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Clinical Concepts > Elimination > Flashcards

Elimination Flashcards

1
Q

purpose of elimination

A
  • balance fluid and electrolytes
  • rid body of wastes
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2
Q

fecal elimination

A
  • Takes 8-72 hours for food to pass through GI tract
  • Gastrocolic and duodenocolic reflex –> stimulates the need to empty your bowels
  • Large Intestine
    • Protected by lubrication
    • Absorbs water and Na+
    • Storage of fecal matter
  • NS control
    • can control when we move our bowels most of the time
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3
Q

urinary elimination

A
  • regulation of body’s fluid (kidneys job)
    • urine output at least 30 ml/hr in adult
    • bladder can store abt 600 ml of urine
  • excretion of urea, creatine, and uric acid
  • selective reabsorption of glucose and protein
    • diabetics = glucose is excreted out into the urine
  • bladder stores urine
  • NS control (can hold our bladder)
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4
Q

factors that affect elimination: age

A

Newborn
- 1st stool–meconium (sticky, odorless & tarry) in 8-24 hrs
- 2-4 stool/day–with formula–soft yellow; w/ breast milk–loose yellow
- 1st voiding may be 24-36 hrs
Toddler
- Toilet trained 2 1⁄2 to 3 years
Adult
- BM regularity is individual–generally daily pattern continues
- Urinary output–1000 to 3000 cc/day
Older Adult
- May have BM q 2-3 days; Peristalsis slows
- Decrease in renal function (30% of nephrons lost by age 80)- Men–
BPH; women–stress incontinence
- Ability to concentrate urine decrease –> frequency
- Decreased bladder muscle tone leads to residual urine after voiding –> increase risk of infection

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5
Q

factors that affect elimination: food and fluid intake

A
  1. Food containing caffeine, alcohol– increase urinary output
  2. Spicy foods–diarrhea & flatus in some
  3. Gas producing foods–cabbage, onions, cauliflower, bananas, apples
  4. Laxative effect–bran, prunes, figs, alcohol
  5. Constipating–cheese, pasta, eggs, lean meats, decrease fluid intake
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6
Q

factors that affect elimination: activity

A
  1. Activity stimulates peristalsis–facilitates defecation
  2. Immobility–constipation, urinary retention, renal calculi
  3. Positioning facilitates elimination–bedpan w/ head elevated; men standing
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7
Q

factors that affect elimination: psychological factors

A
  1. Elimination facilitated with privacy
  2. Stress response–> urinary frequency; often see diarrhea
  3. Depression–> constipation
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8
Q

factors that affect elimination: medications

A
  1. Antibiotics–diarrhea esp in children, older adults
  2. Liquid meds w/ high sucrose content; laxatives –> diarrhea
  3. Narcotics, tranquilizers–> constipation
  4. Stool softeners, fiber products–facilitate defecation
  5. Can cause urinary retention
  6. Diuretics– increase urinary output
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9
Q

factors that affect elimination: medical treatments

A
  1. Barium used in radiologic procedures–> constipation
  2. General anesthesia–> urinary retention, decrease peristalsis
  3. Abdominal surgery–> paralyticileus–> cessation of intestinal movement for 24-48 hrs
  4. Childbirth–>swelling of urethra–>retention
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10
Q

ASSESSMENT OF ELIMINATION: NURSING HISTORY

A
  • Normal voiding/ defecation pattern (everyday? every 2 days)
  • Description of feces/urine
  • Problems with elimination
    • Urination—burning, pain, difficulty starting stream, difficulty w/ continence
    • Defecation—pain, constipation, diarrhea, incontinence, excessive flatus
  • Medications –> can change color of urine
  • Diet & fluid intake
  • Activity patterns –> someone whi us sedentary = rlly slow down the GI tract
  • Elimination aids
    • Warm drinks, foods, enemas, catheters
  • Past abdominal surgery–ostomies (subjective and objective)
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11
Q

ASSESSMENT OF ELIMINATION:
PHYSICAL EXAMINATION

A
  • Abdominal assessment
    • Bowel sounds
    • Distention of abdomen, bladder
  • Skin of perineum
  • Appearance of feces
    • Color (brown, yellow for infant and black at first)
    • Consistency –> soft form or semi solid
    • Shape
    • Odor
    • Constituents
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12
Q

appearance of urine

A
  • Amount
  • Color –> dark means dehydrated
  • Odor
  • Constituents
  • concentrated means dehydrated
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13
Q

drainage tubes

A
  • Amount
  • Color, consistency
  • NG tube or a wound drainage
  • any fluid leaving pt = elimination
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14
Q

ASSESSMENT OF ELIMINATION: MEASUREMENT

A
  • I & O, recording of BM
    • bowel movement: usually just the amt of time they have a bowel movement and measurements if it is liquid
  • Stool occult blood testing (Guaiac)
    • blood can be an early form if cancer
    • blood can be hidden
  • Catheterization for post void residual (PVR)
    • used to have them urinate and then we straight cath them and see how much came back out
    • ask them to urinate and then immediately see how much is left
  • Bladder Scan for PVR
    • urinate, came back right away, put the machine right above the surfaces pubis and try to take a measurement
    • ultrasound for bladder
  • want post voidal residual (PVR) to be 50 ml or less
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15
Q

urinalysis

A
  • Specific gravity 1.005- 1.030
    • how much is dissolved in their urine and how much is liquid
  • Negative for glucose, blood, WBC, protein, acetone
  • blood in urine when ppl menstruate
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16
Q

urine for culture and sensitivity

A
  • Normal is negative
  • Clean voided specimen OR
  • From catheterized specimen
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17
Q

24 hour urine collection

A
  • Timed period begins after patient voids (discard this)
  • Ends with a final voiding
  • Collected with preservatives or kept on ice
  • Aldosterone, Creatinine, Vanillylmandelic Acid(VMA)
  • can test for protein in pregnancy
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18
Q

blood studies

A
  • BUN 10-20
  • Creatinine 0.7-1.5 (want it to be 1)
    • higher the creatine = more damage to kidneys
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19
Q

cytoscopy, proctoscopy

A
  • lights that can look into the bladder and colon
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20
Q

IVP, Barium enema

A
  • Intravenous pyelogram: put dye in the IV and watch the dye and check kidney fxn
  • barium enema: take pics of what’s in the colon
21
Q

constipation

A
  • Difficult or infrequent defecation with passage of hard and dry stool
22
Q

perceived constipation

A
  • Self-diagnosis of constipation combined with abuse of laxatives, enemas, and/ or suppositories to
    ensure a daily bowel movement
23
Q

diarrhea

A
  • passage of unformed, watery stools
24
Q

bowel incontinence

A
  • Change in normal bowel habits characterized by involuntary passage of stool
25
Q

fxnal incontinence of urine

A
  • Inability to prevent escape of urine due to being physically or cognitively unable to get to or use the toilet in time
  • Ex: old person in wheelchair that asked to go but no one takes them
  • know that they have to go and they would go if they could
26
Q

stress incontinence

A
  • Involuntary loss of urine with activities that increase intra-abdominal pressure
  • laughing, sneezing, coughing –> small amts of urine
27
Q

urge urinary incontinence

A
  • Involuntary passage of urine occurring soon after a strong sense of urgency to void
  • large amt of urine
  • gotta go rn
  • comes out rlly strongly and can’t make it to restroom on time
28
Q

Projected outcomes: bowel elimination

A
  • Client has BM once every ___ days
  • Client verbalizes understanding of factors that promote normal defecation
29
Q

projected outcomes: urinary elimination

A
  • Client’s I= O
  • Client has less than 50 cc PVR
  • Client verbalizes understanding of factors that promote normal urination
30
Q

NOC

A
  • Bowel elimination
  • Urinary elimination
  • Urinary continence
31
Q

nursing interventions

A
  • Teach positive habits
    • Exercise/ mobility: imp for bowel movement
    • Fluid intake: 6 to 8 glasses a day
    • Diet: increase fiber, vegetables, wholegrains, breads, cereals, decrease cheese, ice cream
    • Heed urge for defecation/ urination (listen)
    • Avoid laxatives/ enemas
    • Care during periods of diarrhea –> limit fiber, alcohol, dairy (want GI tract to rest)
    • Hygiene: wipe front to back, good hand-washing, good period care, changing undies, etc
  • Toileting
    • Bedpan, urinal, commode
32
Q

POSITIONING A PATIENT ON A BEDPAN

A
  • almost like fowler’s position
  • can use a fracture pan
  • slide it under
  • they can lift their hips
  • risk for sheering and friction
33
Q

bedside commode

A
  • the best to use
  • better than a bed pan
  • men can empty their bladders better w/ this
34
Q

urinal

A
  • getting guys to stand while using it is better
35
Q

condom catheter

A
  • better than internal cath
  • hard to keep it on, they roll off, break down of skin of penis
36
Q

nursing interventions: toileting

A
  • Toileting schedule –> imp
  • Provide for privacy & safety
  • Help patient into normal position for elimination if possible
    • Men standing
    • Commodes better than bedpan
37
Q

nursing interventions: external aids

A
  • Enemas, digital removal of impaction
    • use enemas for constipation but don’t want them to get used to it
    • digital: last resort. wear gloves and put lub and try to break up poop. can drop pts BP and pass out
  • Ostomies
  • Drainage tubes
  • Catheters
    • Maintain sterility of system
38
Q

position an indwelling catheter

A
  • tube should never be on the floor cause then urine will stay in the tube
  • keep it off the floor
39
Q

NIC

A
  • Bowel management
  • Constipation management
  • Diarrhea management
  • Urinary elimination management
  • Urinary retention care
40
Q

evaluation

A
  • Bowel elimination
    • BM ______
    • Verbalizes understanding of normal elimination factors
  • Urinary elimination
    • I=______; O=_______
    • PVR__________
    • Verbalizes understanding of normal elimination factors
41
Q

Which of the following promotes normal defecation? Select all that apply.

A

A. Providing privacy for defecation (correct)
B. Fluid intake of 2000ml/day (correct)
C. Use of laxatives
D. Ignoring the duodenocolic reflex (holding it in)
E. Walking 10,000 steps per day (correct)

42
Q

Which of the following should be included in teaching a female client health promotion measures regarding urinary elimination?

A

A. If your urine becomes cloudy or has blood in it, increase your fluid intake
B. After urination wipe from the anus toward the urinary meatus
C. To strengthen sphincter muscles, do not void when you feel the urge, wait as long as you can.
D. Empty the bladder @ each voiding (correct)

43
Q

During shift report, the nurse learns that an older female patient has had several episodes of incontinence when hurrying to the bathroom. Which of the following
nursing diagnoses is most likely to apply to this patient?

A

A. Stress urinary incontinence
B. Urge urinary incontinence (correct)
C. Functional urinary incontinence
D. Total urinary incontinence

44
Q

The patient has a nursing diagnosis of risk for constipation related to immobility and decreased fluid intake. Which of the following is the appropriately stated projected outcome for this diagnosis?

A

A. Patient will have a bowel movement every other day. (correct. measurable)
B. Patient will drink 2000 ml of fluid every day (intervention)
C. Patient will not be constipated (goal)
D. Patient will be turned every 2 hours (intervention)

45
Q

You are recording I&O for a client at 3 PM. During your shift they vomited 250 ml of yellow liquid, had a liquid stool that measured 100 ml and voided 3 times—150 ml, 200 ml and 100 ml. What was their output on your shift?

A
  • 250 + 100 + 150 + 200 + 100 = 800 ml
46
Q

A client is experiencing oliguria (low urine). Which action should the nurse perform first?

A

A. Increase the client’s intravenous fluid rate.
B. Encourage the client to drink caffeinated beverages.
C. Assess for bladder distention. (correct. we don’t know if they aren’t making the urine or if it isn’t coming out)
D. Request an order for diuretics.

47
Q

When caring for a client with urinary retention, the nurse would anticipate an order for

A

A. Limited fluid intake.
B. A urinary catheter. (correct)
C. Diuretic medication.
D. A colonoscopy

48
Q

A nurse is assisting a client in making dietary choices that promote healthy bowel elimination. Which menu option should the nurse recommend?

A

A. Grape and walnut chicken salad sandwich on whole wheat bread (correct)
B. Broccoli and cheese soup with potato bread
C. Dinner salad topped with hard-boiled eggs, cheese, and fat-free dressing
D. Turkey and mashed potatoes with brown gravy

Clinical Concepts (18 decks)

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