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Skills--urine & bowel

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created 4 years ago by srchilds
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updated 4 years ago by srchilds

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1

pH norm

6.0

2

pH range

4.6--8.0

3

Low pH is ##, What to correct it
Med

< 4.6 acidic
Cranberry juice, (protein, meat is acidic)
Ammonium chloride

4

pH high ##
What to correct it?
Med

> 8.0 Alkaline
Orange juice, dairy, protein, meat,
Potassium citrate, NaHCO3

5

What is specific gravity

Density of dissolved solids

6

Specific gravity normal findings

NML 1.015-1.025

7

Specific gravity < ##
Cause

< 1.015
Dilute, over hydrated, diabetes insipidus

8

Specific gravity > ##
Cause

> 1.025
Concentrated, dehydration. (Concern infants and elderly)

9

Color of urine. Normal findings

Pale, yellow, straw

10

Color of urine abnormal findings. Gold, brown, dark yellow would be called

Amber or tea color

11

Color of urine abnormal findings. Colorless

Diluted

12

Color of urine and normal finding. Red\Pink

Blood, beets

13

Color of urine abnormal findings blue

Methylene blue-diagnostic test
((Cascara-- serina))

14

Color of urine anormal findings. Orange

Pyridium.
Bladder spasm pain. UTI

15

Clarity of urine

The turbidity should be clear, translucent for a fresh sample

16

Clarity of urine abnormal findings

Cloudy-left out on counter.
Sediment.
Purulent---Infection, UTI (foul smell)

17

Odor of urine should be

Odorless, light ammonia. Aromatic but not pungent

18

Odor of urine abnormal findings

Strong ammonia. Purulent (fetid older) follow (purulent UTI). Diabetes will cause fruity or sweet order.
Fruity smell comes from key tones.
Sweet comes from glucose metabolism

19

If urine smells fruity or Sweet caused due from diabetes.
Fruity
Sweet

Ketones
Glucose metabolism

20

Constituents in Urine

Urea, creatinine, trace minerals (potassium and sodium), uric acid, nitrogen, ammonia

21

Abnormal constituents in urine

Blood, albumin\protein, glucose, key tones, pus/bacteria (cast), drug residue, bile

22

What is the minimum amount of urine in one hour

30 mL

23

Sterile specimen would need to be taken how

Catheter-straight or retention. (If a catheter bag has been inserted as soon as the catheter bag is inserted is only time you can take a sterile specimen)

24

Minimum amount needed urinary for lab analysis?
What would need to be done to it?

10 mL.
Refrigerate in a bag especially for lab and in a special refrigerator used only for specimens

25

If you are going to do a 24 hour urine collection how would you start?
What happens if one time the patient flushes toilet without collecting urine?

If it begins at 8:13 AM right down the time have patient urinate then dump that urine. Continue collecting urine until 8:13 AM the next day, that would be your final collection.
-Must start over

26

If you are collecting urine for a C & S how much you urine would you need to collect

About 3 mL. It would go in a gray Vacutainer

27

When sending off a lab specimen, what always has to be done or you could get fired

Name, date, time, your initials

28

What must be done before taking a catheter out of a patient you need to

Empty it

29

When inserting a catheter into a female patient how much should be inserted

2-3 inches, Urine will begin to flow and then advance it another 2 to 3 inches

30

Man how far should a catheter be inserted

7-9 inches

31

When inserting a catheter into a female what would you need to assess for activity to help

Limitations, such as hip surgery for spinal surgery which would contraindicate certain actions by the patient

32

What would you assess for conditions that would be Contraindicated for insertion of a catheter

Urethral strictures or bladder cancer.

33

When removing a catheter and you are extracting the saline out of the balloon, what did they say we need to do

It needs to be emptied at least twice in case a doctor has over inflated the ballon

34

catheterizing a female-- when beginning how do you clean her

Wash the peroneal area first. Then open labia, outside, inside, middle meatus.

35

Catheterizing a man how would you begin when cleaning him?
What if the man is not circumcised?

Start at the meatus with a circular motion in then work your way down.
(She demonstrated this with three motions, meatus 1. Down 2. Further down 3).
Gently lift the foreskin clean and make sure that the foreskin is returned

36

Once the balloon is inflated after catheterization what would you do

Gently tug to make sure it is in place

37

If a urine sample is needed when a person has a catheter how would you obtain this?

Clamp under the access port so it will collect urine.
Clean the access port and use the syringe to obtain it

38

What are large volume enemas that result in rapid colon emptying?
These may be dangerous for patients with?

Hypotonic and isotonic
--Weak intestinal walls, such as those with bowel inflammation or bowel infection.

39

A hypotonic enema is
What does it do?

Water
Distends intestine, increases peristalsis, softens stool

40

An isotonic enema is?
What does it do?

Normal saline solution.
Distends intestine, increases peristalsis, softens stool.

41

Large volume enemas
Adults.
Infants
Temp

500-1000 mL.
115-250 mL
105-110

42

When administering an enema would need to assess the abdomen by?
Because The goal is to______
When would this be done?

Auscultating for bowel sounds, percussion, and palpating.
Increase peristalsis, which should increase bowel sounds
Before and after enema

43

When performing an enema you would need to assess the rectal area for?
Why?
The enema may stimulate a ___response, which increases ___stimulation, causing a ___heart rate

Fissures, hemorrhoids, sores, or rectal tears
Greater care would be needed when inserting the tube.

Vagal. Parasympathetic. Decreased

44

Before performing an enema you would need to assess laboratory work for?
Why

Platelet and white blood cell count.
Contraindicated b/c it could irritate or traumatize the G.I. mucosal, causing bleeding, bowel perforation or infection.
-It would place the patient at risk for bleeding or inflammation should not be performed

45

When performing an enema would need to visually assess the patient for

Dizziness, lightheadedness, diaphoresis, and clammy skin

46

Enema cannot be given to people who have

Severe abdominal pain, bowel obstruction, bowel inflammation or bowel infection, or after rectal, prostrate, or colon surgery

47

Which enema is the safest b/w isotonic and hypotonic

Isotonic
If given too much both can cause fluid and electrolyte imbalance,
But hypotonic can cause water intoxication

48

Enema. That distends intestines, increases peristalsis, softens the stool, is?
Action? Evacuation time?
How high should the bed the elevated while solution is running?
How high should the IV pole text last solution be home? How long should you plan to run solution

Normal saline and Tapwater (hypotonic). Pulls water into the colon which stimulates the defecation reflex. 15 min for evacuation

Comfortable position. No higher than 18 inches. Slowly over 5-10 minutes

49

Who are Hypertonic enemas contraindicated in

Sodium retention. It draws water into the colon which stimulates the defecation reflex. Renal impairment or reduced renal clearance because they have a compromised ability to excrete phosphate adequately.

50

Tapwater (hypotonic).
Amount? Adverse effect?

500-1000 mL.
Fluid and electrolyte imbalance, water intoxication

51

Tapwater (hypotonic) enema takes effect in how many minutes?
What is its action

15 minutes
Dist ends intestine, increases peristalsis, softened stool

52

Hypertonic small amount enema
Takes effect in?
Adverse effect

75-130 mL
5-15 min
Sodium retention

53

Enema
What is the adverse effect of normal saline (isotonic).
Tapwater (hypotonic)

Both fluid and electrolyte imbalance.
Sodium retention.
Water intoxication.

54

Distends intestine, irritate intestinal mucosa, softens stool

Soap

55

Soap enema amount?
Time to take effect?
Adverse effect?

500-1000 mL. (Concentrate at 3-5 mL per 1000 mL).
10-15 minutes.
Rectal mucosal irritation or damage

56

Lubricate stool and intestinal mucosal

Oil retention (mineral, oil, or cottonseed oil)

57

Oil retention amount?
Time to take effect?

150-200 mL.
30 minutes

58

Diagnostic --Ovum parasite
-has to be done how many times?
Would this be put in a C&S?
How was it be obtained?

3
No, b/c it has preservatives
Catch stool

59

Diagnostic---Occult blood is? Hemocult
What color will it turn on the slide?
How many minutes do you have to wait after the sample?

Hidden blood in stool.
Blue.
3-5 minutes

60

What can cause a false positive on a blood diagnostic?

Hemorrhoids, girl on her monthly.
Beets, vitamin C, meds, veggies, tomato, cauliflower, spicy food, arthritis, salicylate (> 325 daily), steroids, iron preparations, anticoagulant drugs

61

How many days did she say pt has to stay off from their meds before giving an occult blood sample

Three days

62

If a person has blood in their stool Dr. will automatically think ___and will order___

Cancer. Colonoscopy

63

Person will need to give how many consecutive stool samples?
How many places will it be taken from?
What color for a positive return?
What do you do with the sample once it is obtained and tested if sending to the laboratory?

-at least 3
-1 from the center of the stool, at an opposite area take another sample with the opposite end of the applicator stick
-Blue
-Place it in a sealable plastic biohazard bag and sent to lab with the pts ID, time date your initials

64

Retention enemas---1) Helps to lubricate mucosa making it easier to poop.
2) Helps to expel farts from the rectum and relieve distention. 3) Used to destroy intestinal parasites? 4) Used to replenish fluids and nutrition rectally?

Oil retention. Carminative. Antihelmintic. Nutritive

65

How much stool is needed to be placed in a laboratory container

1 inch of form stool or 15-30 mL of liquid stool.

66

Preparing patient for a fecal occult blood test=== food and drugs

Avoid red meat, liver and kidneys, salmon, tuna, macro, sardines, tomatoes, cauliflower, horseradish, turnips, melon, bananas and soybeans. Salicylate of > 325 mg daily, steroids, iron preparations, and anticoagulants. Vit. C can give false neg if blood is present.
Foods 4 days
Drugs 7 days

67

Preparing patient for a fecal occult blood test -- menstruating

Postponed the test until 3 days after her period has ended

68

Preparing patient for a fecal occult blood test ----hematuria or bleeding hemorrhoids?
What other two things if they are bleeding from?

Postpone the test if they are present.
Nose or throat

69

Preparing patients for a fecal occult blood test---person who is colorblind

Have somebody else interpret the reading\result

70

When giving an enema how far do you insert the rectum?
Which direction should be pointed?

3-4 inches
Umbilicus

71

Normal platelet range

150,000--400,000/mm3

72

A platelet count of less than ____can seriously compromise the patient's ability to clot blood.

20,000

73

If resistance is met while inserting enema tube, what do you need to do?

Permit a small amount of solution to enter, withdraw tube slightly, and then continue to insert it. DO NOT FORCE ENTRY OF THE TUBE. Ask patient to take several deep breaths.

74

Enema has been ordered to be given until clear. Severe fluid and electrolyte imbalances may occur at the patient is given more than___ cleansing enemas. Results are considered clear whenever there are no more ___ of stool in enema return. The solution may be ___but still considered a clear return?

3
Pieces
Colored

75

If a patient experiences fullness or pain or if fluid escapes around the tube what do you need to do?

Stop administration. Wait 30 seconds to 1 minute and then restart the flow at a slower rate. If symptoms persist, stop administration and contact the patient doc.

76

Are given to remove feces from the colon. Reasons for administering-relieve constipation or fecal impaction, preventing involuntary escape of poop during surgical procedures, promoting visualization of the intestinal track by radiographic or instrument examination, And help to reestablish regular bowel function during a bowel training program.

Cleansing enema\large volume or small volume.

77

Lg volume
Soap
Hypertonic
Oil

15
10-15
5-10
30

78

Distends, increases, softens stool
Distends, irritates, softens
Distends, irritates
Lubricates stool and mucosa

Lg volume
Soap
Hypertonic
Oil

79

Test for certain conditions such as alter disease, inflammatory bowel disorders, and colon cancer, please place the patient high risk for intestinal bleeding

Occult stool

80

What is the reagent substance used to detect hemoglobin molecules in an occult blood test?

Enzyme peroxidase

81

Maybe ordered to screen for pathogenic organisms such as C. diff or ova and parasites, electrolytes, fat, and leukocytes?
If this cannot go to the lab immediately what needs to be done with it? If this is being tested for over and parasites what is best?

-Stool for culture
-sealed in a biohazard bag and refrigerated.
-Ova and parasites Best detected in warm stool.

82

L-dopa turns urine for color

Brown or black

83

Sulfonamides urine color

Yellow or orange

84

If the specific gravity of urine is concentrated, higher than the normal level, if the cause is not dehydration what could it be due to?

Kidney disease

85

Foods & urine
Meats, protein.
Citrus fruits, dairy products, veggies yes. Legumes

Acidic.
Alkaline


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