排泄讲义课件.ppt

Medications Prevent reabsorption Diuretics Urinary retention Anticholinergics Antihistamines Antihypertensives Color change Toxic to kidneys Health Status Emotional Status Anxiety Stress Urgency Frequency Muscle tension Difficult to relax abdominal and perineal muscles Other factors Social cultural norms Privacy environment Facilities Habits Proper positioning Climate Nursing interventions for urination Urinary Retention Urinary Incontinence Interventions for Urinary Retention patient Privacy environment Normal position Sensory stimuli Muscle relaxing Health education habits ：time voiding Medications 灌肠/排便诱导排尿 Catheterization Squatting for female Standing for male Running water Hand in water Warm the bedpan 耻骨上膀胱区热敷或针灸 Interventions for Urinary incontinence patient Maintain skin integrity, promote comfort External drain the urine Restore normal micturition Offer fluid: 2000-3000 ml/day Bladder Retraining: Take to bathroom q1-2H Pelvic floor muscle training, PFMT(Kegels ) Catheterization Psychological support 收缩与放松盆底肌群 开始各持续2秒，重复15次，Tid 每周增加1秒收缩与放松时间，至10秒 维持10秒，重复10次，Qd Catheterization Plastic, rubber or silica gel tube through urethra into bladder Continuous flow of urine Assess hourly urine output Medication therapy Nursing skills for urination Catheterization Types Intermittent Catheterization Insert long enough to drain bladder Repeat PRN Indwelling Catheterization Stays in place Change periodically Indications Intermittent urinary retention--Relieve bladder distention Obtain urinary specimen Assess residual Long term management of spinal cord injury Indwelling Obstruction Surgery （pelvic area、 Urinary system） Measure IO in critically ill Urinary incontinence and Severe retention Terminally ill with trouble moving Care and Removal Care---Maintain flow and prevent infection Sterile Maintain closed system Hang lower than bladder Clean with soap and water at least Qd Area and tube After each BM (bowel movement) M