• urinary retention, bladder distention
• assess urine residual
• accurate measureent f urinary output
• permit healing, edema to decrease
• bladder irrigation
• urinary obstruction
• incontinence
• spinal cord injuries neruomuscular
• urine specimen

• avoid insertion if possible
• absolute sterile techique for insertion
• use smallest catheter size possible
• secure indwelling to avoid trauma
• limit length of time
• good catheter hygiene

size: french scale of numbers according to diameter of lumen

balloon size

 construction: plastic, rubber, silicone, teflon

institution will decide on manufacturer

this requires physician order

assessment- pt hx, condition, purpose, teaching

plan- strict aseptic technique, organize equipment, ask for assistance

implement

evaluate

funciton of catheter/working properly, urinary output, prevent of infection

pt fluid balance, infection symptoms

This system minimize the risk for infection

• hang below waist/bladder without toching the floor, avoid pooling of urine, kinking of tubing
• tubing should be coiled in bed
• all samples collected aseptically through sample port
• drian bag at regular intervals every 4-8 hours
• keep drainage spout covered ,
• remove as soon as possible as pt condition warrants

closed

intermittent: if blockage is suspected due to sediment or clots, medications into bladder

continuous: meds

Open

For larger amount of irrigation into bladder, to fill the bladder for tests

perineal hygiene- soap and H2O, bid

fluid intake- 2000-2500cc/day

patient education on way to reduce infection

to do this you;

• sterile syringe, gloves, towel
• remove tape
• insert syringe to injection port, withdraw solution to deflate balloon
• remove catheter smooth and slow
• pt education before removal
• encourage to void within a couple of hours

suprapubic catheter

surgically placed-exits the body from the bladder through the abdomen, surtured in place usually. Esp used when bladder or perineal surgery has been performed and the risk of urine in the surgical area will lead to infection

same care as foley, site care at the abdominal site

• can be used with a foley catheter or a suprapubic catether
• smaller urine collection bag attaches to pt's thigh or calf
• allows pt freedom to move around during the daytime
• usually use a larger bad during the night

obtaining lab results

via foley, straight cath, midstream voided

have the patient empty his bladder. discard this specimen and note the time

collect all urine for the next 24 hours

at the end of the 24 hour period , have the patient empty his bladder again and add this specimen to the collection

incontinent- ileal conduit urostomy

continent- koch pouch. need to self cath. stoma present, neobladder. works best if bladder neck and urethra are intact

• prepare food for absorption, absorb fluid and nutrients, temporary storage of feces, evacuation

• mouth, esophagus, stomach, small intestine (duodenum, jejunum, ileum) large intestine (cecum, ascending/transverse, descending/sigmoid colon, rectum)

• constipatoin
• inpaction
• diarrhea
• incontinence
• flatulence
• hemorrhoids

• age, physical activity, diet, fluid intake, psychological factors, personal habits, surgery, medication, dx test, pregancy, pain, position

these are also things to assess during history including: mobility, usual pattern, stool char. specific routines, bowel diversions

promote normal elimination- teaching

antidiarrheal agents

cathartics/laxatives

enemas

digital removal

ostomy care

• decreased dietary fiber intake
• decrease/ inadequate fluid intake
• decreased physical activity
• opioid medications

constipation is shown by:

small hard feces

abdominal discomfort (distended abdomen, pain from gas)

no BM x5 days

goal: normal bowel elimination pattern for patient

evidence based practice guidelines:

• fluid intake >1.5L/day
• avoid diuretic fluids
• high fiber diet
• physical activity
• judicous use of laxatives

• this promote defecation by stimulating peristalsis
• removal of impacted feces
• emptying bowel prior to diagnostic tests, bowel surgery
• bowel prep program for sinal cord injury patients
• route for administration of medication

enema

(tap water)

enema

(normal saline)

enema

(soapsuds)

stimulates defecation through intestinal irritation

Castile only

Enema

(hypertonic)

enema

(oil retention)

timing- plan!

evaluate results

documentation

risks: perforatoin of bowel, abdominal pain or cramping, rectal bleeding, chronic use= F/E imbalance, dependence

veins that are enlarged in the rectum

interna/ exteral or both

painful if swollen, distended

due to pressure, constipation/diarrhea, age

50% of pop by age 50 have/had theses

route: oral, rectal

bulk forming: metamucil

emollient/softeners: colace

saline/stimulants:milk of magnesia

stronger stimulants: dulcolax, castor oil

lubricants: mineral oil

antidiarrheals

• bulk-forming
• stool softeners
• lubricants
• stimulants
• suppositories
• enemas

R/T:

medications

altered GI functions secondary to disease process

bacterial contamination

formula/food intolerance

also could have impaired skin integrity

surgical opening in the body from the greek word

"mouth"

an operation to create an opening from an area inside the body to the outside

this type fo surgery which allows for normal body waste to be expelled through a stoma on the abdominal wall

lost of function of the organ due to:

birth defect, disease, injury, disorders

right side= ascending colon

across the top of the abdomen- transverse colon

left side=descending colon

assessment:

stoma (size color, shape)

effluent (consistancy, amount)

management of fecal collection

skincare

psychological consideration

this is typically about 1 inch circular

no sphincter muscle present

red/moist/may bleed if injured/no nerve endings/may move a little vary in shape

usually referred to as budded when first esurgically created

chart volume, consistency, and color of the drainage

peristomal skin: skin surrounding the stoma always assess for breakdown

empty pouch regularly to prevent leakage

deordorizer products available

considerations: maintain proper food and fluid intake

regular exercise

maintain skin integrity

protection form injury to stoma

Psychological adaptation

of ostomy

gradual process, fear/resentment/grief

sexuality concerns

daily life concerns

education: nurse, enterostomal therapy nurse, support groups