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box 46-4, p, 1190
What are some risk factors for getting colon cancer?
- Age: Over 50 years old
- Family history: Colorectal cancer
- Personal history
- Ethnic Background: Jews of eastern european
- Race: African Americans
- Diet: HIgh intake in animal fats and low in fruit and veggies
- Obesity: and inactivity
- Smoking: and alcohol intake
- Diabetes:
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Skills 46-3 pg 1211 - 1215
What are the first steps for Pouching an ostomy?
- 1. Hand Hygiene & Ausculate bowel sounds
- 2. Apply gloves & inspect skin, pouch, & lenght of stay
- 3. Inspect stoma
- 4. Measure stoma
- 5. observe abdominal incision
- 6. Keep record of I&O & remove gloves
- 7. Check for gas accumulation
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Box 46-10 Ostomy Management
What are some client teaching patterns for a client with an ostomy?
- Provide a list of products needed for ostomy care
- Contact # & location of nearest medical supply store
- Show steps for changing pouch
- Let client change puoch while in hospital
- Set up visits from a stoma care nurse
- Provide detailed discharge instructions for everyday activities
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Table 46-5, p. 1198
What are some actions of a bulk forming Laxative?
- High fiber content absorbs water and increases solid and intestinal bulk
- Agents stretch the intestinal wall to stimulate peristalsis
- Absorbs water and increases sold & intestinal bulk
- Choice for chronic constipation
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Skills 46-1 Enemas pg 1200 - 1202
What are the 1st steps in administering a cleansing enema?
- 1. Asses the status of client
- 2. Asses medical history
- 3. Check rationale for enema
- 4. Review health care providers order
- 5. inspect & ausculate abdomen
- 6. Determines clients understanding of enema
- 7. identify client & procedure
- 8. Collect appropriate equipment
- 9.hand hygiene & put gloves
- 10. provide privacy
- 11.raise bed to waist
- 12. put client in sims position
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Box 46-9, p1199
What are the steps in Digital removal of stool?
- Verify medical history & last bowel
- Hand hygiene, inspect, & ausculate
- Explain procedure
- get vital signs before procedure
- Position; knees flexed, back toward you
- privacy, bedpan & cloth underneath
- apply gloves & lubricate 2 fingers
- put finger in rectum n move in a scissor motion till reached hard mass
- remove small pieces & place in bedpan
- Periodically assess vital signs
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Table 45-1, p. 1138
What is nocturia?
voiding one or more times at night
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Table 45-3; p. 1141
What is the normal value in routine urinalysis for pH?
4.6 - 8.0
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skill 45-1, pp. 1142-1144
What are the steps in collecting midstream (clean-Voided) Urine specimen?
- 1. For women spread labia open and clean side to side then middle & for male clean in 3 circular motions.
- 2.Urinate a little in toilet, stop, and then urinate in a cup and collect about 30 - 60 mL
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skill 45-3, pp. 1162-1164
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Table 45-5, p. 1152
What are the different types of urinary incontinence?
- 1. Functional - loss of urine by factors outside the urinary tract
- 2. Stress - involuntary leakage of urine with pressure on abdomen. coughing, sneezing, laughing, r/t increase abd. pressure.
- 3. Urge - Involuntary passage of urine after a strong sense of urgency to void. feels the urge to go suddenly and can’t get to the toilet.
- 4. Mixed - Combination of urge urinary incontinence signs and symptoms
- 5. Reflex - Involuntary loss of urine at intervals without sensations. Unaware the bladder is full and the client voids in response to spinal reflex.
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skill45-10, p. 1169
What are the steps in applying a condom catheter?
- 1. Do assessments & hand hygiene
- 2. Explain procedure to client
- 3. raise bed, drape client, & prepare catheter
- 4. provide perineal care
- 5. apply condom catheter & leave 2.5 - 5cm of space b/w tip of penis & catheter
- 6.secure in place
- 7.attach drainage bag
- 8. make client comfortable & observe
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skill45-4, pp.1166-1168
What are the steps for applying a closed catheter irrigation?
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Skill 45-2 Inserting a straight or indwelling catheter
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box 46-4, p, 1190
What are some warning signs of Colon Cancer?
- Change in bowel habits
- Rectal bleeding
- Sensation of incomplete bowel evacuation
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Skills 46-3 pg 1211 - 1215
What steps should be taken While removing an ostomy pouch?
- 1. determine clients emotional response & knowledge.
- 2. Explain procedure; encourage client to interact.
- 3. Change pouch when client is comfortable
- 4. Hand Hygiene
- 5. Postion; supine or standing
- 6. Place towel under client
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Skills 46-3 pg 1211 - 1215
What steps should be done when an ostomy pouch is already removed?
- 1. Clean skin with warm water
- 2. measure stoma for correct pouch
- 3. Prepare selected pouch
- 4. Gently press on flange to facilate adhesion
- 5.Put small amount of ostomy deodorant
- 6. Properly dispose of soiled equipment & pouch
- 7. Remove gloves & do hand hygiene
- 8. ask if client has discomfort
- 9. observe condition of skin
- 10. Ausculate bowel sounds & observe characteristics of stool
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Table 46-5, p. 1198
What are some risks of a Bulk forming Cathartics?
- Must be mixed with at least 240mL of water & swallowed quickly
- Cannot be given to clients who have restricted intake of fluid
- Follow each dose with 8oz of water
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What is a Cathartics?
- 1. causing emptying of the bowels.
- 2. an agent that empties the bowels.
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Table 46-5, p. 1198
What are the actions of a Emollient or wetting Cathartic?
- Softens stool that lower surface tension of feces
- They increase secretion of water by intestine.
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Table 46-5, p. 1198
What are some risks of a Emollient or wetting Cathartics?
This agent is at very little value for treatment of chronic constipation
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Table 46-5, p. 1198
What are the actions of a saline Cathartic?
- Contain salt preparation not absorbed by intestine
- Lubricates feces
- Osomotic effect to increase pressure in bowel to stimulate peristalsis
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Table 46-5, p. 1198
What are some risks of a saline Cathartic?
- Not for long term management of constipation
- Not for clients with kidney dysfunction
- Not for clients on fluid restrictions
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Table 46-5, p. 1198
What are the actions of a stimulant Cathartic?
- irritate intestinal mucosa to increase motility
- Decrease absorbtion in small bowel & colon
- Phenolphthalein & Danthron cause pink or red urine
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Table 46-5, p. 1198
What are some risks of a stimulant cathartic?
- cause severe cramping
- Not for long term use
- Could cause fluid and electolyte imbalance
- Not for clients who are pregnant or breastfeeding
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Table 46-5, p. 1198
What are lubricants?
- Coats fecal contents for increase motility
- reduce water absorption in colon
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Table 46-5, p. 1198
What are some risk factors for lubricants?
- Decrease absorption of fat soluble vitamins (A,D,E,K)
- can cause a dangerous form of pneumonia if aspirated into lungs
- When taken with emollients mineral oil increases risk for fat emboli
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Skills 46-1 Enemas pg 1200 - 1202
Steps in administering a cleansing enema?
- 1. Add warm solution to enema bag
- 2. Allow solution to fill tubing
- 3. reclamp tube
- 4. lubricate tip of rectal tube 2 1/2 - 3in
- 5. seperate buttocks n tell client to slowly breathe out.
- 6. insert tip in direction to clients umbilicus
- 7. open clamp & slowly let solution enter
- 8. clamp when solution finished
- 9. place tissue around rectum & remove tubing
- 10 dispose soiled
- 11.Assist client to bathroom or bedpan
- 12. inspect stool & abdomen cramping
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis for protein?
none or up to 8mg/100mL
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis for Glucose?
NONE
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis for Ketones?
NONE
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis for Specific Gravity?
1.0053 - 1.030
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis based on microscopic examination for RBCs?
up to 2
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis based on microscopic examination for WBCs?
0-4 per low-power field
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Table 45-3 pg. 1141
What is the normal value in routine urinalysis based on microscopic examination for Crystals?
NONE
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