Transcript Gastroenterology and Urology Care

Gastroenterology and Urology
Care
GENERAL MEDICINE
STANDARD
• HS-TGM-14
– Students will demonstrate understanding of
advanced technical skills in nutrition and fluid
intake, elimination, and ostomy care – Medical
Laboratory, Gastroenterology and Urology
• a. Demonstrate measurement of fluid intake and output including
documentation.
• b. Assist in management of patients receiving tube feedings according to
facility protocol and scope of practice.
• c. Obtain blood glucose samples correctly and record and report findings
to the nurse.
• d. Observe IV site for signs/symptoms of infiltration and report findings to
the nurse.
• e. Demonstrate techniques for peripheral IV removal.
• f. Demonstrate techniques for urinary catheterization including
documentation.
• g. Demonstrate techniques for catheter removal.
• h. Demonstrate techniques for enema administration including
documentation.
• i. Demonstrate techniques for collecting urine and stool specimens
including documentation.
• j. Demonstrate techniques for bladder and catheter irrigation and catheter
care including documentation.
• k. Demonstrate ostomy care procedures
Anatomy
• Digestive System
• Urinary System
– Kidneys, ureters, bladder, urethra
– Nephron:
Intake and Output
• Recording all fluids a person takes in and
eliminates during a certain period of time
– Intake: all fluids taken in by patient
• Oral: water, coffee, tea, milk, juice, soup, gelatin, ice
cream
• Tube feedings: solution containing all of the nutrients
required by the body
– Nasogastric or gastrostomy tube
• Intravenous (IV): fluids given into a vein (blood, plasma)
• Irrigation: fluid placed into tubes that have been
inserted in the body
Output
• All fluids eliminated by the patient
– Bowel Movement (BM): liquid bowel movements
• Solid bowel movements are noted in remarks column
– Emesis: anything that is vomited is measured
• Color, type and other facts are also recorded
– Urine: all urine voided or drained via a catheter
are measured and recorded
– Irrigation: any irrigation or suction drainage is
measured
Intake and Output
• Always follow facilities protocol on how to
measure/record I&O
• Females should urinate in a bedpan or use a
special urine collector used under the seat of
the toilet
• Males should urinate in a urinal
• Be sure to use Standard Precautions when
handling all body fluids
Total Parenteral Nutrition (TPN)
• Form of nutrition given through IV
• TPN is for patients who are unable to eat and
drink normally: comatose, other trauma,
abdominal surgery
• TPN solution contains glucose, salt, lipids,
water, vitamins, amino acids
• Everything is ordered by the doctor
TPN: Central Venous Line (Catheter)
•
Central venous catheters are used
to:
•
Give long-term medicine treatment
for pain, infection, or cancer, or to
supply nutrition. A central venous
catheter can be left in place far
longer than an intravenous catheter
(IV), which gives medicines into a
vein near the skin surface.
Give medicines that affect the heart,
especially if a quick response to the
medicine is wanted.
Give large amounts of blood or fluid
quickly.
Take frequent blood samples without
having to "stick" someone with a
needle.
•
•
•
TPN: PICC line
• A PICC line: peripherally inserted central
catheter.
• Inserted into a peripheral vein, typically in the
upper arm, and advanced until the catheter
tip terminates in a large vein in the chest near
the heart to obtain intravenous access.
• Used for: Prolonged IV antibiotic treatment,
TPN Nutrition, Chemotherapy
Precautions
• With all Central and
PICC lines, standard
precautions need to be
used
• High risk of infection
with a line
• Sterile technique used
when changing,
cleaning, and inserting
a line.
Nasogastric Tube (NG tube)
• http://www.youtube.com/watch?v=MP4drW
Ml_EI
• A nasogastric tube, or NG tube, is a special
tube that carries food and medicine to the
stomach through the nose. It can be used for
all feedings or for giving a child extra calories.
Gastrostomy Tube (G tube)
• A gastrostomy feeding tube insertion is the
placement of a feeding tube through the skin and the
stomach wall, directly into the stomach.
• Babies with birth defects of the mouth, esophagus,
or stomach
• Patients who cannot swallow correctly
• Patients who cannot take enough food by mouth to
stay healthy
• Patients who often breathe in food when eating
G tube
• http://www.youtube.com/watch?annotation_i
d=annotation_707449&feature=iv&src_vid=yB
zy3tHOps0&v=J66zizn8Pf0
Collecting Stool/Urine Specimens
• Routine Urine Specimen
– most common specimen
– Collected from the first morning urine
– Can be collected in a bedpan, urinal, or other
special collector
– Should be sent to lab ASAP, if not keep
refrigerated
Clean Catch or
Midstream Specimen
Urine specimen that is free from
contamination
For a male: use circular motion used at
the urinary meatus at tip of penis
Special care for uncircumcised males
Catheterization for Sterile
Urine Specimen
Tube inserted into bladder
Urine placed in sterile container
24 Hour Urine Specimens
• All urine produced by a patient in 24 hour
period must be saved
• Used to check for kidney function as well as
protein, creatine, hormones, and calcium.
• Preserved with chemicals or cold storage
24-Hour Urine Specimen
• All of the urine produced in a 24 hour period
– Voids bladder because it was produced before the
24-hour start time
– Voiding time is noted as start time
– All urine after this time is saved and tested
Routine Stool Specimen
• Examined for ova and parasites, fats,
microorganisms and abnormal substances
• Should be kept at body temperature and
analyzed within 30 minutes
• Occult blood: blood from areas of intestinal
tract
• Special card used for this test
Stool Specimen Collection
• Patient is asked to defacate in bedpan or
special collection container
• Remove stool with two tongue blades and
place in specimen container
• Label the container with all necessary
information
• Clean bedpan and make sure area is neat and
clean