Bowel Elimination & Urinalysis

Hello all!
Today I will be discussing bowel elimination. I know, to some, this may seem like quite a gruesome subject but i actually love talking about it! It's so facinating! My mum and dad, before i started nursing, were concerned that I wouldn't get used to the 'bad sights' i.e. blood, poo, wee and many more. But actually i don't find it too bad. Anyway, the point i'm trying to make is that it's just a fact of life and it's just part of human anatomy. So, here we go...

GI tract
*Is a tube from the mouth to the anus
*Consists of smooth muscle
*7.5m long
*Includes pharnyx, oesophagus, stomach, small and large intestine

Important organs of the GI tract

Mouth
*Tongue provides taste
*3 gland produce saliva...
1.parotid
2.sub-mandibular
3.sublingual

Pharnyx
*Allows passage of food from mouth to oesophagus
*Epiglottis closes over larnyx to prevent aspiration

Oesophagus
*Muscular tube
*25.5cm long
*moves food from pharnyx to stomach
*Fibres contract, propelling food into the stomach
*Lower end remains closed to prevent reflux of gastric contents

Stomach
*contains two sphincters (muscles)...
1. Cardiac (Protects the entrance to the stomach)
2. Pyloric (Guards exit)
*Stores food
*Mixes food wih gastric juices

Small intestine
*End products of digestion are absorbed through membrane lining of small intestine and into the blood stream
*Nearly ALL digestion and reabsorption takes place in the small intestine

Large intestine
*Absorbs excess water
*Stores food residue
*Eliminates waste

Liver
*Metabolises proteins, fast and carbohydrates
*Detoxifies the blood
*Converts ammonia to urea
*Synthesises proteins, amino acids, vitamin A, D, K and B
*Creates bile to help digest fats and absorb cholesterol

Gallbladder
*Found under the right side of the liver
*Stores bile

Pancreas
*Releases insulin and glycogen into the blood

Key Terms
Mastication - Chewing
Deglutition - Swallowing
Polyuria - increase in volume of urine
Nocturia - getting up frequently in the night to urinate
Anuria - nonpassage of urine
Oliguris - production of abnormally small amounts of urine
Dysuria - Painful urination

Characteristics of normal stool
25% solids
75% water
*Consists of bacteria, undigested fibre, fat, inorganic matter and protein
*Bilirubin produces brown colour of stool
*Bacterial decomposition of proteins creates unpleasant odour of stools
*The 'Bristol Stool Chart' is a chart that is widely used in healthcare settings to determine the type of consistancy of stools

Charateristics of abnormal stool
*White stools indicate malabsoption disorder or blockage in the liver
*Thin stools may indicate haemorrhoids or colorectal cancer

Factors affecting elimination
*Body position - Sitting aids bowel movement. Can be difficult for patients to go when on a bed pan because squatting aids bowel movement.
*Exercise - good muscle tone aids elimination. Reduced physical activity can increase chance of constipation.
*Faecal diversion - alternate route for bowel elimination is called a 'stoma'. This is sometimes performed in patients with bowel cancer, bowel obstruction or in crohn's disease.
Two types of stoma
1. Ileostomy - Part of small intestine redirected through abdominal wall
2. Colostomy - Part of large intestine or colon is redirected through the abdominal wall.
*Fluid intake - Decreased fluid intake means the stools become hard and difficult to pass. The longer the stool remains in the colon, the more dry is becomes. Stool that doesn't remain long in the colon will be watery, resulting in fluid loss.
*Ignoring the urge to defecate - for patients with chronic conditions (or haemorrhoids) it may be painful to go to the toilet or due to lack of privacy they may not be able to go. Both can lead to constipation.
*Lifestyle - Bowel movement is convenient for their lifestyle. Stress, fear, anxiety, anger or depression, including the stress of hospitalisation can alter ones bowel elimination.
*Medication - Opioids and iron tablets can cause constipation. Antibiotics can cause diahorrea. Antacids can cause either.
*Nutrition - increased fibre in diet assists in bowel function (i.e. fruits, veg, cereals.)

Urinalysis
*Urine dip tests - Dip the test stick in the urine specimen for 30 seconds and observe the change in colour against the corresponding chart on the bottle.
*The urine specimen bottles are usually red and have boric acid inside in order to preserve the specimen
*24 hours urine collection bottles (More like 'tubs' i guess...) comes in large white bottles. Make sure these are labelled correctly with the time and date on.

Understanding Urinalysis Results
*Glucose - Excess sugar in the urine usually indicates diabetes mellitus
*Ketones - Indicates diabetic ketosis or calorie deprivation
*Blood - Indicates infection
*Proteins - A small amount of filtered plasma proteins can be found in normal urine but total protein excretion does not normally exceed
150mg/24 hour. If a ppositive reaction is seen this usually indicates infection or poor kidney function
*Bilirubin - Indicates poor liver function, serosis or anaemia
*pH - Normal range approx. 7.4 to 6 in the final urine
*Specific gravity - measures urine density, or the ability of the kidney to concentrate or dilute the urine over that of plasma. A score of 1.002 and 1.035 is considered normal.

Okay, so that's it for today I'm afraid! But i really hope you enjoyed reading this post! To those who aren't nurses, this might sound overbearing but, as a nurse, you just deal with this sorta thing and you realise that it's just human nature and it's nothing to be embarassed about. I also want to say, thank you very much to all my wonderful readers out there - even if you total just one or two, you still mean a lot to me! Thank you for continually reading what I post! See you again soon!

Emily

Guide To Clinical Placements

Hello everyone!!
What a fine day it is - the first of june!! I cannot believe how fast time has gone! I started this course on the 20th Feb and it feels almost like yesterday!
Today I'll still be talking about clinical placements but I'll be writing up a guide! I'll be explaining everything you should expect for your first day, what you should bring and what to do and what not to do. Enjoy!

What to bring

*Yourself - Kinda obvious but would be very hard without
*A fresh, clean and crisp uniform - The night before make sure your uniform is ironed, washed and hung-up on a hanger. You want to make a good impression, after all.
*An A5/A6 notepad - This is very important because on your first day you will learn a lot!! By writing these things down, you can research them later!
*Comfortable shoes - They always stress 'presentation' at university before you start placement. But sod that! You'll be on your feet a lot. Actually, you'll be standing about 95% of the time so pick out shoes that are FLAT and COMFORTABLE. They dont have to look particularly pricey and they dont have to stand out or anything. Just make sure they ensure comfort and are black. (It helps to check your trust policy too!)
*Your phone - bring this as your mum will no doubt want to ensure you are getting on ok but keep it in your locker, not on your person.
*Your practice assessment documents - this is very very important. Dont lose them eight because they have to last the whole three years!!
*Tea bags and your lunch - Normally you can't use the hospital tea bags because they are 'only for the patients' so bring your own. Or buy some at the hospital shop.
*An clear, open mind, ready to take in LOTS of information.
*A smile

What to expect of your placement

*Expect it to be busy - most wards/clinics are, so be prepared to come home feeling exhausted!
*The other staff nurses and HCAs might not be so friendly towards you - this is quite a common occurance but, to be fair, expect this when you start any new job. People in general are xenophobic or just hate training up new people. Dont take it personally. Also they might just be too busy to talk that much. Theres more time to chat on break, I suppose.
*Expect to meet lots of new people and remember lots of new faces - remember that you have to not only remember the faces and names of the patients but also the faces and names of the people you are working with!!
*Expect to be standing 95% of the time - when you get the chance, take a minute just to sit down. I don't mean everytime your at the nurses station, steal a chair for half an hour! I mean, just get the weight off your feet when you have a spare minute because you are bound to be tired and stressed.
*There will be doctors everywhere - well, maybe a bit of an exaggeration but you will see them pretty much everyday and they might ignore you. Try to take the initiative and ask them what they are doing and why. Most dont mind explaining things if they aren't too busy because most of them love their jobs!

What your placement will expect of you

*Be on time - Now, I didn't actually do this very often, I must say. And in my mid-point interview, the staff nurse kind of said, gently-put, that I should 'manage my time better'. Which was pretty fair enough.
*Relating to the last point, take on any advice they give you and do so in a humble manner - we all make mistakes and need advice from time-to-time. But try to accept anything they say because they know best. They are only trying to help you learn.
*Be honest - If you dont know how to do something, say. If you do something wrong, say. If you need help with something, say.
*Be willing - At handover, dont stand chewing gum with your arms crossed. It looks like you actually dont want to be there and you dont actually want to learn. Ask if you can take that cannula out, ask if the nurse you can document something, ask if you can take this patients obs, ask if you can go down to the blood bank for them, ask if you can order a patients TTAs for them. Not only does it show that you are willing to learn, they also realise that you are bothered and they may help you to seek out learning oppourtunities.
*Be tidy - Kind of said this before but I'll say it again because its so important. Remove jewellery, dont wear a ton of make-up, remove false nails and eyelashes. Dont chew gum and wash your hands before handover or touching a patient. Tie your hair up. Most things in nursing are common sense and this certainly is. So make sure you act and LOOK the part.
*Show commitment and be a responsible learner.
*Ask questions - they will not expect you to know everything neither will they expect you to have had care experience before because, believe it or not, a LOT of student nurses actually haven't had any care pexperience before their first placement. I didn't.

Adult learning

*You're not a sixth-form student anymore. You are responsible for your own learning which means that if you are happy to stand in the sluice (And, trust me, this happens!!) they won't come and fetch you and spoon feed you information. So, take the initiative.
*Make sure you keep your PAD docs up-to-date. This is vital as it is you who is responsible for getting the skills signed off. No-one else.
*On your days off, head down to the library and research some of the things you did not understand. If you are unsure what a colonoscopy is, open up the royal marsden and take a quick look. Or just research things online. It all aids towards gaining knowledge!
*On drug rounds, ask the nurse if you can take the leaflets that you inside the drug packets. These leaflets are amazing! They explain the uses of medication and how they work and are perfect for quick reference and gaining knowledge quickly and easily.
*Also, this might be an unconventional one, but you can neevr start learning too early. Even if its your first day, ask the nurse if you can give a patient their Clexane injection, ask if you can prepare medication for IV, ask if you can conduct a blood glucose test. It's good to start early. Better than starting late, anyway.
*Also, always maintain a professional character, you are representing yourself and the university, remember.
*Remember that you are responsible for your own actions.
*Research into your ward specialties.
*Remember your rights as a student and that you are classed as supernumerary and DO NOT count in the numbers.
*Moreover, bear in mind that you DO NOT 'work' there. You are a student and are gaining insight to the work of a nurse. You are there to learn as well as work. Also, you are not under an employment contract and therefore don't actually have the rights of an employee. But refer to a previous post entitled Guide To Choosing A Trade Union which explains why joining a trade union as a student nurse is important.
*Another thing: There will be times when you are sooo busy, yet again there will be times when you'll be sooo bored. When times get boring, don't just sit around. Take this advice: Open the BNF. Every ward has one. Or check that the patients have everything they need and are comfortable. Or just sit and chat to the patients. Fill in some charts. Take a look at the hoards of folders they have on infection control or ward policy. Ask the hostess if she needs any help handing out the trays of food. Check all documentation has been filled in and none are nameless or without a date etc.
*Also, remember to reflect upon mistakes. You can write it down or just vent on your mum! But remember CONFIDENTIALITY!! Dont use a patients name or any other personal detail.

Your mentor/s

*They are there to help you learn, yes, but they are there as a support network. If you are having troouble with something, they are there to sort out the issue you are facing. So, talk to them. That's their job. I actually have spoken to a few other students who have had many problems with their mentors i.e. their mentor didn't speak to them or their mentor was a 'rude cow' or whatever. Well, then, don't just complain about it, do something! Go to your clinical practice facillitator and they will also help you.
*Chase your mentor up to fill in documentation for you, as well! don't leave your PAD docs 'til the last week because you might not get it all done!

Other students

*On your ward, you will almost definately be with other students. These student may be older, younger or more experienced than you. Make sure you talk to them because they will help you as well. On my ward I had a 29-year-old, second-year (almost third-year, actually) who helped me so much. When the other nurses weren't available, she would teach me how to do things e.g. taking out a cannula or doing mannual BP. She also helped me on my assignments as well!
Don't forget to keep in contact with the other students in your cohort too! They act as a great support network for you.

Furthermore...

KNOW YOUR LIMITS!
Make sure that you don't do anything that the university has told you you must not do. i.e. don't touch an IV pump unless a nurse is there to supervise you, don't give an intramuscular if you haven't done the theory for it. Again, kinda common sense but when you are in a difficult situation it's hard to maintain your objectivity.

Ok, I think that's all! I hope you have had a good week and I hope this post has been of some interest to you! Have a good weekend,

Emily x

Reflection, Record keeping, Confidentiality and Drug Calculations

Hi guys!
Today I'll be covering four topics in this one post. Enjoy!

Reflection
Reflection is when you think about an aspect of your professional development as a student nurse. It is considered as very important to your learning and experience. It helps nurses to evaluate their own practice and performance. Bengtsson (1998) suggested that nurses need to learn by these experiences and, by doing so, would become more competent and therefore more able to teach others. Callister (1993) sees reflection on clinical events as an expansion of cognitive learning and suggests that the use of professional journals to record events, and reactions to these events, shapes the future of care delivery. This certainly shows that reflection is vital to a students learning and understanding.
Reflection involves meditating about the experiences of a day in practice, analysing and evaluating decisions made, using self-assessment to improve continually, therefore focusing on lessons learned whilst maintaining objectivity.
This can be done through a SWOT analysis. You may have heard of this before... Using SWOT analysis helps us to consider our possible strengths, weaknesses, opportunities and threats.
We can also use Gibbs Reflective Cycle. (See Image)


Potential barriers to reflection
*Stress
*Lack of honesty
*Time
*Insecurity
*Lack of/too much confidence
*Fear
*Bad/lack of feedback
*Stubborn/narrowmindedness
*Arrogance

So, overall, reflection must be done on a regular basis to be beneficial to nurses. And while reflection is fairly commonplace, it's also a good idea to keep checking this against currently theory and acceptable practice.

Record keeping
In nursing, record keeping is very important as it must reflect high standards of clinical care and health care records must keep continuity of care and accurate account of treatment. Records are therefore used as a vehicle for communication between other health care professionals.
What Health Care Records include
*Clinical notes
*Photos (to observe the development of a complaint)
*Letters
*Print outs from monitoring equipment
*Incident reports
*Emails
*X-rays
*Lab reports


Principles of record keeping
*Handwriting must be legible for others to read.
*Must be signed inluding name and job title printed alongside first entry.
*The date and time must be recorded.
*Records must be in chronological order.
*Language must be easily understood (no jargon!!) and must be accurate with clear meaning.
*Records should identify risks and problems and the possible actions that were taken.
*However, the records must never be altered or destroyed.

Confidentiality
This relates closely to the last topic really.
Confidentiality is defined as 'the duty to maintain confidence and thereby respect the privacy of patients health information'.

Regarding confidentiality, the Nursing and Midwifery Council (NMC) states that...
1. You need to be fully aware of the legal requirements and guidance regarding confidentiality, and ensure your practice is in line with national and local policies.
2. You should not discuss the people in your care in places where you might be overheard. Nor should you leave records, either on paper or on computer screens, where they might be seen by unauthoried staff or members of the public.
3. You should not take or keep photographs of any person or their family, that are not clinically relevant.
So, yeah. It's pretty serious stuff.

Drug Calculations
I love this bit. (;

Drug calculations are important in nursing because obviously administering the wrong dosage of medication could potentially kill someone! (Extreme, maybe, but it could happen...)

Here is a little guide for converting metric units of measure...


                   x1000                        x1000
Grams (g) -------> Milligrams (mg) -------> Micrograms (mcg)
Grams (g) <------- Milligrams (mg) <------- Micrograms (mcg)
                   /1000                        /1000

So...
1g = 1000mg
And...
1mg = 1000 mcg

Moving the decimal point
x1000
Move dm 3 places right.

/1000
Move dm 3 places left.

So...
0.04g = 40mg = 40 000mcg

Test yourself on these conversions...
1. 30 g = ____ mg
2. 2 mg = ____ mcg
3. 800 mg = ____ g
4. 50 mcg = ____ mg
5. 20 mg = ____ g
6. 6500 mcg = ____ mg
7. 900 mg = ____ g
8. 0.1 mg = ____ g
9. 0.25 g = ____ mg
10. 125 mg = ____ g

For more information and more test questions check out this website and this book.

Another tip I have is to go into your local drug store (EG. Superdrug, Boots, Tescos, Asda, Wilkies...) and have a little look at the labels of some medication. Imagine the drugs being prescribed to a patient and think up some possible prescriptions in your head. It's all good practise!


Oral Medication Calculations
Kind of the same as before but now we must administer the right amount of drug to meet the specific needs of a patient.

Example:
A patient prescribed 2.5 mg of ramipril orally. Each tablet contains 1.25 mg. How many tablets should be given? Answer = 2.

Another Example:
How many Metronide 200 mg should be given for a prescription of Metronidazole 400 mg orally? Answer = 2.

Further Example:
How many 30 mg tablets of Codeine should be given for a prescription of Codeine 45 mg? Answer = 1.5.

Test yourself on these calculations...
1. A client is ordered 300 milligrams of Thioridazine. 100 milligram tablets are available. How many tablets will you give?
2. A client is ordered 1 milligram of Diazepam. 2 milligram tablets are available. How many tablets will you give?
3. A client is ordered 0.5 milligrams of Digoxin. 250 microgram tablets are available. How many tablets will you give?
4. A client is ordered 30 milligrams of Diltiazem hydrochloride. 60 milligram tablets are available. How many tablets will you give?
5. A client is ordered 62.5 micrograms of Benztropine Mesylate. 0.25 mg tablets are available. How many tablets will you give?

And that's it! I know it was quite a long post again!
Just to let you know I'll be continually updating my blog of the topics I post about, since in Nursing you are constantly learning new things. I'll especially be updating about what I've learnt in reflection and drug calc. In later posts I hope to discuss dosages of meds for injections and intravenous infusion which I think will be very exciting! ;D
I hope you've enjoyed this post! It has taken me a long time to type all this up! ^ ^
Take care.

Emily