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8/9/2019 O. Elimination & Specimen Collection
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NIGHTINGALE INTERNATIONAL
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Assisting with Elimination
Elimination is the excretion of waste
products (skin, lungs, intestines and
kidneys) Urination
The act of emptying the urinary bladder
Defecation The act of eliminating the feces
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Assisting with Elimination
Allow a patient enough time for eliminationBe prompt to assist the patient
Provide Privacy, close curtain in bedroom
Bathroom doors must be closed
For those patients who cannot assume thenormal squat position, stool risers may be used,which requires less effort to stand or sit
Bedpan should be emptied immediately after
use, cleansed and stored properly. Urine must be recorded if patient is on I&O
monitoring.
Liquid stool is measured per facility protocol
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Assisting with Elimination
Types of Devices used for Elimination
Urinal Device used for collecting urine when patientis unable to get up to use the bathroom
Male urinal & Female urinal
Urine must be recorded if patient is on I&O monitoring.
Liquid stool is measured per facility protocol Bedpan -Device for receiving feces or urine from either
male or female.
High Back
Fracture pan Flat and smaller
Bedside commode Receptacle suitable for use as atoilet.
Bedpan should be emptied immediately after use,cleansed and stored properly.
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Assisting with Elimination
If male cannot use urinal by himself,nurse should provide assistance
Request patient to abduct legs to a slight
distanceHolding the urinal in the handle and directing
the urinal at an angle, place the urinal in
between the patients leg, making certain the
long , flat side which was the opposite of thehandle of the urinal is resting on the bed
Gently raise penis; place fully within the
urinal.
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Assisting with Elimination
Urine
comes from one ofits composition uricacid.
1000 2000 ml of urine
amount of daily bodyformation
Composition of urine
95% water
Salts andnitrogenous wastes
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Assisting with Elimination
Factors that
influence urine
amount production mental and physical
health
oral intake
blood pressure
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Normal Characteristics of Urine with
Elimination
Ranges from pale yellow, straw color to amber(depends on the concentration) yellow colorbecause of urochrome, a pigment resulting frombodys destruction of hemoglobin
Transparent at time of voidingHas characteristic of faintly aromatic odor, at roomtemperature it develops the odor of ammonia as aresult of breakdown of urea
Urine is slightly acidic, pH of 4.6 to 8.0
Healthy urine is sterile, but at room temperature itrapidly decomposes
Is negative of protein, glucose, ketone bodies,RBCs, WBCs & bacteria
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Urine Abnormalities
Erythrocytes Hematuria presence of erythrocytes in the urine
may indicate infection, tumors or kidney disease
Individuals with renal calculi (renal stones) may
have irritation and produce hematuria Ketone Bodies
Ketonuria/ ketone aciduria presence of ketones inurine.
Leukocytes
Presence of WBC in urine
Occurs when there is an infection in urinary tract
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Types of Incontinence
Urinary Incontinence Loss of voluntary
control over voiding
Cause of incontinence
Pressure in the bladderis too great
Sphincters are too weak
Stress
Inability to prevent
escape of small amountof urine during stresssuch as laughing,sneezing, lifting orsudden movement.
Urge incontinence Involuntary passage
of urine occurringsoon after a strongsense of urgency to
void Functional
incontinence
Inability of a usuallycontinent person toreach the toilet in timeto avoid unintentionalloss of urine.
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Types of incontinence
Reflex incontinence Involuntary loss of urine at somewhat
predictable intervals when a specific bladdervolume is reached
Total Incontinence State at which individual experiences a
continuous and unpredictable loss of urine.
Overflow Incontinence characterized by small frequent
voiding due to overfilling of the bladder or to abladder with pathologically decreased volume.
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Managing Incontinence
Teach exercises to strengthen muscles aroundexternal sphincter
Kegel exercises (pelvic floor exercises) involves
tightening of muscle around the vagina and anus
for several seconds. Done at least 10 times, 3 times a day.
Use of disposable under garment or incontinence
pads.
Persistent urge, stress or overflow incontinence mayrequire referral to urologist.
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Managing Incontinence
Bladder training Effective with incontinence due to decreased
perception of bladder fullness or impaired voluntary
muscle control.
Provides cooperative patient to void at 1.5 to 2 hrinterval to achieve continence.
On schedule, pt need to ask if they are wet or dry,
checked for wetness, reminded or assisted to toilet.
Limiting fluids after evening meal minimizes theneed for voiding during the night.
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Managing Incontinence
Credes Method for paralyzed patients withoverflow incontinence
Involves manual pressure over the lower abdomen
to express urine from the bladder at regular
intervals. Requires a measure of expertise toprevent injury to bladder.
Cleansing the skin thoroughly after each episode of
incontinence with warm soapy and drying it thoroughly
help prevent skin impairment
Urine and feces are highly irritating to the skin.
Skin that is continuously exposed become inflamed
and irritated.
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Managing Incontinence
Avoid all negative verbal or nonverbal
expressions. Cleanse the perineum in a
professional, caring matter of fact manner. Under no circumstances should any patient
be reprimanded or humiliated (scolded) for
having an accident.
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Bowel Elimination
Factors Influences Bowel Elimination
Balanced diet
Including high-fiber foods
A daily fluid intake of 2000 to 3000 ml
Activity to promote peristalsis (rhythmic
contraction of the intestine that propel gastric
contents through the GI tract)
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Normal Stool Characteristics
Brown in color
Odor is affected by food types
Has soft formed consistency
Frequently ranges from once qd, to 2-3 x/week
Resembles the shape of the rectum
Contains undigested food, dead bacteria, fat, bile,
pigment, living cells, intestinal mucosa, and water.
Each patient has an individual pattern of defecation
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Promotion ofNormal patterns of Bowel
elimination
Establish routine time for defecation
Heeding the urge to defecate
Sitting on a commode or toilet
Having privacy
Respect patients embarrassment, provide
supportive nursing measure and allow as
much privacy as possible
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Physical Assessment Upon Admission
Assess patients abdomen
Determine any nursing diagnosis r/t alteration inbowel elimination including patterns and habits.
Be alert to habits that are detrimental to normal
bowel function. Long term use of laxatives and cathartics
(substances that produce bowel movements)
Causes the intestines to lose ability to respond to
presence of stool Chronic constipation.
Mineral oil cause reduce absorption of fatsoluble vitamins
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Common Alternatives in Bowel Elimination
Constipation A decrease in a persons normal frequency of
defecation accompanied by difficult or incompletepassage of stool or excessively hard stool
Fecal Impaction
Involve a presence of fecal mass too large or hard tobe passed voluntarily.
Either constipation or diarrhea suggests presence ofimpaction. Seepage of stool.
Diarrhea
Passage of fluid or unformed stool. Distention
State by which person is experiencing abdominaldistention related to unable to pass stool due toconstipation or fecal impaction
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Fecal Impaction
Fecal Impaction
Prolonged retention andaccumulation of feces inthe rectum
Feces are hard or putty likein consistency
Results when constipationis not relieved
More water is beingabsorbed from the alreadyhardened feces.
Liquid seeping from theanus is a sign of fecalimpaction. Liquid fecespass around the hardenedfecal mass in the rectum.
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Administering an Enema Enema is the instillation of
solution into the rectum orsigmoid colon.
PURPOSE: Promotion ofdefecation.
ACTION: the volume andtype of fluid installed canlubricate or break up thefecal mass, stretch the walland initiate defecationreflex.
Enema does not treat the
cause of irregularity orconstipation
Frequent enema disruptsnormal defecation reflexes,resulting in dependence onenema for elimination.
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Types of Enema Solution
Large Volume Enema
Cleansing enema promote complete evacuation offeces from the colon by infusion of large volume ofsolution.
Tap Water Enema
Use of tap water
Soap Suds Enema Use of prepared soap suds
Hypertonic
Prepackaged enema solution
Oil retention Lubricates rectum & colon, softens feces and
facilitates defecation.
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FlatulenceFlatulence Presence of air or gas in the intestinalPresence of air or gas in the intestinaltracttract
CauseCauseIntake of gasIntake of gas--producing liquids and food such asproducing liquids and food such ascarbonated beverages, cabbage or beans.carbonated beverages, cabbage or beans.Swallowed a lot of airSwallowed a lot of airDecreased peristalsis due to abdominal surgeryDecreased peristalsis due to abdominal surgerySome narcotic medicationsSome narcotic medicationsDecreased physical activity.Decreased physical activity.Constipation.Constipation.
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Signs and Symptoms of Flatulence
Distention or swelling of stomach Mild to moderated abdominal cramping
Pain
Management to promote peristalsisincludes
Walking
Rectal tube Presence of rectal tube stimulates
peristalsis and movement of flatus
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Nursing Diagnosis with UTI
Incontinence, functional Urinary-R/T Sensory Deficits
-R/T Cognitive Deficits
-R/T Mobility Deficits
Skin integrity, risk or impaired R/T presence ofurine
Self esteem, situational low R/T inability tocontrol passage of urine
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Incontinence, urge for R/T decrease bladdercapacity due to abdominal surgeries or
indwelling urinary catheter.
Incontinence, stress urinary R/T degenerativechange in pelvic muscles and structural supportassociated with increased age
Infection, risk for R/T inadequate personalhygiene
-R/T lack of knowledge of car of urinary
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Nursing Diagnosis for Altered Bowel
Elimination
Constipation
-R/T dehydration
-R/T decreased activity
-R/T postsurgical Ileus
-R/T inadequate dietary fiber intake
Pain, acute R/T bowel distention
Anxiety R/T bowel function
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Diagnostic Examination
It may be performed by a physician at the patientsbedside or in a specially equipped room fortherapeutic or diagnostic purposes.
The nurses knowledge and organization of thediagnostic procedure can be the keys to success.
Fundamental requirement to protect patients rights:
Informed consent: The patient must fullyunderstand what will be done during a test, surgery,or any medical procedure and must understand the
risks and implications before he or she can legallyconsent to it.
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Diagnostic Examination
Nurses Responsibilities
Reinforce physician's explanation of the procedure;
confirm that the patient comprehends it; and verify
that written consent is not always necessary for an
individual test; informed verbal consent may be
adequate.
Anticipate the needs of the physician and have
proper supplies ready.
Keep the patient adequately informed of procedural
details that could cause discomfort.
Assist the patient throughout the procedure
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Diagnostic Examination P
reparing theP
atient for DiagnosticExaminations
The nurse must be prepared to answerquestions for which the patient may needclarification.
The patient needs to know if Nothing can be taken by mouth (NPO) after
midnight
Breakfast will be held until the examination is
complete A special room or piece of equipment is required
for the test
Medication is needed before or during the test
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Diagnostic Examination
All patients admitted to a health care facilityhave at least one laboratory specimen collectedduring hospitalization.
Laboratory examination of specimens of urine,
stool, sputum, blood, and wound drainageprovides important information about bodyfunctioning and contributes to the assessmentof health status.
Laboratory test can facilitate the diagnosis ofhealth care problems, provide information aboutthe stage and activity of a disease process, andmeasure the response to therapy.
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Specimen Collection
Guidelines for Specimen Collection Consider the patients need and ability to
participate in specimen collection procedures.
Recognize that the collection of a specimen
may provoke anxiety, embarrassment, ordiscomfort.
Provide support for patients who are fearfulabout the results of a specimen examination.
Recognize that children require clearexplanation of procedures and that they needthe support of their parents or family member.
Obtain specimen in accordance with specificprerequisite conditions as
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Specimen Collection
Guidelines for Specimen Collection (continued)Wear gloves when collecting specimens of blood or
other body fluids.
Wash hands and other skin surfaces immediately
and thoroughly if contaminated with blood or bodyfluids; wash hands immediately after removing
gloves.
Collect specimens in appropriate containers, at the
correct time, and in the appropriate amount.
Properly label all specimens with the patients
identification; complete laboratory requisition form
as necessary.
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Specimen Collection
Guidelines for Specimen Collection (continued)
Most specimens are transported to the laboratory in aseparate outer plastic bag.
Deliver specimens to the laboratory within therecommended time or ensure that they are storedproperly for later transport.
Use aseptic technique in all collections to preventcontamination, which can cause inaccurate testresults.
Transport specimens under special conditions asrequired.
Enclose specimenin a plastic bag
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Specimen Collection Collecting a Midstream Urine Specimen
Midstream urine specimen Urine is collected after voiding is initiated (midstream)
and before voiding is completed.
This is the cleanest part of the voided specimen.
Several tests can be ordered on one sample of urine:
pH, protein, glucose, ketones, blood, and specificgravity.
Nurses responsibilities
Collect and label the urine sample.
Ensure safe delivery to the laboratory.
Assess the results.
Collecting a midstream urineCollecting a midstream urinespecimenspecimen
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Specimen Collection
COLLECTING 24 HR URINE COLLECTION PURPOSE: To test renal function and urine
composition (measurements of adenocortical
steroids, hormones, proteins, and creatinine
clearance)
Test must be performed accurately
Residual urine
This is urine left in the bladder after voiding.
The patient voids, and catheterization is performedwithin 10 minutes.
Residual urine is more than 50 ml of urine
remaining in the bladder.
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Specimen Collection
Collecting a Sterile UrineSpecimen
Two methods
Insert a straight
catheter into the urinarybladder and remove
urine.
Obtain a specimen from
the port of an indwellingcatheter using sterile
technique.
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Specimen Collection
Stool Specimen
Stool specimens are
collected and examined
for a variety of reasons.
Determine the
presence of infection,
bleeding, or
hemorrhage
Observe the amount,
color, consistency, and
presence of fats
Identify parasites, ova,
and bacteria
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Specimen Collection
Collecting a Stool Specimen (continued)The nurse collects the feces, labels thespecimen appropriately, and sends the specimen
and laboratory request to the laboratory.
Stool to be examined for parasites must be takento the laboratory immediately in order for the
parasites to be examined under the microscope
while still alive.
Stool specimen for ova and parasite (O&P)examination must be collected in an appropriate
container with a special solution.
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Specimen Collection
Determining the presence ofoccultDetermining the presence ofoccultblood in stoolblood in stool
Collecting a Stool SpecimenCollecting a Stool Specimen
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Collecting a Stool Specimen
Determining the
P
resence of OccultBlood in Stool (Guaiac)The presence of blood in body waste isabnormal.
Bright red blood indicates the blood is freshand that the site of bleeding is in the lowergastrointestinal tract.
Black, tarry feces indicates the presence ofold blood and that the site of bleeding is
higher in the GI tract.Occult indicates blood is present in the stoolbut cannot be seen without a microscope.
Hemocult test detects occult blood in feces.