b.

24 Hour Specimen  Insert catheter 2-3 inches in

i. Discard first voided specimen females and 7-9 inches in
ii. Collect all specimen thereafter until males in a gently rotating
the same time the following day motion.
iii. Soak specimen container in ice or put  Let patient take deep breaths to
in refrigerator relax sphincter
c. Sterile Urine Specimen (for C&S) PROMOTING BOWEL/
i. Obtained through catheterization GASTROINTESTINAL ELIMINATION
 URINALYSIS Bowel/Gastrointestinal Elimination- Basic
BENEDICT’S TEST – to determine presence of needs that removes solid wastes from the body
sugar in the urine. usually through defecation.
o Collect specimen before meals Factors hindering Normal Bowel Elimination:
o Put 5ml of Benedict’s Solution into the test o Accumulation of flatus gas
tube o Accumulation of fluid or feces d/t decreased
o Add 8-10 drops of urine peristalsis
o Heat Benedict’s Solution with urine o Surgical procedures (colostomy)
CLINITEST- to determine sugar in the urine o Head or spinal cord injury
o Put one clinitest tablet in test tube o Colostomy
o Add 5 drops of urine o Immobility
o Add 10 drops of water o Change in diet
o Wait for reaction to occur and compare with o Environment
standard chart Signs of interference in Bowel Elimination:
HEAT AND ACETIC ACID TEST  Decreased bowel sounds
o Collect urine specimen before meals  Flatulence/abdominal distention
o Imaginary divide test tube into three parts  Accumulation of gas in the stomach
o Put 2/3 parts of acetic acid in test tube or intestines
o Add 1/3 part urine  Vomiting
o Heat and observe for CLOUDINESS which  Expulsion of gastric contents
indicates Albuminuria  Constipation
CATHETERIZATION  Difficulty in passage of hard stools
o Insertion of a catheter into the urethra and
 Diarrhea
bladder.  Frequent passage (more than 2
Purposes: episodes) of soft, watery stools
1. Relieve retention
 Fecal impaction
2. Obtain a sterile urine specimen
Normal Characteristics of Stools:
3. Measure residual urine
 Color: yellow or golden brown (d/t
4. Instill medications in the bladder
stercobilin)
5. Irrigate the bladder (treat infections)
 Odor: Aromatic upon defecation (d/t skatole
6. Measure hourly urine output
and indole)
7. Maintain continence
 Amount: Depends on bulk of food intake
Special Considerations:
Alterations in Characteristic of Stools
a. Provide privacy
b. Practice strict asepsis  Melena: Passage of black tarry stools d/t
upper GI bleeding
c. Catheter size:
French #8-10 (Children)  Acolic: Gray, pale or clay colored stools d/t
French #14-16 (Adult female) biliary obstruction
French #16-20 (Adult male)  Hematochezia: Stool with bright red blood
d. Types of catheter: d/t lower GI bleeding
i. Foley- for indwelling catheters,  Steatorrhea: Greasy, bulky, foul smelling
balloon tipped stools d/t hepato-pancreatic obstruction
Using a Foley Catheter Independent Measures to Promote Normal
 Inflate with sterile water of Defecation:
NSS (0.9 NaCL) (Check label o Positioning: thighs flexed while sitting to
for quantity required) increase intra-abdominal pressure
 Limit emptying of the bladder (squatting)
to 200 to 1000 ml only to allow o Assist client to bed pan
for gradual decompression and o High fiber diet
prevent shock. o Adequate fluid intake
o Provide client privacy
 Anchor swelling catheter in
o Exercise
inner aspect of thigh.
Dependent Nursing Measures:
ii. Straight- for intermittent
catheterization  Inserting a rectal tube
Inserting a Straight Catheter  Enema
 Position patient in DORSAL Administering Enema
RECUMBENT The introduction of a solution into the GIT
through the rectum for various purposes.
 Perineal care before
catheterization  Relieve constipation
 Drape DIAGONALLY  Relieve flatulence
 Administer medication
  Lower body temperature  Discontinue Iron
 Evacuate feces in preparation for surgery or  Positive result: gastric cancer, peptic
diagnostic procedures ulcer, colon cancer
Types of Enema: Insertion of Rectal Tube
Non-retention Enemas (to be expelled) ʘ Purpose: Remove flatus and relieve
 Cleansing: Cleanses bowel prior to surgery abdominal distention
or diagnostic procedure. ʘ Position: Left side lying
 Solution used: tapwater, soap suds, ʘ Length of tube to be inserted: 4-6”
NSS 500-1000ml ʘ Duration: 15-20 minutes
 Anti-helmintic: To expel worms ʘ Indicator of effectiveness: Bubbling in
 Quassia solution kidney basin
 Astringent: Control or check bleeding Common Problems in Bowel Elimination
 Alum ʘ Constipation – difficulty in passage of
 Carminative: hard/dry stools
 Expel flatus or gas  Fluids
 Milk and molasses solution  High Fiber Diet
 Introduce 60-180 ml  Regular bowel elimination
 Fleet enema: 100-130 ml  Exercise
Enema to be retained (retention enema)  Reduce Stress
 Diagnostic: outline colon for X-ray, Barium  Administration of laxatives
Sulfate ʘ Fecal Impaction – Mass or collection of
 Emollient: Coat membranes to relieve hardened stools in folds of rectum
irritation, Starch solution.  S/Sx:
 Lubricating: to soften stools - Anorexia
o Olive oil, mineral oil or cottonseed - Nausea and vomiting
oil - Abdominal distention
o Introduce 90-120ml of solution  Interventions:
 Nutrient: to give nourishment - Digital (manual) extraction
o Dextrose solution - Increased oral fluids
 Sedative: induce sleep - High fiber diet
o Paraldehyde solution - Activity and exercise
 Stimulating: stimulate body processes ʘ Diarrhea – increased frequency (2 or more
o Black Coffee episodes) and passage of soft liquid stools
Special Considerations:  Rest
Retention Enemas  Oral Dehydration
 Hang solutions 12 inches from buttocks  Low fiber diet
 Solution temperature: 105-110  BAR diet- banana, apple, rice AM
 Hold solution for 1-3 hours  Avoid excessive hot or cold drinks
Non-Retention Enemas  Anti-diarrheals, absorbents and
 Hang solution 12 inches from buttocks astringents
 Solution temperature: 115-125 F ʘ Flatulence – excessive gas in intestines
 Retain solution for 1-3 hours  Avoid gas forming food
 Knee-chest position
 Position adult patient in sims/left lateral PROMOTING HYGIENE AND COMFORT
 Infants and children on dorsal recumbent Personal Hygiene – Measures to promote
 Use Fr # 22-30 catheter for adults personal cleanliness and grooming
 Use Fr # 12-18 catheter for children Importance:
 Allow solution to flow through tube first to  Maintain client’s well-being and self
expel air esteem
 Lubricate tip and insert 3-4 inches, with tip  Infection control
towards the umbilicus in rotating motion. Determining Factors:
 Instruct patient to breath through mouth - Culture
 Do not administer more than three times at - Socio-economic status
one time - Religion
 If abdominal cramps occur, clamp tubing and - Developmental level
temporarily stop the solution until peristalsis - Health status
relaxes Lower level of solution - Personal experience
 Not to be given to patient suspected having Bathing
bowel obstruction and appendicitis Types:
Stool Examination a. Cleansing Bath
Routine Fecalysis o Complete bath – washes the entire
ʘ Stool body
 Stool specimen in a sterile test tube o Partial bath- cleanses some body
ʘ Gualac Test parts only
 Test for occult hidden blood o Tub/Shower bath – entire body
 Hemoglobin free diet x 3 days b. Therapeutic Bath
 No meals avoid dark colored foods
 o Sitz – Reduce inflammation and
clean perineal and perianal area
o Tepid Sponge Bath – reduce fever
temperature
o Medicated Tub Bath – Relieve skin
irritation
Sitz Bath
 Bath used to soak a clients rectal-
perineal-rectal area
 Buttocks immersed from mid thigh to
iliac crest
 Water temperature 100-155 C (38-46
F)
Purpose:
 Relieve pain and enhance client
comfort
 Promote healing, soften exudates and
hasten suppuration
 Cleans wound of tissue debris or
exudates
 Soothes skin rash or irritation
 Apply medication to large skin areas
 Relax muscles
Tips in doing a Sitz Bath
 Fill tub 1/3 full of water
 Place a bath blanket over client’s
shoulder and knees
 Have patient sit in bath for 15-30
minutes
 Don’t leave patient alone for safety
reasons
 Let patient lie in bed for 30 minutes to
permit circulation to normal
Cleansing Bed Bath
Purposes:
 Cleanse the skin
 Comfort and relaxation
 Stimulate circulation
 Remove secretion and excretions
 Assessment of client
 Inspection for skin breakdown
Special Consideration
- Water temperature – 109 F – 115 F
(43-45 degree Celsius)
- Fold washcloth into a mitt
- Wipe eyes from inner to outer canthus
- Use S-motion when wiping face
- Use long stroke from fingers to axilla
(distal to proximal) ankle to knee and
knee to thigh
- Wash perineum last (“finishing the
bath”)