Module 17 - Elimination Flashcards
Urinary elimination
Passage of urine through urinary tract by means of urinary sphincter and urethra
Bowel elimination
Passage of stool through intestinal tract and dispelling of stool by means of smooth muscle contraction
Normal urinary elimination terms
Micturition, urination, voiding, etc.
Altered urinary elimination terms
Incontinence, enuresis, dysuria, etc.
Normal bowel elimination terms
Bowel movement, defecation, etc.
Altered bowel elimination terms
Incontinence, diarrhea, constipation, borborygmus, etc.
Risk factors for altered urinary elimination
Neurological impairment, mobility impairment, cognitive impairment, infection, medications, etc.
Risk factors for altered bowel elimination
Neurological impairment, mobility impairment, cognitive impairment, diet (low fiber/little fluid), medications, etc.
QUESTION:
What is the age range for children to start controlling their elimination?
CORRECT ANSWER:
Between 2 and 5 years of age
QUESTION:
Is the following statement true or false? - “Men can have retention issues due to prostate enlargement.”
CORRECT ANSWER:
True
QUESTION:
As a nurse, what should you ask about/look for during an elimination assessment?
CORRECT ANSWER:
Usual elimination pattern, changes in elimination pattern, changes in color/frequency/quality of urine or stool, diet, medications, etc.
QUESTION:
What is the minimum amount an average adult should void in one hour?
CORRECT ANSWER:
30 mL
Characteristics of normal urine
Clear/straw/amber color, no microorganisms/blood/glucose/acetone/protein, etc.
Characteristics of normal stool
Brown (for adults), cylindrical shape, soft, formed, etc.
Examples of urinary diagnostic tests
Urinalysis C/S, Intravenous Pylogram (IVP), etc.
Examples of bowel diagnostic tests
Endoscopy, colonoscopy, sigmoidoscopy, barium enema, etc.
Nursing interventions
DO NOT NEED ORDER FOR; toileting schedule, privacy, positioning, strengthen muscles (Kegels), “Heed the need” (don’t make the patient wait)
Over-active bladder (OAB)
Acetylcholine sends messages that make it feel like one has to void, but there is nothing to void
Medications for altered urinary elimination
Antispasmotics/anticholinergics: oxybutynin (Ditropan) darifenacin (Enablex) fesoterodine (Toviaz) solifenacin (Vesicare) tolerodine (Detrol Detrol LA) trospium (Sanctura)
Anti-infectives:
cinoxacin (Cinobac)
nitrofurantoin (Furadantin)
Anti-infectives (not specific to UTIs):
ciprofloxacin (Cipro)
cotrimoxazole (Bactrim, Septra)
Side-effects of antispasmotics/anticholinergics
N/V, tachycardia, dry mouth, urinary retention, and constipation
Side-effects of anti-infectives
N/V/, diarrhea, anorexia, bladder irritation, dysuria; usually affect GI tract
phenazopyridine (Pyridium)
A urinary analgesic (painkiller); urine is color of pill (red)
Medications for altered bowel elimination
Chemical laxative:
bisacodyl (Dulcolax) (OTC)
Bulk laxatives:
magnesium hydroxide (milk of magnesia)
psyllium (Metamucil)
polyethylene glycol (MiraLAX, GoLYTELY)
Lubricant laxative:
docusate (Colace)
Gastrointestinal stimulant:
metoclopramide (Reglan)
Antidiarrheal:
ioperamide (Imodium)
QUESTION: A female patient has stress incontinence. Which of the following data from the patient’s history contributes to this condition (select all that apply)? A. History of 3 vaginal deliveries B. History of competitive swimming C. Client's age of 28 D. Female gender
CORRECT ANSWER:
A and D
QUESTION:
The nurse is instructing the client to do Kegel exercises. What should the nurse tell the patient to do to perform these pelvic floor exercises?
A. Tighten the stomach muscles
B. Lift both legs while lying down
C. Perform leg squats
D. Stop the flow of urine while urinating
CORRECT ANSWER:
D
QUESTION: Following a cystoscopy with biopsy, the nurse should monitor the patient to ensure that he: A. Has a bowel movement B. Has no blood in his urine C. Remains NPO D. Is able to urinate
CORRECT ANSWER:
D
QUESTION:
A male patient is unable to void while lying supine. What can the nurse do to facilitate his ability to urinate?
A. Assist him to a standing position
B. Tell him he must void prior to discharge
C. Pour cold water over his genitalia
D. Ask his wife to assist him in using the urinal
CORRECT ANSWER:
A
QUESTION:
The day after having a barium enema test, the patient is alarmed because his stools are white in color. Which statement by the nurse is most helpful?
A. “Don’t worry, this is normal after a barium enema.”
B. “This is expected, be sure to drink plenty of fluids.”
C. “The stool should return to normal color after 2-3 days.”
D. “This is expected, let me know if your stools are still white after 5 days.”
CORRECT ANSWER:
B
QUESTION:
Which of the following should the nurse teach a patient to prevent recurrent urinary tract infections?
A. Take bubble baths instead of showers
B. Urinate every 6-8 hours
C. Limit your fluid intake so you don’t have to urinate so often
D. Avoid urinary tract irritants such as coffee, tea, and cola
CORRECT ANSWER:
D
QUESTION:
The nurse must perform a straight catheterization for residual urine. In order to carry out this order, the nurse would instruct the nursing assistant:
A. “Let me know when the patient needs to void.”
B. “Let me know as soon as the patient voids.”
C. “Increase this patient’s oral fluid intake.”
D. “Record this patient’s urine output.”
CORRECT ANSWER:
B
Enuresis
Involuntary urination
Functional incontinence
State in which a person experiences an involuntary, unpredictable passage of urine
Hematuria
Blood in the urine
Kegel exercises
Repetitious contraction and relaxation of the pubococcygeal muscle to improve vaginal tone and urinary incontinence
Mixed incontinence
Symptoms of urge and stress incontinence are present, although one type may predominate
Nocturia
Excessive urination during the night
Overflow incontinence
Involuntary loss of urine associated with over-distention and overflow of the bladder
Post-void residual (PVR)
Urine that remains in the bladder after the act of micturition; “residual urine”
Reflex incontinence
Emptying of the bladder without the sensation of the need to void
Stress incontinence
State in which the person experiences a loss of urine of less than 50 mL that occurs with increased abdominal pressure
Total incontinence
Continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation
Transient incontinence
Occurrence that appears suddenly and lasts for 6 months or less and usually is caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment, such as the use of diuretics or intravenous fluid administration
Urge incontinence
State in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void
Urinary incontinence
Any involuntary loss of urine
Bowel incontinence
The inability of the anal sphincter to control the discharge of fecal and gaseous material
Colostomy
An opening into the colon that permits feces to exit through the stoma
Constipation
Passage of dry, hard fecal material
Diarrhea
Passage of liquid, unformed stools
Endoscopy
Direct visualization of hollow organs of the body using an endoscope (a flexible, lighted tube)
Enema
Introduction of solution into the lower bowel
Fecal impaction
Collection in the rectum of hardened feces that cannot be passed
Fecal incontinence
Involuntary or inappropriate passing of stool or flatus
Hemorrhoids
Abnormally distended rectal veins
Ileostomy
Opening into the small intestine allows fecal content from the ileum to be eliminated through the stoma
Laxative
Drug used to induce emptying of the intestinal tract
Occult blood
Blood present in such minute quantities that it cannot be detected with the unassisted eye
Ostomy
General term referring to an artificial opening; usually used to refer to an opening created for excretion of body wastes
Peristalsis
Involuntary, progressive, wave-like movement of the musculature of the gastrointestinal tract
Stoma
Artificial opening for waste excretion located on the body surface
Suppository
Oval-/cone-shaped substance that is inserted into a body cavity and that melts at body temperature
Anuria
Decreased urine output of less than 50 mL in 24 hours
Bacteriuria
Bacteria in the urine
Diuresis
Increased urine volume
Dysuria
Painful or difficult urination
Frequency
Voiding more frequently than every 3 hours
Proteinuria
Protein in the urine
Pyuria
White blood cells in the urine
Cystectomy
Surgical removal of the urinary bladder
Cystitis
Inflammation of the urinary bladder
Urethritis
Inflammation of the urethra
Urosepsis
Spread of infection from the urinary tract to the bloodstream that results in a systemic infection
Antispasmotics/anticholinergics
Agents that block muscle spasm associated with irritation or neurological stimulation
Urgency
The feeling that one needs to void immediately; associated with infection and inflammation in the urinary tract