Question

1. Describe at least eight factors that contribute to constipation.

2. Explain specifically how opioid analgesics affect bowel elimination.

3. Explain what to do if signs or symptoms of a vagal response are noted during enema administration.

4. What can you do to help prevent CAUTIs when inserting an indwelling catheter?

5. How will you perform a 24-hour urine collection when the patient has an indwelling catheter?

6. Explain how to prevent recurring UTIs in female patients.

Answer 1

(10 Constipation is generally described as having fewer than three bowel movement in the week . And a chronic constipation is infrequent bowel movements or difficult passage of stools that persist for several weeks or longer .

The factors that contributing to constipations are as listed below ;-

• Being an older
• Being dehydrated
• having a mental health condition such as depression or an eating disorder like anorexia nervosa
• getting little or no physical activity
• taking certain medication , some are antidepressant or medication to lower blood pressure
• being a women also contributing to the constipation
• eating a diet that's low in fiber
• Having a habbit to frequently control the voluntary action of external sphincter .

(2) Both central and peripheral opioid effects play a role in opioid GI effects . As opioid effect either directly or indirectly on both central or peripheral effecty on bowel function . opioid induced bowel dysfunction is the conseuence of reduced GI motility , increased absorption of fluids from the gut and decreased epithelial secreation. The stool remains in the gut lumen for a longer time , therefore , more fluid is reabsorbed and the stool becomes hard and dry , The above effect are also associated with opioids inhibition of secretomotor neurons in the epithelium of the gut ,

(3) When the enema tube insrted into the patient 's rectum , it immediately stimulate the vagal nerve , and this stimulation of vagus nerves leads to the innervation in the GI tract , heart and also in bronchioles , where the vagus nerve is supplied . Then the heart rate go down to 30 to 40 beats per minute . sometimes it also cause a constriction of bronchioles.

  the patient complaint of light - headedness during the insertion of an enema or during evacuation of the bowel . This is due to vagal nerve stimulation , which can slow the heart rate and alter its rhythm . Then immediately remove and dispose of equipment , and remove gloves and apron and wash the hands . Inform the patient of teh outcome and ensure that the procedure and its result are doumented by using the Bristol stool chart .

(4) As a nurse , We can help the patient in peventing CAUTIs with our adherence to best practice and good hygiene . by following the below steps ;-

• We should be trained in the use of hospital's devices and supplies available there ,
• always use aseptic technique for the placement , manipulation and the maintenance of indwelling catheters.
• always remember that handwashing is the first and the most important preventive measures , and folowed by the use of barrier precautions such as a sterile gloves , drape , sponges , and antiseptic solution and use single use packets of sterile lubricant .
• Following aseptic insertion of tehcatheter by properly trained staff , and maintained a closed darinage and unobstructed urine flow that be sure there are no links in the tubing , etc
• In the post - operative patient , always remove the catheters as soon as possible , The CDC recommends removal within the24 hours , unless there are appropriate indications for continued use .
• If the hospital has implemented protocols for nurse directed removal of unnecessary catheters and become familiar with them and fallow them - these allow for nursing assessment and intervention without a physicians order , whereas some hospitals are instead using the prewritten stop orders to ensure that post - operative catheters are removed within a specified time period , or are implementing a system of the alerts or reminders to remove the catheters that are no longer necessary .

(5) In patient 24 hour collection container may contain the chemical that act as a preservative and are hazardous . So , do not urinate directly into the container , collect urine in a clean and dry vessel and carefully pour the urine into the 24-hour collection container . The some basic steps should be follow sre as listed below;-

• Follow the physician's advice regarding any food , drink or teh drugs before and during collection
• Empty teh bladder completely upon awakening and discard this urine , This is our start date and the time, write it on a paper work or on the collection cantainer
• collect the urine for next 24 hours , The last urine collected should be that voided upon awakening at the second day , and at the same time as the start time .
• Recap the collection container carefully and completely.
• return the collection container to where we are instructed to return it as soon as possible.

Some urine test require that the 24 hour urine colection be refrigerated during collection .

(6) Recurring UTIs is the chronic state of UTIs , that are the infection of the urinary tract that either don't respond to treatment or keep recurring . they may either continue to affect our urinary tract despite getting the right treatment or they may recur after treatment ., The chronic UTIS are most common in women , this is due to two different aspects of basic human anatomy , the first one is to close to the rectum in women , AS a result , it's extremely easy for bacteria , particularly if they wipe back to front instead of front to back . This why young girls get often get UtIs . They haven't learned how to wipe properly .

second is , a women 's urethra is shorter than a man's . . This meanms that the bacteria havea shorter distance to travel to get to the bladder , where they can multiply and more readily cause infection,

SO, we can be prevented UTIs in females by following the steps;-

• urinate as often as needed ( especially after intercourse)
• Wipe front to back after urinating
• drink plenty of water to flush bacteria out of our system
• drink cranberry juice daily
• wear cotton underbear
• avoid tight - fitting pants
• avoid using diaphragms and spermicides for both birth control
• avoid drinking fluids that may irritate our bladder ( like the coffee , citrus fruitt drinks and soda and alcohol)
• use lubrication during sexual activities , if necessary
• avoid bubble baths