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Nursing > 208 Concept: Elimination; topics: Abdomen/GI, male/female genitourinary, anus, rectum and prostate > Flashcards

208 Concept: Elimination; topics: Abdomen/GI, male/female genitourinary, anus, rectum and prostate Flashcards

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1
Q

Define elimination.

A

Broadly speaking, the term elimination refers to the removal, clearance, or separation of matter. From a human physiological perspective, the term elimination is defined as the excretion of waste products.

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2
Q

What is the scope of elimination?

A

Efficient elimination — Waste excretion —– Impaired elimination

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3
Q

What is elimination from the bowels called?

A

passage of stool

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4
Q

What is elimination from the urinary system called?

A

passage of urine

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5
Q

What are risk factors for persistent urinary incontinence?

A 
Advanced 
age 
Female 
Menopause 
Multiparity 
Obesity 
Smoking 
Impaired mobility 
Trauma or surgery pelvic region 
Impaired cognitive, debilitated state 
Neurologic disorders (such as stroke, spinal injury, brain tumor)
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6
Q

What are risk factors for persistent fecal incontinence?

A 
Advanced age 
Diarrhea 
Impaired mobility 
Impaired cognitive 
debilitated state Injury
chronic condition affecting rectal neuropathway
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7
Q

What are risk factors for urine retention?

A 
Advanced age
Male Prostate enlargement, 
inflammation, or infection Pelvic organ 
prolapse 
Pelvic mass 
Pelvic trauma/surgery 
Medications (anticholinergics, sympathomimetics)
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8
Q

What are risk factors for fecal retention?

A 
Advanced age 
Female 
Pregnancy 
Lower income 
Poorly educated 
Sedentary lifestyle 
Dehydration 
Chronic conditions (inflammatory bowel syndrome, depression) 
Medications (opioids, diuretics, antidepressants, aluminum-based antacids)
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9
Q

At what age are children typically potty trained?

A

2-3 years old

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10
Q

What organs would you find in the right upper quadrant?

A
  • gallbladder
  • liver
  • ight kidney
  • hepatic flexure
  • duodenum
  • head of pancreas
  • parts of ascending and transverse colon
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11
Q

What organs would you find in the right lower quadrant?

A
  • appendix
  • cecum
  • right ovary
  • right ureter
  • right spermatic cord
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12
Q

What organs would you find in the left lower quadrant?

A
  • sigmoid
  • left ovary
  • left ureter
  • left spermatic cord
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13
Q

What organs would you find in the left upper quadrant?

A
  • stomach
  • spleen
  • body of pancreas
  • left kidney
  • parts of transverse and descending colon
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14
Q

What organs would you find in the midline?

A
  • aorta (just left of midline)
  • uterus (if enlarged)
  • bladder (if distended)
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15
Q

In infants, how many arteries and veins are in the umbilical cord?

A

2 arteries and 1 vein

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16
Q

In infants, does the liver take up proportionately more or less space than in later life?

A

More

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17
Q

What developmental considerations are there for pregnant women?

A
  • “morning sickness” - no definitively known cause but hormones are suspected
  • Elevated progesterone relaxes muscles and can lead to increased heart burn
  • constipation and increased venous pressure can lead to hemorrhoids
  • bowel sounds are diminished
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18
Q

What developmental considerations are there for older adults?

A
  • fat can accumulate on the belly
  • salivation decreases leading to dry mouth
  • esophageal emptying is delayed, so feeding older adult in supine position increases risk for aspiration
  • gastric secretions decrease; absorption of medication can be impaired and may cause pernicious anemia (from impaired vitamin B12 absorption)
  • more susceptible to dehydration
  • liver decreases in size, though function remains normal
  • renal function decreases
  • increased gall stones
  • risk for colorectal caner increases with age
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19
Q

What factors can lead to constipation in older adults?

A
  • decreased mobility
  • pathological conditions
  • adverse medication effects
  • poor dietary habits (inadequate intake of fluids and fiber)
  • prolonged use of laxatives
  • use of opiods or NSAIDS
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20
Q

What health history topics get covered in an abdomen assessment?

A
  1. Appetite
  2. Dysphagia
  3. Food intolerance
  4. Abdominal pain
  5. Nausea/vomiting
  6. Bowel habits
  7. Past abdominal history
  8. Medications
  9. Alcohol and tobacco
  10. Nutritional assessment
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21
Q

Define pyrosis.

A

Burning sensation in esophagus and stomach, caused by reflux of gastric acid.

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22
Q

Pain from internal organ characterized as dull, general, poorly localized

A

visceral pain

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23
Q

Pain characterized as sharp, precisely localized, aggravated by movement

A

parietal pain (inflammation of overlying peritoneum)

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24
Q

Pain resulting from a disorder in another site.

A

referred pain

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25
Q

What can cause hematemesis (blood in vomit)?

A
  • stomach or duodenal ulcers

- esophageal varices

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26
Q

What might cause black and tarry stool?

A
  • occult blood from gastrointestinal bleeding
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27
Q

What might cause black but non-tarry stool?

A

iron medications

28
Q

What might cause grey stools?

A

hepatitis

29
Q

what might cause red blood in stools?

A
  • gastrointestinal bleeding

- localized bleeding around the anus (hemorrhoids)

30
Q

What can cause peptic ulcer disease?

A
  • frequent use of NSAIDS
  • alcohol
  • smoking
  • H. pylori infections
31
Q

Additional abdominal assessment Hx questions for infants and children.

A
  • breastfeeding or formula
  • table foods
  • eating patterns
  • non-food eating (termed pica)
  • constipation
  • abdominal pain
  • overweight children
32
Q

Additional abdominal assessment Hx questions for adolescents.

A
  • schedule and content
  • exercise
  • underweights (awareness of anorexia nervosa and bulemia)
33
Q

Additional abdominal assessment Hx questions for older adults.

A
  • food access (risk for nutritional deficiency)
  • emotional characteristics (alone or shared)
  • Recall
  • any trouble swallowing
  • bowel movements
34
Q

Measures that enhance abdominal wall relaxation.

A
  • empty bladder ahead of examination
  • keep room warm (prevents tensing of muscles)
  • arms at sides
  • warm the stethoscope
  • keep fingernails short
  • inquire about painful areas and examine last to prevent muscle guarding
  • privacy; covering and draping
35
Q

What might cause excessive belcing?

A

hiatal hernia

36
Q

Why might your urine be the colour of syrup or brown ale?

A
  • liver disease

- severe dehydration

37
Q

Why might your urine be pink or reddish?

A
  • beetroot, berries or rhubarb

- blood in urine (kidney disease, uti, tumour)

38
Q

Why might your urine be orange?

A
  • not drinking enough water
  • liver or bile duct condition
  • food dye
39
Q

Why might your urine be blue or green?

A
  • rare genetic disease
  • bacterial infection
  • dye in food or medication
40
Q

What frequency of bowel movement constitutes constipation?

A

less than 3-4 BMs per week

41
Q

What other reasons could stool be black besides blood or iron medication?

A
  • muconium in newborns

- use of bismuth (pepto)

42
Q

How many levels of the Bristol chart?

A

7

43
Q

Describe the 7 levels of the Bristol chart.

A

1: Separate, hard lumps: very constipated
2: Lumpy and sausage like: slightly constipated
3. A sausage shape with cracks in the surface: normal
4. Like a smooth, soft sausage or snake: normal
5: Soft blobs with clear cut edges : lacking fiber
6: mushy consistency with ragged edges: inflammation
7: liquid consistency with no solid pieces: inflammation and diarrhea

44
Q

Why beside hepatitis might your stool be white/pale/gray?

A

lack of bile, and some anti-diarrheal medications

45
Q

Why might stool be green?

A
  • spinach, kale
  • too much bile
  • not enough bilirubin
46
Q

Why might stool be red?

A
  • blood
  • beets
  • hemorrhoids
  • GI bleeding
47
Q

What is the normal rate of urine output?

A

30 - 40 mL per hour; about 240 mL per 8 hours, though that is still quite concentrated

48
Q

What is the correct sequence for physical examination?

A

1) Inspection
2) Auscultation
3) Percussion
4) Palpation

49
Q

What are the normal and abnormal contours of the abdomen that you might find?

A

Normal: Flat or rounded
Abnormal: Scaphoid or protuberant (except in toddlers and pregnant ladies)

50
Q

What developmental considerations are there for infants and children? (across abdomen, urinary and genital)

A
  • Umbilical cord shows on the abdomen
  • Liver takes up more space in the abdomen
  • Bladder is higher in the abdomen – between symphysis pubis and umbilicus
  • Abdominal wall less muscular – organs easier to palpate
  • Increased risk for dehydration with gastroenteritis due to small body weight. Signs of dehydration (changes in LOC, sunken eyes, tachycardia, tachypnea, & decreased skin turgor)
  • Testes descend along the inguinal canal into the scrotum before birth
  • Effects of maternal estrogen on the external genitalia of newborns – swollen labia
  • Meconium – indicates anal patency
  • Stool is passed by reflex – voluntary control doesn’t start until around 1 ½ - 2 years of age
51
Q

What developmental considerations are there for adolescents? (across abdomen, urinary and genital)

A

Puberty changes – estrogen stimulates cell growth in the reproductive tract and there is development of secondary sex characteristics. First signs are breasts and pubic hair developments (8 ½ - 13).

Menarche -occurs over latter part of the sequence. Irregularity is common.

Prostate gland doubles in size at puberty

52
Q

What developmental considerations are there for adults and older adults? (across abdomen, urinary and genital)

A

Older women - Fat accumulates in the suprapubic area (due to decreased estrogen)

Adipose tissue redistributed

Decreased salivation

Delayed esophageal emptying

Decreased gastric acid secretions – impaired or delayed absorption of medications

Increased risk for dehydration

Liver size decreases

Renal function decreases – increase risk of toxic medication effects

Increased constipation – decreased motility, decreased mobility, medication effects, dietary habits, decreased fluid intake.

Medications can affect sexual performance

Older women – changes in sexual function

Pregnancy – morning sickness (due to hormone changes), acid indigestion (due to esophageal reflux), constipation (due to decreased motility and increased water reabsorption from the colon), decreased bowel sounds (increased belly size displaces intestines)

Menopause due to decreased hormone levels; uterus shrinks and ovaries atrophy

Without sexual activity the vagina atrophies (becomes thinner, drier, itchy) – increased risk for bleeding and vaginitis.

Urinary incontinence is prevalent

Prostate gland enlarges during middle adult years - BPH is present in 10% of males by age 40. This gradually impedes urine output by obstructing the urethra. Also an increased risk of prostate cancer with aging.

53
Q

What are signs of possible intestinal obstruction?

A
  • markedly visible peristalsis combined with abdominal distension
54
Q

True or false: if you hear a bruit while auscultating the abdomen, you should continue

A

False. You should stop and not palpate. Report findings immediately as it could be an aortic aneurysm and you may rupture it if you palpate it.

55
Q

What quadrant should you start auscultation in?

A

Right lower quadrant; bowel sounds are normally present there

56
Q

What is the frequency of normal bowel dounds?

A

5 - 30 times per minutes; don’t really need to count.

57
Q

What is a “growling stomach” called and is it a normal finding?

A

borborymus - yes, normal

58
Q

What is uncommon to hear in bowel sounds and how long should you listen to verify your finding?

A

no sounds: “silent abdomen”. Listen for 5 minutes before deciding they are absent.

59
Q

What are developmental considerations for anus and rectum for newborns?

A
  • meconium; 24 - 48 hours after birth indicates anal patency

- Passes stool by reflex - voluntary control by 1.5 to 2 years

60
Q

What are developmental considerations for anus and rectum for adolescents?

A
  • at puberty, prostate gland undergoes a very rapid increase to more than twice its prepubertal size
61
Q

What is benign prostatic hypertrophy (BPH)?

A

The normal enlargement of the prostate throughout the man’s lifetime.

62
Q

How often is usual screening for colorectal cancer (CRC) for those aged 50 to 74?

A

Every two years for stool tests and every 10 years fir flexible sigmoidoscopy.

63
Q

What health history questions do you ask for anal, rectum and prostate assessment?

A
  • Usual bowel routine
  • change in bowel habits
  • rectal bleeding or blood ins tool
  • medications, including laxatives, stool softeners, and iron
  • Rectal conditions such as pruritis, hemorrhoids or fissures
  • Family history of polyps; inflammatory bowel disease; colon, rectal or prostate cancer
    Self-care behaviours like a high fiber diet
64
Q

What are the steps of the objective assessment for rectum, anus and prostate?

A
  1. Inspect anus and perianal area
  2. Inspect during Valsalva manoeuvre
  3. Palpate anal canal and rectum in all adults.
  4. Test stool for occult blood.
  5. Engage in teaching and health promotion.
65
Q

What factors affect normal bowel elimination?

A
  • diet (fiber and fluid are important)
  • fluid intake ( 6- 8 glasses of non-caffeinated fluids daily; limit coffee and tea as it can irritate bowel and be dehydrating.
  • physical activity
  • personal bowel elimination habits
  • privacy

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