Urinary & Bowel Elimination Flashcards
describe URINARY ELIMINATION
- type of BASIC HUMAN FUNCTION
- can be compromised by illness & conditions
definition of MICTURITION
where the BRAIN gives the bladder permission to EMPTY & BLADDER BEGINS TO CONTRACT
- have the RELAXATION OF THE SPHICTER
- have the RELEASE OF URINE
what are the other names for MICTURITION?
- urination
- voiding
why are CATHETERS USED?
- from SURGERIES
- want to obtain a STERILE SAMPLE
- patient has URINARY INCONTINENCE
- patient has SPINAL CORD INJURIES
what is IMPORTANT TO CONSIDER within CATHETERS?
- catheters are DIRECT PORTALS OF ENTRY–very susceptible to infection
what are some FACTORS THAT INFLUENCE URINATION?
- person’s GROWTH & DEVELOPMENT
- their OWN PERSONAL HABITS
- pt.’s own FLUID INTAKE
- type of MEDICATIONS
- other medical conditions
what are the COMMON URINARY ELIMINATION PROBLEMS?
- URINARY RETENTION
- URINARY TRACT INFECTIONS (UTIs)
- URINARY INCONTINENCE
- URINARY DIVERSIONS (type of stomas – diversions of bladder)
what are some INTERVENTIONS to ensure within URINARY ELIMINATION PROBLEMS?
- can check PVR (URINARY RETENTION)
- UTIs; can be TREATED with ANTIBIOTICS
- always WIPE FROM FRONT TO BACK
- always VOID BEFORE & AFTER INTERCOURSE
definition of URINARY RETENTION
an accumulation of URINE due to the INABILITY of the BLADDER TO EMPTY
definition of URINARY TRACT INFECTION
often results from catheterization or procedure
- the 4th most common HAI
- CAUTI
definition of URINARY INCONTINENCE
- involuntary leakage of URINE
- often is from URGE or STRESS
what are some SYMPTOMS OF UTI?
- DYSURIA
- URGENCY
- FREQUENCY
- INCONTINENCE
- SUPRAPUBIC TENDERNESS
- FOUL ODOR
- CLOUDY URINE
what are some NURSING CONSIDERATIONS?
- INFECTION CONTROL & HYGIENE
- GROWTH & DEVELOPMENT
(infants»_space; greater frequency of voiding)
(pregnancy»frequency of voiding)
(older adults»decreased bladder capacity/increased bladder irritability) - PSYCHOSOCIAL IMPLICATIONS
(self concept & self esteem)
what are some factors to consider during the assessment?
- how does the patient feel about the situation?
- can the patient take care of themselves?
- what are some cultural considerations to consider?
- what is the PATIENT’s HISTORY?
- their patterns of urination
- symptoms of urinary alterations
what are some CHARACTERISTICS of URINE ASSESSMENT?
- INTAKE & OUTPUT
- URINE CHARACTERISTICS;
- COLOR
- CLARITY
- ODOR
what are some factors in LABORATORY & DIAGNOSTIC TESTING?
- LABELING ALL SPECIMENS
- PRESERVATION according to LAB PROTOCOL
- keeping proper INFECTION CONTROL POLICIES
- want to also assess any MEDICATIONS
what are some LABS to do?
- WBC
- GFR (60 or above)
- CREATINE
what are the APPROPRIATE NANDAS?
- URINARY INCONTINENCE; FUNCTIONAL/OVERFLOW/REFLEX/STRESS/URGE
- INFECTION
- IMPAIRED SELF TOILETING
- IMPAIRED SKIN INTEGRITY
- URINARY RETENTION
what are some STRATEGIES FOR HEALTH PROMOTION?
- want to always EDUCATE THE PATIENT
- want to PROMOTE NORMAL MICTURITION
(maintain good elimination habits & proper fluid intake) - want to PROMOTE COMPLETE BLADDER EMPTYING
- want to PREVENT INFECTION
what is SUPRAPUBIC CATHETERIZATION? How is it different from EXTERBAL CATHETERS?
- surgically placed type of catheter which is then connected to a collection bag
external catheters are PLACED ON THE OUTSIDE; often changed out on the regular;
ex. CONDOM CATHETERS
what are methods of CONTINUING AND RESTORATIVE CARE patients undergo regarding urinary elimination?
- goes through more LIFESTYLE CHANGES
- PELVIC FLOOR MUSCLE TRAINING; often seen in pregnant patients
- BLADDER RESTRAINING EXERCISES
- proper TOILET SCHEDULES
- proper SKIN CARE around pelvic area
what are IMPORTANT ASPECTS TO CONSIDER when evaluating the patient?
- how is the patien’s own personal view of themselves/regarding self image?
- how is their voiding pattern?
- does the caregiver/patient know the plan or scheduling regarding the proper interventions?
describe the KIDNEYS
- filtration of waste products of metabolism
- have their units of NEPHRONS that help with filtration
- helps with BP CONTROL & production of ERYTHROPOIETIN; stimulates RBC production & bone marrow maturation
function of the URETERS
transports urine from kidneys to bladder
function of BLADDER
holds urine until urge to pass
function of the URETHRA
pathway for the URINE TO LEAVE THE BODY
- allows for the TIGHTENING OR RELAXING OF THE SPHINCTER MUSCLES in order to retain or remove urine
why is BOWEL ELIMINATION SO IMPORTANT?
- pertains to the REGULAR REMOVAL OF WASTE
- essential for NORMAL BODY FUNCTIONING
how should the NORMAL DEFECATION PROCESS OCCUR?
- should be painless with SOFT STOOL
- no discomfort/regular brown color
what are the FACTORS THAT INFLUENCE BOWEL ELIMINATION (12)?
- AGE
- DIET
- FLUID INTAKE
- PHYSICAL ACTIVITY
- PSYCHOLOGICAL FACTORS
- PERSONAL HABITS
- POSITIONING
- PAIN
- PREGNANCY
- SURGERY/ANESTHESIA
- MEDICATIONS
- DIAGNOSTIC TESTS
what are some FOODS that can change BOWEL ELIMINATION?
- **FIBER is a huge component for elimination
(WHOLE GRAINS, FRESH FRUIT, VEGGIES)
(BROCCOLI, CABBAGE, BEANS) - helps to INCREASE COLONIC MOBILITY & GAS)
how does PHYSICAL ACTIVITY/PSYCHOLOGICAL FACTORS INFLUENCE BOWEL ELIMINATION?
- more activity (ex. ambulation) = the more peristalsis within bowels
- more stress = more diarrhea/difficulty with bowels
what are SOME MEDICATIONS that can INFLUENCE BOWEL ELIMIINATION?
- OPIOIDS (constipation)
- ANTIBIOTICS (diarrhea)
- LAXATIVES
- STOOL SOFTENER
what are some DIAGNOSTIC TESTS that can INFLUENCE BOWEL ELIMINATION?
- ENEMAS
- ENDOSCOPIES
- COLONOSCOPIES
definition of CONSTIPATION
- is a SYMPTOM NOT A DISEASE
- has many probable causes
- medications
- improper diet
- lack of exercise
- reduced fluids
- spinal cord injuries/stroke
- SIGNS:
- infrequent bowel movements
- hard & dry stools
- SIGNS:
- has many probable causes
definition of DIARRHEA
increase in the NUMBER OF STOOLS and passage of LIQUID & UNFORMED DEVES
what are some CAUSES OF DIARRHEA?
- can also be caused by FOODBORNE PATHOGENS
- can also be caused by FOOD INTOLERANCES
- increased irritation of colon - increased secretion of mucus
- risk of DEHYDRATION
- risk of IRRITATION & SKIN BREAKDOWN
definition of FECAL INCONTINENCE
the INABILITY to CONTROL THE PASSAGE OF FECES & GASES from anus
definition of FLATULENCE
- a common cause of ABDOMINAL FULLNESS, PAIN, & CRAMPING
- gas accumulation in the intestines’ lumen
definition of HEMORRHOIDS
DILATED or ENGORGED VEINS within the RECTUM LINING due to increased pressure
- ex. straining during bowel movements
- ex. chronic diarrhea/constipation
- ex. sitting for too long
what are BOWEL DIVERSIONS? or aka OSTOMIES?
certain temporary or permanent openings (STOMA) that allow to bring part of the intestine out through the abdominal wall
what is the difference between IELOSTOMY vs. COLOSTOMY
ILEOSTOMY
- connects to the SMALL INTESTINE (ILEUM)
- collects more of a LIQUID STOOL
COLOSTOMY
- connects to the COLON
- collects more of a SOLID STOOL
what is an IILEOANAL POUCH ANASTOMOSIS?
- surgical procedure for patients who need to have a colostomy for treatment of ulcerative colitis or familial adenopolyposis (FAP)
- removal of colon - creation of POUCH at the end of the SI
- this is then attached to the anus
what are some IMPORTANT QUESTIONS TO ASK DURING ASSESSMENT?
- how is the patient’s diet?
- last bowel movement?
- stool characteristics/patterns?
- any pain during elimination?
- diarrhea/constipation?
- any medications?
what are some DIAGNOSTIC EXAMINATIONS to factor in?
- can take FECAL SPECIMENS
- FOBT; FECAL OCCULT BLOOD TEST
screening for blood in the feces - COLONOSCOPY
- H & H; hemoglobin & hematocrit
what about PHYSICAL ASSESSMENT?
- important to INSPECT, AUSCULTATE, and PALPATE
- looking at SYMMETRY, CONTOURS, and TENDERNESS, SHAPE
- inspecting the mouth, abdomen etc…
what are the APPROPRIATE NANDAS?
- BOWEL INCONTINENCE
- CONSTIPATION
- RISK FOR CONSTIPATION
- DIARRHEA
- LACK OF KNOWLEDGE OF DIETARY REGIME
what are IMPORTANT GOALS & OUTCOMES nurses want to reach regarding BOWEL ELIMINATION?
- able to IMPLEMENT ELIMINATION HABITS OR ROUTINES
- being able to REINFORCE THESE ROUTINES
- able to see progress in LIFESTYLE CHANGES; within DIET, ACTIVITY, IRREGULAR BMS
is it a POSSIBILITY PATIENTS CAN HAVE MULTIPLE DIAGNOSES?
YES!
- patients OFTEN have multiple diagnoses
- must be able to SET PRIORITIES of what needs to be taken care of
- ex. patient can have pain, constipation, and impaired mobility
who are other NURSES or PEOPLE that have to be within this process?
- family members
- dieticians
- WOCN
what are our HEALTH PROMOTION STRATEGIES?
- PROMOTION OF NORMAL DEFECATION
ex. SITTING POSITION
ex. POSITIONING ON THE BEDPAN
how can we have PROPER IMPLEMENTATION METHODS in ACUTE CARE?
- ensure proper environment for the patient; giving PRIVACY
- use of CATHARTICS and LAXATIVES
- use of ANTIDIARRHEAL AGENTS
- knowing the CAUSE OF DIARRHEA/CONSTIPATION
ex. infection? inflammation?
difference between CATHARTICS and LAXATIVES? difference between SUPPOSITORIES vs. ORAL MEDS
CATHARTICS - must more STRONG and RAPID compared to laxatives
SUPPOSITORIES - rectally placed; and ACT MORE QUICKLY vs. oral meds
what type of CLEANSING ENEMAS do we use; what is the safest/most at risk?
CLEANSING ENEMAS help to STIMULATE PERISTALSIS with the instillation of liquid solution into the rectum
- TAP WATER (hypotonic s.)
- NORMAL SALINE (the MOST SAFE)
- HYPERTONIC SOLUTIONS
- SOAP SUDS (the MOST AT RISK–can IRRITATE INTESTINES)
what to remember for ENEMA ADMINISTRATION?
- sterile technique is not needed
- always EXPLAIN the procedure/ positioning/precautions- can be an invasive or quite uncomfortable procedure for some patients
how do we CARE FOR OSTOMIES?
- always making sure to EMPTY THE POUCH ONCE its around 1/2-1/3 FULL
- always want to ASSESS THE STOMA
- always want to PROTECT THE SKIN/NO ODOR
what are the MAIN FUNCTIONS OF THE STOMACH?
- STORAGE for SWALLOWED LIQUID & FOOD
- MIXING OF FOOD with digestive juices - CHYME
- REGULATION OF EMPTYING CONTENTS into SI
- produces;- HYDROCHLORIC ACID (HCI) - protein
- MUCUS - protects stomach mucosa
- PEPSIN - protein
- INTRINSIC FACTOR - absorption of vitamin B12
what is the FUNCTION OF THE SMALL INTESTINE?
- aids in both DIGESTION & ABSORPTION
- introduced to CHYME + mixes chyme with DIGESTIVE ENZYMES (from the pancreas)
- very important & efficient in RESORPTION
what are the MAIN PARTS OF THE SI?
- DUODENUM
- processes fluid
- JEJUNUM
- absorbs carbs & proteins
[both duodenum & jejunum absorb the MOST NUTRIENTS & ELECTROLYTSE]
- ILEUM
- absorbs water, fats, & bile salts
- absorbs vitamins, iron
function of the LARGE INTESTINE
is the PRIMARY ORGAN OF BOWEL ELIMINATION
- FUNCTIONS:
- ABSORPTION
- SECRETION
- ELIMINATION
functions of the RECTUM
- empties fecal matter
- has VERTICAL & TRANSVERSE FLODS to help control expulsion of fecal contents
