Elimination Flashcards
What is the functional unit of the kidney?
Nephron
What are the components of the Urinary Tract?
Kidneys
Ureters
Urinary Bladder
Urethra
What are some terms used to describe Urinary Elimination?
- micturition
- voiding
- urination
What is the average daily output of urine for an adult (14yrs+)?
1,500 mL
What is the average daily output of urine for a school age child, age 8-14 yrs?
800-1,400 mL
What is the average daily output of urine for a school age child, age 5-8 yrs?
700-1,000 mL
What is the average daily output of urine for a preschool age child, age 3-5 yrs?
600-700 mL
What is the average daily output of urine for a toddler, age 1-3 yrs?
500-600 mL
What is the average daily output of urine for an infant, age 2-12 mos?
400-500 mL
What is the average daily output of urine for an infant, age 10 days to 2 mos?
250-450 mL
What is the average daily output of urine for an infant, age 3-10 days?
100-300 mL
What is the average daily output of urine for an neonate, age 1-2 days?
15-60 mL
What are developmental factors regarding urinating that effect infants?
- output
- frequency
- control
What are developmental factors regarding urinating that effect preschoolers?
- independent toileting
- modeling, reminders
- instruction for wiping
What are developmental factors regarding urinating that effect school age children?
- patterns
- enuresis
- nocturnal enuresis
-refers to a repeated inability to control urination
Enuresis
What are developmental factors regarding urinating that effect older adults?
- patterns
- muscle weakness
- nocturnal frequency
What is one thing that all these medications have in common: Anticholinergics Antidepressants Antihistamines Antihypertensives Antiparkinsonism Beta-adrenergics Opioids
They affect urinary elimination
What are some age-related changes regarding urination elimination?
- Renal function declines
- Impaired excretion of drugs
- Bladder more fibrous
- Autonomic regulation decreases
- Age-related weakening
- Risk for hyponatremia
- Polyuria
- Anuria
- Oliguria
- Inadequate kidney function
When assessing a patient for urinary issues, what needs to be assessed?
- Skin assessment
- Abdominal assessment
- Urinary meatus assessment
- Kidney assessment
- Bladder assessment
Describe the characteristics of normal urine.
Amount in 24 hours = 1,200–1,500 mL Color, clarity = straw, amber, transparent Odor = faint, aromatic Sterility = no mircroorganisms present pH = 4.5–8 Specific gravity = 1.010–1.025 Glucose = not present Ketone bodies = not present Blood = not present
When questing a client about elimination, what information do you need to gather?
- Voiding pattern
- Description of urine and any changes
- Urinary elimination problems
- Factors influencing urinary elimination
What are some diagnostic tests involved in assessing urinary elimination?
- Characteristics, components
- Ultrasound
- Uroflowmetry
- Cystometerography
- Radiologic examinations
- Cystoscopy
- Noninvasive tests
What effect do Diuretics have on urinary elimination?
- increase fluid excretion
- prevent fluid retention
What effect do Anticholinergics have on urinary elimination?
-reduce urgency, frequency
What effect do Cholingerics have on urinary elimination?
- stimulate bladder contraction
- facilitate voiding
What are some terms to describe bowel elimination?
Feces
Stool
Defecation
What tends to occur with bowel elimination as we age?
- increased constipation (management, gastrocolic reflex)
- leads to increase laxative use
How can bowel elimination be improved?
- increase bulk in diet (cellulose, fiber)
- increase fluids in diet
- regular activity/exercise
What happens when the urge to defecate is ignored (by toddlers for example)?
- continued water absorption
- makes stool harder, difficult to expel
What factors can affect bowel elimination?
- early bowel training
- medications
- anethesia/surgical procedures
- pathological conditions
- pain
- Rapid movement of fecal contents through large intestine
- Cramps, increased bowel sounds
- Fluid and electrolyte losses
- Risk for skin breakdown
Diarrhea
When inspecting feces for abnormalities what should be observed?
- Color
- Consistency
- Shape
- Amount
- Odor
- Presence of abnormal constituents
What does GFS stand for?
Glomerular Filtration System
- found in the nephrons of the kidneys
- a tuft of capillaries surrounded by Bowman’s capsule
Glomerulus
What are some of the causes of constipation in the older adult?
- Impaired general health
- Decreased physical activity
- Loss of teeth
- Lack of fresh fruits and vegetables
- Self-limited fluid intake
- Decreased frequency of defecation
- Hard, dry, formed stools
- Straining at stool; painful defecation
- Rectal fullness, pressure, incomplete
- Abdominal pain, cramps, distention
- Diminished appetite or nausea
- Headache
Constipation
What are some of the risk factors for constipation?
- Insufficient fiber or fluid intake
- Insufficient activity or immobility
- Irregular defecation habits
- Change in daily routine
- Lack of privacy
- Chronic use of laxatives or enemas
- IBS
- Pelvic floor dysfunction of muscle damage
- Poor motility or slow transit
- Neurologic conditions
- Emotional disturbances
- Medications
What are some of the signs and symptoms of constipation?
- Less frequent than normal pattern
- Frequent flatus
- Abdominal discomfort
- Diminished appetite
- Straining
- Passage of hard, dry stools
- Distended abdomen
- Impaction
What are some diagnostic examinations for bowel issues?
Barium enema
Sigmoidoscopy
Colonoscopy
-the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus
Colonoscopy
- the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon
- two types: flexible & rigid
Sigmoidoscopy
-a special x-ray of the large intestine, which includes the colon and rectum
Barium Enema
What medications assist with constipation?
Laxatives
Stool Softeners
-occurs when the client resists having bowel movements, causing impacted stool to collect in the colon and rectum
Encopresis
-a mass or collection of hardened feces in the folds of the rectum
Fecal Impaction
What are some symptoms of Fecal Impaction?
- Passage of liquid fecal seepage without normal stool
- Constipation
- Rectal pain
- Frequent nonproductive desire to defecate
- Generalized feeling of illness
What are some pathophysiological factors of impaired functioning of the anal sphincter?
Neurologic causes Local trauma Physiologic causes Psychologic causes Age-related changes
- a urinary bladder disorder resulting from interruption of the reflex arc normally associated with voiding urine
- absence of bladder sensation and over-filling of the bladder and inability to urinate voluntarily
Flaccid Bladder
- a technique used to void urine from the bladder of an individual who, due to disease, cannot do so without aid
- executed by holding manual pressure just over the anterior surface of the skin, where the bladder is located
Credé’s Maneuver
-incontinence that occurs when the client coughs, sneezes or jars the body, resulting in accidental loss of urine
Stress Incontinence
-absence of control resulting in incontinence
Total Incontinence
-involuntary loss of urine related to impaired function
Functional Incontinence
-the strong, sudden need to urinate due to bladder spasms or contractions
Urge Incontinence
Though urinary incontinence is not a consequence of aging, what percentage of older women experience it?
30%
What percent of woman in nursing homes experience urinary incontinence?
50%
What are the symptoms of urinary incontinence?
- Inability to avoid urinating
- Inability to urinate
- Increased rate of urination
- Leakage
- Uncontrollable wetting
- Frequent bladder infections
- Developmental considerations
What procedures or surgeries are available to client’s with urinary incontinence?
Indwelling urinary catheter
Intermittent straight catheterization
Remove or repair obstruction, calculi
Resection of prostate
What do medications that are available for urinary incontinence help to achieve?
- Promote contraction of detrusor muscle
- Promote emptying of bladder
What combination of strategies is implemented to help with urinary incontinence?
Education Bladder training Habit training Prompted voiding Pelvic muscle exercises
What are the risk factors for BPH?
- age
- race
- family history
- diet (high in meat)
What are some of the possible complications from BPH?
Diverticula
Hydroureter
Hydronephrosis
- balloon-like growths on the bladder commonly associated with a chronic outflow obstruction (such as benign prostatic hyperplasia)
- usually found in pairs on opposite sides of the bladder, they are often surgically removed to prevent infection, rupture, or even cancer
Diverticula
-a dilation of the ureter
Hydroureter
-distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine distal to the renal pelvis
Hydronephrosis
What are some diagnostic tests available for BPH?
PSA Cystoscopy Post Void Residual ultrasound IVP Urodynamic studies
Test for Prostate abnormalities:
- blood test that measures an enzyme produced by the prostate gland
- normally, small amounts enter the bloodstream from the prostate, but larger amounts enter the blood when the prostate gland is enlarged, infected, or diseased
PSA test (Prostate Specific Antigen)
-a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument
Cystoscopy
-an ultrasound is performed to measure the amount of urine that is left in the bladder after the client has made an attempt to empty it completely
Post Void Residual Ultrasound
-an x-ray test in which a contrast agent is injected into a patient’s vein - the contrast agent acts to outline the patient’s kidneys, ureters, and bladder when x-rays are subsequently taken
IVP (Intravenous Pyelogram)
-a means of evaluating the pressure-flow relationship between the bladder and the urethra for the purpose of defining the functional status of the lower urinary tract
Urodynamic Studies
What are available minimally invasive surgeries for BPH?
Transurethral microwave thermotherapy
Transurethral needle ablation
- a non-surgical, minimally invasive therapy that can be performed under a local anesthetic on an outpatient basis
- the treatment involves inserting a special microwave urinary catheter into the hyperplastic prostatic urethra
- the microwave antenna within the catheter is then heated to destroy the surrounding prostatic tissue
Transurethral microwave thermotherapy (TUMT)
- is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate
- a cystoscope is inserted through the tip of the penis into the urethra
- the doctor then guides a pair of tiny needles into the prostate tissue that is pressing on the urethra, then radio waves are passed through the needles to create scar tissue
- this scarring shrinks prostate tissue, opening up the urinary channel so that urine can flow more easily
Transurethral needle ablation
What are invasive surgeries that are available to BPH patients?
Transurethral Resection of the Prostate (TURP)
Transurethral Incicsion of the Prostate (TUIP)
- a type of prostate surgery that relieves moderate to severe urinary symptoms caused by an enlarged prostate
- a resectoscope is inserted through the tip of the penis and into urethra
- the doctor trims away excess prostate tissue that’s blocking urine flow and increases the size of the channel that allows the client to empty their bladder.
Transurethral Resection of the Prostate (TURP)
- a type of prostate surgery that relieves moderate to severe urinary symptoms caused by prostate enlargement
- a resectoscope is inserted through the tip of the penis and into urethra
- the doctor cuts one or two small grooves in the bladder neck in order to open up the urinary channel, allowing urine to pass through more easily
Transurethral Incicsion of the Prostate (TUIP)
What kind of CAM therapies are available to clients with BPH?
Phytotherapy
the study of the use of extracts of natural origin as medicines or health-promoting agents
-aims to preserve the complexity of substances from a given plant with relatively less processing
Phytotherapy
What tests and assessments are performed by the nurse to assess for BPH?
Digital rectal examination (DRE)
Health history
Laboratory tests
International Prostate Symptom Score
- hyponatremia and water intoxication (symptoms resembling brain stroke in an elderly presenting patient) caused by an overload of fluid absorption (e.g. 3 to 4 Litres) from the open prostatic sinusiods
- this complication can lead to confusion, changes in mental status, vomiting, nausea, and even coma
TURP Syndrome
-a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine
Urinary Calculi (aka kidney stones)
-the formation of stony concretions (calculi) in the urinary system
Lithiasis
-refers specifically to calculi in the kidneys
Nephrolithiasis
-stones form not in the kidney but in the urinary tract
Uroliathisis
What factors contribute to Uroliathisis?
- Supersaturation
- Nucleation
- Lack of inhibitory substances in urine
- Fluid intake
What are renal calculi composed of?
- Calcium oxalate and/or calcium phosphate
- Uric acid
- Struvite stones
What are the risk factors for renal calculi?
- most are idiopathic
- prior personal or family history
- dehydration
- excess dietary intake (high protein, sodium, sugar)
- loss of calcium from bones
What symptom occurs when the urine is partially or gradually obstructed?
Dull, aching flank pain
What symptoms occur with Bladder stones?
Dull suprapubic pain with exercise, voiding
Complications from kidney stones: Kidneys produce urine behind obstruction Pressure builds up Colicky pain on affected side Hematuria, UTI
Hydronephrosis
What testing is available for diagnosing kidney stones?
Urinalysis Chemical analysis of any stones 24 hour urine collection Serum calcium, phosphorus, uric acid Kidneys, ureters, and bladder (KUB) Renal ultrasonography CT scan with/without contrast IVP Cystoscopy
What medications will inhibit or prevent further lithiasis?
Thiazide diuretic
Potassium citrate
What types of Lithotripsy are available for clients with renal calculi (though surgery depends on location, obstruction, renal function, UTI, overall health)?
- Extracorporeal shock wave lithotripsy (ESWL)
- Percutaneous ultrasonic lithotripsy
- Laser lithotripsy
-a procedure that uses shock waves to break a kidney stone(s) into small pieces so that they can more easily travel through the urinary tract and pass from the body
Extracorporeal shock wave lithotripsy (ESWL)
- a nephroscope is inserted into the renal pelvis, and ultrasonic waves are used to fragment the stone
- the fragments are then removed through the nephroscope
Percutaneous ultrasonic lithotripsy
- a surgical procedure to remove stones from urinary tract, i.e., kidney, ureter, bladder, or urethra
- Laser pulses delivered through a fiber optic are used to pulverize the stone, avoiding surgery
Laser Lithotripsy
-an instrument inserted into an incision in the renal pelvis for viewing the inside of the kidney
Nephroscope
What types of surgical interventions are available for clients with BPH?
Ureterolithotomy
Pyelolithotomy
Nephrolithotomy
-an incision in the affected ureter to remove a calculus
Ureterolithotomy
-an incision into and removal of a stone from the kidney pelvis
Pyelolithotomy
-a procedure for removal of a staghorn calculus that invades the calyces and renal parenchyma
Nephrolithotomy
What are type of medication is commonly prescribed for BPH?
Alphablockers
What are examples of the types of Alphablockers that are prescribed for BPH?
Doxazosin
Terazosin
Tamsulosin
What do Alphablockers do for the prostrate?
-they promote vasodilation to cause smooth muscles in the bladder outlet & prostate gland to relax = improved urinary blood flow and reduction of symptoms
What is the most common type of kidney stone?
Calcium Phosphate and/or Oxalate 75-80%
What is the second most common type of kidney stone - In men? In women?
In Men it is Uric Acid 15-20%
In Women it is Struvite 15-20%
