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Question 1

When elimination becomes impaired, nurses need to?

Answer 1

facilitate bladder emptying through use of indwelling catheters, urethral or suprapubic (long term use)

Question 2

Several areas in the brain are involved in bladder control

Answer 2

cerebral cortex, thalamus, hypothalamus and brainstem. There are two micturition centers in the spinal cord; one that coordinates inhibition of bladder contraction and the other that coordinates bladder contractility

Question 3

Typically a sense of urgency occurs when the bladder fills to?

Answer 3

400-600mL

Question 4

In older adults, the ability to hold urine between the initial desire to void and an urgent need to void decreases. Older adults are at increased risk for?, and manual dexterity

Answer 4

urinary incontinence due to chronic illness and factors that interfere with mobility, cognition, and manual dexterity

Question 5

Factors that can impair elimination:

Answer 5

• Social expectations (“holding it” until break, et.)
• Anxiety/ stress
• Depression
• Need for privacy
• Alcohol intake (decreases ADH increasing urine production)
• Caffeine intake (irritate bladder and can prompt unsolicited bladder contractions resulting in frequency, urgency, and incontinence).
• Conditions such as Diabetes, MS and Stroke can alter bladder contractility and the ability to sense bladder filling leading to bladder over activity or insufficient bladder emptying.
• Conditions such as Arthiritis, Parkinson’s disease, dementia, and chronic pain may interfere with timely access to a toilet.
• Spinal cord injury or intervertebral disc disease can cause loss of urinary control due to bladder over activity and impaired coordination between the bladder and urinary sphincter.
• BPH may cause obstruction of bladder outlet leading to retention.
• Trauma specifically to the lower abdomen or pelvic area may obstruct urine flow and require temporary use of an indwelling catheter.
• Anesthetic agents and other agents given during surgery can decrease bladder contractility and/or sensation of bladder fullness leading to urinary retention.
• Other medication issues contributing to altered elimination include: Diuretics: increase UOP by preventing reabsorption of water and electrolytes.
• Anticholinergics may increase risk of urinary retention by inhibiting bladder contractility.
• Hypnotics and sedatives decrease the ability to recognize/ act on urge to void
• Some drugs change the color of urine

Question 6

Important to note that ANY TIME the sterile urinary tract is catheterized, there is increased risk for?

Answer 6

infection

Question 7

Urinary tract infections (UTIs) are usually caused by?

Answer 7

Escherichia coli.

Question 8

Symptoms of a lower urinary tract infection (bladder) can include:

Answer 8

burning or pain with urination (dysuria), irritation of the bladder (cystitis) characterized by urgency, frequency, incontinence, suprapubic tenderness, and foul-smelling cloudy urine.

Question 9

Most common urinary elimination problems involve the?

Answer 9

inability to store urine or fully empty the urine from the bladder, these issues can result from infection, irritable, or overactive bladder, obstruction of urine flow, impaired bladder contractility, or issues that impair innervation to the bladder resulting in sensory or motor dysfunction

Question 10

Common forms of UI are?

Answer 10

urge or urgency UI (involuntary leakage associated with urgency) and stress UI (involuntary loss of urine associated with effort or exertion, on sneezing or coughing. Urinary incontinence associated with chronic retention of urine (formally called Overflow UI) is urine leakage caused by an overfull bladder

Question 11

All specimens collected and sent for laboratory testing need to be labeled with?

Answer 11

the patient’s name, date, time, and type of collection

Question 12

Patients with indwelling catheters require regular perineal hygiene, especially after a bowel movement, to reduce the risk for?

Answer 12

CAUTI

Question 13

A critical part of routine catheter care is reducing the risk for CAUTI. A key intervention to prevent infection is?

Answer 13

maintaining a closed urinary drainage system. Another key intervention is prevention of urine back flow from the tubing and bag into the bladder

Question 14

Prompt removal of an indwelling catheter after no longer needed is a key intervention that has proven to decrease the incidence and prevalence of?

Answer 14

HAUTI (hospital-acquired urinary tract infections) and is one of the ”never events” identified by the Centers for Medicare and Medicaid Services (CMS)

Question 15

Teach patients about foods and fluids that cause bladder irritation and increase symptoms such as frequency, urgency, and incontinence. Teach patients to avoid common irritants such as?

Answer 15

artificial sweeteners, spicy foods, citrus products, and especially caffeine. Encourage patients with edema to elevate the feet for a minimum of a few hours in the afternoon to help diminish nighttime voiding frequency

Question 16

Pelvic floor muscle training (PFMT) “Kegel” exercises involves teaching patients how to identify and contract the pelvic floor muscles in a structured exercise program. The exercises work by?

Answer 16

increasing the pressure within the urethra by strengthening the pelvic floor muscles and by inhibiting unwanted bladder contractions

Question 17

Age influences bowel elimination

Answer 17

Older adults may have decreased chewing ability. Peristalsis declines and esophageal emptying slows. This impairs absorption by the intestinal mucosa. Muscle tone in the perineal floor and anal sphincter weakens, and may cause difficulty in controlling defecation

Question 18

While individual fluid needs vary with the person, however, recommended fluid intake, again, is about?

Answer 18

2.5L daily. Fluid liquefies intestinal contents by absorbing into the fiber from the diet and creating a larger, softer stool mass. This increases peristalsis and promotes movement of stool through the colon

Question 19

Physical activity promotes?

Answer 19

peristalsis.

Question 20

Prolonged emotional stress impairs the function of almost all body systems. During emotional stress, the digestive process is?

Answer 20

accelerated and peristalsis is increased

Question 21

Constipation is a symptom, not a disease, and there are many possible causes.

Answer 21

Improper diet, reduced fluid intake, lack of exercise and certain medications can cause constipation. When intestinal motility slows, the fecal mass becomes exposed over time to the intestinal walls and most of the fecal water content is absorbed. Little water is left to soften and lubricate the stool. Constipation is a significant source of discomfort

Question 22

Sigmoid colostomy:
Transverse colostomy:
Ileostomy:

Answer 22

Sigmoid colostomy: more formed stool.
Transverse colostomy: will be thick liquid to soft consistency.
Ileostomy: fecal effluent leaves the body before it enters the colon, creating frequent, liquid stools

Question 23

Fluid homeostasis is the dynamic interplay of three processes:

Answer 23

Fluid intake and absorption, fluid distribution, and fluid output. To maintain fluid balance, fluid intake must equal fluid output. Because some of the normal daily fluid output (e.g., urine, sweat) is a hypotonic salt solution, people must have an equivalent fluid intake of hypotonic sodium-containing fluid (or water plus foods with some salt) to maintain fluid balance (intake equal to output)

Question 24

Fluid intake occurs orally through drinking but also through eating because most foods contain some water. Food metabolism creates additional water. Average fluid intake from these routes for healthy adults is about?

Answer 24

2300mL, although this amount can vary widely depending on exercise habits, preferences, and the environment. Other routes of fluid intake include intravenous (IV), rectal (e.g., enemas), and irrigation of body cavities that can absorb fluid.

Question 25

Fluid output normally occurs through four organs:

Answer 25

skin, lungs, GI tract, and kidneys

Question 26

The GI tract plays a vital role in fluid balance.

Answer 26

Approximately 3 to 6L of fluid moves into the GI tract daily and then returns again to the ECF. The average adult normally excretes only 100mL of fluid each day through feces. However, diarrhea causes a large fluid output from the GI tract

Question 27

The kidneys are the major regulator of fluid output because they respond to hormones that influence urine production.

Answer 27

When healthy adults drink more water, they increase urine production to maintain fluid balance. If they drink less water, sweat a lot, or lose fluid by vomiting, their urine volume decreases to maintain fluid balance. These adjustments primarily are caused by the actions of antidiuretic hormone (ADH), the renin-angiotensin-aldosterone system (RAAS), and atrial natriuretic peptides (ANPs)

Question 28

ADH regulates the osmolality of the body fluids by?

Answer 28

influencing how much water is excreted in urine. It is synthesized by neurons in the hypothalamus that release it from the posterior pituitary gland. ADH circulates in the blood to the kidneys, where it acts on the collecting ducts.

Question 29

People normally have some ADH release to maintain fluid balance. More ADH is released if body fluids become more concentrated. Factors that increase ADH levels include?

Answer 29

severely decreased blood volume (e.g., dehydration, hemorrhage), pain, stressors, and some medications

Question 30

The RAAS regulates ECF volume by?

Answer 30

influencing how much sodium and water are excreted in urine. It also contributes to regulation of blood pressure

Question 31

Aldosterone circulates to the kidneys, where it causes?

Answer 31

resorption of sodium and water in isotonic proportion in the distal renal tubules. Removing sodium and water from the renal tubules and returning it to the blood increases the volume of the ECF

Question 32

To maintain fluid balance, normally some action of the ?

Answer 32

RAAS occurs

Question 33

ANP also regulates ECV by influencing?

Answer 33

how much sodium and water are excreted in urine. Cells in the atria of the heart release ANP when they are stretched (e.g., by an increased ECV). ANP is a weak hormone that inhibits ADH by increasing the loss of sodium and water in the. Thus ANP opposes the effect of aldosterone

Question 34

Sodium imbalances:

Answer 34

contribute to cerebral dysfunction (confusion, lethargy)

Question 35

Potassium imbalances:

Answer 35

Potentially life threatening cardiac dysrhythmias, cardiac arrest

Question 36

Calcium imbalances:

Answer 36

neuromuscular excitability, hypercalcemia= lethargy