Julian Kate O.

Balintag to pass and take only a minute to push

out.That said, some people do spend a
BSN 1F bit more time on the toilet, so as a
Elimination ( Fecal ) general rule, a poop should take no
more than 10 to 15 minutes.
1. Discuss the physiology of Share on Pinterest
defecation
3. Identify factors that affect
-Peristaltic waves move the feces into
defecation
the sigmoid colon and the rectum
-Sensory nerves in rectum are -Developmental stage
stimulated -Diet
Individual becomes aware of need to -Fluid
defecate -Activity
-Feces move into the anal canal when -Psychologic factors
the internal and external sphincter relax -Defecation habits
-External anal sphincter is relaxed -Medications
voluntarily if timing is appropriate -Diagnostic procedures
-Expulsion of the feces assisted by -Anesthesia
contraction of the abdominal muscles -Surgery
and the diaphragm -Pathologic conditions
-Moves the feces through the anal canal -Pain
and expelled through anus
-Facilitated by thigh flexion and a sitting 4. Identify common causes and
position effects of selected fecal elimination
process
2. Distinguish abnormal
characteristics and constituents of Constipation
-Decreased frequency of defecation
feces
-Hard, dry, formed stools
Color - the brown coloring. Bilirubin, -Straining at stools
-Painful defecation
which is a pigment compound formed
-Causes include:
from the breakdown of red blood cells in -Insufficient fiber and fluid intake
the body, gets the credit for this oh-so- -Insufficient activity
lovely shade of brown. -Irregular habits
Shape - A somewhat loglike shape is
how most poop should come out due to Fecal Impaction
its formation within the intestines. -Mass or collection of hardened feces in
folds of rectum
However, as we’ll get to later, there are
-Passage of liquid fecal seepage and no
a variation of shapes that poop can normal stool
have.And when they differentiate from -Causes usually:
the log/sausage shape, that’s when your -Poor defecation habits
poop is trying to tell you something’s up. -Constipation
Size - Poops shouldn’t come out in
small pellets (something else we’ll get to Diarrhea
-Passage of liquid feces and increased
later) but instead should be a couple frequency of defecation
inches in length, comfortable and easy -Spasmodic cramps, increased bowel
to pass. sounds
Consistency - Anywhere between a -Fatigue, weakness, malaise,
firm and soft consistency is pretty much emaciation
normal. If it sways one way or another, it -Major causes:
-Stress, medications, allergies,
could suggest some digestion or fiber
intolerance of food or fluids, disease of
issues. colon
Length of time (how long it takes ) - A
healthy poop, however, should be easy Bowel Incontinence
-Loss of voluntary ability to control fecal
and gaseous discharges
-Generally associated with:
-Impaired functioning of anal sphincter
or nerve supply
-Neuromuscular diseases
-Spinal trauma
-Tumor
Flatulence
-Excessive flatus in intestines
-Leads to stretching and inflation of
intestines
-Can occur from variety of causes:
-Foods
-Abdominal surgery
-Narcotics
5. Describe methods used to assess fecal
elimination process
Nursing History Assesing for Bowel
Info
-Ascertains the client's normal pattern
-Description of usual feces
-Recent changes
-Past problems with elimination
-Presence of an ostomy
-Factors influencing elimination pattern
Physical Examination Assesing for
Bowel Info
-Examination of the abdomen,
rectum, and anus
-Auscultation precedes palpation
because palpation alters peristalsis
-Inspection of feces for
color,consistency, shape, amount, odor,
abnormal constituents
-Review any data obtained from relevant
diagnostic tests
6. Identify measures that maintain
normal fecal elimination patterns
Privacy – privacy during defecation is
extremely important to many people.
The nurse should therefore provide as
much privacy as possible for such
clients but may need to stay with those
who are too weak to be left alone.
Timing – a client should be encouraged
to defecate when the urge is
recognized.
Nutrition and fluids – the client needs
for regular normal elimination varies,
depending on the kind of feces the client
currently has, the frequency of
defecation, and the types of foods that
the client finds assist with normal
defecation.
Exercise – regular exercise helps
clients develop a regular defecation
pattern.
Positioning – although the squatting
position best facilitates defecation, on a
toilet seat the best position for most
people seems to be leaning forward.
7. Describe the purpose and action of
commonly used edema solutions
-Hypertonic (Fleet phosphate)
-Draws water into colon
-Hypotonic (tap water)
-Distends the colon
-Stimulates peristalsis
-Softens feces
-Isotonic (physiologic saline)
-Distends the colon
-Stimulates peristalsis
-Softens feces
-Soapsuds (pure soap)
-Irritate mucosa
-Distends the colon
-Oil
-Lubricates feces and colonic mucosa
8. Describe essential of fecal stoma
care for clients with an ostonomy
-Normal stoma should appear red and
may bleed slightly when touched
-Assess the peristomal skin for irritation
each time the appliance is changed
-Treat any irritation or skin breakdown
immediately
-Keep skin clean by washing off any
excretion and drying thoroughly
-Protect skin, collect stool, and control
odor with an ostomy appliance
9. Describe the steps in
Administering enema to achieve one
or more of the following actions:
cleansing, carminative, retention, or
return-flow.
Implementation – lubricate about 5 cm
of the rectal tube
Performance
1. prior to performing the procedure,
introduce self and verify the client’s
identity using agency protocol.
5. assist the client in comfortable lying
or sitting position
6. unfasten the belt if the client is
wearing one

2. perform hand hygiene 7. empty the pouch and remove the

3. apply clean gloves
4. provide for client privacy
5. assist the client to a left lateral
position, with the right leg as acutely
fixed as possible, with the linen-saver
pad under the buttocks.
6. Insert enema tube
7. slowly administer enema solution
ostomy skin barrier
8. clean and dry the peristomal skin and
stoma
9. assess the peristomal skin and stoma
10. place a piece of tissue or gauze
over the stoma, and change it as
needed.
11. prepare and apply skin barrier.

8. encourage the client to retain enema

9. assist client to defecate

10. document the type and volume, if

appropriate, of enema given. Describe
the results.

Changing a bowel diversion ostomy

appliance – to assess and care for
peristomal skin; to collect stool for
assessment of the amount an type of
output; to minimize odors for the client’s
comfort and self esteem.

Implementation

1. determine the need for an appliance

change

2. if there is pouch leakage or

discomfort at or round the stoma,
change of the appliance.

3. select an appropriate time to change

the appliance.

Performance

1. introduce yourself and and verify the

client’s identity using agency protocols.
Explain the procedure to the client.

2. perform hand hygiene and observe

other appropriate infection revention
procedures

3. apply clean gloves

4. provide for client privacy

Elimination ( urinary ) - -prescribed diuretic
- -presence of thirst, dehydration,
1. Factors affecting urinary and weight loss
elimination/ voiding - -history of diabetes mellitus,
Developmental factors diabetes insipidus, or kidney
disease.
Infants - urine output varies according
to fluid intake but gradually increases to
250 to 500 ml a day during the first year. - -Oliguria or Anuria (little or no
urine output) – decreased
Pre-schoolers – the pre-schooler is urinary output usually less than
able to take responsibility for 500 ml a day or 30 ml.
independent toileting. - decrease in fluid intake
- -signs of dehydration
School age children – the child’s
- -presence of hypotension, shock
school age elimination system reaches
or heart failure
maturity during this period.
- -history of kidney disease
Older adults – the excretory function of - -signs of renal failure such as
the kidney diminishes with age, but elevated blood urea nitrogen,
usually not significantly below normal serum creatinine, edema
levels unless a disease process
intervenes. Urgency
- -presence of psychological stress
Psychosocial factors – for many - UTI
people, a set of conditions helps
stimulate the micturition reflex. These
conditions include privacy, normal
position, sufficient time, and Dysuria
occasionally, running water. - Urinary tract inflammation,
infection, or injury
Medications – Many medications
- Hesitancy, hematuria, pyuria ,
particularly those affecting the
and frequency
autonomic nervous system, interfere
with the normal urination process and
Enuresis
may cause retention.
- Family history of enuresis
Muscle tone - good muscle tone is - Difficult access to toilet facilities
important to maintain the stretch and - Home stress
contractility of the detrusor muscle so
the bladder can refill adequately and Incontinence
empty completely. - Bladder inflammation,
cerebrovascular, accident, spinal
Pathologic conditions – some cord injury, or other disease.
diseases and pathologies can affect the - Difficulties in independent
formation and excretion of urine. toileting
Surgical and Diagnostic Procedure – - Leakage when coughing,
some surgical and diagnostic laughing, sneezing
procedures affect the passage of urine
and the urine itself. 3. Describe nursing interventions to
maintain urinary elimination, prevent
2. Identify common causes of urinary tract infection and manage
selected urinary problems urinary incontinence.
- Promoting fluid intake
-Polyuria (increased urine output)
Maintaining normal voiding
- -ingestion of fluids containing
patterns
caffeine or alcohol
 Assisting with toileting
Preventing urinary tract infections
Managing urinary incontinence
Continence (bladder) training
4. Identify ways to prevent ways to
prevent urinary infection.
- Drink 64 oz. of water a day
Practice frequent voiding (every 2
to 4 hours)
Avoid use of harsh soaps, bubble
bath, powder, or sprays in the
perineal area
Avoid tight fitting clothes
Wear cotton rather than nylon
under clothes
Always wipe the perineal area
from front to back
Take showers rather than baths
5. Describe the steps in
Applying and external urinary device
Performance 1. Prior to performing the
procedure, introduce self and verify the
client’s identity using agency protocol.
Explain to the client what you are going
to do, why it is necessary, and how he
can participate. 2. Perform hand
hygiene and observe other appropriate
infection prevention procedures. 3.
Position the client in either a supine or a
sitting position. Provide for client
privacy. 4. Apply clean gloves. 5.
Inspect and clean the penis. • Clean the
genital area and dry it thoroughly.
Rationale: This minimizes skin irritation
and excoriation after the condom is
applied. 6. Apply and secure the
condom. • Roll the condom smoothly
over the penis, leaving 2.5 cm. (1 in.)
between the end of the penis and the
rubber or plastic connecting tube. •
Secure the condom firmly, but not too
tightly, to the penis. Some condoms
have an adhesive inside the proximal
end that adheres to the skin of the base
of the penis. Many condoms are
packaged with special tape. If neither is
present, use a strip of elastic tape or
Velcro around the base of the penis
over the condom. Ordinary tape is
contraindicated because it is not flexible
and can stop blood flow. 7. Securely
attach the urinary drainage system. •
Make sure that the tip of the penis is not
touching the condom and that the
condom is not twisted. Rationale:
A twisted condom could obstruct the
flow of urine. • Attach the urinary
drainage system to the condom. •
Remove and discard gloves. • Perform
hand hygiene. • If the client is to remain
in bed, attach the urinary drainage bag
to the bed frame. • If the client is
ambulatory, attach the bag to the client’s
leg. 8. Teach the client about the
drainage system. • Instruct the client to
keep the drainage bag below the level of
the condom and to avoid loops or kinks
in the tubing. Instruct the client to report
pain, irritation, swelling, or
wetness/leaking around the penis to
health care personnel. 9. Inspect the
penis 30 minutes following condom
application and at least every 4 hours.
Check urine flow. Document these
findings. 10. Change the condom as
indicated and provide skin care. In most
settings, the condom is changed daily.•
Remove the elastic or Velcro strip, apply
clean gloves, and roll off the condom.•
Wash the penis with soapy water, rinse,
and dry it thoroughly.• Assess the
foreskin for signs of irritation, swelling,
and discoloration. 11. Document in the
client record using forms or checklists
supple-mented by narrative notes when
appropriate. Record the ap-plication of
the condom, the time, and pertinent
observations, such as irritated areas on
the penis.SAMPLE DOCUMENTATION
Performing urinary catheterization –
Performance 1. Prior to performing the
procedure, introduce self and verify the
client’s identity using agency protocol.
Explain to the client what you are going
to do, why it is necessary, and how he
or she can participate. 2. Perform hand
hygiene and observe other appropriate
infection prevention procedures. 3.
Provide for client privacy. 4. Place the
client in the appropriate position and
drape all areas except the perineum. •
Female: supine with knees flexed, feet
about 2 feet apart, and hips slightly
externally rotated, if possible • Male:
supine, thighs slightly abducted or apart
5. Establish adequate lighting. Stand on
the client’s right if you are right-handed,
on the client’s left if you are left-handed.
6. If using a collecting bag and it is not
contained within the catheterization kit,
open the drainage package and place
the end of the tubing within reach. 7. If
agency policy permits, apply clean
gloves and inject 10 to 15 mL Xylocaine
gel into the urethra of the male client.
Wipe the underside of the penile shaft to
distribute the gel up the urethra. Wait at
least 5 minutes for the gel to take effect
before inserting the catheter. 8.
Remove and discard gloves. • Perform
hand hygiene. 9. Open the
catheterization kit. Place a waterproof
drape under the buttocks (female) or
penis (male) without contaminating the
center of the drape with your hands. 10.
Apply sterile gloves. 11. Organize the
remaining supplies: • Saturate the
cleansing balls with the antiseptic
solution. • Open the lubricant package.
• Remove the specimen container and
place it nearby with the lid loosely on
top. 12. Attach the prefilled syringe to
the indwelling catheter inflation hub.
Apply agency policy and/or
manufacturer recommendation
regarding pretesting of the balloon. 13.
Lubricate the catheter 2.5 to 5 cm (1 to
2 in.) for females, 15 to 17.5 cm (6 to 7
in.) for males, and place it with the
drainage end inside the collection
container. 14. If desired, place the
fenestrated drape over the perineum,
exposing the urinary meatus. 15.
Cleanse the meatus. Note: The
nondominant hand is considered
contaminated once it touches the
client’s skin. 16. Insert the catheter17.
Hold the catheter with the nondominant
hand. 18. For an indwelling catheter,
inflate the retention balloon with the
designated volume. 19. Collect a urine
specimen if needed. For a straight
catheter, allow 20 to 30 mL to flow into
the bottle without touching the catheter
to the bottle. For an indwelling catheter
preattached20. Allow the straight
catheter to continue draining into the
urine receptacle. If necessary (e.g.,
open system), attach the drainage end
of an indwelling catheter to the
collecting tubing and bag. 21. Examine
and measure the urine. In some cases,
only 750 to 1,000 mL of urine are to be
drained from the bladder at one time.
Check agency policy for further
instructions if this should occur. 22.
Remove the straight catheter when
urine flow stops. For an indwelling
catheter, secure the catheter tubing to
the thigh for female clients or the upper
thigh or lower abdomen for male clients
to prevent movement on the urethra or
excessive tension or pulling on the
retention balloon23. Next, hang the bag
below the level of the bladder. No tubing
should fall below the top of the bag.
❻24. Wipe any remaining antiseptic or
lubricant from the perineal area.
Replace the foreskin if retracted earlier.
Return the client to a comfortable
position. Instruct the client on
positioning and moving with the catheter
in place.25. Discard all used supplies in
appropriate receptacles.26. Remove
and discard gloves.• Perform hand
hygiene.27. Document the
catheterization procedure including
catheter size and results in the client
record using forms or checklists supple-
mented by narrative notes when
appropriate.
Performing bladder irrigation –
Performance 1. Prior to performing the
procedure, introduce self and verify the
client’s identity using agency protocol.
Explain to the client what you are going
to do, why it is necessary, and how he
or she can participate. The irrigation
should not be painful or uncomfortable.
Discuss how the results will be used in
planning further care or treatments. 2.
Perform hand hygiene and observe
other appropriate infection prevention
procedures. 3. Provide for client
privacy. 4. Apply clean gloves. 5.
Empty, measure, and record the amount
and appearance of urine present in the
drainage bag. Rationale: Emptying the
drainage bag allows more accurate
measurement of urinary output after the
irrigation is in place or completed.
Assessing the character of the urine
provides baseline data for later
comparison. 6. Discard urine and
gloves. 7. Prepare the equipment. •
Perform hand hygiene. • Connect the
irrigation infusion tubing to the irrigating
solution and flush the tubing with
solution, keeping the tip sterile.
Rationale: Flushing the tubing removes
air and prevents it from being instilled
into the bladder. Irrigation bag Drip
chamber Clamp Bladder Tubing from
bladder Tubing to irrigation port Port for
inflation of catheter balloon Drainage
bag • Apply clean gloves and cleanse
the port with antiseptic swabs. •
Connect the irrigation tubing to the input
port of the threeway catheter. • Connect
the drainage bag and tubing to the
urinary drainage port if not already in
place. • Remove and discard gloves. •
Perform hand hygiene. 8. Irrigate the
bladder. • For closed continuous
irrigation using a three-way catheter,
open the clamp on the urinary drainage
tubing (if present). 9. Assess the client
and the urinary output. • Assess the
client’s comfort. • Apply clean gloves. •
Empty the drainage bag and measure
the contents. Subtract the amount of
irrigant instilled from the total volume of
drainage to obtain the volume of urine
output. • Remove and discard gloves. •
Perform hand hygiene. 10. Document
findings in the client record using forms
or checklists supplemented by narrative
notes when appropriate. • Note any
abnormal constituents such as blood
clots, pus, or mucous shreds.

NUTRITION
1, identify the essential nutrients and
dietary sources
Carbohydrates – are composed of the
elements carbon, hydrogen, and oxygen
and are two basic types: simple
carbohydrates and complex
carbohydrates.
Proteins – amino acids, organic
molecules made up primarily of carbon,
hydrogen, oxygen, and nitrogen,
combine to form proteins.
Lipids – are organic substances that
are greasy and insoluble in water but
soluble in alcohol or ether.
Micronutrients - are one of the major
groups of nutrients your body needs.
They include vitamins and minerals.
Vitamins are necessary for energy
production, immune function, blood
clotting and other functions. Meanwhile,
minerals play an important role in
growth, bone health, fluid balance and
several other processes.
2. Factors affecting nutrition
Development – people in rapid periods
of growth have increased needs for
nutrients. Older adults on the other hand
may need fewer calories and also need
some dietary changes in viw of their risk
for coronary heart diseases,
osteoporosis, and hypertension.
Sex - nutrient requirements are
different for men and women bevause of
body composition and reproductive
functions.
Ethnicity and Culture - ethnicity often
determines food preferences. Traditional
for rice for Asians pasta for Italians curry
for Indians are eaten long after customs
are abandoned.
Beliefs about Food – beliefs about
food on health and well being can affect
food from television, magazines, and
other media.
Personal Preference – people develop
likes and dislikes based on associations
with a typical food.
Religious practice – some Roman
Catholics avoid meat on certain days,
and some Protestant faiths prohibit
meat, tea, coffee, or alcohol. Both
Orthodox and Judaism, Islam prohibit
pork. The nurse must plan care with
considerations of such dietary practices.
Economics – What, how much, and
how often a person eats are frequently
affected by economic status.
Medications and Therapy - the effects
of drugs on nutrition vary considerably.
Health – and individual’s health status
greatly affects eating habits nutritional
status.
Alcohol Consumption – the calories in
alcoholic drinks include both those of
the alcohol itself and of the juices or
other beverages added to the drink.
3. Identify nutritional variation
throughout life cycle
Neonate to 1 year – the neonates fluid
and nutritional needs are met by breast
milk or formula. Fluid needs of infants
are proportionately greater than those of
adults because of a higher metabolic
rate, immature kidneys, and greater
water losses though the skin and lungs.
Toddler - because of Maturing GI tract,
toddlers can eat most foods and adjust
to three meals a day. Toddler’s fine
motor skills are sufficiently well
developed for them to learn how to feed
themselves.
Pre-schooler - The pre schooler eat
adult foods Parents should become
informed about the diet of their child in
day are or pre school settings so that
they can assume that the child’s
nutritional needs are being met.
School of age child – school of age
children require a balanced diet
including approximately 1,600 to 2,200
kcal/day. They can eat three meals a
day and one or two nutritious snacks.
Adolescent – the adolescent’s need for
nutrients and calories increases,
particularly during growth spurt.
Young Adult - Many young adults are
aware of thr food groups but may not be
knowledgeable about how many
servings of each group they need or
how much a serving constitutes.
Middle aged adult – they should
continue to eat a healthy diet, following
the recommended portions of the ffod
groups, with special attention to calcium
and protein intake, and limiting
cholesterol and calorie intake.
Older Adults - the older adults require
the same basic nutrition as younger
adult. However, fewer calories are
needed by older adults because of the
low metabolic rate and the decrease in
physical activity.
4. Discuss nursing interventions to
treat clients with nutritional problems
5. Identify steps used in
Nasogastric tubing
Preparation
You should gather all of your materials
together before you approach the
patient. There are two types of NG
tubes: Levin and Salem sump. A Levin
tube is often used for feeding, and it
has lumens along the lower length.
The Salem sump is used for suctioning
because of the presence of a secondary
tube, or pigtail, which allows for
suctioning without adhering to the
gastric wall. Depending on what you
need or what the doctor has ordered, be
sure to choose the correct tube for the
job. It is important to explain to the
patient the process for inserting the NG
tube, because it can be a scary and
uncomfortable experience. Insertion
Before inserting the tube, you should
measure the length of tube you will
need. Take the end and measure from
the nose to the earlobe, then from the
earlobe to the xyphoid process. Mark
this measurement with tape, and you
can use this as a guide to help you
know how far to insert the tube. Drape
the patient with a towel and have them
hold the glass of water and the straw.
They should sit up as straight as
possible and tilt their head back into a
sniffing position. Lubricate the NG tube
thoroughly to ensure the easiest
insertion possible.
The Process
1. Slowly insert the tube into the nare,
curling down toward the back of the
throat
2. Once you reach the oropharynx, you
may begin to encounter resistance. At
this time, have the patient drop their
chin to their chest
3. As they take swallows of water through
the straw, slowly advance the tube
further. They may cough and gag at this
point, but you should still be sure to
encourage swallowing and incrementally
advance the tube
4. Once you are past the oropharynx, your
patient should relax, and the tube will
advance more easily
5. Insert until you meet your tape mark and
secure the tube
Removing nasogastric tube
1. Prior to the performing the
removal, introduce self and verify
the client. Explain also the steps
And why is it necessary .
2. Perform hand hygiene and
observe appropriate infection
prevention.
3. Provide client privacy
4. Detach tube
5. Remove nasogastric tube.
6. Ensure client comfort
7. Dispose equipment properly
8. Document all relevant
information
Administering a gastrostomy or
jejunostomy tube feeding.
 1. Prior to the performing the
removal, introduce self and verify
2. Perform hand hygiene and
observe appropriate infection
prevention.
3. Provide client privacy
4. Insert a feeding tube if one is
already in place.
5. Check the location of the patency
of the tube
6. Administer the feeding
7. Ensure client comfort and safety
8. Document all assessment and
interventions.
6. Describe parenteral nutrition
Parenteral nutrition (PN) is intravenous
administration of nutrition, which may
include protein, carbohydrate, fat,
minerals and electrolytes, vitamins and
other trace elements for patients who
cannot eat or absorb enough food
through tube feeding formula or by
mouth to maintain good nutrition status.
Achieving the right nutritional intake in a
timely manner can help combat
complications and be an important part
of a patient’s recovery. Parenteral
nutrition is sometimes called Total
Parenteral Nutrition (TPN).