Thursday, February 9, 2012

Bladder questions

•You should check your patients for incontinence:
Every 2 hours

Rationale: Because you should be rounding on your patients and checking on them every 2 hours, this is the best time to check to see if they have been incontinent of bowel or bladder. Urine is acidic, and the longer it remains touching the skin, the more chance a patient has of skin breakdown. If needed, patients should be changed more often, but some may only need changed a few times a day.

•The purpose of bladder training is:
A way for patients to manage urinary incontinence

Rationale: Bladder training is way patients learn to manage urinary incontinence. This lengthens the amount of time between bathroom trips, expands the bladder so it can hold more urine and improves a patient's urge to urinate. The training must be strictly followed according to the program the physician sets up or else it will not work.

•Your patient tells you that she hasn't had a bowel movement in 3 days and feels like she needs to go but she can't. You tell the nurse this patient:
Has constipation

Rationale: Constipation is irregular bowel movements or having difficulty passing stool. This can be painful and frustrating for patients. Let the nurse know you think the patient may be constipated so he/she can assess the patient and treat them accordingly. Constipation can be dangerous for some patients, especially those who just had surgery as the straining can cause the incision to open up.

•You are providing peri-care to a female patient that just had a bowel movement in her adult brief. When you wipe, you should:
Wipe front to back

Rationale: When providing peri-care for a female, always wipe the patient front to back. Stool contains E. Coli, and if a patient is wiped incorrectly, E. Coli can be wiped into the female's urethra. E. Coli is the most common organism causing urinary tract infections which can develop into much worse conditions and be very expensive to treat.

•Which of the following is NOT appropriate when collecting a urine specimen:
Having the nurse label the urine collected

Rationale: When collecting a urine, wipe the patient from front to back first to remove dead skin. Then have the patient start urinating in the toilet, and then begin urinating in the cup, if possible. When finished, label the urine with the patients name & date of birth, or whatever your facility policy says. Only the person collecting the specimen should label it. Refrigerate the urine immediately unless you have specific instructions not to do so.

•The following is an abnormal finding when a patient urinates:
Amber urine

Rationale: Amber urine occurs when a patient is dehydrated or the kidneys are not working properly. This dark-colored urine should alert the nursing assistant that something is wrong with the patient and the nurse should be notified immediately of this finding. This may be a normal finding for a patient with known kidney disease, but if it it new, the longer it goes on means the longer it will take for the patients kidney function to return to normal, if at all.

•You notice that your patients stools are black and tarry. You should notify the nurse of this immediately because:
They could be bleeding internally

Rationale: Black, tarry stools are a major sign that a patient is bleeding somewhere in their intestine and, if left untreated, will lead to death. Medications like iron can cause stools to look like this also, but it is expected and is not a medication reaction. Do not assume they are on iron. Inform the nurse and let them decide the next course of action.

•You notice a patient that was previously continent have frequent episodes of incontinence. You should:
Notify the nurse

Rationale: Although increased incontinence can be normal, other factors may cause this. Diseases of the bladder or intestines, abuse, social problems and more can cause a previously continent patient to suddenly be unable to control their bladder. The nurse will investigate further into this and let you know if an adult brief is necessary to place on the patient or not.

•A patient tells you that it burns every time he urinates and sometimes his urine is reddish in color. You should tell the nurse immediately because you know this is a sign of:
Urinary tract infection

Rationale: Burning sensation, frequent urination, dark urine and blood in the urine are all signs of a urinary tract infection. Patients should be treated for this quickly to prevent it from spreading to the bladder or worse. If left untreated, this infection can go to the blood and cause sepsis, or can cause the kidneys to fail. Notify the nurse immediately if any of these signs are present in your patients.

•You have a patient that is constipated. You should provide them with fluids to drink:
More often than before

Rationale: Extra fluids can help the patient move their bowels easier because it may moisten the stool. When constipated, a patient's stool is usually dry and hard, making it painful to pass through the rectum. Extra fluids can assist with this. Report any complaints or signs of constipation to the nurse so she can also assist the patient with this by medicating them with a stool softener.

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