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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