week 10 : elimination

Question 1

elimination is…..

Answer 1

excretion

Question 2

what is elimination about….

Answer 2

waste formation, waste excretion

Question 3

what happens when you have a urinary tract problem

Answer 3

kidney is not working well

Question 4

age related changes in the urinary tract

Answer 4

optimal blood perfusion tot he kidenys about 1 litre pre minute

by age 80, renal blood flow reduces to about 600 mL/minute

decreased functioning nephrons by about 50%

decreased bladder capacity ( from 300- 500 ml to 200-300 ml) leads to urinary frequency

decreased estrogen in post menopausal women affects the urinary structure ( estrogen receptors in the bladder)

Question 5

true or false. Connective tissue replaces the smooth muscle in the bladder this is relevant to the age related changes in the urinary tract

Answer 5

true

Question 6

weakening of the pelvic floor muscles is related in age changes in the urinary tract . true or false.

Answer 6

true

Question 7

select all that is true

age related changes in the urinary tract

hypertrophy of the muscles in the urinary tract

reduced renal reserve- more susceptible to fluid and electrolyte imbalance and kidney damage due to medications and other external stressors

Answer 7

this is all true

Question 8

what is the renal reserve?

Answer 8

extra execratory capacity

Question 9

Is this true or false. Reduced secretion of anti-diuretic hormone so less able to concentrate urine

Answer 9

this si true

Question 10

Increased time between urge to void and actual need to void is true in terms of age related changes in the urinary tract.

Answer 10

false. it decreases

Question 11

Re-call the age age related changes in the urinary tract :
▪Reduced secretion of anti-diuretic hormone (ADH) so less able to concentrate
urine
▪ Decreased time between urge to void and actual need to void
what characteristics are there?

Answer 11

▪ Enlargement of the prostate gland in men, i.e. BPH (benign prostatic hyperplasia)

▪ Kidney filtration rate is less efficient (less efficient response to dehydration)

▪ Diminished thirst perception – directly affect the older adult’s hydration status

Question 12

True or false. In the absence of disease, an older adult can produce urine sufficiently…

Answer 12

true

Question 13

benign prostate hyperplasia what happens with older men?

Answer 13

as men get older ( this gets bigger inside) which indicates that it is higher risk for urinary infection

Question 14

risk factors : impaired elimination
name 5 examples

Answer 14

age

neurologic impairment - brain or spinal cord trauma

cognitive impairment - lacks of perceptual ability to perceived the ned to urinate or defecate e.g : dementia

medical conditions - stroke, infections ( for example , UTI - very common among older adults and residents in personal care homes), arthritis etc.

adverse medications effects e.g opoids

Question 15

Select all that is true amongst risk factors: impaired elimination

▪Lifestyle e.g. caffeine (irritate bladder), smoking (irritate bladder), alcohol
(sedation influences confusion, immobility; diuretic)
▪ Environment – hazards/obstacles which prevent older adult from getting to the bathroom safely
▪ Diminished mobility – slower movement, decreased strength/range of motion, use of devices, may need increased assistance from social support or health care worker
▪ constipation is normal

Answer 15

the last one is false, constipation is not normal, THIS IS ONLY A MYTH

Question 16

name some issues of retention ( 2)

Answer 16

alteration in urinary elimination

urinary bladder fills but external sphincter does not open for release of urine : urine volume builds, leading to bladder distention; may be caused by certain medications and or psychosocial factors

Question 17

True or false. Important : in the absense of risk factors, healthy older adults experience few negative consequences of urinary elimination.

Answer 17

true

Question 18

alteration in bowel elimination could be one of the issues of retention ?

Answer 18

yes this is true

Question 19

Issues of retention : retention of stool rectum leads to what ?

Answer 19

leads to drying and hardening of stool and then constipation

Question 20

Sign of fecal impaction is series of small episodes of what ?

Answer 20

bowel incontinence

Question 21

with fecal impaction, digital disimpaction (using fingers ) may be needed. is this true or false.

Answer 21

this is true.

Question 22

True or false. Constipation is an age related change.

Answer 22

FALSE IT IS NOT!!! this is important, will be a question in the finals.

Question 23

Retention : Possible complications
Stool retention :
this can lead to what ?

Answer 23

can lead to constipation, pain, loss of appetite, nausea, and vomiting.

Question 24

True or false. Retention : Possible complications : Stool retention

• severe complication : ileus- loss of peristaltic activity

Answer 24

true

Question 25

True or false. Risk of bowel perforation is not life threatening, this is something we can manage.

Answer 25

false, this is life threatening.

Question 26

Retention: Possible Complications Urinary Retention: name the characteristics

Answer 26

▪ Pain, chronic bladder infection, and bladder distention ▪ Bladder distention can lead to “backflow” which can result in pyelonephritis (inflammation of the kidney secondary to a bacterial infection) and renal failure

Question 27

Age-related Changes: Constipation (Retention) Alteration in Bowel Elimination define if this is true or false. Age-related changes lead to the slowing of digested material through the GI Tract, i.e., atrophy of smooth muscles in the colon, reduced secretions, reduced tone of internal/external sphincters, and reduced neural impulses

Answer 27

this is true

Question 28

Age-related Changes: Constipation (Retention) Alteration in Bowel Elimination: Dietary patterns that include adequate ____ and ____ will minimize the risk for constipation.

Answer 28

fiber and fluid

Question 29

Risk factors: Constipation name them

Answer 29

▪Poor diet (inadequate intake of bulk, fiber and fluid) ▪ Medications (including long-term laxative use) Reality is a high percentage of PCH residents take laxatives. ▪ Lack of activity (lack of mobility) ▪ History of constipation ▪ Poor oral health and ill-fitting dentures (decrease intake)

Question 30

Interventions for Constipation : ( this is going to be in the final exam, so study!!! this ) precipitating factors : Physiological : dehydration , insufficient fibre intake, poor dietary habits precipitating factors : functional : decreased physical activity inadequate toileting irregular defecation habits irritable bowel disease

Answer 30

prevention : physiological : encourage fluid intake of 1,500 - 2,000 mL per day and fibre intake of 25-30 per day prevention : functional : encourage physical activity tailored to the person; promote regular and consistent toileting daily , based on the person's triggering meal ; assess and obtain information about functional factors related to constipation

Question 31

For the mechanical precipitating factors below: name the interventions for constipation abscess or ulcer fissures hemorrhoids megacolon pelvic floor dysfunction post surgical obstruction prostate enlargement rectal prolapse rectocele spinal cord injury structures

Answer 31

assess and obtain information about mechanical factors related to constipation, and complete a physical assessment.

Question 32

Precipitating factors : of lack of abdominal muscle tone obesity recent environmental changes poor dentition what are the interventions for this that could be possible cause constipation

Answer 32

assess and obtain information related to constipation, and complete, a physical assessment.

Question 33

Precipitating factors : of Psychological : avoidance of urge to defecate confusion, depression, emotional stress, what are the interventions for this, that could be possible cause constipation

Answer 33

assess and obtain information on psychological factors related to constipation.

Question 34

precipitating factors : of systemic : diabetic neuropathy, hypercalcemia, hyperparathyroidismm hypokalemia, porphyria, uremia, parkinson's disease, cerebro-vascular disease, defective electrolyte transfer what are the interventions for this that could be possible cause constipation

Answer 34

assess and obtain information and dietary history on systemic factors related to constipation

Question 35

Precipitating factors : of pharmacological : ace inhibtors anatcids: calcium carbonate aluminum hydroxide antiarrhythmics anticonvulants antidepressants anti-parkinson's disease medications calcium channel blockers calcium blockers diuretics iron supplements overuse of laxatives non steroidal anti-inflammatory drugs opilates phenothiazines sedatives

Answer 35

review medications and identify those associate with increase risk for constipation ( e.g long term use for laxative use ).

Question 36

types of urinary incontinence ( loss of control ) alteration in urinary elimination : what are the different types of incontinence ?

Answer 36

stress urge overactive bladder functional overflow mixed transient

Question 37

types of urinary incontinence ( loss of control ) stress urge overactive bladder what is the description for these types of incontinence

Answer 37

description : stress: leakage of small amounts of urine during physical movement ( coughing , sneezing, exercising ) urge : leakage of large amounts of urine at unexpected times, including during sleep overactive bladder: urinary frequency and urgency, with or without urge incontinence

Question 38

types of urinary incontinence ( loss of control ) functional overflow mixed

Answer 38

functional : untimely urination because of physical disability, external obstacles, or cognitive problems that prevent person from reaching toilet. overflow : unexpected leakage of small amounts of urine because of full bladder mixed : usually occurrence of stress and urge incontinence together

Question 39

true or false. transient is a type of incontinence, define if this is a true description : leakage that occurs temporarily because of a situation that will pass ( infection, taking a new medication, colds with coughing )

Answer 39

this is true

Question 40

interventions for urinary incontinence : (behavioural) name the categories

Answer 40

scheduled voiding prompted voiding pelvic floor exercises bladder training

Question 41

interventions for urinary incontinence : (behavioural) define if this is true or false. scheduled voiding: based on voiding patterns from bladder diary or common voiding patterns, typically every 2 to 4 hours, treat: urge and functional UI

Answer 41

true

Question 42

interventions for urinary incontinence : (behavioural) define if this is true or false. prompted voiding : scheduled voiding with prompting and verbal reinforcement ( positive )

Answer 42

true

Question 43

interventions for urinary incontinence : (behavioural) define if this is true or false. pelvic floor exercises (kegel): repeated voluntary contraindications, treat stress, urge, and mixed UI

Answer 43

this is true

Question 44

interventions for urinary incontinence : (behavioural) define if this sis true or false. Bladder training: increasing and time between the urge to void and voiding, treat urge incontinence

Answer 44

this is true

Question 45

using a bladder diary is what ?

Answer 45

this is the gold standard for obtaining objective information about voiding patterns ( paper- based or app based )

Question 46

is this in the bladder diary ? bladder and bowel routines but also other related factors ( pain, difficulty stopping and starting )

Answer 46

yes this is included

Question 47

Character of the urine (colour, odour, sediment, clear) and Record of incontinence can also be included in the bladder diary . True or false.

Answer 47

this is true

Question 48

Interventions : urinary incontiennce lifestyle modifications define if these are true or false. fluid intake, caffeine, weight reduction, smoking, bowel management, physical activity.

Answer 48

all true

Question 49

NEVER refer to incontinence products as “diapers” (always maintain personhood). true or false.

Answer 49

true

Question 50

Interventions : urinary incontinence In-dwelling (continuous), intermittent, or external condom catheters ▪ Higher risk of urinary tract infection with long-term use ▪ May be needed short-term: relieve urinary retention, close monitoring of urine output or to assist with wound healing ▪ May be long-term for patients unable to excrete urine without an indwelling or intermittent catheter secondary to neurological condition, blockage, etc. are these true ?

Answer 50

yes this is true

Question 51

Diarrhea (Bowel Incontinence) Alteration in Bowel Elimination: name some characteristics

Answer 51

Frequent passing of watery, liquid, and loose stools ▪ Acute or chronic ▪ Acute diarrhea caused by a virus or bacteria ▪ Chronic diarrhea caused by an underlying disease, i.e. irritable bowel disease (covered in patho/pharm course).

Question 52

Are these true according to diarrhea ( bowel incontienence ) alteration in bowel elimination : ▪ Other causes: medications, lactose intolerance, post-surgery ▪ Clinical considerations: - If possible, identify/treat underlying cause. - Monitor input and output, lab values, and symptoms of dehydration/electrolyte imbalance - Delirium in an older adult may be caused by dehydration/electrolyte imbalance secondary to diarrhea.

Answer 52

yes it is true

Question 53

a sign of fecal impaction is series of what ?

Answer 53

small episodes of bowel incontinence

Question 54

___ still is bypassing around hard impacted stool

Answer 54

liquid stool

Question 55

The CHAMMP tool has been developed by certified wound, ostomy, and continence nurses to assess continence and guide individualized interventions : now define what CHAMMP stands for

Answer 55

C: Continence H: History (Medical/Surgical) A: Assessment of Urinary Incontinence M: Medications M: Mobility Status P: Plan of Care