1. Metro Community College Nursing Program Nancy Pares, RN, MSN

2.  Terms used for expelling urine ◦ Urination ◦ Micturition ◦ Voiding  Know anatomy and physiology ◦ Kidney, nephron, glomerulus

3.  Stage of growth and development  Psychological factors  Sociocultural factors  Personal habits  Muscle tone  Fluid intake  Disease conditions  Surgical procedures  Medications  Diagnostic procedures

4.  Urinary retention  Lower UTI  incontinence

5.  Total  Functional  Stress  Urge  reflex

6.  Urgency  Dysuria  Frequency  Hesitancy  polyuria  Oliguria  Nocturia  Hematuria  Retention  residual

7.  Intake and output  Color  Clarity  odor

8.  Ph  Protein  Glucose  Ketones  Blood  Specific gravity

9.  Clean voided Midstream  Sterile  24 hour  Culture and sensitivity

10.  Positioning  Run water  Immersion  Privacy and time  Adequate fluids

11.  Intermittent  Indwelling  Bladder distention  Prevent skin breakdown  Obtain sterile speciman  Assess residual  Relieve obstructed flow  Surgical procedure  Accurate intake and output  Bladder irrigation

12.  Keep system closed  Keep bag below bladder  Don’t let bag touch floor  Coil excess tube on bed  Check for kinks  Encourage fluid intake  Cath care x2 daily  Empty collection bag every shift

13.  Defecation ◦ Reflex occurs when the fecal mass enters rectum  Voluntary and involuntary  Sphincter relaxation  Valsalva maneuver

14.  Age  Diet  Position  Pregnancy  Diagnostic tests  Fluid intake  activity  Psychological factors  Habits  Pain  Medications  surgery

15.  Irregular habits  Inadequate fluids  Lack of exercise  Low fiber diet  Habitual laxative use

16.  No stool  Continual oozing  Loss of appetite  Abdominal distention  Cramping  Rectal pain

17.  Emotional stress  Intestinal infection  Allergies or intolerances  Medications  Colon disease  Surgical procedures

18.  Spinal cord trauma  Multiple sclerosis  Cerebral vascular accident (CVA)  Muscle tone decreased  pathological

19.  Accumulation of gases  Increased with decreased mobility or obstruction

20.  Increased venous pressure  Excessive straining  Pregnancy  Congestive heart failure  Liver disease

21.  Infant---yellow  Adults---brown ◦ soft formed  Additional notations ◦ Frequency ◦ Shape ◦ constituents

22.  Guaic/hemacult  Melena  Ova and parasites

23.  Diet  positioning  Exercise  Digital stimulation  Timing of defecation  Cathartics/laxatives/enemas  privacy

24.  Tap water ◦ Stimulates by distention ◦ 750-1000 cc  Saline ◦ Stimulates by distention ◦ 1 tsp salt

25.  Hypertonic ◦ Draws fluid into the colon (distention) ◦ 4 ounces of fluid ◦ Ex: fleets  Soapsuds ◦ Irritates mucosa ◦ Castile soap ◦ 7500-1000 cc

26.  Oil retention ◦ Low volume ◦ Softens feces ◦ Must retain for extended time  Up and down flush ◦ Aids expulsion of gas ◦ Small amt of fluid introduced, lower bag--repeat

27.  Explain procedure  Sim’s position  Lubrication tube 3-4 in.  Insert tube gently toward umbilicus  Do not raise container more than 18 in above anus  Ask client to retain as long as tolerable  Record type and amount of soln and content return  Observe for intolerance: