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Questions and Answers
What is the immediate concern that needs to be followed up for the patient irrigating his colostomy 5-6 times a week with 2000 mL each time?
What should the nurse do first when the patient coughs and gag when inserting a nasogastric tube?
Which part of the patient's history alerts the nurse to be especially observant before digital removal of a fecal impaction?
What should the nurse do first if the patient's nasogastric tube has aspirated material with a pH of 8?
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Which patient is a candidate for the Purewick female external catheter?
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Which intervention would the nurse try first for a patient reporting flatulence and a bloated feeling?
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Which areas will the nurse assess for an older patient who frequently experiences constipation? (Select all that apply)
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How do you measure the length of insertion of a nasogastric tube?
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Study Notes
Urinary Drainage and Catheter Care
- Preventing infection in urinary drainage systems involves placing the drainage bag below catheter insertion to avoid backflow.
- Peripheral IV catheter removal requires holding pressure for a minimum of 2 to 3 minutes to facilitate vein contraction and stop bleeding.
- Young children require shorter durations for cold therapy applications due to increased sensitivity to cold.
Positioning for Enemas and Catheter Insertion
- The Sims position is recommended for administering cleansing enemas as it allows for proper gravity flow along the sigmoid colon.
- Proper catheterization begins with checking the healthcare provider's order to ensure equipment and procedure requirements are met.
Promoting Bowel Health in Older Adults
- Increasing fluids, activity, and maintaining a daily meal journal are critical strategies for preventing constipation in older adults.
- Dietary fiber should actually be increased, contrary to the misconception of decreasing it.
Self-Care and Home Health Considerations
- Determining suitability for intermittent self-catheterization involves assessing the patient's understanding of infection signs and their manual dexterity.
- Measuring the patient's first voiding post-catheter removal is essential for detecting potential post-operative complications.
Importance of Skin Care and Monitoring
- With condom catheters, monitoring skin integrity underneath is crucial to prevent irritation or breakdown.
- If a catheter is not draining, troubleshooting for kinks and repositioning the patient is the first action before escalating to other interventions.
Assessments and Interventions for Catheter-Related Issues
- Assessing temperature and urine clarity is vital when exudate is present around an indwelling catheter to evaluate potential infection.
- Specimen collection from a catheter involves using aseptic technique; urine must not be sourced from the collection bag directly to ensure freshness.
Dietary Interventions for Bladder Health
- For bladder retraining, encouraging at least 2000 mL of fluid intake daily supports kidney health and effective bladder function.
Care Strategies for Ostomy Patients
- Patients with ileostomies may require additional teaching for skin protection due to more acidic output compared to colostomy patients.
Colostomy Care Concerns
- Over-irrigation and excessive fluid use for colostomy management can lead to electrolyte imbalances; typical irrigation volumes should be 500 to 1000 mL.
Management of Nasogastric Tube Insertion
- Inserting a nasogastric tube may induce coughing; in such cases, pulling the tube back slightly and instructing the patient to breathe slowly is the immediate corrective action.### Nasogastric Tube Management
- Coughing during tube insertion indicates the tube may have entered the larynx.
- If coughing persists, inspect the throat with a flashlight for potential curling of the tube.
- Inability to breathe requires tube extraction, though reinsertion may be traumatic.
- Aspiration confirms tube placement when it is shown to be in the stomach.
Digital Removal of Fecal Impaction
- Patient history of cardiac disease raises concern due to risks from digital stimulation.
- Vagus nerve stimulation can result in bradycardia and hypotension.
Patient Safety During NG Tube Insertion
- If patient coughs and shows signs of gagging, verifying airway placement is crucial.
- Asking the patient to speak confirms airway patency; inability to speak indicates airway obstruction.
- Consulting healthcare professionals may delay necessary immediate action.
Purewick Female External Catheter Use
- Patients must maintain a supine position during use for effective placement.
- Purewick is an external device not suitable for those with urinary retention or who require precise input/output measurements.
Intervention for Flatulence and Bloating
- Ambulation is the first intervention to stimulate peristalsis and relieve gas.
- Other methods, like rectal tube insertion, are only for severe cases.
Assessment for Constipation in Older Patients
- Key areas to assess include:
- Toileting habits, as they can influence bowel regularity.
- Activity and exercise levels, which affect peristalsis.
- Amount of fluid intake, crucial for softening stools.
- Dietary fiber intake, as low levels can lead to constipation.
- Frequency of laxative use, which can cause dependence.
- Daily hygiene routines do not directly relate to constipation and are not prioritized in assessment.
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Description
Test your knowledge on urinary drainage systems and the associated infection risks. This quiz covers key interventions and best practices for catheter care, directly from Chapter 15. Perfect for nursing students and medical professionals alike!
