Lesson 5 - Elimination Flashcards
Micturition
-urination
Proteinuria
-presence of proteins in the urine
Hematuria
-presence of blood in the urine
Normal Urine Production
-1-2L per day
Indication of Renal Alterations
-less than 30mL per day of urine output
Psychological Factors Influencing Urinary Elimination
-anxiety and stress increases frequency
Sociocultural Factors Influencing Urinary Elimination
-culture, gender, religious practices
-SDOH may influence ability to seek help for chronic conditions
-female circumcision
Fluid Balance (Factors Influencing Urinary Elimination)
-conc. of fluids, solutes, electrolytes can cause an increase in production
-caffeine increases
-alcohol increases ADH release increasing production
Diuresis
-increased urine formation
Diuretics
-increase urine output
-prevent reabsorption
Urinary Tract Infections
-women are more susceptible
-a common nosocomial infection
Hydration
-ideally 1.5-2L/ day fluid intake
Typical Infant Urine Output
-500mL per day
Children and Continence
-gain control of urination between 1-3 years of age
-most kids wet the bed until age 5
Factors that Affect Urination
-bladder problems
-kidney disease
-cancer
-kidney stones
-enlarged prostate
-tumors
-dehydration (fluid intake, diarrhea, vomiting)
-diabetes
-medications
-bladder or kidney removal
-surgery complications
Pelvic Surgeries
-can cause selling and block the flow of urine
Neurological Urination Factors
-impaired neuromuscular function
-damage to spinal cord
-impaired neurological function
Urinary Incontinence
-any involuntary loss of urine
Transient Urinary Incontinence
-urine loss resulting from causes outside of or affecting the urinary system
-resolves when underlying causes are treated
-DEISAPPEAR (causes)
DISAPPEAR
-delirium
-intake of fluids
-stool impaction
-atrophic vaginitis
-psychological problems
-pharmaceuticals
-excess urine output
-abnormal lab values
-restricted mobility
Urgency UI
-urine loss associated with sudden and urgent need to void
-can be overactive bladder syndrome
Stress UI
-urine loss resulting from increased intra-abdominal pressure
Mixed UI
-urine loss that has features of both stress and urge incontinence
Functional UI
-urine loss due to inability to reach the toilet
Multifactorial UI
-urine loss due to multiple factors
Catheters
Nocturia
-bothersome lower UT symptom
-waking from sleep 1+ times to void
Urinary Retention
-the marked accumulation of urine in the bladder as a result of the ability to empty
Urinary Diversion
-creation of an alternate pathway for urine elimination
-temporary or permanent
Dialysis
-used to filter blood if renal cells are lost/damaged
-hemodialysis uses a machine equipped with semipermeable filtering membrane
Women and UTIs
-women are more at risk due to a shorter urethra
____ UTIs are more dangerous than _______
Upper; lower
CAUTI
-catheter-associated UTI
-common nosocomial UTI
-serious implications
Urinary Diagnostic Testing
-urinalysis
-urine culture
-24 hr urine specimen
-pelvic ultrasound
-cytoscopy
Polyuria
-excess urine production at night
Oliguria
-diminished urinary output relative to intake
Elevated Postvoid Residuals
-increased amount of urine remaining in the bladder after a void
-increased susceptibility to a UTI
Urinary Assessment
-gather health history of urination patterns
-physical assessment
-assess urine
-assess perception of urinary problems
-gather lab test data
-fluid intake
-burning
-change in colour/odour
-incontinence
Urination Nursing Interventions
-bedpan
-commode
-portable urinal
-brief
-condom catheter
-bladder irrigation
Urination Health Promotion
-hydration
-voiding frequently
-proper perineum after voiding
-perineal hygiene
-kegel exercises
Fibre
-decreases constipation
Fat and Grease
-can cause diarrhea
Physical Activity
-encourages peristalsis
Medications and BM
-can cause constipation (narcotics and iron supplements)
-can cause diarrhea (antibiotics, gout medications)
Laxatives and Enemas
-help with BM
-dependency can result with prolonged use
Surgery and Anesthesia BM
-can reduce peristalsis
-gas pains
-constipation
Constipation
-diet
-stress
-surgery
-medications
Bowel Impaction
-occurs when constipation does not resolve
-may require enema or distal disimpaction
Diarrhea
-medications
-food
-stress
-infection
-can cause electrolyte imbalance = heart rhythm abnormalities
Infections that Affect BM
-C. diff
-E. coli
-Norwalk virus
-VRE
Hemorrhoids
-swollen veins around the anus and rectum
Anal Fissure
-tear in the inside lining of the anus
Excoriation
-cut, abraised, scraped skin
Are you passing gas?
-very important question
-indicated functioning GI tract
-decreased with lowered mobility, surgery, anesthetics
Subjective BM Assessment
-elimination patterns
-cramping
-problems passing gas
-stool continence
-colour
-consistency
-size
-blood in stool
-frequency
Objective BM Assessment
-bowel sounds
-abdominal assessment
-smell
-blood
-colour
-mucous
-pus
-foreign objects
Bristol Stool Chart
-chart that identifies shape and consistency of stool
BM Nursing Interventions
-toilet
-bedpan
-commode
-incontinence management (briefs, rectal tube)
-laxative
-suppository
-enema
-digital disimpaction
Ostomy
-bowel drainage through the abdomen
-can be temporary to allow healing
-can be permanent due to bowel damage
Illeosomy
-small bowel brought to skin surface
Colostomy
-large bowel brought to skin surface
-can be ascending, descending, transverse, sigmoid
Stoma
-where the intestine is surgically brought to the abdominal wall for bowel elimination
Nurse Responsibilities with Ostomy
-assess skin around stoma
-stoma should be bright red/pink and moist
-assess ostomy bag contents
-assist with emptying and changing bag
BM Health Promotion Considerations
-hydration
-fibre intake
-hand hygiene
-stool regularity
-cleaning of perineum
-kegel exercises
Valsalva Manoeuvre
-pressure exerted by contracting abdomen and diaphragm and closed airway
-should be avoided by patients with heart disease
