ADLs #2 - Midterm Flashcards

Question

In Canada, which guide can help us make healthy food choices?

Answer 1

Eating Well with Canada’s Food Guide - serves as a pattern for eating but not a rigid set of rules - designed to give a balanced, healthy diet - categorized into four basic food groups

Answer 2

1) Grain Products 2) Vegetables and Fruits 3) Milk and Alternatives 4) Meat and Alternatives * Oils and Fats

Answer 3

1) Grain Products: M=8, F=6-7 2) Vegetables and Fruits: M=8-10, F=7-8 3) Milk and Alternatives: M=2, F=2 4) Meat and Alternatives: M=3, F=2 * Oils and Fats: small amount (30-45mL of unsaturated fats each day)

Answer 4

1) Grain Products: bread, pasta, rice 2) Vegetables and Fruits: fresh, frozen, canned vegetables, leafy vegetables, fresh, frozen, canned fruits, juice 3) Milk and Alternatives: milk, soy, yogurt, kefir, cheese 4) Meat and Alternatives: fish, poultry, legumes, eggs, peanuts * Oils and Fats: salad dressing, margarine, mayonnaise, olive oil, lard

Answer 5

- take care of the dietary needs of Winnipeg acute care hospitals and a few personal care homes - unique in Canada - over 7800 customized meals are planned for, prepared, assembled and delivered daily from a centralized location - 3 week cycle of menus provides a wide variety of foods - each patient takes a questionnaire to best suit to their likes, dislikes, allergies

Answer 6

1) age: infants don’t have much say in what they eat, physiological changes due to getting old changes the person’s desire and ability to consume, they need fewer calories, taste/smell/appetite is decreased 2) activity level: being sedentary makes you feel like eating less 3) environment: unpleasant sights, odours and noises can cause loss of appetite 4) stress/emotions: being uncomfortable, in pain, constipated, foul taste in mouth, digestive upset, upset, worried, afraid, angry, excited, lonely can make someone lose appetite 5) appearance of food: pleasant smell of food or that looks attractive can encourage appetite 6) likes and dislikes/personal opinions: everyone has preferences and must be considered when preparing meals, strong opinions could cause problems 7) misinformation/food fads: peer pressure and advertising can contribute to misinformation about food and nutrition which may lead to improper eating habits 8) Cultural and Religious Customs: Jewish eat kosher foods and Mosley’s do not eat pork, religious fasts (don’t eat food) 9) Socioeconomic Status: having a limited income could mean difficulty purchasing meats and milk due to being more expensive 10) Alcohol and Drugs: contribute to dietary deficiency because money needed for food goes toward alcohol and drugs, can interfere with the absorption of nutrients 11) allergies

Answer 7

1 kilogram (kg) = 2.2 pounds (lb) A) 220 lb B) 176 lb C) 112.2 lb

Answer 8

- is one indicator of health and can help to provide insight into their nutritional status - weight gain may indicate a diet higher in calories than needed by the body - weight loss may indicate inadequate nutrition or disease process - major changes must be reported to the nurse or supervisor - can also be a cause of a variety of medical conditions

Answer 9

- measure accurately and report findings to nurse - weigh the person on the same scale at approximately the same time of day with the same amount of clothing on - usually weighed during their weekly bath time

Answer 10

- changing the consistency of the food, making it easier to chew and swallow and decrease the risk of choking - changing the caloric intake (low-calorie diet) - changing the amount of certain nutrients (high-protein diet, low sodium diet) - changing the amount of seasonings (bland diet) - omitting foods that the patient is allergic to - altering the time and number of meals

Answer 11

1) clear fluids - temporary diet made up primarily of water and carbohydrates for energy - used for patients with the flu, fever or diarrhea, recovering from anaesthesia or gastrointestinal surgery - water, tea, coffee, fruit juice, fat-free clear broth 2) full fluids - natural progression from a clear fluid diet - for those with difficulty chewing, swallowing, digesting food, dental surgery, stomach or intestine upsets - clear liquid diet plus custard, egg-nog, strained soups, strained fruit and vegetable, milk, milkshakes

Answer 12

- intermediate step between a full fluids diet and a regular diet - consists of easily digested foods that are mildly seasoned, non-gas forming and relatively low in fibre

Answer 13

- a soft diet contains adequate nutrients and includes liquids and semi-solid foods that have a soft texture and are more easily chewed and digested - food put into blender to achieve desired smooth consistency - for those with no dentures or problems with chewing foods - puréed vegetables, pudding, smoothies

Answer 14

- used for patients who have an irritation or disease of the bowel - omits foods that are difficult to digest - coffee, tea, fruit juices, ice cream

Answer 15

- opposite of low residue diet - includes foods that are high in bulk and difficult to digest - frequently used for individuals who suffer from constipation - fruits and vegetables, whole wheat bread, whole grain cereals

Answer 16

- increased sodium in the diet causes increased water retention - ordered for patients with certain heart conditions and where circulation would be impaired by fluid retention - sodium is in table salt, most people consume 1-2 teaspoons per day - sodium restricted patients are advised not to cook with salt, but substitute with herbs, spices - fruits, vegetables, unsalted butter

Answer 17

- low fat diet ordered for patients who have difficulty digesting fat such as those with gallbladder disease - low cholesterol diet is used to help regulate the amount of cholesterol in the bloodstream - restricted foods are dairy products, fired foods, fatty meats, olives - cooking methods are steaming, baking, broiling, grilling - skim milk, cottage cheese, jelly, fruit, rice, pasta, cereal

Answer 18

- to balance carbohydrates, protein and fats intake to help the patient with diabetes to lead a normal and active life - foods determined by nutritional and energy requirements

Answer 19

- ensure that the patients is awake and alert - offer the bedpan or assist the patient to the bathroom - assist patient to wash hands and face - provide oral hygiene - ensure patient has clean, well-fitting dentures in place and eyeglasses on - report complaints of pain to nurse so that analgesics can be given before the meal is served - position the patient comfortably is sitting in a chair or wheelchair, check the height for the table, ensure the patient’s head and body should be in good alignment with feet firmly supported on the ground - if eating in bed, patient should be sitting upright so elevate the bed as much as possible and support the head and place a pillow behind the shoulders, head should face forward with chin tilted down, over bed table should be placed in front of the patient - place napkin or clothes protector as needed (do NOT refer as bib) - clear away any unpleasant items - ensure room is well lit and free from drafts - keep the environment free of distractions - seat patients together

Answer 20

The ID bracelet is checked to be sure that the patient is receiving the correct meal (particularly if there is an order for a special therapeutic diet).

Answer 21

- removing food covers - opening milk and juice containers - buttering bread - cutting food into bite-size pieces - adding seasonings as allowed (salt, pepper) - positioning cutlery within reach - identifying foods that are on the tray

Answer 22

- non-slip placemats - cutlery with special handles - combination utensils - rocking knife - unbreakable dishes and glasses - suction cups on the bottom of dishes - plate guards - cups with wide handles which fit over the whole hand - glasses with indented rims for people who cannot tip their head back to drink

Answer 23

-use the clock method by using different “times” to describe where food is located on the plate

Answer 24

1) help the patient to a sitting position 2) place the tray on the overbed table or other table 3) remove lids, open milk cartons, cereal boxes, cut meat, butter bread 4) place napkin, clothes protector and utensils within client’s reach 5) measure and record intake 6) check for and remove any food in the client’s mouth, wear gloves 7) remove the tray 8) assist with hand washing, offer oral hygiene 9) clean any spills and change soiled linen 10) help client return to bed

Answer 25

1) sit at eye level, preferably in front of the patient 2) focus your attention on the patient, be friendly and pleasant 3) tell patient that you are putting food in his mouth before each mouthful, follow the patient’s preferences regarding the order in which food items are eaten, avoid mixing foods together unless the patient requests it 4) use a teaspoon to offer only one-half to one teaspoonful of food at a time, place the tip of the teaspoon into the middle of the patient’s mouth 5) if patient is paralyzed on one side, place food in the unaffected side of the mouth 6) do not hurry, feed small amounts slowly, allow sufficient time for chewing 7) be sure that food is being swallowed by watching the adam’s apple, encourage extra swallows between mouthfuls to help prevent buildup of food in the throat 8) offer fluids with every few bites of food, always make sure the mouth is clear of food before giving fluids, give small sips or use a straw 9) allow for rest periods throughout the meal, watch for signs that the patient is tiring 10) encourage patient to assist as much as possible 11) wipe mouth with napkin during and at the end of the meal 12) remember that the patient has the right to refuse food 13) observe for signs of swallowing difficulties 14) be alert for signs of choking, be prepared to perform the Heimlich maneuver 15) report any changes or unusual occurrences 16) report to nurse if client does not complete meal or refuses to eat 17) report amount of diet taken in 18) perform mouth care after feeding in order to remove any food that may not have been swallowed

Answer 26

- dysphasia=swallowing difficulties - swallowing assessment done by a speech language pathologist - feeding recommendations made and followed by staff - some patients may have thickened fluids ordered due to commercial thickener to slow transit time and protect the airway - thickened fluids referred to Nectar Consistency

Answer 27

- dehydrated patients - receiving intravenous therapy - have recently had surgery - have specific condition that require accurate monitoring of their intake

Answer 28

- requires that the type and amount of food the patient has eaten be observed so that an accurate number of calories can be determined - be sure to only consider the food that the patient has actually eaten

Answer 29

- done to determine if patient is having a problem with fluid balance - fluid balance=amount of fluid taken in is equal to amount of fluid put out - fluid balance is necessary for optimal health

Answer 30

1500-2500 mL of fluids a day

Answer 31

- patients who have excess fluids may experience weight gain, edema or congested breathing - these patients are only allowed a very specific amount of fluids in a day and no more

Answer 32

- patients who have a deficit of fluids will be dehydrated and may have a dry mouth and complain of being thirsty - may be encouraged to drink as much fluid as possible

Answer 33

- non per os, nothing per mouth - patients are not allowed to eat or drink anything due to before surgery or when bowel is inflamed and must be rested - nothing to record in the way of intake

Answer 34

- everything that the patient drinks and other items that may be considered more of a “food” than a “drink” - water, milk, juice, coffee, tea, soup, ice cream, popsicles, pudding and gelatin - intravenous fluids are also considered but health care aides are not responsible for monitoring intake of these

Answer 35

- tomato juice - chicken soup - tea - chocolate pudding

Answer 36

1) Pour remaining liquid in the serving container into the graduate 2) measure the amount at eye level, keeping the graduate level 3) check the consumed amount, as recorded on the I&O record 4) Subtract the amount consumed from the full serving amount, and record the amount of intake 5) repeat each step 1 to 4 for each liquid 6) total the intake amounts of all liquids 7) record the time and amount on the I&O record

Answer 37

Something that the body takes in or produces but is unable to use

Answer 38

Waste products are left behind in the blood and in the bowel. The removal of waste products from the body is essential in order to stay healthy.

Answer 39

Solid wastes

Answer 40

Carbon dioxide

Answer 41

Water and other substances

Answer 42

Body cells that burn food for energy

Answer 43

Removes waste products from blood (from body cells burning food for energy) and maintains the body’s water balance

Answer 44

-filters out waste products from the bloodstream and removes them from the body by producing and eliminating urine

Answer 45

- kidneys - ureters - bladder - urethra

Answer 46

- kidneys (two bean-shaped organs) filter the blood and form urine - urine travels down the ureters to the bladder where it is stored - as bladder fills, its walls stretch and send messages to the brain that it should be emptied=urge to void - urine passes out of the bladder when the muscles in the urethra relax (we control these muscles when we decide when to empty our bladders) =urination, voiding, passing water

Answer 47

- 1500mL per day | - 10 to 15 seconds

Answer 48

200-300 mL of urine but it can hold much more than that

Answer 49

1) fluid intake: during low fluid intake kidneys save fluid by decreasing urine output, during high fluid intake kidneys produce more urine 2) muscle tone: weak muscles of the abdomen and pelvis can lead to poor control of urination and involuntary loss of urine = incontinence 3) stress: does not change production of urine but may increase the frequency of urination or prevent a patient from urinating 4) medications: can alter normal functioning of urinary system like those for high blood pressure and heart disease cause the kidneys to take more water out of the blood than they normally would and so creates more urine 5) illness or injury: can prevent kidneys from filtering the blood completely or block the passage of urine or cause an individual to lose control over their usual voiding practices (infection in the bladder often causes frequency and urgency 6) age: as body ages, urinary system becomes less efficient, kidneys are less effective at removing wastes from the blood and urine becomes more dilute, the bladder weakens and loses some of its ability to store urine so that the urge to void is felt more often = frequency or urgency

Answer 50

Poor control of urination and involuntary loss of urine

Answer 51

- follow the patient’s normal voiding routine as much as possible - help the patient to the bathroom, commode, bedpan as soon as the request is made - provide for privacy - help patient assume their normal voiding position - tell the client that running water, flushing of the toilet or sounds from the tv or radio will mask urination sounds - remain nearby if patient is weak or unsteady - allow the client enough time to void, do not rush - assist with proper hand hygiene after voiding

Answer 52

-bottle-like container used for voiding by males

Answer 53

1) give urinal to client if in bed and remind him to tilt the bottom down 2) if client is going to stand, help him sit on side of bed, help put on non-skid footwear, help him stand, give urinal 3) position urinal if necessary, position penis in urinal if patient unable to 4) provide privacy 5) place call bell within reach, ask client to call if he needs help or when done 6) remove gloves and practice proper hand hygiene 7) leave room and close door 8) return when called and knock before entering 9) practice proper hand hygiene and put on gloves 10) close cap on urinal and take to bathroom 11) note colour, amount and character of urine 12) empty urinal, rinse with cold water and clean it with disinfectant 13) return urinal to its proper place 14) remove gloves, practice proper hand hygiene, put on clean gloves 15) help client wash his hands 16) remove gloves and practice proper hand hygiene

Answer 54

- commonly used for both bladder and bowel elimination by females and males use for bowel elimination - two types: regular bedpan and fracture bedpan - should be kept within patient’s reach if they are able to use it independently - always rinse and clean after use - never put on bedside table or on surfaces where food might be placed

Answer 55

-prevent the spread of infections (many of which may be undiagnosed) and are to be used whenever you might be in contact with blood or body fluids (urine or feces included)

Answer 56

1) warm and dry the bedpan, lightly dust the rim of the bedpan with talcum powder 2) lower bedrail, place patient in supine position keeping the bed as flat as possible 3) fold top linens and client’s gown out of the way, keep lower body covered 4) ask client to flex knees and raise buttocks by pushing against mattress 5) slide your hand under lower back and help raise buttocks to slide bedpan under the client 6) if client can’t assist in getting on bedpan, turn client on the side away from you, place bedpan firmly against buttocks, push bedpan down and toward the client, hold bedpan securely, turn the client onto the back, make sure the bedpan is centred and under the client 7) cover the client 8) raise the head of the bed so client is in a sitting position and raise bed rail 9) place toilet tissue and call bell within reach 10) ask client to call when done or if needs assistance 11) practice proper hand hygiene 12) leave room and close door 13) return when called, knock before 14) practice hand hygiene and put on gloves 15) raise bed to comfortable working height, lower bed rail and head of bed, place patient in supine position 16) ask client to raise buttocks and remove bedpan, if not able to, hold bedpan securely and turn client onto the side away from you 17) clean genital area if client can’t, clean from front to back with toilet tissue, provide perineal care 18) cover bedpan and take to bathroom, remember to lower bed and raise bed rail before leaving 19) note colour, amount and character of urine or stool 20) empty and rinse bedpan with cold water, clean with disinfectant 21) remove soiled gloves, practice proper hand hygiene 22) put bedpan and lid away 23) help client practice proper hand hygiene

Answer 57

- looks like a wheelchair with a hole in the middle of the seat with a container underneath to catch the urine or feces - can also be positioned over a toilet instead of having a container underneath - more comfortable than bedpan due to being in a sitting position - may be tiring for some patients to get in and out of bed to use it * for some patients, it might be helpful to remove underwear before transferring them onto the commode

Answer 58

1) bring the commode next to the bed, remove cushion, left container lid 2) help client sit on side of the bed 3) help client put on robe and non-skid footwear 4) cover client with cover or bath blanket 5) place call bell and toilet tissue within reach 6) ask client to call when done or if in need of assistance 7) remove gloves, practice proper hand hygiene 8) leave room and close door 9) return when client calls, knock before entering 10) practice proper hand hygiene and put on gloves 11) help client clean genital area, remove gloves and practice proper hand hygiene 12) help client back to bed, remove robe and footwear 13) put on clean gloves, remove and cover commode container, clean commode 14) take container to bathroom 15) check urine and stool for colour, amount and character 16) empty, clean and disinfect the container 17) return the container to the commode and put commode back to proper place 18) remove soiled gloves, practice proper hand hygiene, put on clean gloves 19) help client with hand washing 20) remove gloves, practice proper hand hygiene

Answer 59

- indwelling urinary catheters | - externally worn condom catheters

Answer 60

- a sterile, flexible tube that is inserted into the bladder to drain urine - a sterile procedure performed by a nurse - two types: straight catheter (drain bladder at the time and then removed) and indwelling catheter or Foley catheter (kept in bladder for a longer period of time, connected to a urine collection bag)

Answer 61

- before, during and after surgery to keep the bladder empty - allows for hourly urinary output measurements in clients with critical illnesses - last resort for managing incontinence since they do not treat the cause of incontinence and risk of infection is high - promote comfort by managing incontinence of weak or disabled clients - diagnostic uses by collecting sterile urine specimens and measuring residual urine (inserted after client has voided)

Answer 62

- make sure urine flows freely through the catheter or tubing (no kinks or lying on tubing) - keep the drainage bag below the level of the bladder - never attach the drainage bag to the bed rail (if raised, drainage bag is higher than bladder) - always check your client’s care plan and agency’s policy - do not let the drain or drainage bag touch any surfaces - encourage fluid intake (2000-2500mL during the day or 6-8 glasses)

Answer 63

1) lower bed rail, put on gloves 2) cover client, fanfold the top linen to the foot of the bed 3) drape client for perineal care 4) place bed protector under buttocks, ask client to flex knees and raise buttocks off the bed 5) give perineal care 6) apply soap to a clean wet washcloth, separate labia or retract foreskin, check for presence of crusts, abnormal drainage or secretions 7) hold catheter near the meatus (insertion point) 8) clean catheter from meatus down the catheter about 10cm, clean downward, away from meatus with one stroke, do not tug or pull on catheter, repeat with clean area of washcloth 9) rinse catheter, clean from meatus down the catheter about 10cm, clean downward away from meatus with one stroke, do not tug or pull on catheter, repeat 10) secure catheter, coil and secure tubing 11) remove bed protector 12) cover the client, remove the cover or bath blanket 13) remove gloves, practice proper hand hygiene

Answer 64

Purpose: to ensure that indwelling catheters are kept clean to reduce infection. 1) wash hands 2) collect supplies: warm water, face cloth, soap, disposable soaker (blue pad), gloves 3) assist client to back lying position with knees slightly flexed and apart 4) ensure client’s privacy before exposing peri area 5) put on gloves 6) place blue pad beneath peri area 7) always wash cleanest area first 8) with warm water only, gently cleanse catheter tube, starting closest to client’s body and moving away from body along catheter 9) repeat using a different area of the washcloth until catheter is free of crusting 10) do not use soap on catheters 11) do not tug on catheter while providing care 12) proceed to provide peri care as required

Answer 65

1) wash hands 2) collect supplies: clean drainage bag, container to receive used drainage bag, gloves, blue pad, alcohol swab, protective end cap 3) put on gloves 4) ensure cleaning solution has been removed from clean catheter bag and that drainage valve is closed 5) place disposable blue pad beneath peri area 6) disconnect drainage tubing from condom/indwelling catheter 7) pinch catheter to stop flow of urine 8) do not allow end of indwelling catheter to come into contact with any other surfaces 9) clean tip of drainage tubing using an alcohol swab in a circular motion for 30 seconds 10) connect new bag to indwelling catheter 11) ensure connection of drainage bag to catheter is secure 12) ensure drainage bag is placed below level of bladder for good drainage 13) do not position drainage bag above level of bladder 14) urinary drainage bag may be hung from bed frame (NOT side rails), clipped to side of mattress using plastic clips or placed in bucket on floor 15) check tubing to ensure no kinks are present 16) secure tubing to client’s upper leg using a leg strap, if client prefers tape, vary location of tape and monitor skin for irritation 17) leg straps should not be so tight that they impair circulation 18) place used drainage bag into collection container and remove to bathroom for cleaning , empty bag following instructions above

Answer 66

1) gloves must be worn for this procedure 2) ensure bag is empty of urine and ensure drainage valve is closed 3) prepare cleaning solution: 1 part vinegar to 4 parts water 4) pour cleaning solution into top tubing of collection bag, a squirt bottle may be used for this purpose 5) swish solution around bag 6) open drainage valve to allow solution to drain into toilet, close valve 7) repeat these steps until the bag and tubing appear clean, 2-3 times 8) bag may be stored with cleaning solution in place (client’s choice), although this practice may cause drainage bags to deteriorate faster 9) place protective cap over catheter end of tubing and hang bag to allow it to dry

Answer 67

- external catheter - alternative to indwelling catheter for men - soft pliable rubber sheath similar to a condom that is fitted over the penis and is usually secured by a strip of tape around the top - condom is connected to a urine collection bag

Answer 68

1) lower bed rail, cover client, lower top linen to the knees 2) ask client to raise buttocks off bed or turn client onto the side away from you 3) slide the bed protector under the client’s buttocks 4) have client lower the buttocks or turn client onto back 5) secure drainage bag to the bed frame (not bed rails) or have a leg bag ready, close the drain 6) expose the genital area 7) put on gloves 8) remove the condom catheter by removing the tape, roll the sheath off the penis, disconnect the drainage tubing from the condom, cap the drainage tube, discard the tape and condom 9) provide perineal care, observe penis for skin breakdown or irritation 10) remove protective backing from the condom 11) hold penis firmly, roll condom onto penis, leave a 2.5 cm space between the penis and the catheter end 12) secure the condominium with elastic tape, apply tape in a spiral, do not apply tape completely around the penis 13) connect the condom to the drainage tubing, coil excess tubing on the bed or attach a leg bag 14) remove the bed protector 15) remove gloves, practice proper hand hygiene 16) cover the client, remove the cover or bath blanket

Answer 69

- from a bedpan or urinal - from a specimen pan on a commode - from a specimen pan which is placed over the toilet (urine collection hat) - from a urine collection bag * first three should be measured and recorded as soon as the patient is done voiding, but a urine collection bag is usually only emptied at the end of each shift

Answer 70

- transfer urine from the collection containers into a measuring cup - container usually called a graduated cylinder or graduate - graduated cylinder is measured in mLs - place the graduate cylinder on a flat surface and read at eye level - record this amount on the Fluid Balance Record under the column marked “urine” in the area “output” - record output amount immediately after emptying the bedpan or urinal

Answer 71

1) pour fluid into the graduate used to measure output 2) measure the amount at eye level, keeping the graduate level 3) dispose of the fluid in the toilet 4) clean and rinse the graduate 5) rinse and clean bedpan, urinal, kidney basin, or other drainage containers 6) remove gloves and perform hand hygiene 7) record the amount on the I&O record

Answer 72

1) put on gloves 2) place the paper towel on the floor, place the graduate on top of paper towel 3) position graduate under drainage bag drain 4) open the clamp on the drainage bag 5) allow all the urine to drain into the graduate, do not let the drain touch the graduate 6) close and position the clamp 7) measure the urine 8) remove and discard the paper towel 9) dispose of the urine in the toilet 10) rinse the graduate, and dispose of the rinse water in the toilet 11) return the graduate to its proper place 12) remove gloves, practice proper hand hygiene 13) record the time and amount on the intake and output (I&O) record

Answer 73

Observe urine for colour, clarity, odour, amount and particles. Urine colour is normally pale yellow, straw coloured or amber. Urine colour can be altered by certain drugs or foods, such as red food dyes, beets, blackberries, and rhubarb. Urine that is not of normal appearance or odour should be reported to the nurse.

Answer 74

- painful or difficult (dys) urination (uria) | - caused by urinary tract infection, trauma, urinary tract obstruction

Answer 75

- blood (hemat) in urine (uria) | - caused by kidney disease, urinary tract infection, trauma

Answer 76

- frequent urination (uria) at night (noct) | - caused by excessive fluid intake, kidney disease, disease of the prostate, congestive heart failure

Answer 77

- scant amount (olig) of urine (uria) usually less than 500mL in 24 hours - caused by inadequate fluid intake, shock, burns, kidney disease, heart failure

Answer 78

- the production of abnormally large amounts (poly) of urine (uria) - caused by medications, excessive fluid intake, diabetes, hormone imbalance

Answer 79

- voiding at frequent intervals | - caused by excessive fluid intake, bladder infections, pressure on the bladder, medications

Answer 80

- patient’s bladder is always full so it frequently leaks urine or the inability to control the passage of urine from the bladder - caused by weak bladder muscles, blockage or obstruction, diabetic neuropathy, multiple sclerosis, spinal cord injuries, trauma, disease, urinary tract infections, surgeries, aging, fecal impaction, constipation

Answer 81

- the need to void immediately | - caused by urinary tract infections, fear of incontinence, full bladder, stress

Answer 82

- blocked urine flow causing urine to accumulate in the bladder - caused by decreased fluid intake, prostate enlargement, fecal impaction, pregnancy, narrowed urethra, spinal cord trauma, anxiety

Answer 83

- it is a major problem faced by older adults, but it is not part of the aging process - not everyone becomes incontinent in their old age - it may result from a mental or physical condition, or from an inability of patients to communicate their needs or from some medications which dramatically increase the amount of urine that the body produces

Answer 84

- the leaking of urine during exercise and certain movements - urine loss is small (less than 50mL) - called dribbling - occurs when laughing, sneezing, coughing, lifting, late pregnancy, obesity - problem is common in women as pelvic muscles weaken from pregnancies and with aging

Answer 85

- the loss of urine in response to a sudden, urgent need to void - can’t get to the toilet in time - urinary frequency, urinary urgency and nighttime voiding are common - caused by urinary tract infections, nervous system disorders, bladder cancer, enlarged prostate

Answer 86

- the leaking of urine when the bladder is too full - client feels as though the bladder is never completely empty and experience only dribbling or a weak urine stream - diabetes, enlarged prostate, and some medications cause this

Answer 87

- loss of urine that occurs when the client has bladder control but cannot get to the toilet in time - immobility, restraints, unanswered calls for help, lack of a call bell within reach, confusion, disorientation, difficulty removing clothes and not knowing where to find the bathroom are all causes of this

Answer 88

1) stimulate the urge to void: help patients assume normal sitting position when voiding, turn on running water, place patient’s hands in basin of warm water 2) maintain normal voiding habits: identify patient’s normal voiding pattern and maintain the same schedule for toileting or bedpan use, respond promptly to requests for toileting assistance, provide privacy for voiding, if music or reading has been part of the normal pattern, continue the practice, allow ample time for voiding (don’t rush the patient) 3) maintain adequate fluids: offer 2000-2500mL fluids throughout the day (avoid fluids two hours before bedtime), consider patient’s preferences when offering fluids 4) teach patient Kegel exercises (helps strengthen muscles involved in voiding): when standing or sitting tighten muscles around anus without tensing buttocks or legs, repeat 4 times every hour, when voiding try to stop and start the flow of urine 5) report and record accurately: number of voidings, number of incontinent episodes, fluid intake 6) follow the retraining plan consistently, be patient, understanding and supportive, never scold, tease or ridicule the patient

Answer 89

Among the cognitively impaired older adults who may experience frequent spontaneous bladder contractions with involuntary emptying of the bladder.

Answer 90

- maintaining skin integrity by providing meticulous skin care - skin that is continually moist becomes macerated and irritated which can lead to skin breakdown - perineal area should be washed with soap and water after periods of incontinence, rinsed well and dried thoroughly - soiled clothing and bed linen should be replaced - for skin that appears reddened and irritated, barrier creams may be applied - specially designed incontinence pads or absorbent underwear may also be used - frequent checking of the patient is essential to ensure they are changed as soon as they become soiled - always wash the skin thoroughly when changing the pad or briefs

Answer 91

- removing rugs so that the floor can be cleaned - using furniture with washable surfaces - using a mattress with a washable surface or protection pad - providing good ventilation - using room deodorizer as needed

Answer 92

- unfold a fresh pad - identify inside and outside front and back (back has refastenable tabs) - explain procedure to the patient and role the patient onto their side - position the back portion of brief toward the head of the bed with white absorbent side up, midline of brief along midline of person’s back - tuck flaps closest to patient under patient - have patient roll over brief far enough to unfold flaps - have patient roll onto back ensure that center of brief is along center of back - bring front of brief up between the legs, the front and back flaps should be pulled to equal heights on the front and back of waist - adjust the brief to fit closely into groin ensure that skin of groin is not pinched in any way - adjust the brief for a close and comfortable fit - attach the back adhesive tapes onto front flaps - soiled briefs should be disposed of in a plastic garbage bag and placed in garbage container

Answer 93

- collected for urine analysis - no special measures are needed - specimen collected at any time - clients can collect the specimen themselves

Answer 94

- perineal area is cleaned before collecting the specimen - this reduces the number of microbes in the urethral area - client starts to void into the toilet, bedpan, urinal or commode - then stream is stopped and a sterile specimen container is held in position - client voids in container until the required amount of specimen is obtained

Answer 95

- all urine voided during a 24-hour period is collected for a 24-hour urine specimen - the collected urine is kept chilled on ice or refrigerated during the collection period to prevent growth of microbes - a preservative is added to the collection container for some tests - to start the collection, the client voids and this first voiding is discarded - all the urine voided during the next 24-hours is then collected

Answer 96

- explain the procedure to the client thoroughly and ensure cooperation - wear gloves and practice medical asepsis - us a clean container for each specimen - label the container accurately, write client’s full name, address or room, bed number, date and time - do not touch the inside of the container or lid - collect the specimen at the time specified - ask the client not to defecate during specimen collection - ask the client to dispose of used toilet tissue in the toilet - put the lid on the specimen container - place the specimen container in a plastic bag for transportation - report and record the following observations: difficulty in obtaining the specimen, colour, clarity, and odour of urine, particles in urine, complaints of pain, burning, urgency, dysuria

Answer 97

- label the container - put the container and lid in the bathroom - provide for privacy - put on gloves - ask the client to urinate in the receptacle (bedpan, urinal or specimen pan), remind the client to put toilet tissue into the wastebasket or toilet - take the receptacle to the bathroom - measure the urine if intake and output is ordered - pour about 120 mL of urine into the specimen container, dispose of excess urine - place the lid on the specimen container, put the container in a plastic bag - clean and return the receptacle to its proper place - help the client with hand washing - remove gloves, practice proper hand hygiene

Answer 98

- provide for safety - label the container - put on gloves and provide perineal care, remove gloves, practice proper hand hygiene - open the sterile kit, use sterile technique - put sterile gloves - pour the antiseptic solution over the cloth intended for perineal care - open the sterile specimen container, do not touch the inside of the container or lid, set the lid down so that the inside is up - for a female: spread the labia with your thumb and index finger (use non-dominant hand), clean down the urethral area from front to back, us a clean corner of the cloth intended for perineal care for each stroke, keep the labia separated to collect the urine specimen - for a male: hold the penis with your non-dominant hand, clean the penis starting at the urethral opening, use the cloth intended for perineal care and clean in a circular motion, keep holing the penis until the specimen is collected - ask the client to void into the toilet, bedpan, commode or urinal - hold the specimen container to collect the stream of urine, keep the labia separated - collect about 30 to 60 mL of urine - remove the specimen container before the client sops voiding - let go of the labia or penis - allow the client to finish voiding into the toilet, bedpan, commode or urinal - put the lid on the specimen container, touch only the outside of the container - wipe the outside of the container - place the container in a plastic bag - provide toilet tissue after the client finishes voiding - remove and empty the bedpan, commode container or urinal - clean the bedpan, urinal or commode container, return the equipment to its proper place - remove gloves, practice proper hand hygiene - help the client with hand washing - repeat proper hand hygiene

Answer 99

Gastrointestinal system

Answer 100

30% dead bacteria and 70% undirected food

Answer 101

- Process of passing stool through the anus | - often called bowel movement or BM

Answer 102

- brown colour - soft - formed - moist - shaped like a rectum - characteristic odour (caused by bacterial action in the intestines)

Answer 103

- colour - amount - consistency - odour - shape - size - frequency - complaints of pain

Answer 104

- defecation is a private act - lack of privacy deters many people from defecating despite having the urge - odours are embarrassing - some clients ignore the urge to defecate when others are present, which can lead to constipation

Answer 105

- many clients routinely have a bowel movement after breakfast - some do relaxing activities like drinking a hot beverage, read a book or newspaper or take a walk - food in the stomach may stimulate the bowels to move

Answer 106

- well balanced diet is needed to promote regular bowel movements - high fibre foods like fruits and vegetables, whole grain cereals and breads leave a residue that provides needed bulk - bran, prunes and juices help prevent constipation - milk causes constipation in some people and diarrhea in others - spicy foods can irritate the intestines resulting in frequent stools or diarrhea - onions, beans, cabbage and cauliflower stimulate peristalsis and results in defecation and could cause stomachaches or bloating - food in the stomach can stimulate bowel movements

Answer 107

- stool consistency depends on the amount of water absorbed in the colon - feces become hard and dry when large amounts of water are absorbed by the colon and when fluid intake is poor, move through colon at a slower rate and result in constipation - warm fluids increase peristalsis

Answer 108

- maintains muscle tone and stimulate peristalsis - irregular elimination and constipation often occurs due to inactivity and bed rest resulting from disease, surgery, injury and aging

Answer 109

- can prevent constipation or control diarrhea and some can cause these as side effects - meds for pain relief often cause constipation - antibiotics often cause diarrhea (antibiotics kills normal flora in the large intestine, normal bacteria are necessary for stools to form)

Answer 110

-as you age the feces pass through the intestines at a slower rate, resulting in constipation

Answer 111

- are not able to control their bowel movements and defecate whenever feces enter the rectum - these clients need a bowel training program with the goal of having a bowel movement at the same time each day

Answer 112

- increase high-bulk food in diet (whole grains, fruit and vegetables) - encourage daily fluid intake of 2000-2500 mL - encourage physical activity to the patient’s level of tolerance and ability - respond immediately when patient expresses the urge to defecate - provide privacy, assist patient to a sitting position, allow adequate time and privacy - avoid expressing over-concern about bowel elimination (can cause tensions and lead to further problems)

Answer 113

- passage of hard, dry stool * patient may complain of abdominal cramps, loss of appetite, nausea, headache, sluggish feeling, need to pass gas and may even pass small amounts of liquid stool around the hard feces in the rectum=oozing) - feces that move through the intestine slowly, allowing more time for water absorption in the colon - causes: low-fibre diet, ignoring the urge to defecate, decreased fluid intake, inactivity, medications, aging - treatment: prevention of constipation is much better than treatment, must ensure adequate activity, fluids and privacy

Answer 114

- prolonged retention and accumulation of feces in the rectum - cause: if constipation is not relieved, more water gets absorbed by the already hard feces - treatment: if left untreated, a fecal impaction can lead to complete bowel obstruction which will require surgery, a physician or nurse performs a digital (finger) exam to check this, physician may order medications and enemas to remove the impaction or remove the mass with a gloved finger=digital removal of an impaction

Answer 115

- frequent passage of liquid stool, moves rapidly through intestines which reduces the time for fluid absorption in the colon - cause: infections, medications, foods that irritate the stomach, pathogens in food and water - treatment: due to loss of water the patient could become dehydrated so follow the care plan to meet the client’s fluid needs, physician may order intravenous fluids in sever cases

Answer 116

- inability to control the passage of feces and gas through the anus - cause: intestinal and nervous system diseases, injuries fecal impaction, diarrhea and some medications, delayed requests for help to use the bathroom - treatment: follow the client’s care plan since patient may resists the care of the health care aide and may be difficult to clean up

Answer 117

- excessive formation of gas or air in the digestive tract - causes: swallowing air while eating and drinking, being tense or anxious, bacterial action in the intestines, gas-forming foods, constipation, bowel and abdominal surgeries, medications that decrease peristalsis - treatment: exercise, walking, left-side-lying position often produce flatus (gas passed through anus) to reduce bloating, physicians may order enemas, medications, or rectal tubes to relieve flatulence

Answer 118

- ask the client to void, provide bedpan, commode or urinal, empty and clean device, wear gloves - place specimen pan under the toilet seat - assist client onto bedpan or commode - ask client not to put toilet tissue in the bedpan, commode or specimen pan, provide a disposable bag for toilet tissue - place the call bell and toilet tissue within reach, raise or lower bed rails - perform hand hygiene and leave the room, stay within hearing distance - return when client calls, knock before entering, perform hand hygiene - lower bed rail near you - put on gloves, provide perineal care - use a tongue blade to take about 30 mL of feces from the bedpan to the specimen container, take the sample from the middle of a formed stool - put the lid on the specimen container, do not touch the inside of the lid or container, place the container in the plastic bag - wrap the tongue blade in toilet tissue and dispose of it - empty, clean and disinfect the equipment - remove gloves, perform hand hygiene - return equipment to proper place - assist the client with hand washing, wear gloves if needed

Answer 119

- certain diseases like abdominal trauma, colon cancer or Crohn’s disease may require a surgical procedure be performed to open and bring the bowel through the abdominal wall to the outside creating what is called a stoma - the opening, which allows stool to drain outside of the body is called an ostomy - enterostomies vary in shape and location on the abdomen - an ostomy bag is attached to the skin around the stoma as a collection method for stool - bag must be emptied when 1/3 full and flushed to promote cleanliness and prevent odours - clients are taught how to perform this care themselves or even a family member

Answer 120

-empty pouch when approximately 1/3 full, do not allow pouch to get too full as it can pull away from the skin -if at all possible, transport your patient to the bathroom for this procedure -collect supplies: bedpan or drainage container, squeeze bottle, warm tap water, toilet tissue, gloves, blue pad *2, deodorant product -wash hands and put on gloves -ensure client’s privacy before exposing ostomy -if care is being provided in bed, place disposable blue pad against client’s skin and under pouch -remove clip from end of pouch and fold cuff back at opening of pouch -use palm of hand to gently press contents from pouch into drainage container or toilet -using squeeze bottle, pour warm water into opening of pouch -repeat this procedure until bag appears clean -do not over-rinse as it may break the seal and cause the pouch to pull away from the skin -if providing care in bed, cover drainage container with second blue pad and set aside -if client uses deodorant product in the ostomy pouch,put drops in at this point (8-10 drops on a cotton ball or tissue) -wipe cuff with toilet tissue and unfold cuff -fold pouch only once, do not roll, replace clip,ensure that clip is securely snapped into place and curve in clip follows curve of body -if providing care in bed, remove drainage container to bathroom and dispose of contents in toilet -rinse with cold water to remove solid contents and follow with warm soapy water to clean -seal garbage bag and remove from room, put supplies away, use room deodorizer if necessary -remove gloves and wash hands -do not attempt to replace an ostomy pouch that has fallen off, notify the client’s nurse or home care supervisor so that a nurse may be dispatched to replace the pouch NOTE: some clients may use a two-piece pouch. It may be attached with a snap seal to a base, which remains attached to the abdomen. This pouch may be removed by opening the seal. replace with a clean pouch, ensuring that the seal is securely closed. The pouch that has been removed should be taken to the bathroom and cleaned using warm tap water. Use two pouches each week, then throw out and use two more.

Answer 121

- pouch is changed every 3 to 7 days and whenever it leaks | - some clients want it changed daily or whenever it becomes soiled