Urine & Bowel Flashcards
1
Q
What part of the body stimulates red blood cell production (erythropoietin)?
A
The kidneys
2
Q
What part of the body produces prostaglandin?
A
The kidneys
3
Q
What structure carries urinary waste to the bladder?
A
The Ureter
4
Q
At what amount of ml in the bladder does a person feels the urge to void?
A
150-250 ml
5
Q
What structure of the body transports urine from the bladder to the exterior of the body?
A
The urethra
6
Q
What is urinary retnetion?
A
When urine is produced normally but not excreted completely from the bladder. This could be due to medications, enlarged prostate or vaginal prolapse.
7
Q
What is cystitis?
A
Infection of the urinary bladder.
8
Q
What are the 3 processes of urine formation?
A
Glomerular filtration.
Tubular reabsorption
Tubular Secretion
9
Q
how does cardiac output affect urine output?
A
Less cardiac output results in less amount of urine.
10
Q
What is tubular secretion?
A
Any waste product that is is excess of the blood, goes back into the tubules and is excreted in the urine.
11
Q
How does the kidneys control BP?
A
Through the RAAS
12
Q
What is the function of prostaglandin?
A
Vasodilator that dilates afferent and efferent vessels.
13
Q
Which medication is anti-prostaglandin and what effect would it have on the kidneys?
A
NSAIDS. Because it will vasoconstrict the kidneys, due the NSAIDs stops production of the prostaglandin and therefore cannot vasodilate.
14
Q
How does the kidneys play a part of vitamin D production?
A
It becomes bioactive (absorbed) in the kidneys by conversion of D2 to D3
15
Q
What happens to the nephrons as we age?
A
Older adults have 50 % less nephrons that they did earlier in life.
16
Q
what effect does the decrease of nephrons and bladder shrinkage have on an older persons urine?
A
The kidneys are not able to concentrate the urine due to lack of tubular reabsorption and tubular secretion.
The reabsorption of sodium is an effect of this. Sodium stays in the tubules and creates a more diluted urine.
17
Q
What happens to the bladder as we age?
A
It loses its ability to stretch properly. So the urgency to void become more frequent.
The bladder is also not able to contract properly, so result is urinary retention because the bladder isn’t emptying properly.
18
Q
How does nerve disorders/ neuromuscular problems such as MS, Parkinson’s, Myasthenia Gravis have an impact on the bladder?
A
The bladder is innervated with nerves, so problems with nerves may lead to problems with incontinency, problems with urgency and urinary retention.
19
Q
How can spinal chord damage or conditions have an effect on bladder?
A
Because this can effect the nerves going to the bladder.
20
Q
What is functional incontinence?
A
The problem is not related to a problems in the urinary bladder itself. but may be due to immobility and weakness.
21
Q
What is nephrotoxic?
A
Something that is toxic to the kidneys. Usually a medication. Examples of these are NSAIDs in large amounts and some antibiotics such as gentamicin.
22
Q
where is the bladder located?
A
Hypogastric region
23
Q
When you do a bladder scan, how many minutes after the patient does the scan need to be done?
A
Within the next 15 minutes otherwise there will be new urine in the bladder again.
24
Q
How do you measure urine output?
A
You need to pour the collected urine into a cylinder/collector to measure amount.
25
What is the minimum amount of urine that you need for an Urine analysis/UA?
Min. 10 ml of urine.
26
What catheter do we use if we are not able to get any urine for an UA from a clean catch midstream specimen?
We need to use a straight catheter for collection.
27
What is a 24 hrs urine collection?
Start collecting over 24 hrs. We do not use the morning pee on the first day cue to this being the urine from yesterday. The last amount of urine collected is on the second morning.
28
Where is point of care urine testing done?
At the patients bedside.
29
What is Anuria?
less than 50 ml of urinary output per 24 hrs
30
What is Dysuria?
Painful urination.
31
What is Glycosuria?
Presence of glucose in the urine
32
What is Nocturia?
Awakening at night to urinate.
33
What is Polyuria?
Excessive urinary output
34
What is Oliguria?
Less than 400 ml of urinary output in 24 hrs.
35
What is Proteinuria?
Protein in urine
36
What is Pyuria?
Pus in the urine
37
What is meant by turbidity when it comes to the UA?
Turbidity refers to cloudiness, can you see through the urine? Is it clear? Normal urine is clear and see -through and cloudiness is abnormal and require further investigation as there might be an bacterial infection.
38
Why are cranberries good for UTI's?
Because it will make your urine more acidic and will therefore help prevent UTI's. (Doesn't heal or cure).
39
What does specific gravity measure in your urine?
It measures the concentration of your urine. Urine is normally 1.015 - 1.00. Water is 1.00 and urine is going to be higher as there are electrolytes in the urine. Closer to 1 means that it is more dilutes and closer to 1.015 means that the urine is very concentrated.
40
What are constituents of urine?
Organic/Inorganic elements in the urine. Abnormal constituents are pus, blood, albumin, glucose, ketones, casts, gross bacteria and bile,
41
What does albumin in your urine indicate?
Damage/inflammation to the glomerulus.
42
What does bile in the urine indicate?
Liver problems
43
What are Urodynamic Studies?
A group of tests that measure how urine flows, are stored and is eliminated in the lower urinary tract. Used to identify abnormal voiding patterns in incontinence or inability to void.
44
What is Cystoscopy?
Visual examination of the bladder. Used to view, diagnose and treat conditions affecting the lower urinary tract, interior bladder, urethra and ureteral orifers.
45
What is Intravenous Pyelogram?
Radiographic examination of the kidney and ureter after a contrast material is injected intravenously. Used to diagnose renal disease and urinary tract dysfunction. Dye goes in blood stream and goes into urinary system for elimination.
46
What is Retrograde Pyelogram?
Radiographic and endoscopic examination of kidneys and ureters with the placement of a ureteral catheter up to the renal pelivs. Contrast material is injected into the renal pelvis though the catheter followed by imaging.
47
What does a high creatinine level indicate?
Problem with the kidney. Its the only organ that excretes creatinine.
48
What is the contraindication to using dye for diagnostic testing of the kidneys?
Elevated BUN and Creatinine levels because this may indicate kidney damage, The dye may induce nephropathy due to being hypertonic and draws water and can dehydrate a patient and decrease perfusion to the kidney. Decreased perfusion may lead to kidney failure.
49
What is advised to do after the patient have been exanimated with dye?
Encourage the patient to drink lots of water to flush out the dye.
50
What is the normal range for BUN in older adults?
8-23 mg/dl
51
What is the normal range for creatinine in older adults?
0.6-1.3 mg/dl for men
0.6-1.1 mg/dl in women
52
What is the 2nd most common infection in older adults?
UTI
53
What is the leading cause of systemic infection in older adults?
UTI's. It can lead to urosepsis.
54
Why are women more vulnerable of developing UTI?
Due to having shorter urethra. And urethra is close to the rectum.
55
What is pyelonephritis? And what are the signs and symptoms
Upper UTI, affects the kidneys and the ureters. S&S are same as with cystitis as well as pain in the back (costal vertebral angle, fever, chills, nausea and vomiting.
56
What is Cystitis? And what are the signs and symptoms
Lower UTI affects the bladder and urethra. S&S are burning sensation when voiding, pain when urinating, and increased frequency and urgency.
57
What is the most common cause of UTI's?
E-coli that is present in the stool.
58
What are the risk factors of UTI's?
Sexually active people. Act may damage urethra and increase UTI risk.
Diaphragm - Contraceptive, may push on urethra and impede flow of urine
Post menopause - decrease of estrogen causes dryness and thinning of genitalia as well as weakening of pelvic muscle.
Healthcare affected is the indwelling catheter (Foley)
Diabetes ; Glucose in urine increases risk of bacterial infection
Changes is the bladder such as aging.
Enlargement of prostate in men.
59
What prevention strategies/ treatments do we use for UTI's?
Antibiotics
Increased fluid intake to flush out bacteria
Tell patients to avoid baths as there are chemicals in the bath that may irritate the urethra.
Wear breathable cotton underwear.
Void immediately after intercourse.
60
When taking care of a patient suffering from an UTI, why do we need to send their urine for gram stain and culture sensitivity analysis?
First it is important to make sure that the sample is sterile and taken either mid stream or from a catheter. The gram stain will identify if the bacteria is gram negative or positive. The culture identifies what type of bacteria it is (most common e-coli)
61
If culture and sensitivity identifies the type of bacteria causing the infection, why do we need to do a gram stain test?
Because culture and sensitivity takes 3 days and gram stain only takes 2 hrs. This identify what antibiotic you should start the patient on depending on if the bacteria is gram positive or negative.
62
When you get the test results of the culture and sensitivity analysis back there will be 3 letters. S,R and I.. what does these stand for?
S - Sensitive
R - Resistance
I - Intermediate
63
Why is it important to make sure that the patient is receiving an antibiotic with an S after it?
This indicates that the patient is taking the right antibiotic for the specific bacteria causing their infection.
An R means that the antibiotic would need to be changed by the provider.
64
What is Transient incontinence?
Temporary but acute incontinence that will go away with treatment, for example a patient taking Diuretics.
65
What is stress incontinence?
An intra-abdominal pressure that may occur during sneezing, coughing, laughing, exercising, multiple childbirths, obesity and straining from chronic constipation.
66
What is urge incontinence?
Involuntary loss of urine that occurs soon after feeling an urgent need.
67
What is overflow incontinence?
chronic urinary retention: involuntary loss of urine associated with overdistention and overflow.
68
What is functional incontinence?
loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory or disorientation
69
What is reflex incontinence?
Experience emptying of the bladder without the sensation of the need to void caused by spinal cord injuries
70
What is mixed incontinence?
urine loss of two or more types of incontinence
71
What is total incontinence?
Continuous and unpredictable loss of urine resulting from surgery, trauma or physical malformation
72
For a person suffering from functional incontinence, why would we assess their environment?
To ensure that there is nothing blocking their path to the bathroom or providing bedside commode.
73
Why should a patient suffering from urgent incontinence avoid caffein and alchol?
Because these beverages increases the urgency to go.
74
What are some ways we treat incontinence?
Pelvic floor muscle training
Biofeedback - notifying patient to become aware of when they need to void
Scheduled voiding
Weight loss - obesity = increased abdominal pressure.
Pharmacologic treatment ex anticholinergic (relaxes the bladder and holds more)
Mechanical treatment - surgery as last resort.
75
How many lumen does a straight cat. have? and how is it used?
Single lumen. It is placed to remove urine and then taken out again.
76
What is the name of the catheter that stays in your bladder? How many lumen does it have?
Foley Catheter/ Indwelling Catheter. It has a double lumen. One lumen is to inflate the balloon so that the catheter is anchored into the bladder.
The balloon in inflated with sterile water that is pushed through the lumen.
77
What is a 3-way catheter and what is it used for?
A 3 way catheter has 3 lumens and is used from bladder irrigation (flushing the bladder with a sterile fluid to remove/prevent blood clots, mucus, debris or other buildup.
Could be done after surgery.
To measure urine, you need to subtract whatever fluid that was irrigated.
78
What is a Coude tip foley and straight catheter and what is it used for?
Has curved tip compared to a regular catheter. Used for patients with prostate issues.
79
Which catheter is used to relieve acute urinary retention and obtaining a sterile urine specimen when patient is not able to voluntarily void.
A straight catheter.
80
Would urinary retention or incontinence be a reason to place a catheter on a patient?
No. Only acute urinary retention.
We want to avoid catheters as much as possible due to increased risk of infection.
81
What would we use for incontinence if we don't want to use a catheter?
We can do a condom cap or PureWick
82
If a person suffering from chronic incontinence and it is determined that they do need a Foley catheter, where should this be inserted.
It should be inserted in the suprapubic area due to this area being cleaner.
83
How often should a catheter be cleaned with soap and water?
Every 8 hrs. and after every BM.
84
What happens if the urinary bag at the end of the catheter is becoming full and not emptied accordingly?
Bag should be emptied at least every 8hrs. If not it can become full and urine may start to flow back up in the catheter and into the urethra. This urine is no longer sterile as it has been excreted and this may cause infection.
bag should be emptied at least every 8 hrs.
85
What is the Cecum?
The first part of the large intestine.
86
what is the function of the colon?
To propel stool out.
Absorb water and electrolytes
87
Why is the stool harder when you are constipated?
Because the stools sits in the colon for a longer period of time and the colon keeps absorbing water from it. This will make the stool harder.
88
Which electrolytes does the colon absorb?
Sodium and chloride (water follows)
89
Which electrolytes does the colon secrete?
Since the colon absorbs sodium, it will secrete potassium.
Since it absorbs chloride it will secrete bicarbonate
90
Does a variety of bacteria in the colon make our gut healthy or sick?
Healthy.
91
What type of food is good for your gut bacteria?
Fiber rich food.
92
What is soluble fiber?
Fiber that comes from fruits, vegetable, and whole grain. Picks up cholesterol and excretes it.
93
What is insoluble fiber?
Fiber that cannot be digested but creates bulk enables less water to be absorbed. Prevents constipation.
94
What effects does aging have on digestion?
Slowing of GI motility
Increased stomach emptying time
Decreased muscle tone of the colon - can lead to fecal incontinent.
95
What is diverticulitis?
Outpouching of areas in the colon. Results in pain in the LLQ. Caused by weakening of the muscles in the colon.
96
What are the warning signs of colorectal cancer?
Increased cases among young adults.
Bleeding with BM
changes in bowel movements
Feeling of not emptying the bladder.
97
Why is stool brown?
Because of the bile. This is the normal color for stool.
98
What does black, tarry stool (melena) indicate?
Bleeding in the upper GI tract. Black due to the iron in the red blood cells being digested and iron being released. Blood is digested due to the bleeding being in the upper GI tract. Offensive smell.
99
If there is fresh blood in the stool (hematochezia), where is the bleeding coming from?
Caused by lower GI bleeding.
100
What causes clay colored stool?
Pale due to absence of bile. Could be caused by a tumor or other obstruction blocking the bile duct. Stool will be hard due to bile being a laxative agent.
101
How much stool needs to be collected to do a stool culture?
At least 1 inch formed stool or 15-30 ml of liquid stool.
102
Why may medications such as aspirin , NSAIDs, Iron, anticoagulants and steroids provide a false positive for occult blood at a bedside test?
NSAIDs, Steroids and Aspirin these irritate the GI tract and might cause micro bleed.
Iron may also give a false positive.
Anticoagulants may cause false positive due to increased risk of bleeding.
103
Why may vitamin C and eating citrus fruits cause a false negative on an occult blood stool test?
Vitamin C is an antioxidant, which may react with the oxidation process of the reactant on the test card.
104
What test is performed with suspected upper GI bleed?
An EDG which is an Esophagogastroduodenoscopy.
105
What test is performed for suspicion of lower GI bleed?
Colonoscopy.
106
What is Fluoroscopic Examination?
Patient drink a chalky barium and several x-rays are taken as the barium is moving through the GI tract. We are able to detect obstruction.
Water needs to be given after to flush out barium.
107
What is a fleet enema?
bottle solution used to treat constipation. Can come in a sodium solution, (hypertonic solution) draws water from the cells in the rectum and help to soften the stool.
another fleet enema contains mineral oil which lubricates the stool in the rectum.
108
What is the classification for diarrhea?
More than 3 loose stools per day. There may be intestinal cramping due to increase in peristalsis and there may be blood in the stool.
109
What can manual evacuation of stool trigger?
The vagal nerve which could potentially lower the BP
110
What is the main cause of excessive flatulence ?
Malabsorption which could potentially be related to pathology such as celiac disease, Crohn's disease, ulcerative colitis.
111
What are gas forming food?
Allium family : onions, garlic , scallions,
Cruciferous family : cauliflower, Brussel sprouts, broccoli
Alcohol, chocolate, fatty foods.
112
Which side of the stomach will an Ileostomy be on?
Always the right side.
113
With ileostomy, what consistency will the stool be and what should the patient be encouraged to do?
The stool will be loose and the patient should be encouraged to drink fluid to replace fluid loss.
114
Is it painful for the patient if we touch the stoma?
No, because there are no nerve endings in the stoma.
115
When should you empty the colostomy bag?
When its 1/3 full.
116
when you measure the stoa when changing the appliance, how much bigger do you want to cut the hole in the wafer?
1/8 - 1/16 - no bigger than 1/8
