Elimination Flashcards
basic structures that influence bladder function
- cerebral cortex
- hypothalamus
- thalamus
- brainstem
the need to void
coordinated relaxation of urethral sphincter and pelvic floor muscles while the bladder contracts
bladder capacity
400-600 mL
urge to void
250-450mL
adults void…
- q 2-4 hrs
- 5-6 times a day
adult average output per day
1500 mL
adult hourly output
30mL
normal bowel function:
- color
- odor
- consistency
- frequency
- shape
- constituents
- brown
- pungent
- soft and formed
- depends, everyone is different
- resembles diameter of rectum
- undigested food, dead and live bacteria, fat, bile pigments, cells lining intestines, mucosa, water
factors affecting urinary function
- fluid and food intake
- muscle tone
- psychosocial factors
- pathological factors
- developmental
- surgical and diagnositc procedures
- medications
Modifiable risk factors for urinary function
- obesity
- pregnancy
- diabetes
- enlarged prostate
- poor lifestyle habits
- UTI
- Medications
- Procedures
Non-modifiable risk factors
- spina bifida
- females (shorter urethra)
factors affecting bowel function
- age (decreased absorption)
- position during defecation (squat)
- diet and fluid intake
- pain
- physical activity
- surgery and anesthesia
- psychological factors
- meds (narcotics)
- personal habits
Types of urinary function alterations
- rentention
- UTI
urine rentention
inability to empty the bladder properly (acute or chronic)
key signs of urinary retention
- bladder distention
- absence of urine output for several hours
- feeling of pressure or severe pain
- overflow incontinence
complications of urinary rentention
- vesicoureteral reflux
- hydronephrosis
vesicoureteral reflux
backward flow of urine from the bladder into the kidneys
hydronephrosis
A condition characterized by excess fluid in a kidney due to a backup of urine.
Risk factors for urinary retention
- male (older they are, higher risk)
- stroke
- narcotics
- anesthesia
- decreased mobility
goal & treatment
goal: void freely
treatment: positioning, privacy, bladder scan, schedule, fluids
UTI
- invasion of urinary system by microorganisms
- 40% of HAIs
- up to 80% are from foleys
- 7% increase in bacteria in the urine each day a catheter is in place
CAUTIs cause…
- increased hospitalization
- increased morbidity
- increased mortality
- longer hospital stays
- increased hospital costs
most common organism causing UTIs..
E.Coli
Lower UTIs
- pain/burning during urination (dysuria)
- fever, chills, nausea, vomitting
- malaise
malaise
a general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to identify
Cystitis
UTI involving bladder
- frequent sensation or need to urinate
Upper UTIs
UTI involving kidneys
- flank pain, tenderness
- fever
- chills
UTIs lead to confusion…
in the elderly
UTI prevention
- alternatives to foleys
- external catheters
- bladder outlet obstruction
- assess urinary volume with bladder scan
- perform I&O catheter
Most effective strategy to prevent CAUTI
not to insert an indwelling urinary catheter
Types of bowel function alterations
- diarrhea
- constipation
- impaction
- bowel incontinence
diarrhea
- passage of liquid stool
- increase fluid intake
- administer antidiarrheal medications
- assess for cause
constipation
- infrequent passage of hard stool
- increase fluid and fiber intake
- increase activity level
- administer enema
- medications
- evaluatie medication profile for GI side effects
bowel incontinence
- inability to control release of feces
- administer bowel training
- treat with surgery
- remove fecal impaction
- diet adjustment
- administer medications
impaction
- mass or collection of hardened feces in the folds of the rectum
- manual removal may be necessary
- administer enema as necessary
- evaluate medication profile for GI side effects
- improve defecation habits and reduce constipation
straining a BM
- increases BP
- inceases ICP
- tachycardia
- especially restricted from cardiac patients
hemorrhoids
dilated, engorged veins in the lining of the rectum
urostomy
- surgical procedure that creates a stoma for the urinary system
- made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible (after extensive surgery or obstruction)
urinary catherization
- intermittent (I&O)
- indwelling (foley)
When is it appropriate to catheterize a patient
- urinary retention
- surgery
- prolonged surgery
- epidural prolonged immobilization
When is it inappropriate to catheterize a patient?
incontinent
Safety alert for catheters
Vasovagal response
vasovagal response
- when the bladder is extremely full and urine rapidly releases into the foley.
- BP drops and the patient can pass out
- Clamp and raise legs
National Patient Safety Goal
use best practices to prevent UTIs
- strict asepsis
- closed system
- lower than bladder
- never on the floor
Interventions after foley removal
- education post removal
- schedule toileting
- manual compression of bladder (Rede’s Method, relaxes the bladder)
colostomy
surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place
Modifiable risk factors for bowel function
- consuming poor diet low in fiber and fluids
- taking meds long term
- traveling
- poor hygiene
- lower socioeconomic status
Long term meds that can effect bowel function
- antibacterials
- proton pump inhibitors
- BP meds
- opioids
- antihistamines
- iron supplements
Urinary Diagnostic Tests
- 24 hr urine
- bladder scan
- IVP
- Retrograde pyelography
- renal arteriograph
- Cytoscopy
- Kidney biopsy
IVP
x-ray exam that uses an injection of contrast material to evaluate your kidneys, ureters and bladder and help diagnose blood in the urine or pain in your side or lower back
Retrograde Pyelography
urologic procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast (up from the bladder to the kidney) is opposite the usual flow of urine.
Cytoscopy
endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The cystoscope has lenses like a telescope or microscope
Bowel Diagnostic Tests
- blood and fecal tests
- digital rectal exam
- colonoscopy
- enema x-ray
- defecography
- anorectal manometry
Urinary Function: Children
- Potty trained at 2-4 yrs old
- day time control before night time control
Urinary Function: Elderly
- decreased kidney size
- decreased tone and elasticity of bladder, ureters, and urethra
- decreased bladder capacity
Urinary Function: Pregnancy
- increased pressure on bladder
- increased frequency of urination
Collaborative Urinary Management
- pharmacologic therapy
- dialysis
dialysis
- peritoneal dialysis
- hemodialysis
hemodialysis
Blood flows through catheters —> passes by dialysis solution in an external machine —> returns to patient
peritoneal dialysis
dialysis solution is instilled into abdominal cavity through a catheter —> allowed to rest there while fluid and molecules exchange —> removed through the catheter
Collaborative Bowel Management
- Meds (laxatives, antidiarrheal, stool softeners)
- Surgical resection with or without an ostomy
EBP constipation management
- increased fluid and fiber
- dietary education
- bowel training (digital stimulation)
- Kegel exercises and biofeedback used to strengthen rectal muscles
- “no strain” education
