Transcript Urinary Elimination

Concept: Mobility
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Concept: Mobility
Mobility, the ability to move freely,
easily, rhythmically, and purposefully
in the environment, is an essential part
of living.
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Systemic Effects of
Immobility
Mindmap
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Metabolic changes
Psychosocial Effects: Depression
Respiratory Changes
Cardiovascular Changes
Musculoskeletal changes
Integumentary changes
Urinary elimination
Bowel elimination
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Gas Exchange
Respiratory Changes
• Atelectasis (collapse of alveoli)
• Hypostatic pneumonia (inflammation of the lung
from stasis or pooling of secretions)
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Gas Exchange
Respiratory Changes
Atelectasis and Hypostatic Pneumonia
Assessments
• Monitor RR and
characteristics of
respiratory system
• Monitor Breath Sounds
every 2 hrs
Interventions
• Deep breathing and
coughing
• Incentive spirometer
• Encourage Fluids
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Perfusion
Orthostatic hypotension
When you stand up, gravity causes blood to
pool in your legs. This decreases blood pressure
because there's less blood circulating back to
your heart to pump.
Orthostatic or postural hypotension occurs
when something interrupts the body's natural
process of counteracting low blood pressure.
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Perfusion
Orthostatic Hypotension
Assessment
• Vital Signs before
and after OOB
(↑pulse rate;
↓BP)
Interventions
• Dangle before
getting OOB
• OOB: chair or
ambulate
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Perfusion
Thrombus
• Thrombus is an accumulation of platelets,
fibrin, clotting factors, and the cellular
elements of the blood attached to the interior
wall of a vein or artery, which sometimes
occludes the lumen of the vessels.
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Perfusion
Thrombus
Assessment
• Determine if pt is at risk
• Monitor for S/S
– Calf pain
– Tenderness, swelling
warmth, and erythema
– Cyanotic
– Edema
– A cord may be palpated
over the vein
Interventions
• Leg, foot, and ankle
exercises q 1 hr
• Encourage fluids
• Change position q 2hr
• OOB: chair or ambulate
• Administer anticoagulant
therapy: heparin
• SCD: sequential
compression devices/TEDs
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VTE: Mortality and Morbidity
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300,000 to 650,000 with VTE per year
100,000 to > 200,000 deaths per year
Most are hospital related.
VTE is primary cause of fatality in half
– More than HIV, MVAs, Breast Ca combined
– Equals 1 jumbo jet crash/day
• 10% of hospital deaths
• Huge costs and morbidity
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Concept: Perfusion
• Anti-embolism Stockings
• Sequential
Compression Device
Purpose: Decreases venous
stasis by increasing venous
return through the deep
veins of the legs.
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Perfusion
Pulmonary embolism
Pulmonary embolism
A blockage of a pulmonary artery by foreign
matter. The obstruction may be fat, air,
tumor tissue or a thrombus
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Skeletal Effects
osteoporosis, joint contracture, footdrop
• Muscle Effects:
Lose of lean body mass
–Decreased muscle mass strength
–Atrophy
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Skeletal Effects
Disuse osteoporosis
• Disuse osteoporosis: Immobilization
results in bone resorption
–These patients are at risk for
pathological fractures
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Skeletal Effects
Joint Contracture
• Joint contracture is an abnormal and
possible permanent condition
characterized by fixation of the joint.
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Skeletal Effects
osteoporosis, joint contracture, footdrop
Assessment
• Determine if
patient is at risk
(Immobility)
Interventions
• Exercise
Active ROB
Passive ROM
CPM (continuous
passive motion)
• Use splints when
ordered
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Splints used for foot-drop
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Urinary Elimination
Urinary status & renal calculi
• Urinary stasis:
–Risk for UTI
– Risk for Renal Calculi: calcium stones that
lodge in the renal pelvis or pass through the
ureters
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Urinary Elimination
Urinary status & renal calculi
Assessment
• Determine if patient is
at risk:
Risk factors for UTI
Poor peri care after BM
Use of indwelling
catheters
Renal Calculi: Risk factors
Hypercalcemia
Dehydration
Interventions
• Encourage fluids
• Toilet q 2 hrs
• Encourage mobility
• Discontinue Foley ASAP
• Teach how to perform
correct peri care after
BM
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Bowel elimination
Constipation
• Constipation is due to stasis of fecal material
in the rectum and sympathetic nervous
system activity.
• May present as ribbon-like diarrhea and fecal
smearing
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Bowel elimination
Constipation
Assessment
• Determine if patient is at
risk
• Monitor/record
frequency and
consistency of stool
Intervention
• Encourage fluids
• Encourage mobility
• Provide diet: fruits,
vegetables, and fiber
• Administer stool
softeners or enemas
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Integumentary
Pressure ulcers
• A pressure ulcer is a
specific tissue injury
caused by unrelieved
pressure that results in
ischemia and damage to
the underlying tissue
• Pressure ulcers occur
most commonly over
bony prominences.
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Integumentary
Pressure ulcers
Assessment
Interventions
• Determine if patient
is at risk
• Turn q 2 hrs/shift
weight q 15 min
• Pad bony
prominences
• Apply skin lotion
• Apply air mattress
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Metabolic changes
• ↓ Appetite → Negative Nitrogen Balance
What is Negative Nitrogen Balance?
• The resting body requires less energy, the cellular
demand for oxygen is decreased, leading to a
decreased metabolic rate. In the immobilized
patients, however, factors such as fever, trauma,
chronic illness, or poor nutrition can actually increase
the body’s metabolic demands and increase
catabolism. If unchecked, this process results in
muscle wasting and a negative nitrogen balance.
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Metabolic changes
• ↓ Appetite (anorexia) → Negative Nitrogen Balance
– Wt loss, ↓muscle mass, and weakness
• Hypercalcemia
– Pathological fractures
• ↓GI mobility
– Constipation
– Fecal impactions
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Metabolic changes
Assessment
• Monitor labs for
hypercalcemia
• Monitor for
constipation and fecal
impactions
Interventions
• Provide high-protein,
high- calorie diet
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Psychosocial Effects
Depression
Immobilization often leads to emotional and
behavioral responses, sensory alterations, and changes
in coping.
Sensory deprivation: altered sleep patterns and
significant increases in anxiety, hostility, and
depression.
Depression: feelings of sadness, melancholy, dejection,
worthlessness, emptiness, and hopelessness
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Psychosocial Effects
Depression
Assessment
• Determine if patient is at
risk
Observe the patient’s
coping strategies
Intervention
• Provide personal routine
• Provide/encourage
informal socialization
• Talk with patient during
activities
• Encourage reading
newspaper and books
• Provide radio, TV and
videotapes
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