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Lisa Flatt, RN, MSN, CHPN
Lower GI tract The Large intestine consists of:
____________ ____________ ____________
Sigmoid Colon Rectum & Anus
Where does the majority of bowel absorption take place?_____________________
Can you voluntarily contract and relax the anal sphincters?_____________________
Is the GI tract sterile?_____________ Where is the peritoneum?_________ Is the peritoneal area sterile?_______
Surgery that involves the bowel is considered “unclean” because the bowel contents and flora contain a large amount of bacteria, that if spread to the peritoneum cause peritonitis.
How would a patient develop peritonitis if they have abdominal surgery – that does not involve the bowel? (like a C-section)
Feces/fecal matter/bowel movement /stool– what are some other terms patients may use?
“Normal stool” is soft, firm, brown and formed
Abnormal consistency: diarrhea, constipated (hard, rock-like), flakey, fulminant, frothy, liquid
“Abnormal” colors: white, yellow, green, red, black, clay-colored, chalk-colored
Constipation Diarrhea Fecal impaction Flatulence – aka fart Incontinence Helminths--worms
Kidneys Ureters Bladder Urethra
Nephron – the functional unit of the kidney Glomeruli- filters wastes; absorption,
resorption and reabsorption of fluids & electrolytes = initial production of urine
Loop of Henle – tubular system in the glomeruli (descending & ascending) that transport the urine, it starts as H2O and becomes more acidic as it moves down the loop
What is the difference between the male and female urethra?________________________
What does UTI stand for?________________ Is a UTI in a male or female considered an
emergency and very serious? _________ Why?_____________________________
Is the Urinary Tract sterile?____________ Is urinary function usually decreased as a
result of the loss of one kidney?_________
Define Pyelonephritis __________________ Can upper urinary tract infections be
considered life-threatening?_____________ Are lower UTI’s more common in men or
women?_____________________ How are they treated?______________ What are some drug classifications used
to treat UTI’s?___________
Urine/Making water/ pee pee/ wee wee – can you think of any other names?
“Normal” appearance – clear and light yellow in color
“Abnormal” findings - blood, sediment, mucus or calculi (stones), brown color, foul smelling, sluggish (thick)
What can dark colored urine indicate?_____________
What if urine is bloody/red colored?_______
Who is at the highest risk for urinary retention? ____Why?__________________
Retention Urgency Frequency Incontinence Nocturia Polyuria Enuresis
Sex Age & Developmental Level Individual Preferences and patterns
(dietary habits) Physical condition Cultural, spiritual and/or religious factors Socioeconomic factors Environmental factors Psychological factors
Meconium – dark green sticky mucousy- protects bowel in utero
Breast – yellow and seedy (colostorum) Formula – brown, formed (poop less)
Brown, formed and regular Potty trained Regression – stressors, new babies in
the house Loss of some function - activity
Soft, brown Incontinent Constipated Peristalsis – slow down (gastroparesis, biopsy) Mental – obsessed Regular – for that person Dependent on laxatives BPH- retention, difficulty start and stop Neurogenic bladder – urinary retention Caffeine is a cathartic
How do the various stages of life affect elimination?_________________________
What affect can activity have on intestinal elimination?_________________________
What affect does physical condition have on intestinal elimination?__________________
What affect does diet have on intestinal elimination?__________________________
Activity, diet, fluids, fibers all affect bowel status Using laxatives, enemas, suppositories can lead to inability
to poop on own Diuretics – rid body of excess fluid, increase urination Stool softeners – make soft NOT laxatives Sleep - regularity Stress – diarrhea or constipation Abdominal and pelvic muscle tone - continence Catheterization – sphincter muscle damage – leaking or
retention Rectal tube – for fecal elimination (diarrhea) – other systems Depression and other mental illness
How often do you have a BM? What does it look like? Do you use laxatives regularly? Stool
softeners? When was your LBM? Do you pass gas? Do you stomach pain? Does your abdomen
feel hard or distended? Bowel sounds in all quadrants?
How often do you urinate? Do you pee at night? Do you have pain with urination? Do you dribble/leak? Incontinent? What color is it? What does it smell like? Is it foul? Do you see mucus, stones or sediment?
Milky? Do you see any red? Blood streaks?
PROBLEM WHAT TO DO
Constipation Diarrhea Fecal impaction Flatulence Incontinence Helminths
Fluids, laxatives, stool softeners, activity
Clear liquids, fiber, medications, stool sample
Disimpact, enema, suppository Beano, fiber Attends, Depends, bowel and
bladder program, muscle strengthening, Kegel’s
Kill the worms!
PROBLEM WHAT TO DO
Frequency Nocturia Urgency Dysuria Enuresis – define length
of dry time Incontinence Retention Polyuria
B&B program, UTI/labs/tests B&B program, decrease
fluids prior to sleeping B&B program, UTI/labs/tests UTI/labs/tests Labs/tests B&B program, Kegel’s Labs/tests/BPH Asses fluids, diabetes,
labs/tests/UTI
DISEASE/CONDITION CAUSE AND TREATMENT
UTI – BPH – Incontinence –
Functional Overflow Reflex Total
Retention – Urinary suppression -
Urinary Tract Infection – bacteria or fungus
Prostate, aging process Varies with type BPH, sphincter valve
issues, catatonia (mental issues), spinal cord injuries
Kidneys no longer make urine
Other Stuffs
Disease: Cancer & chemotherapy use– degradation of mucosal lining, diarrhea, blood, poor absorption, constipation
Diarrhea **8 or more liquid stools in one day* Parasites, worms, medications, foods, stress,
diet, IBS, Chron’s, CDIFF!!!!!!!!! Incontinence – drugs, sphincter control,
diseases (tumors), stress, abuse, sneezing (haha)
Neurogenic bladder – full bladder does not stimulate the need to pee
Urinary Devices and Interventions
Urostomy Stents Foley catheters Coude catheters Condom catheters Urine pouches – U bags – Pee Pouches Straight catheterization Suprapubic catheters
GI Devices and Interventions
Colostomy Ileostomoy Jejunostomy Gastrostomy tube Flexible Sigmoidoscopy Upper GI Lower GI Rectal Tubes Bowel Management Systems
Enemas
Cleansing enemas “Fleets” Irrigation enemas – colonic irrigation Medicated enemas Carminative enema - flatus
expellation enema Oil retention enema
Output
Less than 30 ml of urine per hour is decreased
Monitor urine output every 6-8-12-24 hours Record BM’s Emesis NG Output Liquid stool Bed sheet soaked in perspiration
Intake
Fluids Foods with high water IV and PO Fluids Tube feedings Free water with tube feedings
Tests- GI and GU
BUN and Creatinine Urinary pH Ketones Specific Gravity Urinalysis Urine culture and sensitivity Occult Blood Blood Urobilinogen Stool tested for wormies, cdiff, bacteria, ova and parasites Xrays/CT scans/Ultrasounds/Intravenous pyelogram IVP/MRI Cystoscopy Pyelogram
The Nursing Process
Assessment – Analyze Nursing Diagnosis Planning Implementing Evaluating
Scenario
74 y/o man, daily laxative use, constipated history, medications: lasix, metformin, cholesterol, metoprolol, poor diet Analyze: hx constipation, BP, diabetic, cholesterol issues, diet issues,
decreased activity, laxative abuse Nursing Dx: Constipation related to daily laxative usage Plan: Client will: increase activity by walking 4 blocks daily, decrease
laxative use to 3 times weekly, follow diet as recommended by dietician, increase fluids to 2 liters per day, use stool softeners daily, increase fiber intake to 20 gm/day,
Implement: Obtain dietary consult; Obtain PT/OT consult; Instruct on how to measure fluid intake and healthy fluid options; Instruct on s/s of constipation; instruct on s/s normal BM; instruct of side effects of medications including: lasix, laxatives and other medications; instruct on daily walk; instruct on keeping 7 day –diet-fluid-exercise-blood sugar log -- all accomplished in two weeks
Evaluation: Patient & family verbalizes side effects of laxative use and other medications; return demonstration of exercises; Shows 7 day log and able to analyze areas that are strengths and weaknesses; compliant with diabetic diet and diet as recommended by dietician; verbalizes healthy fluid options; verbalize free of s/s constipation