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201B Exam2 > 201 B Exam 2 GI and GU > Flashcards

201 B Exam 2 GI and GU Flashcards

Gastrointestinal Assessment and Genitourinary Assessment (99 cards)

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1
Q

how long does it take for the bowel to return to functional after a GI surgery?

A

1 week to return to functional

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2
Q

what would a surgeon want to know from you about their post-op pt. after bowel surgery before they allow them to eat?

A

-pain levels ↓
-NG tube drainage↓
-BM yet?
-Flatus?
-bowel sounds?
-Ambulating?

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3
Q

in an interview about the GI system what is some subjective data you should look for?

A

last BM
BM description
any nausea
passing gas (flatus)
fullness or bloating/distention

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4
Q

what is some objective data to look for about the GI system?

A

% of meals taken
last BM
character of BMs
intake of fluids
emesis (vomiting)
physical assessment data

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5
Q

what is the order of assessment for the abdomen?

A

inspection, auscultation, palpation (“look, listen, feel”)

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6
Q

nurses only do what kind of palpation of the abdomen?

A

light palpation (deep palpation is only done by a physician)

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7
Q

what are normal bowel sounds?

A

active with irregular gurgling, tinkling every 5-15 sec

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8
Q

what are hyperactive bowel sounds?

A

loud, high-pitched, >every 5-15 sec.

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9
Q

what are hypoactive bowel sounds?

A

faint sounds, < every 5 sec. may not be in all quads,
can be completely absent (ex. after GI surgery)

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10
Q

what are the landmarks of the abdominal area?

A

RUQ
LUQ
RLQ
LLQ

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11
Q

what are the regions of the abdominal area?

A

epigastric region (top)
umbilical region (middle)
suprapubic region
(bottom) aka
hypogastric region

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12
Q

do you palpate the quadrants or the regions of the abdomen?

A

the 4 quadrants are palpated (lightly)

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13
Q

what do we look for when palpating the abdomen? what is normal and abnormal?

A

-normal: soft, non-tender,
pain free
-abnormal: guarding, rigid, tense, firm, tenderness, pain

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14
Q

what are some abnormal abdomen complications that we do NOT palpate?

A

-apendicitis
-acute abdomen (sudden
severe abdominal pain)
-known or suspected
abdominal aortic
aneurysm (AAA)

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14
Q

what is ischemic bowel?

A

the large or small intestine is injured due to not enough blood supply

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15
Q

define illeus

A

loss of forward flow of intestinal contents due to decreased peristalsis, secondary to anesthesia, handling of intestines during surgery, electrolyte imbalance, infection or ischemic bowel

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16
Q

what are interventions for ileus?

A

detection ,
notify MD,
ambulate
hydrate
GI rest
limit opiods
NG tube to suction
oral care

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17
Q

what are the clinical signs of ileus?

A

abdominal pain,
distension
absent bowel sounds
vomiting
constipation
dehydration

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18
Q

large abdomen vs. distension
“inspection”

A

large: uniformly rounded, umbilicus deeply sunken

distended: single rounded curve, umbilicus may flatten or protrude, skin may “glisten” bc stretched

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19
Q

large abdomen vs distension
“auscultation”

A

large: + bowel sounds

distended: varies

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20
Q

large abdomen vs distension “palpation”

A

large: soft, non-tender

distended: firm or rigid, tenderness/pain , guarding

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21
Q

which of these is under voluntary control?

the defecation reflex

the internal anal sphincter

the external anal sphincter

A

the external anal sphincter

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22
Q

feces is what % water and what % solids

A

75% water and 25%

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23
Q

what is the range of normal frequency of bowel?

A

it can vary from 1 to 2 a day to 1 every 1 to 3 days

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24
what are 9 factors affecting bowel elimination?
1. nutrition 2. fluid intake 3. activity 4. lifestyle 5. position (bed rest) 6. pregnancy 7. medications 8. therapeutics (diagnostic tests , surgery) 9. age
25
what are the criteria (2 or more) for constipation?
less than 2-3 BM/week greater than 25% of the time: -straining -lumpy, hard stools -incomplete evacuation
26
what are some associated signs and symptoms of constipation?
-painful BMs -bloating, -rectal fullness -malaise -loss of appetite
27
what are the signs of fecal impaction?
-no BM in 3-5 days -passage of liquid/semi-liquid stool around area of impaction
28
does an enema require a physicians order?
yes
29
what is the purpose (5) of an enema?
-to cleanse bowel (for a procedure or surgery) -bowel training -relive gaseous distension -administer medication -to treat constipation/fecal impaction
30
why is a kayexalate enema given?
to reduce high potassium levels if a person is unable to take medicine orally
31
is a fleet enema considered a medication?
yes
32
what is the volume of a small enema?
approx 150 mL
33
what is an example of a small enema?
fleets, oil retention
34
what is the volume of a large enema?
up to 1,000 mL water or saline
35
what is an example of a large enema?
tap H2O or soap suds (to irritate bowel into having a BM)
36
what position is patient to be in for an enema?
left-lateral, Sim's position
37
How long recommended to wait after giving enema before trying to have a BM?
as long as possible to get max effect (5 min. is goal)
38
how far is recommended to insert enema meds into rectum?
3-4 inches
39
what is a "Harris flush"?
a return flow enema that allows solution and air bubbles to return as you raise and lower the enema bag. Goal is to remove painful gas from patients who have had abdominal surgery
40
what are two adverse effects to watch out for when giving enemas?
abdominal pain excess vagal stimulation
41
what does excess vagal stimulation cause?
lower HR (bradycardia)+ lower BP (hypotension) = syncope
42
is a physicians order required for digital disimpaction?
yes
43
what should you assess before performing digital disimpaction?
vital signs because of increased risk of vagal stimulation
44
what is occult blood?
blood in stool that is not easily visible or detected
45
what is a hemoccult test?
chemical test that checks for hidden blood in a stool sample
46
what is a guaiac test?
aka fecal occult blood test (FOBT) diagnostic procedure that checks for hidden blood in a stool sample. (Guaiac is chemical that reacts to blood)
47
what is a KUB?
it is an X ray test that examines the kidneys, ureters and bladder. used to asses the urinary system and check for causes of abdominal pain
48
what are the structures of the urinary system?
-kidneys -nephrons -ureters -bladder -urethra
49
what is the average urinary volume per void?
250-400 mLs
50
what is the adult normal urinary output per day (U/O/ 24hrs) ?
1500 mLs/day
51
what is the adult minimum urinary output for 1 hour? for 24 hrs?
minimum 30 mLs per hour minimum 720 mLs per 24 hrs **these are important. we keep track of these
52
what do casts indicate?
they indicate infection or impaired kidney function
53
what to look for when assessing urine?
volume per void color clarity odor any discomfort with voiding?
54
what is the average volume of an adult bladder?
500mLs, may distend to hold 2x that amt
55
how does your body know the bladder is full?
a full bladder activates stretch receptors and then signals are sent via spinal cord to voiding reflex center
56
define dysuria
painful or difficult urination, may be associated with infection or partial obstruction
56
define hesitancy
difficult to start a steam or keep it going
57
define urgency in GU assessment
a sudden almost uncontrollable need to urinate
58
define frequency in GU
the need to urinate at short intervals
59
define hematuria
blood in urine, may be due to trauma, kidney stones, infection
60
define nocturia
frequent urination after going to bed, assoc with ↑ liquid intake or UT problems or cardiac problems
61
define polyuria
excessive urination, caused by excessive hydration, diabetes, or kidney disease
62
define oliguria
urine out put of less than 400mL in 24 hr
63
define anuria
absence of urine, less than 100mL in 24 hr., assoc. w/ kidney failure or CHF
64
define pyuria
pus in urine, caused by lesions or infection in UT
64
what are 8 nursing interventions to promote voiding?
1. privacy 2. time 3. assess voiding routine 4. assist PRN 5. encourage voiding Q4 hrs 6. ↓ anxiety, discomfort 7. analgesics (pros and cons) 8. sensory stimuli (run water)
65
what is the nephron?
the filtration unit of the kidney involved in the formation of urine
66
what is the purpose of the kidneys?
-filter metabolic waste, toxins, drugs, hormones, salts and water from blood stream and excrete them as urine. -help regulate blood volume -produce red blood cells -secrete renin -activate vit D
67
what does the urethra do?
transports urine from bladder to body's exterior
68
what are ureters?
narrow tubes that carry urine from kidneys to bladder
69
what does the bladder do?
a sac-like organ that receives and stores urine delivered by ureters
70
what inspections are done GU assessment?
1. inspect perineal areas (for excoriation or skin breakdown) 2. urine 3. cather? 4. Urostomy? (permanent) or suprapubic catheter?
71
what is the nursing role in the case of urinary retention?
-inspection pf bladder -palpation of bladder -use of ultrasonic scanner aka "bladder scanner"
72
is an order required for use of the bladder scanner?
no
73
what is CAUTI
catheter associated urinary tract infection
74
what are 6 clinical manifestations of a UTI?
-dysuria -increase WBC counts -fever, chills(rigors) -*older adults: cognitive impairment - urine, cloudy, foul smelling, -pyuria -symptoms vary w/ individuals
75
what are 2 causes of UTIs?
1. E coli (from GI) 2. nosocomial -poor catheter technique, catheter care or indwelling too long (Aka CAUTI)
76
geriatric physical changes in GU system
about ↓30% function 2/3 nephrons at 80 yrs ↓blood flow to kidneys ↓muscle tone (ureters, bladder and urethra)
77
geriatric GU nursing interventions
-assessmet, -protective devices (briefs, pads) -indwelling catheter care -measurement of I/O -education -condom catheter use -adjust schedule or environment
77
geriatric specific GU issues
nocturia private about issues female: loss of muscle tone (caused by menopause or pregnancy) male: enlarged prostate blocks urine urine leakage retention of urine after void ↑bladder infections
78
what is a dependent loop?
a section of excess drainage tubing in a urine drainage system that forms a low point and can cause urine or liquid to accumulate. ***It is important to avoid back flow of urine.***
79
what is stress incontinence?
involuntary loss of urine with increased abdominal pressure in the absence of an overactive bladder ex: pregnancy, sneezing, obesity
80
what is urge incontinence?
involuntary loss of urine with a strong urge to void (overactive bladder)
81
what is overflow incontinence?
leakage of urine with distended bladder ex: fecal impaction, neurological disorders, enlarged prostate
82
what is functional incontinence?
untimely loss of urine with no urinary or neurological cause
83
what is unconscious (reflex) incontinence?
loss of urine when person does not know the bladder is full and has no urge to void ex: CNS disease, bladder inflammation
84
in a case of urinary retention what is a goal amount of urine to be left after voiding (measured by bladder scan)?
post voiding residual volume of less than 150 mL Treas p. 1017 and p.1035 (how to use scanner)
85
for an indwelling catheter it is important that the drainage bag is where?
below bladder level
86
when obtaining a urine sample from a closed system what do you never do? why?
never disconnect the catheter from the drainage tube to obtain a sample. this would create a portal of entry for pathogens
87
an indwelling catheter bag is attached to where?
frame of bed , not side rails
88
for an indwelling catheter, where is the catheter tubing attached?
to the body, usually the thigh
89
in catheter care what needs to be cleaned?
clean the perineal area and catheter
90
an indwelling catheter is a __________ system
closed
91
for an indwelling catheter is is important to always check there are no ________?
dependent loops
92
what are three things to do often with urine bag?
assess urine measure output empty bag
93
a condom catheter cannot be used if there is what?
any skin breakdown or irritation
94
the 5 pre-procedure assessments for a condom catheter
1. assess cognitive status 2. assess pattern of voiding 3. assess skin 4. whether penis is retracted and how much 5. assess for neuropathy (Treas p 1051)
95
there are 16 (!) factors affecting urine output, what are they? good luck, someone help me split this up!
in alphabetical order 1. body position 2. cognition 3. disease processes 4. fluid/blood loss 5. Hypotension 6. intake/nutrition/IV 7. kidney failure 8. meds 9. muscle tone 10. neurological injury 11. NPO 12. Obstruction 13. pregnancy 14. psychological factors 15. surgery 16. UTIs

201B Exam2 (2 decks)

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