Metro Community College Nursing Program Nancy Pares, RN, MSN

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

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

 Urinary retention  Lower UTI  incontinence

 Total  Functional  Stress  Urge  reflex

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

 Intake and output  Color  Clarity  odor

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

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

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

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

 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

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

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

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

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

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

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

 Accumulation of gases  Increased with decreased mobility or obstruction

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

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

 Guaic/hemacult  Melena  Ova and parasites

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

 Tap water ◦ Stimulates by distention ◦ cc  Saline ◦ Stimulates by distention ◦ 1 tsp salt

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

 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

 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: