CH5 Elimination Flashcards
Physiology of Urinary Elimination Depends on effective functioning of:
* Upper urinary tract
* Kidneys, ureters
* Lower urinary tract
* Bladder, urethra, pelvic floor
* Cardiovascular system
* Nervous system
* Kidneys
* Nephron (Functional unit of the kidney)
Urine is formed here
* Ureters
* Bladder
Considerable distention capability
Normal capacity 300–600 mL of urine
* Urethra
* Length in adult woman ____ cm
Women more prone to urinary tract infections (UTIs)
Length in male approximately __ cm
Infection of urethra can extend through urinary tract to kidneys
3–4 ,
8
_________:
* Vagina, urethra, and rectum pass through
* Muscles, ligaments extending from symphysis pubis to
coccyx
* Continence mechanism
Internal sphincter under involuntary control
External sphincter under voluntary control
Pelvic Floor
Urination
* _______ relaxes, stimulating urge to void.
* If appropriate, conscious portion of the brain relaxes external urethral sphincter muscle.
* Urine is eliminated through urethra at the meatus.
* Pelvic floor tone aids voluntary control.
Internal sphincter
Factors Affecting Voiding
* Developmental factors
Infants, Pre-schoolers, school-age children, older adults
* Psychosocial factors
Privacy, position, sufficient time
__________________________________________
* Medications (Diuretics)
- Muscle tone:
(Important to maintain stretch, contractility of
detrusor muscle
Pathological condition
The kidney
Heart, circulatory disorders
Urinary stone (calculus)
Hypertrophy of the prostate
Diseases of prostate gland) - Surgical and diagnostic procedures
- Pathological Conditions
- Fluid and food intake
Certain fluids increase urine production
Alcohol, fluids with caffeine
Average daily urine output (>14 years old to adult and older adult)
1500 ml,
1500 ml or less
Altered Urinary Elimination:
Low urinary output (Less than __ mL/day or mL/hour):
______少尿/____無尿症
500, 30,
Oliguria, anuria
Altered Urinary Elimination:
_____多尿
May follow ______
Can cause excessive fluid loss
Polyuria, polydipsia
Dialysis:
When ____ occurs;
has two types: __________
anuria (lack of urine),
Hemodialysis,
Peritoneal dialysis
Altered Urinary Elimination:
______夜尿症
Voiding two or more times at night
nocturia
Altered Urinary Elimination
Frequency
Voiding at frequent intervals (more than ____ times per day)
four to six
Altered Urinary Elimination
Urgency
Sudden, strong desire to void
With or without presence of ________ in bladder
large amount of urine
Altered Urinary Elimination
_____(排尿困難)
-Voiding that is painful, difficult
-Associated with urinary hesitancy
Dysuria
Altered Urinary Elimination
_____ (遺尿症)
-Involuntary urination in children beyond age of voluntary bladder control
Enuresis
Altered Urinary Elimination
Urinary incontinence (尿失禁)
* Only normal in ______
Stress urinary incontinence (SUI)
* Weak pelvic floor muscles
* Urethral hypermobility
Urge urinary incontinence
* Inability to stop micturition
Mixed urinary incontinence
* Symptoms of both
Overflow incontinence
* Neurogenic bladder (Bladder fullness not perceived)
infants
Altered Urinary Elimination
Urinary retention
* Emptying of bladder impaired, urine accumulates, and the bladder becomes over distended
Common causes:
* Prostatic hypertrophy, Surgery, and some medication
* Acute urinary retention is the most common in the ______
Client with urinary retention may experience overflow
* Incontinence, eliminating _ ml of urine at frequent Interval
* The bladder is _____ on palpation and may be displaced to one side of the midline
first 2-4 hours post-operation,
25-50,
firm and distended
Assessment (urination)
Nursing history
1-5: ________
6. Factors influencing elimination pattern
- Normal voiding patterns
- Appearance of urine
- Recent changes
- Past or current problems
- Presence of ostomy
Assessment (urination)
Physical assessment and hydration status:
- Percussion of kidneys to detect tenderness
- Palpation and percussion of bladder
- Inspection of urethral meatus for swelling, discharge, inflammation
- Inspect skin for color, texture, turgor, signs of irritation, edema
Assessment (urination)
Assessing urine:
- 96% water
- 4% solutes
- Organic solutes include urea (chief solute), ammonia, creatinine, and uric acid
- Inorganic solutes include sodium, chloride, potassium sulfate, magnesium, and phosphorus
- Measure urinary output
- Measure residual urine: Postvoid residual (PVR)
Assessment (urination)
Diagnostic tests:
- Blood urea nitrogen (BUN)
- Creatinine clearance
Implementation (urination):
Maintaining normal urinary elimination,
Preventing urinary tract infections
Implementation (urination):
Maintaining normal urinary elimination (3 methods)
1) Promoting fluid intake
2) Maintaining normal voiding habits
3) Assisting with toileting
Implementation (urination):
Preventing urinary tract infections (7 methods)
1) Drink eight 8-oz glasses of water per day
2) Practice frequent voiding (every 2–4 hours)
3) Avoid harsh soaps, bubble baths, powder or sprays in perineal area
4) Avoid tight-fitting clothing
5) Wear cotton, not nylon, underclothes
6) Girls and women : Always wipe perineal area from front to back following urination or defecation
7) Take showers rather than baths if recurrent urinary infections are a problem
Managing urinary incontinence:
- Providing continence training
* Bladder training
* Habit training
* Prompted voiding - Pelvic muscle exercises
- Maintaining skin integrity
- Applying external urinary drainage devices
Managing urinary retention:
Flaccid bladder
* Weak, soft and lax muscle
* If failed: indwelling urinary catheter (Foley’s catheter)
Urinary catheterization:
- Condom catheter preferred because less risk of UTI
- Catheter Associated Urinary Tract Infection (CAUTI): urinary tract infection that occurs while an indwelling catheter is in place of __ hours of its removal
48
Most waste products excreted within __ hours of ingestion
48
Defecation
-Expulsion of feces assisted by contraction of the ______
-Feces move through ___ and are expelled through ___
-Normal defecation is facilitated by:
* Thigh flexion
* Sitting position
abdominal muscles and diaphragm,
anal canal, anus
Feces
* About ___% water, ___% solid materials
* Normally brown
* Stercobilin (糞膽素) and urobilin (尿膽素) derived from _____
* Amount of gas produced per day varies per individual
75, 25, bilirubin (膽紅素)
Bush dog fecal scoring scale: __ is normal
__ is dry and hard
__ is liquid
4, 1, 9
Factors That Affect Defecation
1) Development :
a) First fecal material passed by newborn usu. up to
24 hours after birth: Meconium
b) Toddlers: some control of defecation starts at 1.5 – 2 years of age
c) School –age and adolescents : bowel habit similar to adult
d) Up to ½ of older adults suffer from constipation
2) Diet
3) Fluid intake and output
4) Activity (Stimulates peristalsis)
5) Psychological factors (Anxiety, anger)
6) Defecation habits (When urge ignored, ultimately lost)
7. Medications
a) Affect appearance, timing, quality
b) Laxatives
8. Diagnostic procedures
9. Anesthesia and surgery (listen to bowel sounds after surgery)
10. Pathologic conditions (Spinal cord, head injuries decrease sensory stimulation)
11. Pain
Fecal Elimination Problems
Constipation cause by:
- Insufficient fiber and fluid intake
- Insufficient activity
- Irregular bowel habits
- Changes in routine, lack of privacy
- Chronic laxative or enema use
- Fecal impaction (Mass or collection of hardened feces in folds of rectum)
Characteristics of normal and abnormal urine:
Amount in 24 hours (adult)
Normal:1200-1500 mL
Abnormal: under 1200 mL
(Urinary output normally is approximately equal to fluid intake. Output of less than 30mL/h may indicate decreased blood flow to the kidneys and should be immediately reported)
Characteristics of normal and abnormal urine:
Color, clarity
Normal: straw, amber, transparent
Abnormal: dark amber, cloudy, dark orange, red or dark brown, mucous plugs, viscid, thick
Characteristics of normal and abnormal urine:
odor
Normal: faint aromatic
Abnormal: offensive
Characteristics of normal and abnormal urine:
sterility
Normal: no microorganisms present
Abnormal: microorganisms present
Characteristics of normal and abnormal urine:
pH
Normal: 4.5-8
Abnormal: over 8, under 4.5
Characteristics of normal and abnormal urine:
specific gravity
Normal: 1.010-1.025
Characteristics of normal and abnormal urine:
Glucose
Normal: not present
Characteristics of normal and abnormal urine:
Ketone bodies (acetone)
Normal: not present
Characteristics of normal and abnormal urine:
Blood
Normal: not present
Abnormal: occult/ bright red
Characteristics of normal and abnormal feces:
color
Normal: brown (adult) yellow (infant)
Characteristics of normal and abnormal urine:
Consistency
Normal: formed, soft, semisolid, moist
Abnormal: hard, dry
Characteristics of normal and abnormal urine:
shape
Normal: cylindrical about 2.5 cm in diameter in adults
Abnormal: narrow, pencil-shaped, or stringlike stool (obstructive condition of the rectum)
Characteristics of normal and abnormal urine:
amount
Normal: varies with diet (about 100-400g/day)
Characteristics of normal and abnormal urine:
odor
Normal: aromatic (affected by ingested food and individual’s own bacterial flora)
Abnormal: Pungent
Characteristics of normal and abnormal urine:
constituents
Abnormal: pus, parasites, blood, large quantities of fat, foreign objects
