Elimination

Question 1

Melena

Answer 1

black stools d/t gi bleeding

Question 2

Hematochezia

Answer 2

red blood in stool

Question 3

Normal Bristol stool

Answer 3

3-4

Question 4

Constipated Bristol stool

Answer 4

1-2

Question 5

Diarrhea Bristol stool

Answer 5

5-7

Question 6

Types of Incontinence

Answer 6

Urge
Stress
Overflow
Functional 
Mixed

Question 7

Location of Micturition Reflex

Answer 7

Sacral region

Question 8

Location of Sympathetic Nerves

Answer 8

Thoracolumbar

Question 9

Location of Parasympathetic Nerves

Answer 9

Cranial/Cervical, Sacral

Question 10

Definition & Causes of Urge Incontinence

Answer 10

sudden, intense need to void

neurogenic bladder

Question 11

Definition & Cause of Stress Incontinence

Answer 11

small increase in intraabdominal pressure –> voiding
multiple vaginal births
weak pelvic floor muscles

Question 12

Definition & Causes of Overflow Incontinence

Answer 12

overdistended bladder leads to small leakage throughout the day
benign prostatic hyperplasia

Question 13

Functional Incontinence

Answer 13

caused by a functional impairment that prevents someone getting to the bathroom in time

Question 14

Bladder anatomy

Answer 14

body = stores urine
neck = continuous with urethra
trigone area = triangular area of ureteral openings & urethra

Question 15

Parasympathetic receptors

Answer 15

muscarinic (M)

nicotinic (N)

Question 16

N receptors

Answer 16

located in the synapses of SNS/PNS neurons at the motor end plate of striated muscle fibers @ the external sphincter or pelvic floor

Question 17

M receptors

Answer 17

located in the post-ganglionic parasympathetic endings of detrusor muscle

Question 18

A-1 receptors

Answer 18

sympathetic receptor located in the trigone area

contraction = prevent bladder emptying

Question 19

B-2 receptor

Answer 19

located in the detrusor muscle

increase relaxation = increase storage capacity

Question 20

Vesicoutereal reflux

Answer 20

when urine backflows from bladder to kidneys via the ureters

Question 21

Ureter anatomy

Answer 21

do not have valves

enter the bladder posteriorly @ an oblique angle. bladder expansion occludes the ureter preventing backflow

Question 22

Etiology of bladder obstruction

Answer 22

BPH
Gonorrhea/STI's
bladder tumors
constipation, fecal impaction 
poor pelvic floor support

Question 23

Bladder diverticulae

Answer 23

outpouchings that form when inner layers of the bladder herniate through the serosa
lack muscle fibers –> noncontractile
contribute to urinary stasis and infection

Question 24

Excretion definition

Answer 24

excretion of waste (urine/stool) from the body

Question 25

Parasympathetic innervation

Answer 25

controls contraction of the detrusor muscle and internal sphincter promotes urination

Question 26

Sympathetic innervation

Answer 26

promotes relaxation of the detrusor muscle and trigone area | promotes bladder retention

Question 27

Somatic innervation

Answer 27

controls relaxation/contraction of the external sphincter

Question 28

Pontine Storage center

Answer 28

located in the brainstem | receives afferent stimuli from bladder

Question 29

Pelvic nerve

Answer 29

innervates detrusor muscle

Question 30

Pudendal nerve

Answer 30

innervates external sphincter

Question 31

Bladder volumes

Answer 31

150 mL = sensation of needing to go (can be delayed) 400-500 mL = full bladder 700 mL = painful. may cause overflow

Question 32

Determinants of urinary elimination

Answer 32

``` intake/output of fluids renal perfusion (determines GFR) GFR nephron function bladder capacity unobstructed flow functional bladder, sphincters, pelvic floor muscles intact neurological function ```

Question 33

Aging & Urinary elimination

Answer 33

``` decreased nerve function muscular atrophy --> weak pelvic floor muscles altered fluid intake polypharmacy co-morbidities BPH (men) decreased kidney function (decreased GFR) decreased mobility/cognition ```

Question 34

Post residual volume

Answer 34

volume remaining in bladder post-void usually <50 mL increases with age

Question 35

DIAPPERS acronym

Answer 35

``` causes of urinary incontinence D I A P P E R S ```

Question 36

Oxybutynin MOA

Answer 36

anticholinergic drug. inhibits action of acetylcholine @ post-ganglionic receptors. used to treat neurogenic/overactive bladder by inhibiting contraction of GU smooth muscle.

Question 37

Oxybutynin therapeutic effects

Answer 37

increased bladder capacity delayed desire to void (decreases sensory input) decreased urge incontinence, urinary urgency, frequency

Question 38

Neurogenic bladder

Answer 38

disruption in the neural pathways can cause either 1) overactive bladder (increased spasticity --> urge incontinence) 2) areflexic bladder (lack of contractions --> overflow incontinence)

Question 39

Loperamide MOA

Answer 39

aka Imodium antidiarrheal. inhibits nervous stimulation of GI wall decreasing peristalsis, prolonging GI transit time & increasing absorption.

Question 40

Loperamide Therapeutic fx

Answer 40

decreased diarrhea decreased fecal volume decreased loss of fluid & electrolytes

Question 41

Normal urinary findings

Answer 41

``` SG: 1.010-1.025 pH: 4.5-6.5 (acidic) straw color output: 30 mL/hr no bacteria, protein, RBCs, glucose ```

Question 42

Urinary Incontinence Interventions

Answer 42

voiding diary limit fluids 2-3 hrs before bed/outings limit caffeine, alcohol, carbonated drinks (diuretics) time/prompted voiding bladder retraining biofeedback --> electrical stimulation of pelvic area kegel exercies/physiotherapy

Question 43

Fecal Incontinence Interventions

Answer 43

``` limit caffeine, alcohol (diuretics) limit fatty foods, dairy, spicy food (if diarrheic) increase fiber intake kegel exercises timed voiding ```

Question 44

Geriatric absorption

Answer 44

increased gastric pH decrease in absorption, GI secretions, motility decreased peripheral perfusion

Question 45

Geriatric distribution

Answer 45

decreased CO, peripheral perfusion --> decreased distribution decrease in muscle mass, increase fatty tissue reduced plasma albumin levels --> enhanced drug fx

Question 46

Geriatric metabolism

Answer 46

decreased hepatic & renal function | reduced first-pass metabolism

Question 47

Geriatric excretion

Answer 47

decreased renal function --> decreased excretion