10/19/2011 1 Kidneys Remove waste from the blood to form urine Ureters Transport urine from the kidneys to the bladder Bladder Reservoir for urine until the urge to urinate develops Urethra Urine travels from the bladder and exits through the urethral meatus Disease conditions Sociocultural factors Psychological factors Muscle tone 10/19/2011 2 Fluid balance Surgical procedures Medications Diagnostic examinations Urinary retention Urinary tract infections Urinary incontinence Urinary diversions Asepsis Client education Catheterization and other procedures 10/19/2011 3 Functional Overflow Reflex Stress Urge Nursing history ? Pattern of urination ? Symptoms of alterations ? Factors affecting urination Physical assessment ? Skin and mucous membranes ? Kidneys ? Bladder ? Urethral meatus 10/19/2011 4 Assessment of urine ? Intake and output ? Characteristics: color, clarity, odor ? Urine testing: specimen collection Common urine tests ? Urinalysis ? Specific gravity ? Culture Diagnostic examinations ? Consents ? Allergies ? Pre- and post-procedure interventions Incontinence Risk for infection Toileting self-care deficit Impaired urinary elimination Urinary retention 10/19/2011 5 Goals and outcomes ? Client will void within 8 hours after catheter removal ? Client?s bladder is not distended on palpation Setting priorities Continuity of care Client education Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake Promoting complete bladder emptying Preventing infection: hygiene and acidifying urine Maintaining elimination habits Medications Urethral catheterization Alternatives to urethral catheterization: suprapubic catheters, condom catheters 10/19/2011 6 Types Insertion Drainage systems Routine care: hygiene, fluids Prevention of infection Irrigations and instillations Removal Strengthening pelvic floor muscles Bladder retraining Habit training Self-catheterization Maintenance of skin integrity Promotion of comfort Ascertain if client has met outcomes and goals. Evaluate how the client reports progress made. Help the client redefine goals if necessary. Revise nursing interventions as indicated. 10/19/2011 7 Mouth Digestion begins with mastication Esophagus Peristalsis moves food into the stomach Stomach Stores food; mixes food, liquid and digestive juices; moves food into small intestines Small intestine Duodenum, jejunum, and ileum Large intestine The primary organ of bowel elimination Anus Expels feces and flatus from the rectum Age Diet Fluid intake Physical activity Psychological factors Personal habits 10/19/2011 8 Position during defecation Pain Pregnancy Surgery and anesthesia Medications Diagnostic tests Constipation Impaction Diarrhea Incontinence Flatulence Hemorrhoids Bowel diversions: ostomies ? Loop colostomy ? End colostomy ? Double-barrel colostomy ? Alternative procedures Psychological considerations 10/19/2011 9 Loop colostomy ? Temporary in the transverse colon End colostomy ? Proximal end forms stoma and distal end is removed or sewn closed Double-barrel colostomy ? Bowel is surgically cut and both ends are brought through the abdomen Ileoanal pouch anastomosis ? Pouch is a reservoir for wastes which are eliminated from the anus Kock continent ileostomy ? Small intestines forms a pouch which is emptied several times a day Macedo-Malone antegrade continence enema (MACE) ? A procedure developed for client who has neuropathic or structural abnormality of the anus. Elimination pattern Characteristics of stool Routines Use of medications or enemas Presence of bowel diversion Changes in appetite Diet and fluid intake 10/19/2011 10 Prior medical history and use of medications Emotional state Exercise patterns Presence of discomfort Social history Mobility and dexterity Physical examination ? Mouth ? Abdomen ? Rectum ? Fecal specimens Diagnostic examinations Client expectations Bowel incontinence Constipation Diarrhea 10/19/2011 11 Goals and outcomes ? Client sets regular defecation habits ? Client implements a regular exercise program Setting priorities Continuity of care Promotion of normal defecation Sitting position Positioning on bedpan Privacy Medications ? Cathartics and laxatives ? Antidiarrheal agents 10/19/2011 12 Cleansing Tap water Normal saline Hypertonic solutions Soapsuds Oil retention Others: carminative and Kayexalate Digital removal of stool Insertion and maintenance of a nasogastric tube ? Purposes Decompression, enteral feeding, compression, and lavage Irrigation Pouching Skin barriers and care Nutritional considerations 10/19/2011 13 Bowel training Maintenance of proper fluid and food intake Promotion of regular exercise Hemorrhoid care Maintenance of skin integrity Client care Client expectations Jerry Microsoft PowerPoint - Chapter_044 Revised [Compatibility Mode]
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