Bowel and Urinary Elimination Flashcards
Define micturition
the act of urinating
What are 8 factors influencing micturition?
- growth and development
- sociocultural factors
- psychological factors
- personal habits
- fluid intake
- pathological conditions
- surgical procedures
- diagnostic examinations (caths)
What is decreased in older adults related to micturition?
amount of nephrons, bladder tone, bladder capacity, and the amount of time between the urge to go and releasing urine
What is increased in older adults related to micturition?
bladder irritability, bladder contractions during bladder filing, risk of urinary incontinence
What is urinary retention
the inability to partially or completely empty the bladder
How can you diagnose post-void residual
ultrasound of bladder after urination
does a nurse need an order to scan the bladder after a patient urinates
no
what is the most common bacteria in the urinary tract?
e. coli
what is bacteriuria
bacteria in the urine (doesn’t necessarily mean UTI)
What are 8 examples of risk factors of UTIs
- has a catheter
- any instrument in the urinary tract
- urinary retention
- urinary / fecal incontinence
- poor perineal hygiene
- females
- frequent sexual intercourse
- uncircumcised males
what are the top 2 focal points about CAUTIs
early recognition and prompt intervention
what is urinary incontinence
involuntary loss of urine
What are the 3 forms of urinary incontinence
urgency
stress
overflow
what are the 9 risk factors for urinary incontinence
- women / elderly
- obesity
- multiple pregnancy / vaginal births
- neuro disorders (Parkinson’s, CVA, spinal cord injury, MS)
- Medication
- Confusion
- Dementia
- Immobility
- Depression
Why is it important to assess a patients bladder / urination pattern?
to find a baseline or what is normal to compare to when things change
What are s/s of urinary alterations
urgency
dribbling
hematuria
retention
polyuria
hesitancy
how do you assess for kidney tenderness
percuss the costovertebral angle (CVA) which is the space formed by the 12th rib and the spine
what is the normal urine output
> 30 ml / hour
When should the nurse be concerned about urinary output amount
< 30 ml / hour for 2 hours
If urine appears thick and cloudy, what could the nurse infer
may have bacteria and WBC present but could also be urine from the first urination of the day (may appear this way because the urine has sat in the bladder all night)
if we need to know the exact amount of urine a patient makes in an hour what is the best way to do this
by use of a urinary catheter
when collecting urine for a urinalysis what is the best practice
to get fresh urine - not urine that has been sitting in the bag
how quickly must the nurse get urine off for a culture
30 minutes
what is the purpose of an abdominal xray in relation to urination
determines size, shape, symmetry, and location of structures of the urinary tract
what special prep needs to be included for a patient that is to have an abdominal xray
none
What are some health promotion topics the nurse could share with a patient with urinary problems
promote self care practices
maintain normal routine
promote healthy nutrition and fluid intake
avoid constipation if possible
avoid smoking
strengthen pelvic floor muscle
for men: be vigilant about prostate health
report any changes to the doctor
what is the appropriate / ideal amount of fluid intake per day
2300 ml
what are some ways to help patients increase their fluid intake
schedule times to drink
identify fluid preferences
have high fluid foods (fruits)
stop drinking about 2 hours before bed to avoid night urination
when would the nurse encourage double voiding
in cases of bladder retention
what are some nursing actions the nurse can do independently for urinary retention
assess and monitor urine output
assess for bladder distention
assist patient to normal position for urination
run water / flush commode to stimulate urination
apply cold compress to abdomen
What are the do’s of skin care with incontinence of the bladder
treat and identify early
use skin risk assessments
use barrier creams
ensure adequate hydration
what are the don’ts of skin care with incontinence of the bladder
use traditional soap and water
double padding the bed
leaving soiled pads
who would need a coude tip catheter
men with an enlarged prostate
when would a suprapubic catheter be placed
when there is blockage of the urethra or when an indwelling catheter causes irritation
within how many hours should a patient void after removing a catheter
6-8 hours
when is it considered constipation
having < 3 bowel movements per week
what are some common causes of constipation
irregular bowel habits
improper diet
reduced fluid intake
lack of exercise
stress
certain medications
ignoring the urge to go
GI disorders
what are some reasons that older adults are more at risk of constiplation
lack of muscle tone
slowed peristalsis
lack of exercise
not enough fluid intake
too many dairy products
lack of fiber
medications
what are 4 specific complications of constipation
hemorrhoids
anal fissure
fecal impaction
rectal prolapse
what position does the patient need to be in for an enema insertion
left lying lateral sims
if a patient complains of pain while administering an enema
slow the rate by lowering the height of the bag
if the patient’s abdomen becomes rigid while administering an enema what should the nurse do
stop the administration
impaction results from what
results from unrelieved constipation and the inability to expel hardened feces retained in the rectum
what could happen if a fecal impaction is not relieved
intestinal obstruction
who is at risk for fecal impaction
those that are debilitated, confused, or unconscious
how would you check for a fecal impaction
a digital exam of the rectum
what are the s/s of fecal impaction
inability to pass stool for several says despite the urge to go
continuous oozing of liquid stools
loss of appetite
N/V
abdominal cramping
abdominal distention
rectal pain
what is an intervention for fecal impaction
digital removal of stool
what is diarrhea
loose watery bowel movements
what are the potential causes of diarrhea
foodborne pathogens, food intolerances / allergies, surgery, diagnostic testing, enteral feeings
what are 3 specific complications from diarrhea
skin irritation, dehydration, and nutritional concerns
what type of anti-diarrheal agent would you use against c. diff
nothing, you don’t want to use anti-diarrheal agents with c.diff
who is at risk for c.diff
those taking antibiotics, elderly, immunocompromised, those in long-term care facilities, GI procedures, previous hx of c.diff
what are the complications of c.diff
dehydration, kidney failure, toxic megacolon, bowel perforation, death
how do you prevent c.diff
washing hands with soap and water, avoid unneeded antibiotics, clean surfaces with bleach, and use contact D isolation
what is bowel incontinence
inability to control passage of feces and gas from the anus
what are the potential causes of bowel incontinence
muscle / nerve damage
any physical condition that impairs the anal sphincter function
constipation / diarrhea
large volume stools
surgery
rectal prolapse
what are some of the risk factors of bowel incontinence
age
female
nerve damage
dementia
physical disability
what are s/s of flatulence
abdominal distention, cramping, bloating, pain
what are potential causes of flatulence
constipation, food intolerance, GI diseases (IBS, chrons), stress
to avoid gas, the nurse would suggest what type of fiber
insoluble fiber
what foods contain insoluble fiber
whole wheat, nuts, green beans, potatoes
what foods contain soluble fiber
flax, broccoli, Brussel sprouts
what are hemorrhoids
dilated / engorged veins in the lining of the rectum
what causes hemorrhoids
increased venous pressure from straining
what are potential treatments for hemorrhoids
proper diet, increase activity, fluids, topical medications, surgery, sitz bath
what are the risk factors for colon cancer
african americans, high intake of red meat/processed meat with low fiber, obesity, 50+, lack of physical activity, alcohol / tobacco use, family hx, hx of inflammatory bowel disease and personal hx of colorectal cancer, colorectal polyps
what are the warning signs of colon cancer
changes in bowel habits
bleeding from anus
blood in stool
abdominal pain
loss of appetite
persistent lethargy and looking pale
jaundice
unexplained weight loss
when assessing bowel movements what should be included in the assessment
amount, color, odor, consistency, frequency, shape, and constituents
what does a fecal occult blood test test for
hidden blood / detects cancer
what are the2 purposes of an NG tube
decompression and enteral feedings
when and how often does guaiac fecal occult blood test done
annual and 45
when and how often should someone start getting colonoscopies
every 10 years, starting at 45
how do you assist a patient on to a bed pan that can assist with movement
raise head of bed 30-60 degrees
have patient flex knees and move hips upward
help lift patients bottom up to slide bedpan under
how do you assist a patient on to a bed pan that cannot assist with movement
roll patient on side
place bed pan against bottom
roll patient on back
raise patient head of bed 30 degrees
bend knees
