Urinary & bowel elimination, nurse as educator, spiritual health
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- Name the reflex that controls fullness in the rectum
- Sacral Cord Reflex
- What type of muscles line the internal sphincter?
- Longitudinal muscles.
- How is the external sphincter controlled?
- Consciously by the person in the cerebral cortex
- What will happen to the defecation reflex if there is an injury below T12?
- The reflex will not occur
- What will happen to the defecation reflex if there is an injury above T12?
- The defecation reflex will occur
- People with an injury below T12 will have to have this to control solid elimination...
- Bowel management program
- What other function do sacral nerves control?
- Urination
- What gives the color to stool?
- bilirubin pigment
- What color is stool of a person with gall bladder disease who produces no bile?
- Grayish
- What color is the stool of a person with a liver problem (cirrhosis)?
- Grayish-whitish
- What can be true of a person with bloody stools?
- GI Bleeding, colon bleeding
- What color is the stool of a person with stomach bleeding?
- Tarry black because the blood in the stomach is digested.
- What type of stool is characteristic of a person with a superinfection?
- Green, liquid.
- An stool with excessive mucous indicates...
- Inflammation or CDiff infection.
- What does it indicate when there are lots of WBC's in the stool?
- Sign of infection
- What color is stool of a person on antibiotics?
- Green/gray color
- What color stool will a patient have after a barium test?
- Whitish
- What does it indicate when a patient has blood streaks on the outside of stool?
- Hemmorhoids
- What is the normal stool pattern?
- Every 1-3 days
- What is the first stool of an infant called?
- Muconium - and it's black and tarry looking.
- A tube-like connection in the bowel that can be between the bowel and bladder, bowel and skin, or bowel and vagina.
- Fistula
- When does a fistula occur?
- In malnutrition or inflammation
- What is one of the causes of constipation?
- High fat diet
- A twisting of the intestines that causes the feces to not move along.
- Volvulus
- Name 4 bowel obstructions
-
Volvulus (twisting)
Tumor
Intussusception (telescoping)
Strangulation (through hernia) - What type of medication induces bowel movement?
- Laxative
- What type of medication induces a bowel movement and is very potent and fast-acting?
- Carthartic
- When is a laxative contraindicated?
- In undiagnosed abdominal pain, possible inflammatory disorders such as appendicitis, ulcertaive colitis. Use caution in pregnancy and breastfeeding.
- What problems do carthartics cause?
- Fluid and electrolyte disturbances
- Some problems of laxatives in pregnant women.
-
May initiate labor
Laxatives go into fetus and fetus has diarrhea (fluid & electrolyte imbalance) - Don't give laxatives to a patient with severe anemia because it can cause
- further loss of nutrients
- Surgery patients can use what type of laxative.
- mild laxatives
- Never give a fiber laxative in an NG tube because it can
- clog the tube
- How does a fiber laxative work?
- It increases bulk and water in the stool and increases peristalsis
- What happens when a laxative is given without enough water?
- The stool gets hard and solid.
- What do you always assess before giving a laxative?
- Bowel sounds.
- A laxative coats the inside of the colon and has a demulcent effect - therefore it is good for people with
- irritable bowel syndrome (IBS)
- A condition whereby a patient has alternating diarrhea and constipation with pain.
- Irritable bowel syndrome
- What type of laxative is good for a patient with diverticular disease?
- Bulk-forming Laxative
- Do laxatives cause physical dependence?
- No
- What is another name for stool softener?
- Emolliant
- These specific drugs have an osmotic effect and are used as prep for colonoscopy
- saline cathertics
- What is the safest type of laxative?
-
Bulk forming laxative
Metamucil, Naturacil, Cologel, Hydrolose, Mitrolan - What type of laxative works the quickest?
- Stimulant cathartics
- What type of laxative works in 1-3 hours
- Cathartic
- Which laxative works in 1-3 days?
- Stool softeners
- Which type of laxative is used after a myocardial infarction, cataract surgery, pregnancy, stroke patients?
- Stool softener
- Which type of laxative would you never use in an NG tube?
- Bulk-forming laxative
- Which type of laxative contains a salt preparation and causes fluid and electrolyte imbalances?
- Cathartic
- Which laxative would you not use in clients with kidney dysfunction?
- Cathartic
- How do cathartics work?
- Irritate the mucosa to stimulate motility.
- Which laxative is used in severe constipation?
- Cathartic
- Which laxative has side effects of flatulence, cramps, gas, belching?
- Lubricant Laxative
- Which laxative decreases absorption of fat-soluble vitamins (A,D,E,K)?
- Lubricant laxatives
- What type of laxative is Metamucil?
- Bulk forming laxative
- What type of laxative is GoLytely?
- Lubricant laxative
- What laxative is used before a colonoscopy?
- GoLytely, lubricant laxative.
- What type of laxative is Colase?
- Stool softener
- Which type of laxative works in 6-8 hours?
- Lubricant laxative
- Which laxative is the most potent?
- Cathartic
- Which laxative can cause pneumonia if aspirated?
- Lubricant laxative
- Which laxative may cause pruritis?
- Lubricant laxative
- What is a PEG solution used for?
- Bowel cleansing before a colonoscopy.
- What type of laxative is Milk of Magnesia?
- Saline cathartic
- What type of laxative is Fleet?
- Saline cathartic
- What type of laxatives are Ex-Lax and Correctol?
- Stimulant cathartics.
- What laxative used to be used commonly and is a stimulant cathartic?
- Castor oil
- What type of laxative is used to decrease blood ammonia in chronic liver disease?
- Lactulose (Lubricant laxative)
- What is another name for stool softeners?
- emollient or fecal moistening agent
- What type of laxative should you avoid taking with milk or antiacids?
- Stimulant Cathartic - Dulcolax, Biscodyl
- How fast do stimulant cathartic suppositories work?
- 15-60 minutes
- What type of laxative discolors the urine pink, red, violet or brown and comes in a liquid form with an anise flavoring?
- Cascara (stimulant cathartic)
- How should castor oil be given?
- On an empty stomach because it retards emptying of the stomach.
- How should a lubricant laxative be given?
- The client should be upright. Test swallowing before administering.
- How can you make castor oil more tasty?
- Mix with baking soda and orange juice.
- Which laxative can produce cardiac distress, respiratory distress, and nausea with repeated large doses?
-
Stimulant cathartics.
Phenolphthalein (Doxidan, Correctol, Ex-Lax) - How much water should be given with Polyethylene glycol solution (PEG)?
- 240cc q 10 min - total 4 liters
- What are some causes of constipation?
- irregular bowel habits, low fiber diet, high fat diet, fluid intake less than 1500cc.
- What are some types of enemas?
-
Fleet - hypertonic
Saline - safest
Soap suds
Tap water - never give to children
Oil retention - for impaction - What is a serious complication of diarrhea?
- Dicubitis ulcer - can occur in 1 day of diarrhea.
- Causes of diarrhea
-
emotional stress, intestinal infection
food allergies, intolerance to greasy, spicy foods, tube feedings w/ inadequate water, antibiotics, colitis, chron's disease - What antidiarrheal agent causes blue gums?
- Pepto bismol (bismuth)
- When using synthetic opioids you should monitor for what?
- toxic response
- What antidiarrheal has an anticoagulent effect?
- Pepto bismol - bismuth
- What nerve controls micturition?
- Sacral nerve
- What type of action is the micturition reflex?
- involuntary
- What type of action involves relaxation of the external urethral sphincter?
- Voluntary
- What is the name of the muscles in the bladder that contracts during micturition?
- The detrusor muscle
- Decreased blood flow to the kidney from intravascular fluid volume deficit results in ...
- oliguria or anuria
- A dilation of the kidney pelvis & calyces due to obstruction of the pelvic outlet.
- Hydronephrosis
- Urinary stasis can lead to ...
- UT infection
- When there is damage to the spinal cord above the sacral region a person can get...
- reflex bladder
- An injury below T12 in the sacral area can damage the reflex arc and result in ...
- Autonomic Bladder
- Management of autonomic bladder is managed by ...
-
intermittent catheterization
Alphaadrenergic blocker
urinary diversion surgery
implantable sphincter stimulator - Alphaadrenergic blockers such as prazosin relax the bladder sphincter by ...
- stopping the sympathetic and maximizing the parasympathetic nervous system.
- Bladder distention can cause this by compressing the vessels in the bladder...
- hypertension
- The normal amount of urine that an adult voids in a day.
- 1500 ml
- A protrusion of the bladder into the vaginal canal resulting in inability to empty bladder completely is called ...
- Cystocele
- A test that shows the outline of the kidneys, bladder, ureters, urethra. It cannot be given to people who are allergic to iodine and fish.
- Intravenous pyelogram (IVP)
- Symptoms of urinary retention include...
- bladder distentin and small frequent voiding w/o emptying the bladder.
- Two drugs that are given as a bladder antispasmodic
-
Probanthene
Bella Donna & Opium suppository (B&O) - What type of drug is prazosin?
- Alphaadernergic (blocks the sympathetic nervous system and maximizes the parasympathetic nervous system.)
-
Females should wipe from front to back
drink 2000-3000 mL per day
void at least q4h
avoid bubble baths & tub baths
avoid nylon underwear and thongs
void immediately after sex - Things to do to prevent a UTI
- A type of drug for the treatment of UTI
- Fluoroquinolones
- Two very common drugs used to treat UTI's
-
Levofloxacin (Levaquin)
Ciprofloxacin(Cipro) - When giving sulfa drugs the top nursing priority to prevent crystals in the urine and to clear the urinary tract of pus is...
- 2500 - 3000 mL Fluid intake
- When taking sulfa drugs, one may get an adverse effect of
- serum sickness in 7-10 days with joint pain, uritcaria, leukopenia
- A urinary tract analgesic
- Pyridium (phenazopyridine) discolors the urine reddish orange.
- An infection of the upper urinary system is called
- Pyelonephritis
- A defining characteristic of pyelonephritis is...
- very high fever (along with low back pain, N,V, h/a, weakness, cloudy urine, high WBC's.)
- The most important treatment of pyelonephritis is
- IV fluids for nausea, vomiting & to flush kidneys of pus
- When a patient has urge incontinence this may be prescribed to increase the bladder capacitiy & sphincter tone.
- Anticholinergic
- In a teaching plan, the five components to include for each domain.
-
Client learning outcome (goal)
Teaching strategy (how)
Criteria for evaluation (test)
Documentation (report)
Teaching content (explanation) - What are the 3 domains in a teaching plan?
- Cognitive, Affective, Psychomotor
- What is the most important teaching strategy?
- Praise the client for accomplishments.
- Which type of laxative irritates the mucosa of the colon?
- stimulant cathartic
- Which laxative creates an osmotic effect?
- Saline Cathartic
- Which laxative lowers the surface tension of the stool
- stool softener
- Which laxative is an osmotic bowel cleansing?
- Saline cathartic
- Which laxative relieves straining on defecation?
- stool softener
- Which laxative decreases the blood ammonia level?
- Lactulose (a lubricant laxative)
- Which laxative penetrates and coats the stool prevents excessive absorption?
- Lubricant laxatives
- Which laxative is contraindicated in kidney disease?
- Saline cathartics
- Which laxative could cause aspiration in a dysphagic client?
- Mineral Oil
- Which specific laxative results in a bowel obstruction if not mixed with 240cc of water?
- Metamucil
- Which laxative should be avoided during pregnancy and lactation?
- Dulcolax (stimulant cathartic)
- Which laxative is preferable to use at bedtime?
- Colace because it works in 6-8 hours.
- Types of loss
-
Actual
Perceived
Maturational
Situational
Anticipatory - Engel's Model of Grief
-
Shock and Disbelief
Protest
Disorganization
Reorganization - Kubler Ross's Stages of dying
-
Denial, Anger, Bargaining, Depression
Acceptance - Preparation of body
-
Bathe dirty areas
close eyes and mouth, towel under mouth
raise head
take tubes out if allowed
tag corpse