The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [190]
4 Annotate the fluid balance chart accurately. The fluid balance of all patients having bladder irrigation must be monitored. So that urine output is known and any related problems, for example renal dysfunction, may be detected quickly and easily. E
Postprocedural considerations
Documentation
Bladder irrigation recording chart
The bladder irrigation recording chart (Figure 6.10) is designed to provide an accurate record of the patient’s urinary output during the period of irrigation. Record the time (column A) and the fluid volume in each bag of irrigating solution (column B) as it is put up.
Figure 6.10 Bladder irrigation recording chart.
When the irrigating fluid has all run from the first bag into the bladder, record the original volume in the bag in column C. Record the corresponding time in column A. Do not attempt to estimate the fluid volume run-in while a bag is in progress as this will be inaccurate. If, however, a bag is discontinued, the volume run-in can be calculated by measuring the volume left in the bag and deducting this from the original volume. This should be recorded in column C (Scholtes 2002).
The catheter bag should be emptied as often as is necessary, the volume being recorded in column D and the corresponding time in column A. The catheter bag must also be emptied whenever the bag of irrigating fluid is empty, and the volume recorded in column D.
When each bag of fluid has run through, add up the total volume drained by the catheter in column D, and write this in red. Subtract from this the total volume run-in (column C) to find the urine output (D 2 C = E). Write this in column E. Draw a line across the page to indicate that this calculation is complete and continue underneath for the next bag.
Faecal elimination
Definition
Faecal elimination is the process of elimination – simply the expulsion of the residues of digestion, faeces, from the digestive tract (Thibodeau and Patton 2007b). The act of expelling faeces is called defaecation.
Anatomy and physiology
This section will consider the normal structure and function of the bowel, which includes the small and large intestine (Figure 6.11). The small intestine begins at the pyloric sphincter of the stomach, coils through the abdomen and opens into the large intestine at the ileocaecal junction. It is approximately 6 m in length and is divided into three segments: the duodenum (25 cm), jejunum (2.5 m) and ileum (3.5 m) (Thibodeau and Patton 2007b). The mucosal surface of the small intestine is covered with finger-like processes called villi, which increase the surface area available for absorption and digestion. A number of digestive enzymes are also secreted by the small intestine (Tortora and Derrickson 2009).
Figure 6.11 The gastrointestinal tract.
Movement through the small bowel is divided into two types, namely segmentation and peristalsis, and is controlled by the autonomic nervous system. Segmentation refers to the localized contraction of the intestine, which mixes the intestinal contents and brings particles of food into contact with the mucosa for absorption. Once the majority of a meal has been absorbed through this process, intestinal content is then pushed along the small intestine by repeated peristaltic wave-like actions. Intestinal content usually remains in the small bowel for 3–5 hours (Tortora and Derrickson 2009).
The total volume of fluid, including ingested liquids and gastrointestinal secretions, that enters the small intestine daily is about 9.3 litres. The small intestine is responsible for absorbing around 90% of the nutrients, electrolytes and water within this volume by diffusion, facilitated diffusion, osmosis and active transport (Tortora and Derrickson 2009). Water is able to move across the intestinal mucosa in both directions, but is influenced by the absorption of nutrients and electrolytes. As various electrolytes and nutrients are actively transported out