Urine and Bowel Elimination Flashcards
What is micturition?
Means to urinate. It is a complex process involving the bladder, urinary sphincters, and CNS
How does the brain respond to the urge to urinate?
CNS sends message and external sphincter relaxes and bladder empties
When does voiding happen?
When bladder contraction and urethral sphincter and pelvic floor muscles are used.
How does the brain play a role in Micturition?
Impulses from the brain respond or ignore the urge
What are the factors influencing urinary elimination?
-Growth and development- 18 to 24 months control, PT STARTS
-Sociocultural factors- personal habits, need for privacy
-Psychological Factors
- Personal habits
- Fluid intake
-Pathological conditions-DM, MS, spinal cord, stroke, dementia, affect CNS and how to interpret the signal
-Surgical procedures- trauma, Abdominal surgery, postop- urinary retention. Meds that affect UR- diuretics.
-Diagnostic Exam- urinary catheterization
What are decreased urinary changes in older adults?
- Amount of nephrons
-bladder muscle tone
-bladder capacity
-Time between initial desire to void and urgent need to void
What are increased urinary changes in older adults?
-bladder irritability
-bladder contractions during bladder filling
- risk of uriary incontinence
What are three common urinary elim problems?
- Urinary Retention
- UTI
- Urinary Incontinence
What is urinary retention?
Inability to partially or completely empty the bladder
Can urinary retention be acute or chronic?
Yes.
acute- postop and post labor.
chronic- slow onset, decrease in voiding volume and straining to void over time. Frequency problems, incontinence, or sensations of incomplete emptying
How do we diagnose urinary retention?
Post- void residual (PVR)
Bladder scan via ultrasound (Indep nursing intervention)
- also can do an INO cath can also be used.
What type of incontinence is considered with urinary retention?
Overflow INCONTINENCE
What is the most common cause of UTI?
E. Coli
UTI can be located?
Anywhere along the urinary tract is in an infection
Bacteria can be present but not always…
cause an UTI, will monitor for symptoms
Who is at risk for UTI?
- indwelling cath patients
-any instrument in the urinary tract
-urinary retention
-incontinence
-poor perineal hygiene - females
- frequent sexual intercourse
-uncircumcised patients
Do elderly patients normally present with typically UTI symptoms?
Not always, sometimes neurological or from a fall.
CAUTI infection
- major risk of development
-costly for hospital
-can be reasonably prevented-good peri care
-focus on early recognition and treatment
-keep sterile on insert
What is urinary incontinence?
involuntary loss of urine
What are the types of urinary incontinence?
urgency (older adult- timing), stress (women- laughing, cough, sneeze) and overflow (bladder too full).
often multifactorial
What are the incontinent risk factors?
- women and elderly
-Obesity
-Multiple pregnancies/ vaginal births
-Neurological disorders: Parkinson’s, CVA, spinal cord injury, MS
-Medication therapy: diuretics, opioids, anticholinergics, calcium channel blockers, sedatives/hypnotics
-Confusion
-Dementia
-Immobility
-Depression
Wendy and Ed, obesity pregnant nerves : medication, confusion, immobility and depression
Assessment know how to address…
assess abdomen, kidneys, genitalia, urethal meatus, peri area
Assessment considerations…
-Assess understanding and expectations of treatment
-Be professional
-Assess ability to perform necessary behaviors associated with voiding
-Assess for any culture or personal considerations
-Past medical & surgical history Medication use
-Normal bowel & urinary elimination
patterns
-Sleep, activity, & nutrition
Assessment: What is the history of the patient with urination? (Pattern of Urination)
- Frequency and times of voiding
-Normal amount with each void
-History of recent changes
What are Symptoms of urinary alterations?
-Urgency
- Dysuria
- Frequency
-Hesitancy
- Polyuria
-Oliguria
-Nocturia
-Dribbling
-Hematuria
-Retention
Upper UTI can turn into what kind of infection ?
kidney (pyelonephritis) will see costovertebral tenderness- assess by palpitation over the kidney area.
How do you do an assessment of urine?
- Intake and output
- Evaluates bladder emptying
- Renal function
-Fluid & electrolyte balance
-Can be an HCP order or nursing judgement
-Normal urine output >30 mls/hr
- Concerned if < 30 mls/hr for 2 hours* - Characteristics of urine
* Color
* Clarity
* Odor
Color of urine
Color
- Normal
* Pale straw color to amber- depends on concentration
-Abnormal
* Hematuria
* Color changes
clarity of urine
Clarity
-Normal- transparent at first void
-Urine that sits- cloudy
-Thick and cloudy- bacteria and WBCs
- Early morning void-can appear this way as well since it sat in bladder all night
Oder of urine
Normal
- Odorless
-Ammonia smell
- Abnormal- Offensive- May indicate UTI
- Some foods change odor- Fruity- acetone
How do we measure urine?
with a catheter.
Urometer- more detailed measurement.
30 mL is normal for every 1 hour
Normally change bag every 4-8 hours.
If patient is Independent..
- use male or female urinal
-speci- hat in the toilet
Urine testing
- label the correct way! know how to collect the specimen.
-Send as soon as you receive unless it is a timed test
-Know if you need a preservative or not
What is an urinalysis?
To test for a UTI
What does the nurse need to know about urinalysis?
- must be fresh urine
-Collect during normal voiding, indwelling catheter, or urinary diversion - Must have freshly voided urine
-Cannot take urine from catheter bag
-Possibly use Reagent strips
urinalysis chart
Appearance & Color= Clear, amber, yellow=Bacteria, certain foods, blood, medications,hydration status
Odor= Aromatic= infection
pH 4.6-8.0 =Alkaline- loss of acid. Acidotic=urine that sits for hours, sleep.
Protein Up to 8mg/100ml = Sensitive indicator of kidney function
Glucose= Negative= Diabetes Mellitus (DM)
Ketones=Negative DM= Dehydration, starvation
Excessive aspirin ingestion
Specific Gravity 1.005-1.030
High= reflects concentrated dehydration
Low- overhydration
RBC= Up to 2= Damage to glomeruli, trauma, catheter
trauma
WBC= 0-4 = Inflammation or infection
Bacteria =Negative= Possible UTI
Leukocyte esterase= Negative= Possible UTI
Casts= Negative= Indicate renal disease
Crystals= Negative= Indicate increased risk of renal calculi
Culture and Sensitivity
Can obtain from:
* Clean-voided or clean-catch/mid-stream urine specimen
* Urinary catheter
* Urinary diversion
* Send to lab within 30 minutes
* Preliminary report should be available within 24 hours
* Must use STERILE specimen cup
-Obtained to determine presence of pathogenic bacteria
-Important to test the sensitivity of any growing bacteria to various antibiotics
-Should obtain before any antibiotic administration
-To save money culture only done if urinalysis suggest infection
what is an abdominal Xray-KUB?
-Determines size, shape, symmetry, location of structures of the urinary tract
-Common Uses:
-Detect & measure urinary calculi
-NO Special Preparation
Nursing Problems r/t Urinary Elimination
*Impaired Urinary Elimination
*Urinary Retention
*Incontinence
* Functional urinary
* Overflow urinary
* Reflex urinary
* Stress urinary
* Urge urinary
*Impaired Comfort or Pain
*Impaired Skin Integrity or Risk for impaired skin integrity
*Knowledge Deficit
*Body Image Disturbance
*Risk for Infection
Health promotion and patient education
Promote self-care practices
Maintain normal routine
Promote healthy nutrition and fluid intake
Things to avoid:
◦ Constipation
◦ Smoking
Strengthen pelvic floor muscles
Men: Be vigilant about your prostate health
Report any changes in urinary tract
Maintaining Adequate Fluid Intake
2300 mls/day - if renal function is
ok, no heart disease & no need for fluid restriction
Helps flush solutes to limit bladder irritability
If fluid intake needs increased:
◦ Schedule times to drink
◦ Identify fluid preferences
◦ High fluid foods (fruits)
◦ Stop drinking about 2 hours before
bedtime to prevent nocturia
Urinary Retention: Nursing Care
Assess & monitor urine output
Assess for bladder distention
Assist patients to normal position for urination
Run water or flush commode
Apply cold compress to abdomen
Encourage double voiding
If bladder does not empty fully, try around the clock voiding
Using the crede method is not recommended unless approved
by HCP
Intermittent catheterization or catheterization
Preventing Infection..
-Follow hospital protocol
-Assess for s/s of infection
-Perform perineal hygiene
-Void at regular intervals
-Adequate fluid intake
-Female considerations
Incontinence Care
-Be respectful of patient’s feelings
-Pelvic floor muscle training
-Lifestyle changes
-Bladder retraining
-Toileting schedule
-Intermittent catheterization
-Meticulous skin care
-Absorbent pads & catheters
incontinence care continued
electrical Stimulation
There are meds that can help – example = anticholinergics
Interventional Therapies:
◦ Bulking material injections
◦ Botox
◦ Nerve stimulators
Surgery:
◦ Sling
◦ Bladder neck suspension
◦ Prolapse surgery
◦ Artificial urinary sphincter
Meticulous Skin Care, what do you do?
Do’s:
◦ Identify & treat early
◦ Use skin risk assessment tools
◦ Use appropriate skin barrier products
◦ Ensure adequate hydration
◦ Consult WOCN if needed
Meticulous skin care, what do you not do?
DO NOT:
Use traditional soap & water
◦ Double padding the bed
◦ Leave soiled pads
What are the Types of catheters to use?
Single lumen
Indwelling catheter
3-way/ 3 lumen
Coude tip
◦ Curved rounded- prostate
Suprapubic External Catheters
Suprapubic -placed in the bladder
through abdominal wall
◦ Sutured in place
◦ Used when blockage of urethra
or when indwelling catheter causes irritation
External catheters
◦ Males: condom cath
◦ Females: Purewick
Nursing care: cath, What does the nurse do?
-Regular perineal care (Peri-Care)
-Provide catheter care or baths per hospital protocol
-Secure catheter to prevent movement or pulling
-Empty drainage bags when ½ full
-Ensure no kinks in catheter tubing & below bladder
-Do not allow catheter drainage bag to touch the floor
-Maintain a closed drainage system
-Accurate monitoring of output
-Timely removal
Before cath insertion…
Peri-care
◦ Females- front to back
◦ Males- uncircumcised
Can delegate to nursing assistant or patient
CHG or castile wipes
Post- Catheter Removal
Patient should void within 6-8
hours post-removal
Monitor ability to void and empty
Measure accurate urine output
Patient educational
◦ First voids can cause discomfort
Factors Influencing Bowel Elimination
-Age
-Diet
-Fluid Intake
-Physical Activity- be more active
-Psychological Factors
-Personal Habits
-Positioning During Defecation
-Pain
-Pregnancy Surgery & Anesthesia Medications -Diagnostic Tests
Older adult care focus
Trouble chewing
* Esophageal emptying slows
* Impaired absorption
* Weakened sphincters
* Decreased
* Hydrochloric acid
* Absorption of vitamins
* Peristalsis
* Sensation to defecate
* Lipase to aid in fat digestion
common bowel elimination problems
Constipation
Impaction
Diarrhea
Bowel Incontinence
Flatulence
Hemorrhoids
constipation, What is it?
-Constipation is a symptom- not a disease
-Having fewer than 3 bowel movements a week*
- hard dry stools
-can very from person to person
Symptoms of constipation
Symptoms
* Infrequent BMs
* Discomfort
* Hard, dry stools= difficult to pass
