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Elimination TAS

Urinary and Bowel Elimination NP1 Test 4

What amount of urine is considered normal when performing a bladder scan? less than 450 mL
What factors make up urinary elimination assessment? -Inspect abdomen, urinary meatus and urine -Palpate -Percuss
What to consider in nursing notes concerning urinary elimination... - Stressors (causes of urinary retention?) - Degrees of reaction - Short term goal? - Nursing orders/rationale?
What is considered "adequate hydration"? 2000-3000mL per day
What are three keys ways to decrease stressors and increase lines of defense concerning urinary retention? 1. Provide privacy 2. Positioning 3. Sufficient time
What is the best position to encourage urination in males? standing
How is bladder training performed? Intermittently clamp the catheter for specific periods of time prior to catheter removal.
After catheter removal... - attempt to void every 2 hours while awake - drink 8-10 glasses of liquid per day - May experience stress incontinence (Kegel exercises) - Plan regular trips to the bathroom
How much urine is needed for a urinalysis? 30 mL
In what time frame should urine samples get to the lab? 30 minutes unless on ice
What is the normal range for specific gravity of urine? 1.010-1.030
The normal pH range for urine is: 4.5-8
The normal range for output of urine is... 1000-2000mL per 24 hrs
Men struggle more with: A- urge incontinence B- stress incontinence A- urge incontinence
Women struggle more with: A- urge incontinence B- stress incontinence B- stress incontinence
Male incintinence may stem from: A- Parkinson's Disease B- Overactive bladder C- Enlarged prostate D- Diabetes E- All of the above E- All of the above
What can the following factors cause? Injury due to childbirth or trauma, Emotional legacy of trauma and anger, Atrophy of bladder muscle and tissue due to loss of estrogen. Female incontinence
Choose all that apply. Female incontinence can be caused by: A- insufficient fluid intake B- uterus pressing on the bladder C- Irritants and inflammation D- spicy foods B and C
T or F. When collecting a 24 hour urine specimen, never collect urine when the client first wakes, as it is contaminated. False. Only the urine of the FIRST morning is skipped.
When collecting urine specimens, it is good nursing practice to only collect the minimal amount of urine necessary for the procedure to minimize client embarrassment. False. It is a good habit to collect at least 30mL of urine for all procedures.
To get the most untainted specimen, waste NO urine when collecting a clean catch. T or F False. Client should start voiding, and sample should be collected midstream, then client should finish voiding.
How much urine is necessary for a creatinine clearance study? A- 1mL B- 30mL C- Everything after the first morning D- 3mL C- All urine except the very first morning urine must be collected for a creatinine clearance procedure.
What does specific gravity indicate about a urine sample? urine concentration
_________ exercises are common use for reducing stress incontinence in men and women. Kegel
polyuria production of abnormally large amounts of urine by kidneys
polydipsia excessive fluid intake
oliguria low urine output usually <500mL per day
anuria lack of urine production
nocturia voiding 2 or more times per night
frequency voiding more than 4-6 times per day
Sudden strong desire to void urgency
painful or difficult urination dysuria
The client's bladder is over distended with urine. The client is experiencing: A-anuria B-urinary incontinence C-polyuria D-urinary retention D- urinary retention
The client tells you they have no control over urine passage. The client is experiencing: A-anuria B-urinary incontinence C-polyuria D-urinary retention B- urinary incontinence
What equipment is typically used with male urinary incontinence? condom catheter
When applying a condom catheter to an uncircumcised client, the best nursing practice is to retract the foreskin. False. Never retract the foreskin of an uncircumcised client when applying a condom catheter.
How much space should be between the condom tip and the connecting tube and penis when applying a condom catheter? 1 inch
What nursing practice is best when caring for a client that has a condom catheter? Assess 30 minutes after application
T or F. Condom catheter changes follow the same procedures as foley catheter changes. False. Condom catheters should be changed daily and skin care provided.
Condom catheter use carries a lower chance of infection than foley catheters. T or F. True
What is rebound tenderness? When client experiences no pain under the pressure of palpation, but does experience pain when pressure is released.
Choose the urinary incontinence: Involuntary loss of urine associated with over distention of the bladder. A- functional B- overflow C- reflex D- total E- urge B- overflow
Choose the urinary incontinence: Involuntary passage of urine occurring soon after a strong sense of urgency to void. A- functional B- overflow C- reflex D- total E- urge E- urge
Choose the urinary incontinence: Continual and predictable loss of urine. A- functional B- overflow C- reflex D- total E- urge D- total
Chooses the incontinence: Inability of usually continent person to reach toilet in time to avoid unintentional loss of urine. A- functional B- overflow C- reflex D- total E- urge A- functional
Choose the urinary incontinence: Involuntary loss of urine at somewhat predictable intervals when specific bladder volume is reached. A- functional B- overflow C- reflex D- total E- urge C- reflex
Define constipation. Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard stool.
return flow enema enema to facilitate expulsion of flatus
cleansing enema enema to prepare intestine for some diagnostic test and surgeries
What is the correct heights for an enema bag for a high cleansing enema? 18 inches
What distance should an enema tubing be inserted? 3-4 inches
oil retention enema enema that lubricates rectum and anal canal to facilitate stool passage
left lateral Sim's correct position for a low cleansing enema
The large intestine is 50 to 60 inches long in the adult; and includes the cecum,ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus. T or F True
The main functions of the colon include absorption of water & nutrients, mucoid protection of the intestinal wall, and fecal elimination. T or F True
Constipation is the most common bowel management problem in the elderly due a variety of stressors including loss of abdominal muscle and loss of large intestine muscle tone. T or F True
Stools for clients with upper gastrointestinal bleeding are black or tarry in color. T or F True
The purpose of the hemoccult test with a stool sample is to determine if there are microscopic amounts of blood (occult blood) in the stool. T or F True
Some stool specimens are temperature sensitive and must be sent to the lab immediately. T or F True
The best way to promote normal bowel habits is to use a laxative daily. T or F False
An important reason that the nurse discourages the client from straining when defecating. straining stimulates the vagus nerve resulting in bradycardia (pulse <60/minute) and possible fainting.
The nurse just completed discharge teaching with a 69 year old male at risk for constipation. He states he needs 500 ml of fluid/day, 20 to 35 grams of fiber/day, a regular exercise routine and a planned time to have a BM each day. Which part is false? The suggested fluid intake is more than 500mL per day
The degrees of reaction for a client with a “fecal impaction” include: a history of no BM for several days, loss of appetite, nausea, abdominal distension and a small amount of loose stool.
What does a low volume cleansing enema do? draws fluid into the colon by osmosis and stimulates peristalsis.
Created by: tiffiny090180