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What are the four common problems in fecal and urinary elimination?
What are the four common problems in fecal and urinary elimination?
Constipation, fecal impaction, diarrhea, and bowel incontinence
What is the recommended frequency of monitoring vital signs for a patient with diarrhea?
What is the recommended frequency of monitoring vital signs for a patient with diarrhea?
Every 4 hours
To prevent dehydration and maintain physiological stability, patients with diarrhea should be encouraged to increase their intake of ______.
To prevent dehydration and maintain physiological stability, patients with diarrhea should be encouraged to increase their intake of ______.
fluids
What type of fiber should be limited in patients with diarrhea?
What type of fiber should be limited in patients with diarrhea?
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Perianal hygiene is important for preventing skin breakdown and infections in patients with diarrhea.
Perianal hygiene is important for preventing skin breakdown and infections in patients with diarrhea.
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What is the purpose of a rectal suppository?
What is the purpose of a rectal suppository?
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Rectal suppositories should be stored in a refrigerator if required.
Rectal suppositories should be stored in a refrigerator if required.
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Which of these is a contraindication for administering a rectal suppository?
Which of these is a contraindication for administering a rectal suppository?
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Which of these actions should be performed when inserting a rectal suppository?
Which of these actions should be performed when inserting a rectal suppository?
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After inserting a rectal suppository, how long should the patient hold it in their rectum?
After inserting a rectal suppository, how long should the patient hold it in their rectum?
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What are the three reasons for giving an enema?
What are the three reasons for giving an enema?
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What type of enema involves a solution being returned after administration to stimulate defecation?
What type of enema involves a solution being returned after administration to stimulate defecation?
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Administering a fleet enema is contraindicated if the patient has a poor general condition.
Administering a fleet enema is contraindicated if the patient has a poor general condition.
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The rectal tip of a fleet enema should be inserted firmly to ensure the solution reaches the rectum.
The rectal tip of a fleet enema should be inserted firmly to ensure the solution reaches the rectum.
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How long should a client hold a fleet enema before attempting to evacuate?
How long should a client hold a fleet enema before attempting to evacuate?
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What are the different types of urinary elimination problems?
What are the different types of urinary elimination problems?
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Enuresis is a condition that only affects children.
Enuresis is a condition that only affects children.
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Which of these is an appliance commonly used for assisting bedridden clients with elimination?
Which of these is an appliance commonly used for assisting bedridden clients with elimination?
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Bedpans should be covered immediately after being used by the client.
Bedpans should be covered immediately after being used by the client.
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What safety measures should be taken when using a commode chair for a bedridden client?
What safety measures should be taken when using a commode chair for a bedridden client?
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A urinal is a container used for collecting male urine.
A urinal is a container used for collecting male urine.
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Respond promptly to the client's elimination requests regardless of your other tasks.
Respond promptly to the client's elimination requests regardless of your other tasks.
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Always ensure privacy by screening the bed before offering a bedpan to a client.
Always ensure privacy by screening the bed before offering a bedpan to a client.
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When assisting a client to use a bedpan, instruct them to flex their hips and knees and press palms and feet against the mattress to raise their buttocks.
When assisting a client to use a bedpan, instruct them to flex their hips and knees and press palms and feet against the mattress to raise their buttocks.
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When placing the bedpan, ensure the client's buttocks seal the bedpan's rim.
When placing the bedpan, ensure the client's buttocks seal the bedpan's rim.
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Always report any abnormalities observed during the bedpan process to the nurse in charge.
Always report any abnormalities observed during the bedpan process to the nurse in charge.
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What is the primary purpose of an external urinary drainage device?
What is the primary purpose of an external urinary drainage device?
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Before using an external urinary drainage device, the nurse should explain the procedure and reason to the client or their significant others.
Before using an external urinary drainage device, the nurse should explain the procedure and reason to the client or their significant others.
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The condom sheath used for an external urinary drainage device should be applied tightly around the penis to prevent leakage.
The condom sheath used for an external urinary drainage device should be applied tightly around the penis to prevent leakage.
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The tip of the penis must touch the condom sheath to ensure a secure fit.
The tip of the penis must touch the condom sheath to ensure a secure fit.
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The condom sheath is best changed every 2-3 days for optimal hygiene.
The condom sheath is best changed every 2-3 days for optimal hygiene.
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After applying an external urinary drainage device, the genital area should be assessed daily or during diaper changes for any signs of irritation or constriction.
After applying an external urinary drainage device, the genital area should be assessed daily or during diaper changes for any signs of irritation or constriction.
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Perineal care should be conducted daily and only when needed for a client with an external urinary drainage device.
Perineal care should be conducted daily and only when needed for a client with an external urinary drainage device.
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What are the three main purposes of changing diapers and providing perineal-genital care to an incontinent client?
What are the three main purposes of changing diapers and providing perineal-genital care to an incontinent client?
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When changing a diaper for a male client, the ideal position is supine with knees flexed and hips slightly externally rotated.
When changing a diaper for a male client, the ideal position is supine with knees flexed and hips slightly externally rotated.
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When cleansing the perineum for a male client, use a separate quarter of the washcloth for each stroke, wiping from the pubis to the rectum.
When cleansing the perineum for a male client, use a separate quarter of the washcloth for each stroke, wiping from the pubis to the rectum.
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When changing diapers and performing perineal-genital care for a client, it's important to secure the napkin snugly but not too tightly to prevent discomfort and skin irritation.
When changing diapers and performing perineal-genital care for a client, it's important to secure the napkin snugly but not too tightly to prevent discomfort and skin irritation.
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Prompt cleansing after bowel movements is essential to maintain self-esteem, prevent pressure sores, and reduce the risk of microbial growth.
Prompt cleansing after bowel movements is essential to maintain self-esteem, prevent pressure sores, and reduce the risk of microbial growth.
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Why is documenting intake and output important?
Why is documenting intake and output important?
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When documenting urine output, Report if less than 30ml/hr.
When documenting urine output, Report if less than 30ml/hr.
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Study Notes
NUR1012 Fundamentals of Nursing I - Elimination Care
- Intended Learning Outcomes: Students will be able to list common fecal and urinary elimination problems, describe nursing care for clients with those problems, and describe insertion procedures for rectal suppositories, fleet enemas, intake and output measurements.
Bowel Elimination Problems
- Constipation: Fewer than 3 bowel movements per week; hard, dry stools.
- Fecal Impaction: Severe constipation where stool is impacted and cannot be expelled.
- Diarrhea: More than 3 bowel movements per day; loose or liquid stools.
- Bowel Incontinence: Inability to control bowel movements.
- Excessive Flatulence: Excessive gas production.
Nursing Management of Diarrhea
- Identify & Treat Underlying Causes: Resolve the underlying causes to prevent recurrence.
- Monitor Vital Signs: Frequently monitor vital signs for dehydration.
- Monitor Intake & Output: Monitor daily intake and output to maintain hydration.
- Administer IV Fluids: Administer IV fluids as prescribed.
- Encourage Oral Fluid Intake: Encourage oral hydration to prevent dehydration.
- Administer Oral Glucose/Electrolyte Solutions: Replenish lost electrolytes as prescribed.
- Increase Soluble Fiber Intake: Increase soluble fiber intake from foods like rice and potatoes.
- Limit Insoluble Fiber Intake: Limit insoluble fiber intake from foods like whole wheat and cereals.
- Avoid Foods Causing Diarrhea: Avoid foods/drugs known to cause diarrhea.
- Promote Dietary Adjustments: Make dietary adjustments to reduce the frequency and severity of diarrhea.
- Promote Perianal Hygiene: Promote perianal hygiene and use skin barriers to prevent skin breakdown.
- Provide Psychological Support: Provide psychological support to alleviate anxiety and stress.
Nursing Management of Constipation
- Identify & Treat Underlying Causes: Treat any underlying causes to prevent recurrence.
- Monitor Intake & Output: Monitor intake and output to assess hydration status.
- Encourage Fluid Intake: Adequate fluid intake is necessary to soften stools.
- Encourage High-Fiber Foods: Encourage intake of high-fiber foods like fruits, vegetables.
- Promote Regular Bowel Movements: Promote regular bowel movements.
- Encourage Physical Activity: Encourage regular physical activity to stimulate peristalsis.
- Review & Adjust Medications: Review and adjust medications that may cause constipation.
- Administer Laxatives: Administer laxatives as prescribed.
Insertion of Rectal Suppository
- Assessment: Identify the correct client, check doctor's prescription and contraindications (e.g., bowel surgery, severe hemorrhoids, PR bleeding, fistula), and check client's knowledge of the procedure.
- Planning: The client's needs are fulfilled and the client is safe and comfortable.
- Preparations: Explain/reassure the client, ensure privacy, hand hygiene, gather equipment (tray/receiver containing rectal suppository, gloves, water-based lubricant, and gauze).
- Implementation: Loosen client's trousers, position client, put on gloves, remove the suppository wrapper, lubricate the tip, instruct client to relax and take a deep breath, insert suppository, change gloves, assist client to put on trousers, instruct client to hold suppository for 15-20 minutes, advise to defecate, and discard used gloves.
- Observe, Document, Report & Evaluate: Observe client's condition, any abdominal pain, amount and characteristics of stool, document on IPMOE and MEWS chart, and report results and abnormalities.
Administering an Enema
- Reasons: Relieve constipation, empty bowel for surgery/investigation, introduce drugs/fluids/nutrients.
- Types: Non-retention (cleansing), and retention enemas.
- Fleet Enema: Ready-to-use disposable enema; contains sodium phosphate, increasing volume and water content of stool, stimulates peristalsis.
- Contraindications: Poor general condition, uncooperative clients, severe hemorrhoids, rectal bleeding, anal/perineal wounds, carcinoma of the lower bowel, recent bowel surgery.
- Implementation: Position client in left lateral position, protect under buttock, carefully insert lubricated tip of the bottle into the anus, squeeze solution into rectum, withdraw tip, and arrange client in a comfortable position.
Altered Urinary Elimination
- Polyuria: Excessive urine production.
- Oliguria: Low urine output (less than 500mL/day for adults).
- Anuria: Absence of urine production (less than 100mL/day).
- Nocturia: Frequent urination at night.
- Urgency: Strong desire to urinate.
- Dysuria: Painful or difficult urination.
- Enuresis: Involuntary urination in children beyond expected age.
- Urinary Retention: Inability to empty the bladder.
Appliances Used for Elimination
- Bedpans: Shallow basins with smooth rims, often made of stainless steel, plastic, or disposable materials to accommodate bowel or urinary needs.
- Commode Chairs: Designed for bedside use; equipped with lockable wheels ensuring safety.
- Urinal: Plastic or stainless containers for urine collection for male clients, used after being covered to maintain hygiene.
General Principles in Meeting Client's Elimination Needs
- Respond promptly: Promptly respond to clients' elimination requests.
- Practice hand hygiene: Practice hand hygiene and appropriate glove usage per need.
- Cover: Cover the bedpan/urinal to minimize odor and embarrassment.
- Privacy: Provide clients with privacy.
- Safety: Remain with ill or helpless clients for safety.
- Comfort: Ensure comfort by supporting the back.
Procedure for Offering Bedpans
- Privacy: Ensure privacy.
- Client Position: Help clients roll down their trousers and flex their hips & knees.
- Secure: Press their palms and feet against the mattress for support and a proper bedpan positioning.
- Alignment: Ensure the bedpan is in the correct anatomical position (opening towards the feet).
- Placement: Secure client positioning on the bedpan.
- Monitoring and Recording: Observe and document amount, color, and abnormalities of stool in the I&O chart.
- Reporting: Report any abnormalities to the nurse in charge.
- Evaluation: Evaluate if the pre-set goals were met and note unexpected outcomes.
Application of External Urinary Drainage Device
- Explanation: Educate the client and significant others on the procedure and reasons for applying the device.
- Privacy: Provide privacy.
- Perineal Care: Perform meticulous perineal care, observing the genital skin condition.
- Application: Apply a correctly sized condom sheath, holding the penis firmly to avoid creases and ensuring no twisting of the sheath when connecting it to a urine bag.
- Change: Change the condom daily or as needed.
- Assessment: Assess for skin irritation, excessive discharge, or constriction.
- Perineal Care: Perform perineal care daily.
- Observation and Documentation: Observe, document, and report on the genital skin and provided care.
Changing Diaper and Perineal-Genital Care to Incontinent Client
- Purpose: Maintain hygiene, comfort, and dignity, and prevent skin irritation/pressure sores/infections, and promote self-esteem and comfort.
- Assessment: Assess client's general condition, self-care ability, skin integrity, soiling of pajamas/linens, and pertinent history (perineal hygiene practices, pain, discomfort, indwelling catheters, recent surgeries).
- Planning: Client comfort and dignity, and maintaining skin integrity as goals.
- Preparation: Explain/reassure client, gather cotton wool pads, incontinent pads/disposable napkins, barrier cream (e.g., zinc oxide).
- Implementation: Hand hygiene, position client supine (male-knees flexed), (female-spread apart), cleanse perineal area from front to back, remove soiled pads, and place a fresh one properly.
- Skin Care: Use barrier creams, moisture, etc.
- Evaluation: Ensure client's cleanliness, comfort, safety, and privacy throughout the procedure and document urinary and fecal outputs.
- Documentation: Report and document client's skin condition in the I&O and the nursing kardex.
Measuring & Recording Intake & Output
- Purposes: Assess hydration and nutritional status, assess renal and circulatory function, estimate fluid for replacement, monitor treatment effects (e.g., diuretic).
- Measuring Urine Output: For ambulatory adults – measuring jug/urinal (male), bedpan (female); dependent clients – bedpan/urinal/incontinent sheath.
- Recording Urine Output: Document date, time, color, nature, and amount of urine.
- Measuring Drainage: Document date, time, color, nature, and amount of drainage or vomitus.
- Recording Stool Output: Document date, time, color, nature, and amount of stool discharge.
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