Measuring Urine Output

Measuring Urine Output

• Instruct the patient to void into a bedpan, urinal, or specimen container in bed or the bathroom
• Don gloves before handling any bodily fluids
• Pour the urine into an appropriate measuring device to quantify output
• Ensure accurate measurement by placing the calibrated container on a flat surface and reading it at eye level
• Note the amount of urine voided, and record it on the appropriate form
• Discard the urine in the toilet unless a specimen is needed for analysis
• If a specimen is required, pour the urine into an appropriate specimen container

Devices for Collecting & Measuring Urine

• Bedpans, urinals, and specimen containers are used for collecting urine
• There are various measuring devices that accurately measure urine output
• Bedside commodes offer a convenient toileting solution for patients with mobility issues
• Condom Catheters are external collection devices of urine
• Indwelling urinary catheters are internal
• Bladder scanners are devices to measure urine retained in the bladder after voiding, also known as "residual" urine
• Urine retention may be due to obstruction or loss of muscule tone in the bladder

Stool Characteristics

• Stool volume varies based on diet
• High-roughage diets result in more feces, while soft diets result in less
• Large diarrheal stools suggest small bowel or proximal colon issues
• Small, frequent stools with urgency indicate left colon or rectum disorders
• Brown stool color comes from stercobilin, a bile pigment derivative
• Yellow stool in breastfed infants is due to rapid peristalsis
• Black stool can indicate intestinal bleeding
• Melena, a thick, black, tarry stool, is caused by upper GI bleeding
• Lower intestinal tract bleeding or hemorrhoids can result in fresh blood in the stool
• Diet can influence stool color: red meat darkens, milk lightens
• Stool darkens with standing
• Lack of bile can cause white or clay-colored stool
• Iron salts and bismuth subsalicylate can cause black stool
• Antacids can cause whitish stool
• Stool odor is characterized as pungent and can be affected by ingested foods
• Indole and skatole contribute to the characteristic odor of stool
• pH value, excessive putrefaction, and blood can influence color
• Consistency should be soft, semisolid, and formed
• The consistency is influenced by fluid and food intake, and gastric motility
• Decreased time spent in the intestine results in more liquid stool
• The shape of formed stool is about 1 inch (2.5 cm) in diameter, with a tubular shape
• Variations in shape and size can indicate different conditions of the colon
• A gastrointestinal obstruction may result in a narrow stool, Rapid peristalsis thins the stool
• Increased time spent in the large intestine may result in a hard stool
• Normal and abnormal constituents can be found in stool
• Waste residues of digestion, intestinal secretions, shed epithelial cells, bacteria, and inorganic material can be found in stool
• Internal bleeding, infection, inflammation, and other pathologic conditions may also result in abnormal constituents

Commonly Used Enema Solutions

• Tap Water (Hypotonic): Distends the intestine to increase peristalsis, softens stool, volume is 500-1,000 mL
• Watch out the risk of fluid and electrolyte imbalance, water intoxication, should not be used on children, retention time is 15 minutes
• Normal Saline (Isotonic): Distends the intestine to increase peristalsis, softens stool, volume is 500-1,000 mL, retention time is 15 minutes
• Soap: Distends and irritates the intestine to stimulate peristalsis, softens stool, use only castile soap due to rectal mucosa irritation from other soaps, volume is 500-1,000 mL, retention time is 10-15 minutes
• Hypertonic: draws fluids out of he interstitial space into the colon, leading to distention and stimulates peristalsis, retention time is 5-10 minutes
• Volume is 70-130 mL, may be irritating to the rectum, and avoid in patients who are dehydrated due to sodium retention
• Oil (mineral, olive, or cottonseed oil): Lubricates stool/intestinal mucosa and is often used as a retention enema, volume is 150-200 mL, retention time is 30 mins

Harris Flush

• Return-flow enema specifically for "gas" relief
• Alternating flow into/out of rectum 5-6 times
• Raise the enema bag 12-18" above abdominal level, and then alternate to level lower than hips to promote gas expulsion
• Use 100-200 mL of water, change as desired

Suppositories

• Healthcare worker must double-glove before administration
• Use a generous amount of lubricant to facilitate insertion
• Insert approximately 2 inches past the internal sphincter
• Insert against the wall of the rectum, not directly into the stool
• Have patient hold the suppository in place until they feel the urge to defecate

Cleansing Enema

• Position patient on their left side for optimal administration
• Enema solution temperature should be 105 to 110°F
• Volume: administer 750-1000 mL of the enema solution
• Lubricate the enema tip (2-3 inches), insert 3-4 inches into the rectum
• Ensure solution us retained

Colostomy

• A surgical opening into the colon
• Stoma: the opening created by the ostomy

Ostomy Management

• Provide patient with emotional support and physical care
• Monitor stoma and peristomal skin: Normal stoma should appear pink to red and may bleed slightly when touched
• Normal peristomal skin should appear without irritation each time with appliance changes
• Skin breakdown should be treated if neccessary
• Keep skin clean by washing off any excretion, drying skin thoroughly
• Protect skin, collect stool, and control odor with an ostomy appliance
• Different stoma appliances include: Skin barrier, pouch, one or two piece, etc
• Ostomy pouches can be either closed or drainable
• Generally, empty the pouch 1–2 times daily when it's 1/3 to 1/2 full
• Change the appliance twice weekly or every 7 days, or with leakage if need be

Ostomy Management and Skin Barriers

• Prepare and apply skin barrier
• Measure stoma with stoma guide.
• Trace and cut skin barrier material to be no more than 1/8 to 1/4 inch larger than the stoma.
• Remove barrier backing.
• Press adhesive side onto skin, avoiding wrinkles; hold for 30 seconds.
• For the 2-piece system, remove tissue and snap appliance onto the flange or skin barrier wafer.
• Apply closed drainable pouches per instructions
• Document Care