Elimination Flashcards
Urethra length
Females: 1-2 inches
Males: 8 inches
Normal urine
VOLUME: ~250-400ml per void; Normal production = 30ml/hr and 1,200-1,500ml/day (adult); or 500-600ml/day (newborn)
COLOR: Light yellow
CLARITY: Clear without sediment
ODOR: NO odor
Factors affecting urination
Factors:
1. Fluid intake – influences output and frequency
- Hypovolemia – loss of fluid
- Nutrition – food content, salt, ETOH, caffeine
- Body position – work with gravity
- Cognition – dementia/confusion, stroke
- Psychological factors – stress, running water, warm water, privacy
- Obstruction – anatomical, disease process
- Infection – E. coli
- Medications – diuretics
Altered urinary function
Terms:
1. DYSURIA: Painful urination
- POLYURIA: 2,500-3,000ml/day
- OLIGURIA: <500ml/day
- ANURIA: <100ml/day
- URGENCY: Inability to delay micturition
- FREQUENCY: Small frequent voids (~250ml per void)
- NOCTURIA: Waking up to void
- HEMATURIA: Blood in urine
- PYURIA: Pus in urine
- RETENTION: Inability to void
Urinary incontinence
Types of urinary incontinence:
1. STRESS: Increased abdominal pressure on the bladder causing it to leak (i.e. Coughing, laughing, sneezing, lifting)
- FUNCTIONAL: Unable to recognize the need to go to the toilet, locate or access the toilet, or manage personal needs (disability-associated; i.e. Due to meds., impaired ambulation)
- TOTAL: Continuous, involuntary, and total loss of urinary control (i.e. Due to spinal cord injuries, multiple sclerosis)
Urine collection
Methods:
1. RANDOM SPECIMEN: Does NOT need to be sterile (i.e. collect from container or nun’s cap)
- CLEAN CATCH: Sterile; three wipes
- 24-HOUR COLLECTION: helps diagnose kidney problems; often done to see how much creatinine clears through the kidneys, and measure protein, hormones, minerals, and other chemical compounds (Keep urine container refrigerated, and do NOT include first morning void)
- CATHETER SAMPLE: Sterile (i.e. collect directly from output port in straight cath or indwelling Folley)
Collecting urine from young children
Catheterization is NOT recommended; instead, use a non-invasive collection bag
Diagnostic tests
Urine tests:
1. SPECIFIC GRAVITY: Weight or concentration of urine compared to water, using a urinometer (Normal = 1.010-1.025); LOW = Over-hydration; HIGH = Fluid volume deficit
- REAGANT STRIPS: Dipped in urine to measure substances such as glucose, proteins, and ketones
- URINALYSIS: Most common diagnostic test that requires 20-30ml sample; measures pH, specific gravity, glucose, proteins, ketones, bacteria, RBCs, and WBCs
- URINE C&S: Identifies microorganisms and requires ~24-48 hrs. culturing; often related to antibiotic use
Urinary health promotion
Health promotion:
1. Fluid intake – flush system and strengthen bladder
- Proper wiping technique – prevent UTIs
- Kegels (contraction and release of the pelvic floor muscles) – strengthen muscle tone
Urinary catheters
Indications of use: Inability to void, accurate measurement, irrigation, and comfort
Types of catheters:
- STRAIGHT – one-time use
- INDWELLING (FOLLEY) – continuous use; dual lumen
- TRIPLE LUMEN – irrigation and intravesical medication
Risks: Infection, trauma
Nursing responsibilities
- Placement and removal (~72 hours)
- Assessment
- Sample collection
- Troubleshoot
- Irrigation – i.e. Irrigate with 5-10cc NS if visible sediment
Bladder irrigation
Purpose:
1. Washout bladder
- Prevent clot formation
- Treat bladder calculi
- Antibiotics
Urostomy: ILEAL CONDUIT
Surgical diversion of urine to the outside of the body, using ~15-25 cm. of the ileum
Ureters are attached to one end of the removed ileum; the other end of the ileum is brought through the abdomen as a stoma
Urine flows continuously (and involuntarily) into a collecting pouch on the exterior
Urostomy: CONTINENT UROSTOMY (Kock pouch, Indiana pouch)
Surgically created bladder made from a loop of the ileum or cecum, that is attached to the ureters
Emptied via self-catherization
Other types of urinary catheters
- SUPRAPUBIC CATHETER: Inserted directly into the bladder through the abdomen
- NEPHROSTOMY TUBE: Inserted directly into the kidneys
- CONDOM CATHETER
Bladder scanner
Ultrasonic device used to assess urinary retention
Checks PVR (post void residual)
Peritoneal dialysis
A treatment for kidney failure that uses the peritoneum (lining of your abdomen) to filter the blood
Catheter is surgically placed, allowing the infused dialysate to “dwell” in the abdomen
Ongoing, daily (4-6 hrs. per exchange)
Hemodialysis: Access
Access sites:
1. ARTERIOVENOUS (AV) GRAFT: Synthetic tube is used to surgically join an artery and vein; Can be accessed by needle 2-3 weeks after placement
- VENOUS CATHETER (Shiley): Central line catheter usually dedicated to dialysis
- AV FISTULA: Surgically created connection between an artery and vein; Can be accessed by needle after maturing; Assess for bruit and thrill
Hemodialysis
Pt’s blood flows through the dialysis machine to remove excess fluid, minerals, and waste
Procedure is completed at dialysis centers by specially trained dialysis nurses (~3 days/week)
Factors affecting bowel elimination
Factors:
1. Nutrition
- Fluid intake – stool is 75% water
- Hemorrhoids
- Medication – narcotics, iron, and antacids
Altered bowel function
Terms:
1. CONSTIPATION – Infrequency, painful, hard/dry stool
- FECAL IMPACTION: Accumulation of stool in rectum, often requiring digital disimpaction; S/S: Loss of appetite, N/V/, LEAKAGE
- DIARRHEA – Due to increased motility, medications (i.e. Post-antibiotic C. diff infections)
- INCONTINENCE: Involuntary
- DISTENTION: Inactivity; Abdomen may be taut/firm
- DISEASE PROCESS (i.e. Crohn’s, cystic fibrosis)
- PARALYTIC ILEUS (i.e. Due to surgery, anesthesia, or ischemia)
Specimen
Types of specimen:
1. STOOL SAMPLE/CULTURE: Abnormal bacteria; sent to lab
- O&P (Ova and Parasites): Suggestive by constant D/; sent to lab
- FOBT (Fecal occult blood test): Check for blood in stool
Diagnostic tests
Stool tests:
1. UPPER GI: Barium swallow; Fluoroscopy to visualize the esophagus, stomach, and duodenum
- LOWER GI: Barium enema; Fluoroscopy to visualize the rectum, LI, and lower part of SI
- ERCP – ENDOSCOPIC RETROGRADE CHOLANGIOPANCREOTOGRAPHY: Diagnose and treat problems in the liver, GB, bile ducts, and pancreas; Viewed with endoscope and dye
- EGD – ESOPHAGOGASTRODUODENOSCOPY: Visualize the esophagus, stomach, and duodenum; Can be used for biopsy
Colonoscopy
Purpose: Locate abnormal growths (polyps), bleeding, and ulcers
Colonoscope is inserted through the anus to examine the entire length of the colon; Can be used for biopsy
Recommended: >50 y/o, FHX
Enema
Purpose: Cleansing of large bowel
Types of enemas:
1. SMALL VOLUME: Commercially prepared oil or water-based solutions; ~150cc
- LARGE VOLUME: Warm tap water or saline; 1,000cc (adult), 240-350cc (children), and 15-60cc (infant)
- RETURN FLOW: Used to remove flatuence (intestinal gas) and stimulate peristalsis; Repeat 300-500cc as necessary; Fluid along with flatuence is drawn out by lowering the container below the level of the bowel
Flexi-Seal
Fecal collection bag for severe/continuous D/
Fecal diversion
Intestine is surgically brought through the abdominal wall as an ostomy/stoma (opening); Temporary or permanent
Types of colostomy:
1. ASCENDING – Semi-liquid stool (does NOT work well with irrigation); digestive enzymes destroy healthy stoma cells
- TRANSVERSE – i.e. Loop or Double-barrel ostomy
- DESCENDING & SIGMOID – Formed stool (work well with irrigation)
Colostomy care
ASSESSMENT: Pink, no pain (no nerve endings), flush with skin
CLEANING: Soap and water
BAG CHANGING: Disposable vs. reusable; Irrigation q24h at the same time every day = Eliminates the need for colostomy bag
EMOTIONAL SUPPORT: Groups, special clothing
