Bowel and Urinary Elimination

Question 1

What is impaction ?

Answer 1

when the stool gets stuck
- have to get a order to get it out

Question 2

What are hemorrhoids ?

Answer 2

little bubbles that come out of your anus
- lining is swollen
- usually from pressure

Question 3

How do laxatives work ?

Answer 3

• bring water into poop to make it easier to get out
• or stimulate the muscles to contract to get it out

Question 4

For administering enema’s what position should they be in ?

Answer 4

left laying in sims position
- pad the bed really good so you don’t dirty the bed

Question 5

What is the mechanism of action for tap water enema ?

Answer 5

hypotonic
- volume stimulates defecation
- do not repeat because of water toxicity (body soaks up the water really good) and fluid overload

Question 6

What is the mechanisms of action of normal saline enema ?

Answer 6

isotonic
- volume stimulates peristalsis
- the safest type of enema

Question 7

What is the mechanism of action of hypertonic/fleet enema ?

Answer 7

hypertonic
- it pulls fluid from the body causing rectal distension
- can cause dehydration
- 120-180 mL is the normal amount

Question 8

What is the mechanism of action of soap suds enemas ?

Answer 8

it causes intestinal irritation and stimulates peristalsis
- only use castile soap
- carefully with pregnant and elderly pt’s

Question 9

What is the mechanism of action of oil retention enemas ?

Answer 9

lubrication
- can retain for several hours

Question 10

What is the mechanism of action of carminative enemas ?

Answer 10

used for gas
- varies by type
- reduces distention

Question 11

What are the mechanism of action of medication enemas ?

Answer 11

varies depending on the type
- Kayexalate is used to decrease potassium levels
- do not use kayexalate for pt’s with hypokalemia

Question 12

What type of feces are found in the jejunum ?

Answer 12

wet feces

Question 13

What is bowel diversion ?

Answer 13

temporary or permanent surgical opening of the ileum (ileostomy) or colon (colostomy) pulled through the abdominal wall to create a stoma

Question 14

What is the purpose of the ostomy pouch ?

Answer 14

• protects the skin
• contains fecal material
• remains odor free
• comfortable and inconspicuous

Question 15

What are some nutritional considerations with an ostomy ?

Answer 15

• low fiber foods for the first weeks
• eat slowly and chew food completely
• drink 10 to 12 glasses of water daily
• patient may choose to avoid gassy foods

Question 16

What is the purpose of the NG tube salem sump ?

Answer 16

decompression

Question 17

What type of NG tube is for enteral feedings ?

Answer 17

Dobhoff
- small bore

Question 18

What type of NG tube is for compression ?

Answer 18

Sengstaken-Blakemore

Question 19

What type of NG tube is for lavage ?

Answer 19

larger bore

Question 20

How do we measure NG tube lengths ?

Answer 20

• nose to earlobe to xyphoid
• mark length with marker or tape

Question 21

How do you insert a NG tube ?

Answer 21

• lubricate the whole NG tube
• have pt. take sips of water or swallow while you insert the tube (push tube in while they swallow)
• once you start to put it in don’t stop cause it can activate the gag reflex
• have their head down since it opens up the airwards

Question 22

What is the best way to check for placement of a NG tube initially ?

Answer 22

X-Ray

Question 23

How do you maintain the NG tubing ?

Answer 23

• flush with air to check patency per policy (often every 4 hrs)
• frequent checking nasal mucosa and nose where tube is taped
• frequent mouth care (gets dry often and still do mouth care)
• sore throat management (spray/lozenge)
• set up suction as ordered

Question 24

What is urinary retention ?

Answer 24

an accumulation of urine due to the inability of the bladder to empty

Question 25

What is a urinary tract infection ?

Answer 25

results from catheterization or procedure

Question 26

What is urinary incontinence ?

Answer 26

involuntary leakage of urine

Question 27

What is urinary diversion ?

Answer 27

diversion of urine to external source

Question 28

What is hemodialysis ?

Answer 28

a machine manually draws out the impurities out of the blood - machine acts as the filter and then the "clean" blood gets put back into the patient

Question 29

What is peritoneal dialysis ?

Answer 29

a catheter that is inserted in the peritoneal to remove impurities from the blood - has to be sterile

Question 30

What do you do if you unsuccessfully insert a Foley catheter on a patient with a vagina ?

Answer 30

can leave the sterile one in as a landmark and then try again fresh - can't just take it out and try again because the urethra has bacteria in it that shouldn't go into the vagina

Question 31

What are indwelling catheters for ?

Answer 31

short-term use - closed drainage system for urine

Question 32

What are retention catheters ?

Answer 32

commonly used postoperatively because of several lumens to allow for drainage of urine, irrigation of the bladder, and instillation of meds into bladder

Question 33

What are coude catheters for ?

Answer 33

for pt's that have prostatic hyperplasia (enlargement) - curved tip for easy insertion

Question 34

What are suprapubic catheters for ?

Answer 34

similar to indwelling catheters but put into surgical opening in abdomen rather than urethra

Question 35

What are condom catheters (external urine) ?

Answer 35

peeing into the condom - take off each day, clean it, and put fresh one on - has sticky adhesive - doesn't require sterile insertion technique

Question 36

What type of catheter doesn't require any drainage system ?

Answer 36

straight catheter

Question 37

Where would you collect urine specimens when a pt is catheterized ?

Answer 37

from the catheter's tubing between the bladder and collection bag - not from bag because it goes through the tubing in the collection bag where it sits in a unclean environment

Question 38

When getting a urine sample do we use clean or sterile technique ?

Answer 38

use surgical asepsis when obtaining it, and transfer into a sterile cup

Question 39

What are some characteristics of a standard collection bag ?

Answer 39

- has a large capacity - has to hung from a non-moveable part of the bed or wheelchair - have to keep bag below pt's bladder

Question 40

What are some characteristics of a leg-bag drain ?

Answer 40

- smaller in size and attaches directly to the pt - must be emptyied often