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Effective Bowel Training
Strategies
The Musical Experience (Carlow University)
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Answer Key + ATI + elimination + jh
This section appears to be a detailed answer key for a nursing exam or assessment. It covers various topics related to elimination, such as:
Implementing a bowel training program for a client. Administering a tap water enema to a client who is constipated. Causes of constipation. Teaching a client about a new prescription for docusate. Discussing a high-fiber diet with a client who has constipation. Providing instructions to an older adult client who reports constipation. Administering a bisacodyl suppository to a client. Caring for an older adult client who reports taking bisacodyl tablets daily. Assessing a client who reports taking bisacodyl to promote a daily bowel movement. Understanding the purpose of a guaiac stool test. Providing instructions for a client scheduled for a colonoscopy. Explaining the mechanism of action of metoclopramide to a client with nausea.
Each question and answer provides detailed information and rationale to help the reader understand the concepts related to elimination and nursing care.
Reglan (Metoclopramide) and Its Effects
Mechanism of Action
The medication relieves nausea by promoting gastric emptying. Reglan is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Reglan works by promoting gastric emptying.
The medication does not work by decreasing gastric acid secretions. Reglan does not decrease gastric acid secretions.
The medication does not relieve nausea by slowing peristalsis. Reglan does not slow peristalsis.
The medication works by relaxing gastric muscles. Metoclopramide increases gastric muscle contraction.
Postoperative Bowel Function
Hypoactive bowel sounds in two quadrants do not indicate that the client's peristalsis is returning. Hypoactive bowel sounds are an expected finding postoperatively and do not indicate the return of peristalsis.
The client's request for a cup of tea and some toast does not indicate that peristalsis has returned.
The passage of flatus and belching indicate the return of peristaltic activity.
Abdominal distention is more likely to indicate the absence rather than the return of peristalsis.
Spina Bifida and Bladder/Bowel Management
The client's statement about performing catheterization every 4 hours is appropriate, as the condition affects bladder and bowel continence, and infrequent emptying of the bladder can result in stasis and urinary tract infections.
The client's statement about carrying a water bottle and drinking a lot of water is appropriate, as extra fluids help to maintain fluid balance and flush the body's urinary system, which is important for individuals with spina bifida who are at an increased risk for urinary tract infections.
The client's statement about using a suppository every night to have a bowel movement is appropriate, as using a suppository to stimulate a bowel movement every 1 to 2 days is recommended for individuals with spina bifida.
The client's statement about doing wheelchair exercises while watching TV is appropriate, as wheelchair exercises maintain skin condition and upper body strength, which is important for individuals with spina bifida who are at an increased risk for impaired skin integrity.
Managing Incontinence in Clients with
Dementia
When caring for an older adult client with dementia who has frequent episodes of urinary incontinence, the nurse should:
Take the client to the bathroom every 2 hours to establish a regular toileting pattern and promote bladder control. Avoid using adult diapers, as they do not address the behavioral aspects of incontinence. Refrain from requesting an indwelling urinary catheter, as this should be a last resort due to the potential complications.
Types of Urinary Incontinence
Stress Incontinence : Associated with a loss of urine during physical exertion. Urge Incontinence : Associated with a strong desire to urinate. Overflow Incontinence : Occurs when the pressure of urine in an overfull bladder overcomes sphincter control, resulting in constant leakage of small amounts of urine and a distended, palpable bladder. Reflex Incontinence : Associated with neurologic dysfunction and occurs when no warning or stress precedes periodic involuntary urination.
Assessing Urinary Retention
Manifestations of urinary retention include:
Voiding a small amount of urine (less than 100 mL) frequently (2 to 3 times per hour) and dribbling of urine.
Documenting Urine Output
Oliguria : Urine output between 100 mL and 400 mL in 24 hours.
The nurse should not document the following terms, as they do not accurately describe the client's condition:
Enuresis (involuntary urination) Anuria (total urine output less than 100 mL in 24 hours) Nocturia (frequency of urination during the night)
Elimination
Cystoscopy Procedure
When teaching a client about a cystoscopy procedure, the nurse should include the following information: The client should increase oral fluid intake following the procedure to increase urine output and limit dysuria (painful urination) which can occur due to the procedure. The client might have blood-tinged, or pink, urine after the procedure. The client should report dark red urine because it is an indication of bleeding. The provider will prescribe nothing by mouth starting either at midnight the night before the procedure or nothing by mouth for several hours before the procedure. The procedure is performed with the client in the lithotomy position.
Bed-Wetting in Hospitalized Children
When a 4-year-old child with croup wets the bed overnight during hospitalization, the nurse should respond to the parents' concern as follows: "It is expected for children who are hospitalized to regress. The toileting skills will return when your child is feeling better." Regression of recently learned skills, such as toilet training, is an expected behavior in hospitalized children due to the stress of hospitalization. The nurse should reassure the parents that the child will regain bladder control when feeling better.
Stool Specimen Collection
When obtaining a stool specimen from a client, the nurse should: Collect the specimen using a non-sterile object, usually a tongue blade. A sterile swab is used if a culture is to be obtained. Collect the specimen in a dry container free of urine. Label the specimen container and place it in a clean, plastic biohazard bag which is also labeled. This ensures proper identification and prevents contamination and spillage during transport. Send the specimen container immediately to the laboratory. A delay in transport can result in altered laboratory findings.
Midstream Urine Sample Collection
When instructing a female client about collecting a midstream urine sample, the client should understand the following: The client should begin urinating, then move the container into the urine stream. The client should cleanse the perineal area from front to back to avoid introducing bacteria from the anal area into the area of the urinary meatus.
The client will need to collect urine for a period of 24 hours. The client should store the urine on ice or refrigerate it. The client should discard the first urine specimen and start the collection time with the second specimen. The client should avoid exercising during the testing time because it can cause an increase in the creatinine values.
Preventing Skin Breakdown in Incontinent Clients
When caring for a client with urinary incontinence, the nurse should implement the following action to prevent the development of skin breakdown: Apply a moisture barrier ointment to the client's skin after cleansing and drying the skin. This helps prevent further contact of the skin with urine.
Chronic Constipation Management
When teaching a client with chronic constipation, the nurse should include the following in the teaching plan: The client should increase water intake to at least eight 8 oz glasses daily. The client should consume a diet with high-fiber food sources, including bran and complex carbohydrates. Fiber intake should be spread throughout the day to achieve maximum benefit.
Daily bowel movements are not necessary, provided the stools are not hard and dry.
When recommending herbal supplements for a client with chronic constipation, the nurse should suggest flaxseed, as it is a high-fiber product that can help relieve constipation.
Urinary Frequency During Pregnancy
When responding to a prenatal client's concern about urinary frequency at 7 weeks of gestation, the nurse should explain that: Urinary frequency is due to increased bladder sensitivity during the first trimester and recurs near the end of the pregnancy as the enlarging uterus places pressure on the bladder.
Discontinuing an Indwelling Urinary Catheter
When preparing to discontinue a client's indwelling urinary catheter, the nurse should first: Assess the client's ability to void by performing a bladder scan to determine the post-void residual (PVR). This is the initial assessment the nurse should perform using the nursing process.
Catheter Removal Procedure
Positioning the Client
The first action the nurse should take when removing a catheter is to position the client in a supine position. This allows for adequate visualization and assessment of the perineal area, and promotes client comfort and relaxation during the procedure.
Measuring and Documenting Urine
After positioning the client, the nurse should measure and document the amount of urine in the drainage bag. This provides important information about the client's fluid balance and urinary output.
Removing Securing Tape or Device
The next step is to remove any tape or device that is securing the catheter to the client's thigh. This will allow for the safe and comfortable removal of the catheter.
Deflating the Catheter Balloon
Finally, the nurse should deflate the catheter balloon using a sterile syringe. This is an appropriate action, but it should not be the first step taken in the catheter removal process.
