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Foundations: Exam 3 > Elimination > Flashcards

Elimination Flashcards

1
Q

Urethra length

A

Females: 1-2 inches

Males: 8 inches

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2
Q

Normal urine

A

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

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3
Q

Factors affecting urination

A

Factors:
1. Fluid intake – influences output and frequency

  1. Hypovolemia – loss of fluid
  2. Nutrition – food content, salt, ETOH, caffeine
  3. Body position – work with gravity
  4. Cognition – dementia/confusion, stroke
  5. Psychological factors – stress, running water, warm water, privacy
  6. Obstruction – anatomical, disease process
  7. Infection – E. coli
  8. Medications – diuretics
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4
Q

Altered urinary function

A

Terms:
1. DYSURIA: Painful urination

  1. POLYURIA: 2,500-3,000ml/day
  2. OLIGURIA: <500ml/day
  3. ANURIA: <100ml/day
  4. URGENCY: Inability to delay micturition
  5. FREQUENCY: Small frequent voids (~250ml per void)
  6. NOCTURIA: Waking up to void
  7. HEMATURIA: Blood in urine
  8. PYURIA: Pus in urine
  9. RETENTION: Inability to void
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5
Q

Urinary incontinence

A

Types of urinary incontinence:
1. STRESS: Increased abdominal pressure on the bladder causing it to leak (i.e. Coughing, laughing, sneezing, lifting)

  1. 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)
  2. TOTAL: Continuous, involuntary, and total loss of urinary control (i.e. Due to spinal cord injuries, multiple sclerosis)
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6
Q

Urine collection

A

Methods:
1. RANDOM SPECIMEN: Does NOT need to be sterile (i.e. collect from container or nun’s cap)

  1. CLEAN CATCH: Sterile; three wipes
  2. 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)
  3. CATHETER SAMPLE: Sterile (i.e. collect directly from output port in straight cath or indwelling Folley)
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7
Q

Collecting urine from young children

A

Catheterization is NOT recommended; instead, use a non-invasive collection bag

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8
Q

Diagnostic tests

A

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

  1. REAGANT STRIPS: Dipped in urine to measure substances such as glucose, proteins, and ketones
  2. URINALYSIS: Most common diagnostic test that requires 20-30ml sample; measures pH, specific gravity, glucose, proteins, ketones, bacteria, RBCs, and WBCs
  3. URINE C&S: Identifies microorganisms and requires ~24-48 hrs. culturing; often related to antibiotic use
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9
Q

Urinary health promotion

A

Health promotion:
1. Fluid intake – flush system and strengthen bladder

  1. Proper wiping technique – prevent UTIs
  2. Kegels (contraction and release of the pelvic floor muscles) – strengthen muscle tone
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10
Q

Urinary catheters

A

Indications of use: Inability to void, accurate measurement, irrigation, and comfort

Types of catheters:

  1. STRAIGHT – one-time use
  2. INDWELLING (FOLLEY) – continuous use; dual lumen
  3. TRIPLE LUMEN – irrigation and intravesical medication

Risks: Infection, trauma

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11
Q

Nursing responsibilities

A
  1. Placement and removal (~72 hours)
  2. Assessment
  3. Sample collection
  4. Troubleshoot
  5. Irrigation – i.e. Irrigate with 5-10cc NS if visible sediment
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12
Q

Bladder irrigation

A

Purpose:
1. Washout bladder

  1. Prevent clot formation
  2. Treat bladder calculi
  3. Antibiotics
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13
Q

Urostomy: ILEAL CONDUIT

A

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

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14
Q

Urostomy: CONTINENT UROSTOMY (Kock pouch, Indiana pouch)

A

Surgically created bladder made from a loop of the ileum or cecum, that is attached to the ureters

Emptied via self-catherization

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15
Q

Other types of urinary catheters

A
  1. SUPRAPUBIC CATHETER: Inserted directly into the bladder through the abdomen
  2. NEPHROSTOMY TUBE: Inserted directly into the kidneys
  3. CONDOM CATHETER
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16
Q

Bladder scanner

A

Ultrasonic device used to assess urinary retention

Checks PVR (post void residual)

17
Q

Peritoneal dialysis

A

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)

18
Q

Hemodialysis: Access

A

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

  1. VENOUS CATHETER (Shiley): Central line catheter usually dedicated to dialysis
  2. AV FISTULA: Surgically created connection between an artery and vein; Can be accessed by needle after maturing; Assess for bruit and thrill
19
Q

Hemodialysis

A

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)

20
Q

Factors affecting bowel elimination

A

Factors:
1. Nutrition

  1. Fluid intake – stool is 75% water
  2. Hemorrhoids
  3. Medication – narcotics, iron, and antacids
21
Q

Altered bowel function

A

Terms:
1. CONSTIPATION – Infrequency, painful, hard/dry stool

  1. FECAL IMPACTION: Accumulation of stool in rectum, often requiring digital disimpaction; S/S: Loss of appetite, N/V/, LEAKAGE
  2. DIARRHEA – Due to increased motility, medications (i.e. Post-antibiotic C. diff infections)
  3. INCONTINENCE: Involuntary
  4. DISTENTION: Inactivity; Abdomen may be taut/firm
  5. DISEASE PROCESS (i.e. Crohn’s, cystic fibrosis)
  6. PARALYTIC ILEUS (i.e. Due to surgery, anesthesia, or ischemia)
22
Q

Specimen

A

Types of specimen:
1. STOOL SAMPLE/CULTURE: Abnormal bacteria; sent to lab

  1. O&P (Ova and Parasites): Suggestive by constant D/; sent to lab
  2. FOBT (Fecal occult blood test): Check for blood in stool
23
Q

Diagnostic tests

A

Stool tests:
1. UPPER GI: Barium swallow; Fluoroscopy to visualize the esophagus, stomach, and duodenum

  1. LOWER GI: Barium enema; Fluoroscopy to visualize the rectum, LI, and lower part of SI
  2. ERCP – ENDOSCOPIC RETROGRADE CHOLANGIOPANCREOTOGRAPHY: Diagnose and treat problems in the liver, GB, bile ducts, and pancreas; Viewed with endoscope and dye
  3. EGD – ESOPHAGOGASTRODUODENOSCOPY: Visualize the esophagus, stomach, and duodenum; Can be used for biopsy
24
Q

Colonoscopy

A

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

25
Q

Enema

A

Purpose: Cleansing of large bowel

Types of enemas:
1. SMALL VOLUME: Commercially prepared oil or water-based solutions; ~150cc

  1. LARGE VOLUME: Warm tap water or saline; 1,000cc (adult), 240-350cc (children), and 15-60cc (infant)
  2. 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
26
Q

Flexi-Seal

A

Fecal collection bag for severe/continuous D/

27
Q

Fecal diversion

A

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

  1. TRANSVERSE – i.e. Loop or Double-barrel ostomy
  2. DESCENDING & SIGMOID – Formed stool (work well with irrigation)
28
Q

Colostomy care

A

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

Foundations: Exam 3 (3 decks)

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