NUR1012 Fundamentals of Nursing I Elimination Care 2024-2025 S1 PDF

NUR1012 FUNDAMENTALS OF NURSING I Elimination Care 2024-2025 S1 1  Intended Learning Outcomes Upon completion of this lecture, students will be able to: 排泄 ⚫ list the common problems in fecal and urinary elimination ⚫ descr...

NUR1012 FUNDAMENTALS OF NURSING I Elimination Care 2024-2025 S1 1  Intended Learning Outcomes Upon completion of this lecture, students will be able to: 排泄 ⚫ list the common problems in fecal and urinary elimination ⚫ describe the nursing care for clients with bowel and urinary elimination needs ⚫ describe the procedure of insertion of rectal suppository, administration of fleet enema, and measuring and recording intake and output ↓ 灌腸 2 Elimination 3  Bowel Eliminations Problem ⚫ Constipation 便秘 Fewer than 3 bowels open/week Dry, hard stool ⚫ Fecal impaction ⚫ Diarrhoea 腹 More than 3 bowels open/day Loose or liquid stools ⚫ Bowel incontinence ⚫ Excessive flatulence 4  腹瀉 Nursing Management of Diarrhea 1. Identify and treat any underlying causes to resolve diarrhea and prevent recurrence. 2. Monitor vital signs every 4 hours to detect early signs of dehydration and other complications. 0 3. Monitor intake and output daily to ensure adequate hydration and fluid balance. 4. Administer0IV fluids as prescribed and encourage oral 0 fluid intake to prevent dehydration and maintain physiological stability. ∞ 5. Administer oral glucose or electrolyte solution as prescribed to replenish lost electrolytes and maintain balance. 5  “ Nursing Management of Diarrhea insolublefeber egiriver 6. Increase soluble fiber intake (rice, potatoes). Limit insoluble fiber (whole wheat, cereals, vegetables), fatty foods, and caffeinated items. Avoid foods/drugs causing diarrhea to firm up stools and reduce bowel stimulation. 7. Implement dietary adjustments to reduce the frequency and severity of diarrhea. anus 8. Promote perianal hygiene and use skin barriers if needed to prevent skin breakdown and infections. 9. Provide psychological support as needed to alleviate anxiety ~ and stress, which may exacerbate symptoms. 6  便秘 Nursing Management of Constipation why taouslepalron 1. Identify and treat any underlying causes to resolve constipation and prevent recurrence. 2. Monitor intake and output daily to assess hydration status, Adequate fluid intake is necessary to soften stools and promote regular bowel movements. 3. Encourage intake of high-fiber foods, such as fruits and vegetables. Fiber adds bulk to stools, facilitating easier bowel movements. 4. Encourage adequate fluid intake. Fluids help soften stools, making them easier to pass. 7  Nursing Management of Constipation 5. Promote regular physical activity. Exercise stimulates peristalsis, aiding in bowel movements. 6. Encourage establishing a regular bowel habit and not ignoring the urge to defecate. Regular habits promote consistent bowel movements and prevent constipation. 7. Review and adjust medications that may cause constipation. Identifying and modifying constipating medications can alleviate symptoms. 8. Administer laxatives as prescribed. Laxatives stimulate ↓ defecation and provide relief from constipation. 便藥瓜 momig 8 大 Insertion of Rectal Suppository 9  Rectal Suppository Description: Conical-shaped, solid gelatine preparation with lubricants/drugs 颺 Administered via rectum (PR) Absorbed through rectal mucous membrane (e.g., aspirin, anusol, paracetamol) ”墟境四藥 — — Indications: 利痛 Relieve constipation Empty bowel before surgery/X-ray studies (e.g., intravenous pyelogram) Alternative medication administration route Storage: Store in a refrigerator if required 10 Insertion of Rectal Suppository 1 Assessment  Identify the right client  Check doctor’s prescription  Check client's GC, indication, and contraindication, e.g. any bowel surgery performed, severe hemorrhoid, PR bleeding, fistula  Check the client's knowledge regarding the procedure Planning Goals  Client’s needs fulfilled  Client is safe & comfortable 11 Insertion of Rectal Suppository 2 Planning Preparations  Client – explain/reassure  Environment - ensure privacy  Nurse - hand hygiene  Equipment (tray/receiver) containing:  rectal suppository as prescribed  Gloves  Water-based lubricant (K.Y. Jelly)  gauze 12 Insertion of Rectal Suppository 3 Implementation  Loosen the client‘s trousers and roll them down to knee-level  Arrange the client in the proper position:  Adult - Lt lateral position with knees and hip well flexed  Small child - lie the child prone on the nurse‘s lap  Put on disposable gloves  Remove the wrapper and lubricate the round tip of the suppository with water- soluble lubricant  Instruct the client to relax by taking a deep breath 13 Insertion of Rectal Suppository 4 Implementation (cont’d)  Insert the suppository gently into the rectum in the direction toward the umbilicus until you feel it pass the internal anal sphincter  Adult - insert with index finger for about 7 cm  Small child - insert with a little finger, and squeeze the buttocks together to prevent the suppository from being pushed out 14 Insertion of Rectal Suppository 5 Implementation (cont’d) ho  Change glove and clean client’s anus if necessary 以伍忍 ←  Assist client to put on trousers  Arrange the client in a comfortable position  Instruct the client to hold the suppository in the rectum for around 15-20 minutes or until there is an urgent desire to defecate, then he/she can open his/her bowel  Discard used disposable gloves and wash and dry hands thoroughly 15  Insertion of Rectal Suppository 5 Observe, Document, Report & Evaluate Observe: Report: Results and abnormalities Client's condition Signs of abdominal pain Evaluate: Amount & characteristics of Check if pre-set goals are stool met Document: Note any unexpected outcomes Sign on IPMOE Record on MEWS and I&O chart: Time, type of suppository given Result(good/fair/poor) Amount & characteristics of stool 質星 16 色 17 Administering an Enema 18  Administering an Enema 灌易 Reasons for Giving an Enema 1. Relieve constipation 2. Empty bowel before surgery or investigation 3. Introduce drugs, fluids, or nutrients Types of Enema: 1. Non-Retention/Cleansing Enema: Solution returned after administration to stimulate defecation (e.g., fleet enema, soap enema, normal saline). 2. Retention Enema: Solution retained for absorption of drug, fluid, or nutrients (e.g., Resonium C for hyperkalemia, NS). 19  Administering Fleet Enema liquid fom Ready-to-Use Disposable Enema Features: Collapsible bottle with pre-lubricated insertion tip Contains sodium phosphate Mechanism: Increases volume & water content of stool Stimulates peristalsis to promote bowel evacuation Contraindications: No t d :.. this Poor general condition ( ky ) Uncooperative (restless/confused) Severe hemorrhoids Rectal bleeding Anal/perineal wound Carcinoma of the lower bowel Recent bowel surgery 20 一 小  Administering Fleet Enema Implementation 1. Position client in Lt lateral and place the waterproof sheet under buttock 2. Remove protective cap of the fleet enema 3. Expel any air inside the bottle 4. Insert the lubricated rectal tip of the bottle into the anus gently 5. Never force the tip or solution into the rectum as this may cause injury 6. Squeeze the solution containing in the plastic bottle into the rectum 7. Withdraw the tip on completion and arrange client in comfortable position 8. Advise client to hold until the urge to evacuate is strong (usually 5 – 10 minutes) 9. Offer client bedpan if client has strong desire to defecate or allow client to go to toilet 10. Observe, document and report the administration and evaluate effectiveness of the procedure. 21 业 Altered Urinary Elimination aria  Polyuria - Production of abnormally large amount of urine poly -  Oliguria - Low urine output (less than 500ml per day or 30mL an oilg - uria 0 hour for an adult)  Anuria - Lack of urine production (less than 100ml per day) anuriva  Nocturia - Frequent or repeated voiding during night time (more than 2 times)  Urgency - Sudden strong desire to void 排泄  Dysuria - Painful or difficult voiding ( 屆道步  Enuresis - Involuntary urination in children beyond the age when ∝ voluntary bladder control is normally required, usually 4 or 5 years of age, but may also occur in adult sooml wo - →  Urinary retention - Impairment of bladder emptying, resulting in accumulation of urine in the bladder daflamnatrow 22 Appliances used for Elimination  Ambulatory clients can use the toilet independently, while bedridden clients should be provided with bedpans or urinals to accommodate bowel and urinary needs. Bedpan: Commode chair: Urinal: shallow basin, smooth rim, for bedside use Plastic/stainless stainless lock wheels before steel steel/plastic/disposable. use. container for Covered immediately after male urine use by the client. covered after 23 use.  General Principles in Meeting Client’s < Elimination Needs 牌時地 1. Respond promptly to elimination requests. 2. Practice hand hygiene and use gloves as needed. 3. Cover the bedpan/urinal to minimize odor and embarrassment. 4. Provide privacy. 5. Stay with ill or helpless clients for safety. 6. Ensure comfort by: 1. Supporting the back or using a semi-Fowler’s position. 2. Warming metallic bedpans/urinals with warm water. 3. Placing toilet articles and call bell within reach. 4. Covering the client with bed linen. 7. Offer wet tissue and alcohol-based hand rub for hand hygiene. 24  Procedure for Offering Bedpans. 1. Carry a clean bedpan and cover from the sluice room. 2. Ensure privacy by screening the bed. 3. Help the client roll down their trousers to knee level. 4. Instruct the client to flex hips and knees, and press palms and feet against the mattress to raise buttocks. 5. On signal, assist by lifting the client's sacral region and placing the bedpan: Direct opening of the bedpan towards the foot end of the bed. Ensure the client's buttocks seal the bedpan's rim. 6. Check placement by looking between the client’s legs; ensure the client is clear of pajamas. 7. Observe and document the amount, color, characteristics, and abnormalities in the I&O chart and nursing kardex. 8. Report abnormalities to the nurse in charge. 9. Evaluate if the preset goals are met. 10. Note any unexpected outcomes, such as difficulty in urination/defecation. 25 Application of External Urinary Drainage Device X 長期 26 用  Application of External Urinary Drainage Device 1. Explain the procedure and reason to the client/significant others. 2. Provide privacy. 3. Perform perineal care and observe the genital skin condition. 4. Apply a correctly sized condom sheath. 5. Hold the penis firmly and roll the condom on. 6. Apply elastic tape in a spiral, not too tight. 7. Ensure the tip of the penis does not touch the condom. 8. Connect the condom sheath to a urine bag, ensuring it is not twisted. 9. Change the condom sheath daily and as needed. 10. Assess the genital area daily or during diaper changes for skin irritation, excessive discharge, or constriction. 11. Perform perineal care daily and as needed. 12. Observe, document, and report the condition of the genital skin and care provided. 27 Changing Diaper and Perineal-Genital Care to Incontinent Client Purpose: 1. Maintain hygiene, comfort, and dignity. 2. Prevent skin irritation, pressure sores, and infections. 3. Promote self-esteem and comfort. Assessment: 1. General condition and self-care ability. 2. Skin integrity and presence of irritation or inflammation. 3. Degrees of soiling of pajamas and linens. 4. History of perineal-genital hygiene practices, pain, discomfort, / indwelling catheter, and recent surgeries. 28 Changing Diaper and Perineal-Genital Care to Incontinent Client Planning Goals: Promote client comfort and dignity. Maintain skin integrity. 啊 Preparation: Client: Explain the procedure and provide reassurance. Equipment: Cotton wool pads, incontinent pads/disposable napkins, barrier cream (e.g., zinc oxide). Environment: Ensure a quiet, warm, and private setting. 29 Changing Diaper and Perineal-Genital Care to Incontinent Client Implementation: 1. Perform hand hygiene and don disposable gloves. 2. Position client: Male: Supine with knees flexed and hips slightly externally rotated. Female: Supine with knees flexed and spread apart; (Berman, Snyder & Frandsen, 2022) cover body and legs with a blanket. 30 Changing Diaper and Perineal-Genital Care to Incontinent Client 前到役 3. Cleanse the perineum gently from front to back, removing all traces of feces and urine: Male: Wash and dry upper inner thighs and penis. Retract the foreskin, clean the glans penis to remove the 垢 smegma if necessary, and replace the foreskin to prevent constriction. Female: Clean labia majora, then spread labia to wash folds between labia majora and minora. Use separate quarters of the washcloth for each stroke, wiping from the pubis to the rectum. (Berman, Snyder & Frandsen, 2022) 31  Changing Diaper and Perineal-Genital Care to Incontinent Client 由 牌雨边 5. Pay attention to skin folds and rinse well with warm water if necessary. 6. Dry the perineum thoroughly to prevent microbial growth. 7. Apply barrier cream to protect the skin. 8. Change the napkin: Gently lift the client's hips by having them press their feet and palms against the mattress or assist if necessary. Remove the soiled napkin by rolling it inward to contain the soiling. Place a clean napkin under the client, ensuring it is properly positioned to catch any future incontinence. Secure the napkin snugly but not too tight. 9. Perform care of pressure points. 10. Arrange the client in a comfortable position. 32 大 Changing Diaper and Perineal-Genital Care to Incontinent Client Evaluation: 1. Ensure client’s cleanliness, comfort, safety, and privacy throughout the procedure. 2. Document urinary and fecal output in the intake and output chart. 3. Report and document the client's skin condition. Notes: 1. Prompt cleansing is crucial for hygiene, preventing pressure sores, and maintaining self-esteem. 2. Moisture supports microbial growth; ensure the perineum is dry. 3. Use separate quarters of the washcloth to prevent microorganism transmission. 4. Seek assistance if necessary. 33 Measuring & Recording Intake & Output 从 34  Measuring & Recording Intake & Output balane C? ) β Purposes Measuring OUTPUT  Assess hydration & nutritional status  Assess renal & circulatory  Vomitus 螋  Urine (Report if output = +ve balance  Intake < output = -ve balance 古tal Report gross discrepancy of fluid balance! 39  Reference Berman, A., Snyder, S. J., & Frandsen, G. (2022). Kozier and Erb’s Fundamentals of nursing: Concepts, process, and practice (11th ed.). Pearson. Caple, C. (2017). Administration of medication: Rectal suppository. Glendale: CINAHL Information Systems, EBSCO Publishing. Retrieved from: http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=e23e3ea7-d937- 4b8a-90ec- a00cc4137eed%40sessionmgr102 Craven, R. F., Hirnle, C. J., & Henshaw, C. M. (2017). Fundamentals of nursing: Human health and function (8th ed.). PA: Wolters Kluwer. Hospital Authority Head Office. (2015). Basic Nursing Standards for Patient Care – Incontinent sheath application. Retrieved from: http://nursenet.home/Coordinating%20Committee%20%20Grade%20Nursing%20Approv ed%20Pa p/Nursing%20Quality%20and%20Safety/Nursing%20Standard/Basic%20Nursing%20Stand ards%20o n%20Incontinent%20Sheath%20Application.pdf Lynn, P. (2015). Taylor’s clinical nursing skills. A nursing process approach (4th ed.). PA: Wolters Kluwer. Peate, I. (2015). How to administer suppositories? Nursing Standard, 30(1), 34-36. Perry, A. G., Potter, P. A. & Ostendorf, W. (2018). Clinical nursing skills & techniques (8th ed.). MO: Elsevier Smith, S. F., Duell, D. J., Martin, B. C., Aebersold, M. L., & Gonzalez, L. (2017). Clinical nursing skills: Basic to advanced skills (9th ed.). Pearson. 40