Bowel, Urinary, And Nutrition

Question 1

Factors affecting bowel elimination for older adults

Answer 1

Decreased peristalsis
Relaxation of sphincters

Question 2

Fiber requirement

Answer 2

25 to 38 g/day

Question 3

Fluid requirement

Answer 3

2 L/day for females
3 L/day for males
For both fluid and food sources

AKA 2500 mL a day of both fluid and food

Question 4

Emotional distress on elimination

Answer 4

Increases peristalsis and exacerbates chronic conditions (colitis, Crohn’s disease, ulcers, IBS)

Question 5

Depression on elimination

Answer 5

Can lead to decreased peristaltic activity and constipation

Question 6

Immobility

Answer 6

Can result in difficulty contracting gluteal muscles and defecating

Question 7

Painful elimination

Answer 7

Hemorrhoid, fissures, perinatal surgery can lead to suppression of the urge to defecate
Opioid use contributes to constipation

Question 8

Surgery and anesthesia

Answer 8

Slowing of intestinal activity (rationale for auscultating bowel sounds before advancing diet)

Question 9

Fecal incontinence

Answer 9

Inability to control defecation, often caused by diarrhea
Determine causes: medications, infections, or impaction
Apply moisture barrier
Provider can prescribe fecal incontinence pouch to prevent stool from coming in contact with skin

Question 10

Flatulence

Answer 10

Encourage ambulation to promote the passage of flatus
Check for abdominal distention and the ability to pass gas through the anus

Question 11

Hemorrhoid education

Answer 11

Use a sitz bath, warm water, or ice pack to promote relief from hemorrhoid discomfort

Caused by constipation, straining, liver disease, pregnancy, and heart failure

Question 12

Constipation education

Answer 12

Increase fiber and water consumption
Encourage regular exercise
Give bulk-forming products before stool softeners, stimulants, or suppositories
Enemas are a last resort

Question 13

Diarrhea nursing care

Answer 13

Determine the cause (wanna rule out C. Diff)
Administer meds to slow peristalsis
Apply moisture barrier
Suggest yogurt after diarrhea to balance bacteria

Question 14

Medications for constipation

Answer 14

Laxatives: soften stool
Cathartics: promote peristalsis (make patients keep going very strong and potent)
Can be given Imodium for patients who keep going but have to rule out C.diff first

Question 15

High potassium levels

Answer 15

Can cause arrhythmias
Frequent stools can help pass all the potassium out

Examples of potassium foods
Bananas
Dried beans
spinach
Tomatoes

Question 16

High ammonia levels

Answer 16

Can present as being very confused (can cause brain damage, comma, and even death)
Have liver failure (liver disease is the most common cause of high ammonia levels)
May order lactulose to also have frequent stools which will lower ammonium levels

Question 17

Ostomy care

Answer 17

Remove pouch from stoma
Inspect stoma, should appear moist, shiny, and pink red and beefy
Cut the opening 1/8 larger allowing only the stoma to appear through the opening
(Leaving 1/8 more will help prevent irritation around the skin of the stoma)
Apply barrier pastes to creases
Fold the bottom of the pouch and place the closure clamp on pouch

Question 18

Problem with laxative overuse

Answer 18

Weakens bowels expected response to distention from feces (can cause chronic constipation)
Electrolyte imbalance : low sodium (neuro condition: seizures, coma, death), low calcium (tremors, osteoporosis), low potassium (muscle weakness, arrhythmia)

Question 19

Normal urine output when training

Answer 19

Normal urine output is 30 mL/hr (less than 30 mL an hour for 2 hrs is a concern)
Frequency of bowel and bladder training : 2 hour is maximum
Check on patient every hour
Turning the patient is every 2 hours

Question 20

How to assess for urinary retention

Answer 20

*Bladder scan**
Noninvasive
Does not need a doctors order

Question 21

Ng tube how to verify placement

Answer 21

Aspirate the pH level should be 4.5 or less
Have to confirmed with a chest X-ray

Question 22

Saturated fat vs unsaturated fat

Answer 22

Saturated fats are animal fats (bad fats) cause high cholesterol levels leading to atherosclerosis
ex: meats, butter, dairy products(cream cheese)

Unsaturated fats increase levels of good cholesterol (HDLs)
ex: mineral oils, nuts, fish, seeds, peanut butter, avocado

Question 23

High fiber food examples

Answer 23

Grains, cereal (Raisin Bran, cheerios), skim milk, toast (whole wheat bread), apples with the skin, Dried fruit (prunes, figs)

Question 24

Foods that can cause constipation

Answer 24

High fatty foods
cream cheese, pancakes with syrup, cheddar cheese

Question 25

Assessment for bowel elimination

Answer 25

Ask patient what is a normal bowel movement for them (everyone is different)
What is their usual bowel habits

Question 26

Oliguria

Answer 26

The production of abnormally small amounts of urine
(Urinary retention)
Inspect first the abdomen
Then palpate it to assess for bladder distention
Then do a bladder scan

Question 27

Anuria

Answer 27

Failure of the kidneys to produce urine.
No urine output

Question 28

Closed system

Answer 28

Try to keep the systems closed
Increase the chance of urinary tract infection
Every time open tube then increase risk of infection

Question 29

Tasks to delegate to AP

Answer 29

Take specimens to lab
Put tube back on
Cannot do an enema
Can empty a bedside commode
They cannot take out a Foley catheter
They can take obtain a pee sample from a cup and take to lab
They cannot do anything invasive

Question 30

Clear liquid

Answer 30

Food that’s they can see through
Examples:
Fruit juices
Gelatin (jello)
Broth

this diet is usually limited to a few days because it does not have high nutritional value

Question 31

Full liquid diet

Answer 31

Clear liquids plus dairy products (must verify if patients are able to tolerate lactose)
Examples
All juices
Yogurt
Pudding
Some facilities include puréed vegetables
Smoothies
Beverages
Examples: tea, nutritional drinks

Question 32

Serous drainage

Answer 32

The portion of the blood (serum) that is watery and clear of slightly yellow in appearance (fluid in blisters)

Question 33

Sanguineous drainage

Answer 33

Contains serum and red blood cells. It is thick and appears reddish. Brighter drainage indicates active bleeding; darker drainage indicates older bleeding/drainage

Question 34

Serosanguineous drainage

Answer 34

Contains both serum and blood. It is watery and looks pale and pink due to a mixture of red and clear fluid

Question 35

Purulent drainage

Answer 35

The result of infection. It is thick and contains white blood cells, tissue debris, and bacteria. It may have a foul odor, and its color (yellow, tan, green, brown) reflects the type of organism present. (Green for a pseudomonas areuginosa infection)

Question 36

Foods that promote wound healing

Answer 36

• Protein: building block of amino acids

• Lean meats
• Fish (grilled salmon is a better source)
• Best protein comes from
o Beans
o Eggs
o Poultry
o Legumes (peas)

Question 37

Normal albumin ranges

Answer 37

3.5-5.5 g/dL

Question 38

Importance of albumin

Answer 38

If albumin levels are low (less than 3.5 g/dL), this is because a lack of protein puts the client at greater risk for skin breakdown, slowed healing, and infection.

Albumin is a protein made by the liver that can promote wound healing.

Question 39

Eviseration

Answer 39

Eviserated wound: use a sterile moisten gauze to cover it

Steps
o This is a ruptured wound that involves the protrusion of visceral organs through a wound opening.
o Call for help. Notify the provider immediately
o Stay with client
o Cover the wound and any protruding organs with sterile towels or cover with dressings soaked with sterile normal saline solution to decrease the chance of bacteria invasion and drying of the tissues. Do not attempt to reinsert the organs
o Position the client supine with hips and knees bent.
o DO NOT place clients in Fowler or valsalva maneuver because if can cause too much pressure on their abdomen.

Question 40

Potassium

Answer 40

Cardiac care (EKG monitoring)
Normal ranges are 3.5-5.2 mEq/L

Question 41

BUN and Creatine are used for what

Answer 41

Kidney function renal tests
Monitor kidney (renal) health

Question 42

Using a Cane

Answer 42

o Nurse should stand on the weak side of the patient
o Patient should hold cane on their strong side
o Cane will move with the weak side together followed by the strong side after
o Proper cane height should be even with the wrists.
o Allow 15-30 degree elbow flexion
o Should be about 15 cm (6 inches) from foot

Question 43

Using a walker

Answer 43

o Push walker first then take a step (repeat)
o Walker should be pushed about 15 to 20 cm (6-8 inches) forward.
o Walker height should be even with wrists
o Elbow flexion should be at a 15-30 degree angle

Question 44

Measures for pt with urinary incontinence

Answer 44

Prevent skin breakdown by providing a moisture barrier or skin protectant cream

Question 45

Isotonic exercises

Answer 45

Things that require movement repetitively
Walking, swimming, bicycling, stair master, high repetitive movements against low resistance

Isotonic is having the same tension on a muscle

Question 46

White Blood cells tests determine

Answer 46

Is used to determine infection

Infectious and inflammatory diseases
Ex: leukemia and lymphoma; and bone marrow disorders.