Unit Two: Elimination Flashcards
Definition of elimination
The secretion and excretion of physiological waste products by the kidneys and intestines
Concepts related to elimination
Fluid and electrolytes Self care and self image Mobility Inflammation Teaching Dan learning
Alterations in Urinary elimination
Polyuria Urinary frequency Anura Olxiguria Polydipsia Nocturia Urgency Dysuria Urinary frequency Retention Neurogenic bladder
Bowel Elimination
Diarrhea
Constipation
Bowel incontinence
Impaction
Nursing Assessment for elimination
Change in voiding patterns Medications Use of elimination aids Diet Fluid intake Stress Disease Appearance of urine and stool
Independent Interventions for alterations in urinary elimination.
Monitoring I’s and O’s Personal Hygiene Cath use and care Urine Collection Client Education
Independent Interventions for Bowel elimination
Client dietary education
Client physical education
Bowel training
Personal hygiene
Collaborative Interventions for alterations in urinary elimination
Diuretics
Anticholinergics
Cholinergics
Dialysis
Collaborative interventions for bowel elimination
Laxatives
Stool softeners
Antidiarrheals
Surgery
Urinary Incontinence
Involuntary urination. A symptom not a disease; normal consequence of aging.
Etiology and Pathophysiology
Results from higher than normal bladder pressures or reduced urethral resistance.
Relaxation of pelvic musculature
Disruption of cerebral and nervous system control
Disturbances of bladder and musculature
Urinary incontinence risk factors:
*Age Women more than men Obesity Smoking Constipation Pregnancy Depression Neurological disorders Certain medications Diabetes Inactivity
Prevention of Urinary incontinence
Life-style modification Maintaining a healthy weight High fiber diet Avoid bladder irritants Drinking adequate fluid but not excess Exercising regularly Not smoking Reviewing medications Reducing physical barriers to toileting for clients at high risk
Clinical manifestation of urinary incontinence
Inability to avoid urinating Inability to urinate Increased rate of urinations Leakage Uncontrolled wetting Frequent bladder infections Developmental considerations
Diagnostic tests for urinary incontinence
Bladder diary Urinalysis Blood tests 24-hour urine Post void residual measurement Urodynamic testing stress test Ultrasound Cystoscopy
Pharmacological therapy for urinary incontinence
Urge incontinence: -antispasmodic-oxybutin(ditropan) -Anticolinergic-tolterodine(Detroit) Stress incontinence : -imipramine (tofranil) BPH: -Alpha blockers (cardura, hytrin, Flomax) -5 alpha reductive inhibitors (avodart, proscar)
Nonpharmacological therapies for urinary incontinence
Kegel exercises Behavior modification Absorbent pads/diapers Pessary in vagina to hold up bladder Urethral insert to plug leaks Catheter Surgery
Patient Education for Urinary incontinence
Maintain generous fluid intake Wear comfortable clothing Maintaining good hygiene Preform pelvic muscle exercises Reduce consumption of caffeinated fluids Reduce consumption of citrus juices Regular primary care examinations Report changes in urine, symptoms to primary care provider Avoid constipaiton
Etiology and pathophysiology of Urinary retention
Mechanical obstruction, functional obstruction
Risk factors of urinary retention
Age Male Previous bladder, prostate, or voiding problems Urinary incontinence Voluntary urinary retention Infection Immobility Chronic Pain Emotional destress Cognitive impairment -Stroke or neurological disease Costipation Drugs
Drugs that cause Urinary Retention
*Anticholinergics
*Opioids
Anti anxiety
Antidepressants
Antiparkinsonian
Antipsychotics
*Antihistamines
Prevention of Urinary Retention
Identify pt’s at risk Behavioral modifications Time voiding Assist pt to toilet Provide bedside commode Teach intermittent self catheterization 5-alpha reductive inhibitors for men with BPH
Acute bladder retention
Is considered a medical emergency; is the sudden painful inability to void a full bladder
Chronic urinary retention
Usually painless; common in men, increase in residual ruin volume
Constipation
Three or less bowel movements in a week. Little or no passage of stool. Most common in older people. Can be caused by postponing urge or chronic use of laxatives.
Impaction
Stool gets hard and causes a blockage. Often leads to incontinence seepage of foul smelling liquid from rectum. Often caused by dependence on laxatives
Risk factors of bowel incontinence, constipation, and impaction
Activity Diet Drugs Large bowel disorders Psychogenic—“I need to have a BM every morning at 8” Systemic problems Chronic laxative use Inflammation Local trauma Neurologic causes Other physiological causes Psychological causes
Methods of prevention for bowel incontinence, constipation, and bowel impaction
Nutrition *6-8 glasses of water a day Exercise Acting on urge to defecate Avoid long term use of laxatives Good dental hygiene Regular toileting schedule Kegel exercising
Diagnostic tests for people with constipation, impaction, and bowel incontinence
Digital rectangular exam Anorectal manometry Barium enema Sigmoidoscopy Colonoscopy
Pharmacological therapy for constipation, impaction, and bowel incontinence
Bulk-forming laxatives Stimulants Osmotic Stool softeners Lubricants Saline laxitives Chloride channel activators Enemas Suppositories Prokinetic drugs
Nonpharmacologic therapy for constipation, impaction, and bowel incontinence
Education Nutrition Behavioral management Bowel training Biofeedback Manual removal stool
The nurse is caring for a client in a long-term care facility who has not had a bowel movement in 5 days. The unlicensed assistive personal report that the client is passing a very small amount of liquid stool. What action should the nurse take initially?
A. Check the client for impaction
B. Advise the healthcare provider of the situation
C. Document the findings
D. Administer a laxative
A. Check for impaction
Which statement provides evidence that an older adult who is prone to constipation is in need of further teaching?
A. I drink one and one and a half quarts of liquids each day
B. I need to take a laxative such as milk of mag if I don’t have a bowel movement everyday
C. If my bowel pattern changes I should call you
D. Eating my meals at regular times is likely to result in regular bowel movements
B
The nurse is working with a family of an older pt with bowel incontinence. Which intervention will the nurse teach the family about bowel incontinence?
A. Place the client in a brief at all times
B. Place the client on the commode at the same time every day
C. Do not try to stimulate stools with suppositories
D. Ask the client to tell the family when the urge to defecate
B.
