Week #8 Supporting Hygiene and Elimination - DM Fall 23 (1).pptx

NSE111: Week #8 Supporting Elimination Reminders:  This is another heavy deck – review in chunks to facilitate better understanding and retention!  Take time in working through the CJM Activity – it will help solidify your understanding and application  Sign up for Week #10/#11 Performance T...

NSE111: Week #8 Supporting Elimination Reminders:  This is another heavy deck – review in chunks to facilitate better understanding and retention!  Take time in working through the CJM Activity – it will help solidify your understanding and application  Sign up for Week #10/#11 Performance Testing – check in with your lab instructor Week #8 Learning Objectives  Identify considerations to assess (cognitive/physical functioning) prior to planning the client’s elimination needs.  Identify factors that commonly influence urinary and bowel elimination.  Identify key terms related to urinary (micturition, voiding, nocturia, urinary retention, urinary incontinence) and bowel elimination (defecation, constipation, diarrhea, bowel incontinence, flatulence).  Describe characteristics of normal urine and stool and how to assess intake and output.  Identify nursing interventions to promote normal micturition and bowel elimination to reduce urinary incontinence, constipation, and to maintain established routines.  Identify nursing interventions that reduce urinary tract infections (cleaning of perineum and catheter care) and maintain skin integrity Mosby Videos  Assisting with a urinal  Assisting with a bedpan  Performing perineal care for a female patient  Performing perineal care for a male patient  Providing catheter care  Collecting a Mid-stream Urine Specimen NSE111 Week #8 Agenda Class Lab Urinary and Bowel Elimination Appropriate Personal Hygiene Case Studies and Practice in the Lab Reflect on your nursing practice in the lab today and identify learning strategies to implement for improvement in your practice. Case Study Elimination: Two Types Urinary Bowel Nursing Process and Clinical Judgement Factors Influencing Urination  Disease Conditions  Medication  Surgical Procedures  Physiological Factors  Mobility Key terms related to Urinary Elimination: Matching Process of Emptying Bladder 1. Micturition 3. Urinary Retention 2. Nocturia 4. Urinary Incontinence Any involuntary loss of urine Accumulation of urine in the bladder as a result of the bladder’s inability to empty Waking from sleep one or more times to void Urinary Assessment: Recognize Cues  Gather health history for the patient’s urination pattern, symptoms and factors affecting urination  Physical assessment of the patient’s body systems potentially affected by urinary changes  Assess characteristics of urine (Potter & Perry, 2019, p. 1215) Urinary Assessment: Analyze Cues  Knowledge in…  Physiology of fluid balance  Anatomy and physiology of normal urine production and urination  Pathophysiology of selected urinary urination  Caring for patient with alteration in urinary elimination  Caring for patient at risk for urinary infection Assessment Urinary Elimination Characteristics of Urine  Colour  Pale, Straw Coloured to Amber  Maybe altered by medications & food  Clarity  Normally transparent  Odor  Characteristic odour Average fluid intake is about 2200ml to 2700ml per day Oral intake account for 1100 to 1400 ml, and solid foods for about 800 ml to 1000ml When monitoring client’s intake and output, all fluid consumptions are recorded on an intake and output record (Potter & Perry, 2019, p. 1019, 1176) Assess Intake and Output Assess Intake and Urine Output When monitoring urine output, consider what are some recognizing cues one should report? (Potter & Perry, 2019, p. 1176) Infection Control: Gloves Position of Client • Supine/Fowlers: Front to Back • Lateral: Cleansing back, buttocks and anal area • Dorsal Recumbent: Cleansing perineum Wash perineum area from front to back • Use separate sections of washcloth for each stroke • Dry area well Perineum Care Perineum Care Male  Retract foreskin if uncircumcised penis  Use circular motion from meatus outward  Downwards along the shaft  Gently lift scrotum and clean Female  Wash labia majora, minora urethra and vagina front to back  Inside to outside Urine Collection – Mid-Stream (Clean-Voided) Urine Specimen  Assess the patient  When patient last voided  Level of awareness or developmental stage  Mobility, balance and physical limitation  Understanding related to purpose of test and method of collection  Provide fluid to drink a 1/2 hour before collection unless contraindicated, (such as fluid restriction), if patient does not feel urge to void (Potter & Perry, 2019, p. 1178-1180) Mid-Stream (Clean-Voided) Urine Collection - Female Mid Stream (Clean-Voided) Urine Collection - Male Encourage Voiding regularly (approximately every 3 to 4 hours) Support patient learn to relax and stimulate the micturition reflex • Female – Squatting or sitting position • Male – Standing position Provide Sensory Stimuli • Running water • Stroking the inner thigh may stimulate sensory nerves and promote micturition reflex • Pour warm water over the patient's perineum to create the urge to urinate Maintain Elimination Habit • Obtain usual voiding pattern when taking the nursing history Maintain adequate fluid Intake of 1500 to 2000ml • Maintaining an adequate fluid intake of 1500 to 2000 ml promote continence because concentrated urine can irritate the bladder mucosa (Potter & Perry, 2019, p. 1185-1186) Nursing Intervention: Promote Normal Micturition Perineal-Genital Care Assess:  Irritation, excoriation, inflammation, swelling  Excessive discharge  Odour, pain, or discomfort  Urinary or fecal incontinence  Recent rectal or perineal surgery  Indwelling catheter  preferences Perineal-Genital Care Equipment:  Bath towel  Bath blanket  Clean gloves  Bath basin with fresh warm water  Soap  Washcloth Perineal-Genital Care: Females  Wipe from area of least to greatest contamination (pubis towards rectum)  Spread labia with one hand  Start at urethra first* and wipe downwards  Use separate corners of washcloth for each wipe  Wash folds between labia minora then labia majora  Dry area well in the same order  Wash and dry upper/inner thigh area  Note*: P&P variation in order of cleansing the perineum Perineal-Genital Care: Males  Cleanse the urethral meatus tip first  Wash and dry penis using firm strokes  If uncircumcised, retract foreskin to cleanse and then replace foreskin to prevent constriction  Wash and dry the scrotum too  Wash and dry upper/inner thigh area Nursing Interventions: Reduce Urinary Tract Infections (UTI) Good perineal hygiene (cleaning urethral meatus) Maintaining adequate daily intake of fluids (1500 to 2000 ml) Bowel Elimination Factors Affecting Normal Bowel Elimination  Diet  Fluid Intake  Physical Activity  Personal Bowel Elimination Habits  Privacy  Age related changes (Potter & Perry, 2019, p. 1216-1217; 1219-1220) Key terms related to Bowel Elimination: Matching 1. Defecation 2. Constipation As a result of gas production in the lumen of the intestine, the bowel wall stretches and distends. Difficulty evacuation of feces, inability to defecate at will and hard feces 3. Diarrhea 4. Bowel Incontinence Increase in the number of stools and the passage of liquid, unformed feces Inability to control the passage of feces and gas from the anus 5. Flatulence Process of Emptying Bowel Bowel Assessment: Recognize Cues  Obtain diet and medical history  Identify signs and symptoms associated with altered elimination patterns  Determine the impact of underlying illness, activity patterns, and diagnostic tests on bowel elimination patterns (Potter & Perry, 2019, p. 1217) Bowel Assessment: Analyze Cues Knowledge in…  Normal gastrointestinal anatomy and physiology  Factors that influence bowel elimination  Common intestinal alteration (Potter & Perry, 2019, p. 1217) Assessment Bowel Elimination Characteristic of Stool  Colour  Odor  Consistency  Amount  Shape  Constituents (Potter & Perry, 2019, p. 1217-1218; 1223) Promotion of Normal Defecation (Potter & Perry, 2019, p. 1215) Positioning Client on Bedpan (Potter & Perry, 2019, p. 1216) Fecal Specimens  Establish daily bowel routine  Maintain adequate fluid and food intake Nursing Intervention: Promote Normal Bowel Elimination  1500 to 2000 ml fluid per day  Dietary fibre intake 25 to 30 g per day  Regular exercise  Ensure patient privacy  Curtain should be pulled  Call Bell  Closing Bathroom Door (Potter & Perry, 2019, p. 1229) Provide Privacy Assist client to maintain normal elimination habits Sufficient time, client routine Assist client with toileting Increase head of bed, proper positioning, bed pans, urinals, commodes Maintain skin integrity Encourage and monitor adequate fluid and food intake based on client needs and conditions Encourage physical activity and exercise Key Points to Remember with Elimination Infection Control Practices – Assisting with Elimination What are important infection control practices when assisting client with elimination? Name the Elimination Equipment Changing Incontinent Brief  Position the clean, fully-opened incontinence brief so that the lining of the brief is next to the client's skin. Make sure the tape tabs are at the back of the client. Note that the side of the brief is fan-folded on the side next to the client, with the adhesive strips at the top. The client is ready to be rolled onto the brief for proper fitting.  Roll the client onto the back. Bring the front of the brief through the client's legs  Smooth the brief across the abdomen and fit a side of the brief around each of the legs. Fasten the bottom adhesive tabs on either side to the front of the brief  Gently pull the brief upward so the brief fits well in the groin and crotch area. Readjust the fastening tapes as needed to ensure a proper fit. (Sorrentino, Remmert, & Wilk, 2018, p. 668-677)  Assisting with a urinal  Assisting with a bedpan  Performing perineal care for a female Lab patient  Performing perineal care for a male patient  Providing catheter care Week #9 – Supporting Nutritional Intake and Oral Hygiene Preparation for Next Week