Fundamentals

of Nursing
 URINARY
ELIMINATION
C. Catheterization

Purposes
Relieve acute urinary retention
Relieve chronic urinary retention
Drain urine preoperatively &
postoperatively
Types of Catheter

a. Indwelling Catheter
Use a closed drainage system
Inflate balloon w/in guidelines of manufacturer

Care:
Cleanse around area
Dont pull on catheter
Dont use powder
Dont open the drainage system
b. Suprapubic Catheter

Placed to drain the bladder

Achieved via a percutaneous
catheter or by way of an incision
through the abdominal wall
Care:
regular assessment
skin care
periodic clamping of the catheter

Care: (site)
sterile techniques
dressings
c. Intermittent Self-catheterization
Purpose:
to drain the bladder
gain control of the bladder
 Bowel
Elimination
A. Ostomy

a. Ileostomy
Liquid to semi-formed stool
May affect fluid & electrolyte balance
Digestive enzymes
lavage to clear food blockage
b.Colostomy
Ascending
Transverse
Loop stoma
oUsually temporary
Double barrel
Similar to loop but bowel is surgically
severed
C. Sigmoidostomy
Formed stool
Bowel can be regulated
May be irrigated

Stoma assessment
a. Color
b. Edema
A. complications of mobility

1. Skin change-decubitus ulcer

2. Musculoskeletal changes
3. Respiratory changes
4. Cardiovascular changes
5. Urinary changes
6. Psychosocial changes
a.1 Types of exercise
1. Passive
2. Resistive
3. Isometric
4. Range of Motion (ROM)
5. Active
a.2 Use of mechanical aids to promote mobility
1. Crutches
a. Support feet and legs during walking
b. Adjust hand bars to allow elbow flexion
c. Use well-fitting shoes with non-slip soles
d. Use rubber suction tips
e. used as temporarily or permanently
f. Teach client crutch walking
2. Cane
a. Provides stability
b. Adjust cane
c. Teach client on how to hold the cane
d. Move cane @ same time as the weaker
leg
3. Walker
a. to assist in weight-bearing
mobility
b. Teach client how to sit & turn

4. Prosthetic devices

5. Brace-support for weakened

muscles
PAI N
Theories of Pain

a. Specificity theory
b. Pattern theory
c. Gate Control Theory
Pain Assessment

Influencing factors
Past experience with pain
Age
Culture and religious beliefs
Level of anxiety
Physical state
Characteristics of pain
Location
Quality
Intensity
Timing and duration
Precipitating factors
Aggravating factors
Alleviating factors
Interference with Activities of Daily Living
Patterns of response
Types of Pain

1. Acute
2. Chronic

Medical Treatment
Pharmacologic
Nonpharmacologic Intervention
a. Acupuncture
b. Relaxation Techniques
c. Electronic Stimulation
d. Distraction
e. Ice and Heat Therapies
f. Guided Imagery
Patient-Controlled Analgesia (PCA)
Type of intravenous pump that allows
the client to administer his own
narcotic analgesic.

Goal: To achieve more constant level

of analgesia.
Nursing Interventions

1. Instruct client in use of PCA pump

2. Frequently assess client
Interventions for Pain
1. Evaluate objectively the nature of the
patients pain
2. Use a pain intensity scale of 0 to 10
3. Assess relief from medications & duration of
relief. (Use the same measuring scale every
time).
4. Base the initial analgesic choice on the
patients report of pain.
5. Administer drugs orally whenever possible
6. Administer analgesia around the clock
7. Convey the impression that the patients
pain is understood & that the pain can be
controlled.
8. Take a careful pain history
9. Reevaluate the pain frequently.
10. Use alternative measures to relieve
pain
11. Provide ongoing support & open
communication.
12. Consider referral to a pain specialist for
intractable pain.
13. Provide education.
A. Method of administration of medications
& importance of maintaining prescribed
schedule

B. Need to call health professionals if pain

has increased or occurred in another area
of the body

C. Side effects of medication