Unit Two: Elimination

Question 1

Definition of elimination

Answer 1

The secretion and excretion of physiological waste products by the kidneys and intestines

Question 2

Concepts related to elimination

Answer 2

Fluid and electrolytes
Self care and self image
Mobility 
Inflammation
Teaching Dan learning

Question 3

Alterations in Urinary elimination

Answer 3

Polyuria
Urinary frequency
Anura
Olxiguria
 Polydipsia
Nocturia 
Urgency
Dysuria
Urinary frequency
Retention
Neurogenic bladder

Question 4

Bowel Elimination

Answer 4

Diarrhea
Constipation
Bowel incontinence
Impaction

Question 5

Nursing Assessment for elimination

Answer 5

Change in voiding patterns
Medications
Use of elimination aids
Diet
Fluid intake
Stress
Disease
Appearance of urine and stool

Question 6

Independent Interventions for alterations in urinary elimination.

Answer 6

Monitoring I’s and O’s
Personal Hygiene
Cath use and care
Urine Collection
Client Education

Question 7

Independent Interventions for Bowel elimination

Answer 7

Client dietary education
Client physical education
Bowel training
Personal hygiene

Question 8

Collaborative Interventions for alterations in urinary elimination

Answer 8

Diuretics
Anticholinergics
Cholinergics
Dialysis

Question 9

Collaborative interventions for bowel elimination

Answer 9

Laxatives
Stool softeners
Antidiarrheals
Surgery

Question 10

Urinary Incontinence

Answer 10

Involuntary urination. A symptom not a disease; normal consequence of aging.

Question 11

Etiology and Pathophysiology

Answer 11

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

Question 12

Urinary incontinence risk factors:

Answer 12

*Age
Women more than men
Obesity
Smoking
Constipation
Pregnancy
Depression
Neurological disorders
Certain medications
Diabetes
Inactivity

Question 13

Prevention of Urinary incontinence

Answer 13

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

Question 14

Clinical manifestation of urinary incontinence

Answer 14

Inability to avoid urinating 
Inability to urinate 
Increased rate of urinations
Leakage
Uncontrolled wetting
Frequent bladder infections
Developmental considerations

Question 15

Diagnostic tests for urinary incontinence

Answer 15

Bladder diary
Urinalysis
Blood tests
24-hour urine
Post void residual measurement
Urodynamic testing stress test
Ultrasound
Cystoscopy

Question 16

Pharmacological therapy for urinary incontinence

Answer 16

Urge incontinence:
-antispasmodic-oxybutin(ditropan)
-Anticolinergic-tolterodine(Detroit)
Stress incontinence :
-imipramine (tofranil)
BPH:
-Alpha blockers (cardura, hytrin, Flomax)
-5 alpha reductive inhibitors (avodart, proscar)

Question 17

Nonpharmacological therapies for urinary incontinence

Answer 17

Kegel exercises
Behavior modification
Absorbent pads/diapers
Pessary in vagina to hold up bladder
Urethral insert to plug leaks
Catheter
Surgery

Question 18

Patient Education for Urinary incontinence

Answer 18

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

Question 19

Etiology and pathophysiology of Urinary retention

Answer 19

Mechanical obstruction, functional obstruction

Question 20

Risk factors of urinary retention

Answer 20

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

Question 21

Drugs that cause Urinary Retention

Answer 21

*Anticholinergics
*Opioids
Anti anxiety
Antidepressants
Antiparkinsonian
Antipsychotics
*Antihistamines

Question 22

Prevention of Urinary Retention

Answer 22

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

Question 23

Acute bladder retention

Answer 23

Is considered a medical emergency; is the sudden painful inability to void a full bladder

Question 24

Chronic urinary retention

Answer 24

Usually painless; common in men, increase in residual ruin volume

Question 25

Constipation

Answer 25

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.

Question 26

Impaction

Answer 26

Stool gets hard and causes a blockage. Often leads to incontinence seepage of foul smelling liquid from rectum. Often caused by dependence on laxatives

Question 27

Risk factors of bowel incontinence, constipation, and impaction

Answer 27

``` 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 ```

Question 28

Methods of prevention for bowel incontinence, constipation, and bowel impaction

Answer 28

``` 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 ```

Question 29

Diagnostic tests for people with constipation, impaction, and bowel incontinence

Answer 29

``` Digital rectangular exam Anorectal manometry Barium enema Sigmoidoscopy Colonoscopy ```

Question 30

Pharmacological therapy for constipation, impaction, and bowel incontinence

Answer 30

``` Bulk-forming laxatives Stimulants Osmotic Stool softeners Lubricants Saline laxitives Chloride channel activators Enemas Suppositories Prokinetic drugs ```

Question 31

Nonpharmacologic therapy for constipation, impaction, and bowel incontinence

Answer 31

``` Education Nutrition Behavioral management Bowel training Biofeedback Manual removal stool ```

Question 32

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

Answer 32

A. Check for impaction

Question 33

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

Answer 33

B

Question 34

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

Answer 34

B.