Elimination Flashcards
What is nocturnal enuresis?
Also called bedwetting, it is the involuntary passing of urine during sleep. It often occurs because the feeling of the small bladder does not awaken the child during the night and instead stimulates an automatic voiding reflex. It is especially prevalent in children who are deep sleepers.
What is the involuntary passing of urine when control should be established (approximately 5 years of age), that is a problem for some school-age children?
Enuresis
What is polyuria?
The production of abnormally large amounts of urine by the kidneys, often several liters more than the clients usual daily output. Polyuria can occur after excessive fluid intake, or it may be associated with diseases such as diabetes, and chronic nephritis.
A medical condition in which extreme thirst leads to compulsive intake of excessive amounts of fluid, is associated with polyuria.
Polydipsia
Factors affecting urinary elimination
Fluid and food intake- when the amount of fluid intake increases, the fluid output normally increases accordingly.
Muscle tone- good muscle tone maintains the elasticity and contractility of the detrusor muscle, allowing the bladder to feel adequately an empty completely.
Psychosocial factors- stimulation of the micturition reflex may be affected by privacy, positioning, sufficient time, and occasionally, running water. Absence of the clients accustomed conditions may produce anxiety and muscle tension that prevent the individuals relaxing the abdominal and perineal muscles and the external urethral sphincter, so voiding is inhibited.
Pathological conditions- some renal diseases and conditions affect the formation and excretion of urine.
Surgical and diagnostic procedures- some surgical and diagnostic procedures affect the passage of urine and even the urine itself.
Medications- many medications, particularly those affecting the autonomic nervous system, interfere with the normal urination process and may cause retention.
Absence of urine production.
Anuria
Scant urine output, usually less then 500 mL per day or 30 mL per hour for an adult.
Oliguria
Extra: May result from abnormal fluid losses or a lack of fluid intake, it often indicates impaired blood flow to the kidneys or impending renal failure, and it should be reported promptly to the primary care provider. Rapid restoration of renal blood flow and urinary output may prevent renal failure.
Voiding at frequent intervals, that is, more than 4 to 6 times a day. Increased fluid intake causes some increase in the frequency of voiding.
Urinary frequency
Normal findings during an abdominal assessment
The abdomen should be slightly concave, symmetrical, without distention or masses.
Urinary urgency
Strong desire to void that may be caused by inflammation or infection in bladder or urethra
Painful or difficulty voiding
Dysuria
Voiding that occurs more than usual when compared with clients regular pattern or generally excepted norm of voiding once every 3 to 6 hours
Urinary frequency
Undue delay and difficulty in initiating voiding
Urinary hesitancy
A large volume of urine voided at any given time
Polyuria
A small volume of urine or output between 100 and 500 mL/24 hours
Oliguria
Excessive urination at night, interrupting sleep
Nocturia
RBC’s in urine
Hematuria
Bladder emptying is impaired, urine accumulates, and bladder becomes over distended
Urinary retention
Prostatic hyperplasia, surgery, medications such as anticholinergics, antidepressants, antipsychotics, antiparkinsonian agents, antihypertensives can all be causes of what common urinary elimination problem?
Urinary retention
Involuntary urination
Incontinence
Involuntary loss of urine of less than 50mL occurring with increased abdominal pressure through coughing, laughing, or lifting
Stress incontinence
Involuntary loss of urine at predictable intervals when bladder reaches a specific volume
Reflex incontinence
Involuntary loss of urine soon after a strong urge to avoid
Urge incontinence
Involuntary, unpredictable passage of urine
Functional incontinence
Continuous and unpredictable involuntary loss of urine
Total incontinence
_______________ is a surgical rerouting of urine from kidneys to a site other than bladder, usually when bladder is removed or diseased.
Ureterostomy
When the ureter is brought directly to skin surface to form a small stoma
Cutaneous ureterostomy
Disadvantages include that stomas provide direct access to microorganisms from skin to kidneys, small stomas may present difficulty in fitting pouches, stenosis of stomas may occur as a complication
A segment of ileum is separated from small intestine and formed into a pouch with open and brought out through abdominal wall to form stoma; ureter is implanted into ileal pouch.
Ileal conduit
A common urinary test:
macroscopic and microscopic analysis of urine to determine physical and chemical characteristics
Urinalysis
A clean catch specimen or catheter specimen is needed to identify infecting organism and most effective antibiotic; culture requires 24 to 72 hours for organism growth and identification
Urine culture/sensitivity
IV injection of a radiopaque contrast medium concentrates in urine to aid visualization of kidneys, ureters, and bladder
Intravenous pyelogram (IVP) or intravenous urogram (IVU)
IV injection of radiotraces or isotopes evaluates renal size, shape, position, function or blood flow to the kidneys; is recorded by a scintillation camera
Renal scan
Normal amount of urine in 24 hours
1200 - 1500 mL
Normal color, clarity of urine
Strong, Amber; transparent
Abnormal: dark amber, cloudy, dark orange, red or dark brown, mucous plugs, viscid, thick
Normal odor of urine
Faint, aromatic
Abnormal: offensive
Normal sterility of urine:
No microorganisms present
Abnormal: microorganisms present
Normal pH of urine
4.5–8
Abnormal: under 4.5 or over 8
Normal finding for glucose in urine
Not present
Abnormal: present
Normal findings for Ketone bodies in urine
Not present
Abnormal: present
High-frequency sound waves are used to create images of urinary system
Ultrasound
Directly visualizes urethra and bladder with a cystoscope that is a self contained optical lens system and provides a magnified illumination view of bladder
Cytoscopy
Detects amount of urine in bladder to help determine need for voiding or straight catheterization; may be done by nurses or other personnel trained to use portable device
Bladder scanner at bedside
What are some teaching and health promotion for urinary elimination?
- Adequate hydration
- Personal hygiene
- Empty bladder completely – regular exercise increases muscle tone that helps maintain ability to contract bladders detrusor muscle for complete emptying; abdominal muscle contraction assist in bladder emptying; teach Kegel exercises - contract perineal muscles and hold for a count of 3 to 5 seconds and relax; do 10 contractions 5 times daily
- Infection prevention measures
Characteristics of normal stool:
Color?
Varies from light to dark brown; foods and medications may affect color
Characteristics of normal stool:
Odor?
aromatic, affected by ingested food and persons bacterial flora
Abnormal infrequency of defecation and abnormal hardening of stools
Constipation
Accumulated mass of dry feces that cannot be expelled
Impaction
Involuntary elimination of feces, usually indicates a health problem at any age after toilet training
Incontinence
Expulsion of gas from rectum
Flatulence
Dilated portions of veins in anal canal causing itching and pain and possible bright red bleeding upon defecation
Hemorrhoids
