USCR Elimination Flashcards
What is elimination?
Excretion of waste products by the skin, kidneys and intestines.
What to look for in an assessment for elimination?
Client’s Health History
Interview (BCF data: subjective)
Physical Examination
(objective data)
Diagnostic and laboratory studies
Urinary elimination depends on what 4 urinary tract organs?
Kidneys (filter urine)
Ureters
Bladder
Urethra
factors influencing urination?
Age Psychosocial factors* Fluid and food intake Medications Muscle tone and activity Pathological conditions Surgical and diagnostic studies
What to look for in bladder assessment?
empty bladder distended bladder urinary retention retention with overflow incontinence
What is a distended bladder?
full, palpable bladder
What is urinary retention?
inability to void or empty bladder completely
what is retention with overflow?
small amount of urine escapes bladder despite retention
what is incontinence?
involuntary urination)
(symptom of something else going on)can be due to physiological, neurological disorders
normal frequency of urine elimination?
5-7 times/day
Normal urine output= 1500-1600 mL/24 hours; about 500 mL/4 hours; at least 30 mL/hr
What is dysuria?
painful or difficult urination (UTI is most common cause of dysuria)
what is urgency?
increased urge to void
what is hematuria?
blood in urine
what is nocturia?
excessive urination during the night
what is hesitancy?
inability to induce urinary flow
what is dribbling?
inability of urinary sphincter to contract completely resulting in drops of urine
what is polyuria?
increased urination (>3L of fluid in 24hr) usually seen in diabetes mellitus water follows glucose out during filtration, too much glucose to reabsorb=incr water loss=incr urine); or diabetes insipidus (disorder of urine concentration).
What to look for in assessment of urine?
colour (straw colour –> tea colour)
clarity (clear –> cloudy –> turbid)
odour (no smell –> strong nitrate)
quantity (drips –> 1L+)
Urine test?
Sterile container for C&S (culture & sensitivity)
Culture to identify microorganism
Sensitivity to identify antimicrobial/antibiotic the microorganism is sensitive to.
dipstick
action demand for urine?
Maintain normal urinary
elimination by:
assuming normal positioning for urination, e.g. standing for men squatting for women
Taking time to void
voiding when the urge arises (don’t ignore it).
maintaining privacy if required
practicing proper hygiene (wipe front to back) to prevent UTI.
drinking at least 2 L of fluid to prevent UTI and ensure quantity of urine.
voiding immediately after sexual intercourse to prevent UTI.
what is bowel elimination?
Elimination of the waste products of digestion from the body is essential to health
factors affecting bowel elimination?
age diet fluid intake activity psychological factors defecation habits medication diagnostic procedures anaesthesia and surgery pathological conditions pain Food and fluid intake Exercise Laxatives
what is constipation?
<3 stools/week
what is impaction?
unrelieved constipation
what is diarrhea?
increased frequency of defecation
risk of dehydration
what is fecal incontinence?
large amount of loose, water stools (IBS) chronically loosing too much fluid
what is flatulence?
passing gas
what are hemorrhoids?
dilated, engorged veins in lining of rectum
can cause discomfort and pain + bleeding
What to look for in abdominal assessment?
Look (slightly convex, distended, smooth)
Listen (auscultate)
Feel (palpate for masses or tender areas)
Before doing physical assessment, make sure to have a detailed health history; that is, the patient’s assessment of their normal frequency, stool characteristics (formed, hard, liquid), pain (location, type) and self-care habits (fiber, fluids, laxatives, exercise).
abdominal assessment?
Abdomen: distended soft/hard pain sounds
Abdominal quadrants Right upper Left upper Right lower Left lower
bowel sounds?
Are heard in all quadrants
Usually are high pitched
Occur irregularly 5-35 times per minute
**Bowel sounds are auscultated before palpation of abdomen. Can anybody tell me why that is?
when you start palpating, you are stimulating the bowel and you will get a false auscultation reading
stool assessment?
color, consistency, shape, odor, frequency
3x/week-3x/day is normal range to go
melenia: black tarry stool = bleeding in upper intestinal track
grey/white stool: obstruction of bowel tract
stool laboratory tests?
ova & parasites
Culture will produce many bacteria; labs looking for those that may cause pathological conditions.
Sensitivity of pathogen to specific antibiotics.
Test for occult blood?
Hemoccult: test specifically for occult or hidden blood in the stools, which is the result of GI bleeding that is not visible to the naked eye.
what is documented in client chart?
Last BM recorded
Medications taken for BM
Enema given
action demand for dedication?
Promote normal defecation by:
taking time to defecate responding to the urge to defecate eating a diet high in fibre drinking at least 2000 mL fluid/day exercising daily avoiding the regular use of laxatives
functions of the skin?
Protects from injury and passage of micro organisms
Regulates body temperature
Secretes sebum – softens & lubricates skin
Transmits sensations – pain, temperature, touch & pressure
Produces vitamin D
FACTORS AFFECTING SKIN INTEGRITY?
immobility (pressure sores) inadequate nutrition, hydration fecal and urinary incontinence decreased mental status diminished sensation excessive body heat advanced age
Skin Assessment?
colour turgor intact cleanliness/odour texture temperature (warm/cold) moisture edema
Skin Assessment?
changes in skin
e.g. colour
texture
edema
itchiness
any lesions
changes in lesions or molesSelf Care Practices for sun?
How much time in the sun? Use of sun screen? Use of sun lamps? Wears hat in sun? Hygiene practices at home: -frequency of bath -type of soap -moisturizer
Action demand for skin?
Maintain elimination processes through good skin integrity by:
practicing proper hygiene, e.g. don’t use rough soaps, moderate water temperature.
eating a well balanced diet, e.g. protein builds tissues.
doing regular exercise.
drinking adequate fluid
intake (2 L / day).
action demand for sun protection?
Protect the skin from sun and cold: SUN sunscreen at least 15 SPF and containing both UVA and UVB protection wear hat in the sun cover arms and legs stay indoors when sun is strongest
action demand for cold weather?
wear warm clothing
cover face, ears
prevent metal from touching skin
what is menstruation?
A discharge of blood, secretions, and tissue debris from the shedding of the endometrium from the non-pregnant uterus that recurs at approximately monthly intervals.
what to look for in menstruation assessment?
Duration of period = average 3-5 days
Regular periods = average 28 days
intervals
Menarche = first menstruation (onset)
Menopause = period which marks the permanent cessation of menstrual activity.
menarche?
first menstruation (onset)
menopause?
period which marks the permanent cessation of menstrual activity
menstruation assessment?
colour = bright red –> brown
amount = spotting –> heavy
odour = slight smell
what is amenorrhea?
absence or suppression of menstruation (including pregnancy, lactation, & menopause or illness/ pathology)
what is dysmenorrhea?
pain associated with menstruation
menorrhagia?
abnormally heavy or prolonged bleeding, interfering with normal ADL (soaking more than 1 sanitary pad per hour for several hours); may show signs of anemia
metrorrhagia?
bleeding between periods
self care practices for menstruation?
Hygiene
Comfort measures
Exercise
Sex when menstruating
products that can cause vaginal infection?
Use of: major causes of infections deodorized tampons, pads douches vaginal sprays bubble bath super-absorbent tampons (Toxic Shock Syndrome)
toxic shock syndrome?
S & S: A sudden high fever.
Low blood pressure (hypotension)
Vomiting or diarrhea.
A rash resembling a sunburn, particularly on your palms and soles.
Confusion.
Muscle aches.
can cause death!
