NCLEX Review Guide: Fundamentals, Elimination & Procedures, Pre-op/Post-op Care

Urinary Elimination

• Normal urine output is 30-50 mL/hour or 1500-3000 mL/day for adults
• Oliguria is urine output less than 400 mL/day, while anuria is less than 100 mL/day
• Factors affecting urination include fluid intake, medications, stress, pregnancy, and neurological conditions

Bowel Elimination

• Normal bowel movements range from 3 times daily to 3 times weekly depending on individual patterns
• Constipation lasting >3 days requires intervention to prevent impaction
• Bristol Stool Chart helps assess stool consistency and identify elimination problems

Catheterization

1. Gather sterile supplies and explain procedure to patient
2. Position patient (dorsal recumbent for females, supine for males)
3. Perform hand hygiene and don sterile gloves
4. Cleanse urethral meatus with antiseptic solution
5. Insert catheter using sterile technique until urine flows
6. Inflate balloon if indwelling catheter, secure properly

Enema Administration

• Position patient in left Sims' position to follow natural bowel curve
• Insert tubing 3-4 inches for adults, using water-soluble lubricant
• Hold enema bag 12-18 inches above rectum for proper flow rate

Pre-op Assessment & Preparation

• Verify surgical consent is signed and witnessed before any pre-operative medications
• NPO status must be maintained - typically 8-12 hours for solids, 2 hours for clear liquids
• Remove jewelry, dentures, contact lenses, and nail polish before surgery
• Complete pre-operative checklist including allergies, vital signs, and surgical site marking

Patient Education

• Teach deep breathing, coughing, and leg exercises to prevent post-op complications
• Explain pain management options and importance of early mobilization
• Discuss expected recovery timeline and discharge planning needs

Immediate Post-op Care

• ABCs first - assess airway, breathing, circulation upon arrival from PACU
• Monitor vital signs every 15 minutes × 4, then every 30 minutes × 4, then hourly
• Assess surgical site for bleeding, drainage, and signs of infection
• Check positioning and function of drains, catheters, and IV lines

Ongoing Post-op Management

1. Encourage deep breathing and coughing every 2 hours while awake
2. Assist with early ambulation as ordered (usually 6-8 hours post-op)
3. Monitor for return of bowel sounds and normal elimination patterns
4. Provide adequate pain management to facilitate recovery
5. Assess for complications: infection, DVT, pneumonia, ileus

Essential Memory Aids

• RACE for post-op assessment: Respiratory, Abdominal, Circulatory, Elimination
• PAIN management: Position, Assess, Intervene, Notify if ineffective
• STERILE technique: Scrub, Time limits, Equipment ready, Respect boundaries, Inspect supplies, Limited talking, Efficiency