white When is it important to measure strict Input & Output? • CHF, Kidney Disease, syndrome of inappropriate antidiuretic hormone secretion (SIADH), diabetes insipidus (DI), ICP risk • Dehydration (diarrhea, vomiting, ↓ PO intake) • IVF • Edema presence What nursing actions should be done if urine is not draining from an indwelling Foley catheter? • Ensure catheter is not in vaginal orifice, leave in place and place new catheter directly above it before removing old catheter. • Check tube for kinks, move tubing and drainage bag to facilitate drainage • Check if catheter plugged with sediment, if so, get order from PCP and gently irrigate catheter to restore flow What is a colostomy? • Surgical opening in abdominal wall for fecal elimination, located @ colon • Allows formed feces in colon to exit through stoma • May be temporary or permanent Why would a patient need a colostomy? • Bowel diversions to allow intestine to rest/heal after a disease, surgery, or injury • - - - - - - - -- - - - • Withhold food and oral fluids (NPO) • Pain meds (narcotics) can exacerbate issue • Surgical intervention may be needed if condition persists What is C.-Difficile and what is the plan of care for a pt. with C. Difficile? • Clostridium dificile – bacterium causing symptoms ranging from diarrhea to lifethreatening inflammation of colon • Treat w/ antibiotics but stop AB that triggered C.diff if possible • Vancomycin, metronidazole (Flagyl) • Fidaxomycin (Dificid) more effective and more expensive than above ABs • Fecal Microbiota Transplant (FMT) • Probiotics • Push fluids and balance nutrition What is Benign Prostate hypertrophy (BPH)? How is it treated? • Enlargement of prostate gland which impairs urination • 5-alpha reductase inhibitors (finestaride/Proscar) - ↓ prostate size• Alpha – adrenergic receptor blockers (tamsulosin/Flowmax), alfuzosin (UroXatral), doxazosin (Cardura) • Herbal therapy (saw palmetto), unestablished effectiveness What symptom is associated with feeding intolerance? • Galactosemia – deficiency in liver enzyme needed to break down lactose What risk factors are associated with diarrhea and bowel incontinence? • Diarrhea – psychological stress, meds, cathartics, food allergies, intolerance (food/fluid), colon diseases; diseases affecting digestion, absorption, & secretion in GI tract • Bowel Incontinence – elderly, physiologic/lifestyle changes, foods w/constipating effects (processed cheese, lean meat, eggs, pasta), pts on prolonged bedrest, , psychologic stress