Elimination Flashcards
Melena
black stools d/t gi bleeding
Hematochezia
red blood in stool
Normal Bristol stool
3-4
Constipated Bristol stool
1-2
Diarrhea Bristol stool
5-7
Types of Incontinence
Urge Stress Overflow Functional Mixed
Location of Micturition Reflex
Sacral region
Location of Sympathetic Nerves
Thoracolumbar
Location of Parasympathetic Nerves
Cranial/Cervical, Sacral
Definition & Causes of Urge Incontinence
sudden, intense need to void
neurogenic bladder
Definition & Cause of Stress Incontinence
small increase in intraabdominal pressure –> voiding
multiple vaginal births
weak pelvic floor muscles
Definition & Causes of Overflow Incontinence
overdistended bladder leads to small leakage throughout the day
benign prostatic hyperplasia
Functional Incontinence
caused by a functional impairment that prevents someone getting to the bathroom in time
Bladder anatomy
body = stores urine
neck = continuous with urethra
trigone area = triangular area of ureteral openings & urethra
Parasympathetic receptors
muscarinic (M)
nicotinic (N)
N receptors
located in the synapses of SNS/PNS neurons at the motor end plate of striated muscle fibers @ the external sphincter or pelvic floor
M receptors
located in the post-ganglionic parasympathetic endings of detrusor muscle
A-1 receptors
sympathetic receptor located in the trigone area
contraction = prevent bladder emptying
B-2 receptor
located in the detrusor muscle
increase relaxation = increase storage capacity
Vesicoutereal reflux
when urine backflows from bladder to kidneys via the ureters
Ureter anatomy
do not have valves
enter the bladder posteriorly @ an oblique angle. bladder expansion occludes the ureter preventing backflow
Etiology of bladder obstruction
BPH Gonorrhea/STI's bladder tumors constipation, fecal impaction poor pelvic floor support
Bladder diverticulae
outpouchings that form when inner layers of the bladder herniate through the serosa
lack muscle fibers –> noncontractile
contribute to urinary stasis and infection
Excretion definition
excretion of waste (urine/stool) from the body
Parasympathetic innervation
controls contraction of the detrusor muscle and internal sphincter
promotes urination
Sympathetic innervation
promotes relaxation of the detrusor muscle and trigone area
promotes bladder retention
Somatic innervation
controls relaxation/contraction of the external sphincter
Pontine Storage center
located in the brainstem
receives afferent stimuli from bladder
Pelvic nerve
innervates detrusor muscle
Pudendal nerve
innervates external sphincter
Bladder volumes
150 mL = sensation of needing to go (can be delayed)
400-500 mL = full bladder
700 mL = painful. may cause overflow
Determinants of urinary elimination
intake/output of fluids renal perfusion (determines GFR) GFR nephron function bladder capacity unobstructed flow functional bladder, sphincters, pelvic floor muscles intact neurological function
Aging & Urinary elimination
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
Post residual volume
volume remaining in bladder post-void
usually <50 mL
increases with age
DIAPPERS acronym
causes of urinary incontinence D I A P P E R S
Oxybutynin MOA
anticholinergic drug. inhibits action of acetylcholine @ post-ganglionic receptors.
used to treat neurogenic/overactive bladder by inhibiting contraction of GU smooth muscle.
Oxybutynin therapeutic effects
increased bladder capacity
delayed desire to void (decreases sensory input)
decreased urge incontinence, urinary urgency, frequency
Neurogenic bladder
disruption in the neural pathways can cause either
1) overactive bladder (increased spasticity –> urge incontinence)
2) areflexic bladder (lack of contractions –> overflow incontinence)
Loperamide MOA
aka Imodium
antidiarrheal. inhibits nervous stimulation of GI wall decreasing peristalsis, prolonging GI transit time & increasing absorption.
Loperamide Therapeutic fx
decreased diarrhea
decreased fecal volume
decreased loss of fluid & electrolytes
Normal urinary findings
SG: 1.010-1.025 pH: 4.5-6.5 (acidic) straw color output: 30 mL/hr no bacteria, protein, RBCs, glucose
Urinary Incontinence Interventions
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
Fecal Incontinence Interventions
limit caffeine, alcohol (diuretics) limit fatty foods, dairy, spicy food (if diarrheic) increase fiber intake kegel exercises timed voiding
Geriatric absorption
increased gastric pH
decrease in absorption, GI secretions, motility
decreased peripheral perfusion
Geriatric distribution
decreased CO, peripheral perfusion –> decreased distribution
decrease in muscle mass, increase fatty tissue
reduced plasma albumin levels –> enhanced drug fx
Geriatric metabolism
decreased hepatic & renal function
reduced first-pass metabolism
Geriatric excretion
decreased renal function –> decreased excretion
