Week 6 Urinary and Bowel Flashcards
What are the functions of the kidneys
- filter wastes, toxins, excess ions, and H2O
- help regulate blood volume, BP, electrolytes, acid-base
- secondary functions erythropoietin, secrete renin and activate vitamin D3
What is the primary job of the nephron
formation of urine
What is the process of urinary elimination
- filling of bladder (200 to 450 mL of urine)
- activation of stretch receptors in bladder wall
- signaling to the voiding reflex center
- contraction of detrusor muscle
- conscious relaxation of external urethral sphincter
Explain typical urinary patterns
- 50-60mL of urine/hour
- five to six times per day
- normal specific gravity 1.002 to 1.030
What are some life span considerations for older adults
- kidney function decreases
- urgency and frequency common
- loss of bladder elasticity and muscle tone leads to nocturia and incomplete emptying
What are the factors that affect urinary elimination
- personal
- sociocultural
- environmental
- nutrition
- hydration
- activity level
- medications such as diuretics, anticholinergic, and nephrotoxic meds
- surgery and anesthesia
What are pathological problems that can affect urinary elimination
- bladder/kidney infections
- kidney stones - renal calculi
- hypertrophy of the prostate (benign prostatic hyperplasia)
- mobility problems
- cardiovascular and metabolic disorders (decreased blood flow through glomeruli)
- neurological conditions
- communications problems
- alteration in cognition
What are things that you can do to promote normal urination
- provide privacy with curtains or doors
- assist with positioning (males = standing, women = seated upright)
- facilitate toileting routines (identify the client’s pattern)
- promote adequate fluids and nutrition
- assist with hygiene
What are the common urinary studies
- freshly voided specimen
- clean catch
- sterile specimen
- 24 hr urine
- urinalysis
- dipstick testing
- specific gravity
- serum (creatinine, blood urea nitrogen, glomerular filtration rate)
What are the alterations in urinary elimination
- UTIs
- urinary retention
- urinary incontinence
- urinary diversion/urostomy
What are the risk factors for impaired urinary elimination
- sexually active women
- use spermicidal contraceptive gel
- older women
- pregnant women
- enlarged prostate
- presence of indwelling catheter
- kidney stones
- diabetes mellitus
- immunocompromised
- history of UTI
What are the symptoms related to impaired urinary elimination
- bladder spasms
- burning with urination
- chills
- dysuria
- edema
- fever
- flank pain due to kidney infection
- foul smelling urine
- hematuria
- urinary frequency
What are the evaluations (lab tests) you would do for impaired urinary elimination
- midstream, clean catch urine specimen for culture
- dipstick urine looking for leukocytes, blood, estrace, and nitrates
- negative dipstick does not rule out UTI
What are the treatments for impaired urinary elimination
- antibiotic treatment
- cystitis (symptomatic) oral
- pyelonephritis IV antibiotics
- phenazopyridine
- liberal fluid intake
What are the nursing interventions for urinary elimination
- prevention (remove catheter ASAP)
- teaching
- 8 to 10 8 ounce glasses fluids
- urinate when feel urge
- wipe front to back
- wear cotton underwear
- urinate after intercourse
- avoid spermicidal - if history of UTI
- avoid bubble baths
- report symptoms promptly
What are reasons for urinary retention
- obstruction in urinary tract
- neurological problems
- medications and anesthesia
- musculoskeletal
- psychological
What are the acute urinary retention symptoms
- urinary hesitancy, dribbling, or weak urine stream
- urgent need to urinate
- pain, discomfort, bloating in lower abdomen
What are the chronic urinary retention symptoms
- urinary frequency
- trouble beginning a urine stream
- weak or an interrupted stream
- urgency, but with little stream
- feels urination urge, even after voiding
- mild, constant discomfort in lower abdomen
What are the managements for urinary retention
- monitor for distention
- measure post-voiding residual
- drain the bladder either with straight catheter, indwelling catheter (foley), or suprapubic catheter
What are patient teaching things you can do for managing urinary retention
- crede’s maneuver
- pelvic floor muscle exercises
- intermittent self-catheterization
- contact healthcare professions if: complete inability to urinate, fever, vomiting, pain, chills, or blood in urine
What are the managements of urinary incontinence
- prevent skin breakdown
- encourage/teach lifestyle modifications
- implement bladder training
- encourage client to perform kegel exercises
- use anti-incontinence devices as needed
- strategies to promote independent urination such as: pharmacological interventions, surgical interventions, parental teaching for enuresis
What are the structures of bowel elimination
- upper gastrointestinal tract
- small intestine
- large intestine
- rectum and anus
What are the factors affecting bowel elimination
- developmental stage
- personal and sociocultural factors
- nutrition/hydration/activity
- medications
- surgery and procedures
- pathological conditions including neurological disorders, cognitive conditions, and pain or immobility
What are the common diagnostic tests for bowel
- radiographic views (flat plate of the abdomen)
- direct visualization (colonoscopy or sigmoidoscopy)
- laboratory studies (stool for occult blood)
- nursing responsibilities/patient preparation for tests
What are the normal stool characteristics and variations that occur with frequency, color, shape, consistency, and odor
- frequency: Normal = 2-3 BMs/week
Variations:
- hypermotility = >6 stools/day
- hypomotility <1 stool/week - color: normal = brown
Variations:
- white or clay colored = absence of bile or use of antacids
- light brown = diet high in milk or low in meat
- pale, fatty stool (steatorrhea) = malabsorption of fat
- black, tarry stool (melena) = iron medication, GI bleeding
- red stools (hematochezia) = lower GI bleeding or hemorrhoids
3. Shape: Normal = 2.5cm in diameter Variations: - narrow, pencil shaped - intestinal obstruction or constipation - small marble shaped - slow peristalsis
- consistency: Normal = formed, soft, moist
Variations:
- hard stool = constipation, dehydration
- liquid stool = diarrhea, rapid peristalsis - odor: normal: pungent, affected by foods
Variations:
- strong foul odor
- blood in stool or infection
What are some things you can do to promote regular defecation
- privacy
- correct position (seated upright)
- timing (often occurs after meals; some clients may need assistance)
- fluid intake
- proper diet (fresh fruits, vegetables, whole grains, fiber)
- exercise/physical activity (three to five times a week; range of motion for clients on bedrest)
What are the common alterations in defecation
- diarrhea
- constipation
- fecal impaction
- bowel diversions
What are the risk factors, assessments, and complications of diarrhea
Risk factors:
- contaminated food
- viral infection
- dietary change
- side effect of medication
- psychosocial, behavioral
Assessment:
- bowel pattern
- dietary pattern (spiced, fatty, fiber)
- fever, nausea, vomiting
- skin mucous membranes
Complications:
- fluid and electrolyte imbalance (K+)
- impaired skin integrity
What are the risk factors, assessments, and complications for constipation
Risk factors;
- short term = lifestyle factors
- long term = physiological factors
Assessment:
- subjective = abdominal pain, tenderness, loss of appetite, rectal pressure, fatigue, indigestion
- objective = abdominal distention, blood with stool, decreased stool frequency and volume, hard stools, hypo or hyperactive bowel sounds
Complication:
- hemorrhoids
- tears in the colon wall or anus
- anal bleeding
What are the risk factors, assessments, and complications for fecal impaction
Risk factors:
- prolonged constipation
Assessment:
- constipation plus liquid stool and vomiting
- severe symptoms tachycardia, dehydration, fever, agitation, confusion, urinary incontinence
Complication:
- tears in the colon wall or anus
- anal bleeding
What are the managements for diarrhea
- monitor stools to quantify diarrhea
- assess and monitor for fluid imbalance
- monitor for alterations in perineal skin integrity
- proper dietary teaching (clear liquid, bananas, rice, applesauce, toast BRAT, foods to avoid)
- antidiarrheal medications: not recommended for acute diarrhea, Lomotil, Imodium, teach clients about over the counter aids, not used very often (never used for kids)
What are the managements for constipation
- increase intake of high fiber foods
- increase fluid intake
- increase activity/exercise
- provide privacy
- help client to a position that facilitates defecation (ideally seated position)
- allow uninterrupted time
- offer laxatives when lifestyle changes are ineffective to avoid body becoming accustomed to drugs
What are the managements for bowel incontinence
- monitor bowel pattern and skin breakdown, redness or irritation
- toileting (uninterrupted time, or attempt at regular intervals and time most likely to occur)
- skin care: change ASAP, prompt hygiene care, keep skin scrupulously clean, use skin protection products
- absorbent products: pads and shield; never refer to incontinence pads as diapers
- fecal drainage device
- bowel training
What are the advantages and limitations of external collection devices used for bowel incontinence
Advantages: prevent skin breakdown, minimize odor, track output accurately, and enhance patient comfort
Limitations: not for ambulatory, agitated, or active clients - dislodged, causing skin breakdown
What are the advantages and disadvantages/precautions of internal drainage devices used for bowel incontinence
Advantages: protect perianal skin, protect caregivers from potentially infectious stool, decrease urinary tract infections
Disadvantages and precautions: FDA approved, only 29 consecutive days, and not for pediatric patients. Other contraindications include severe hemorrhoids, recent bowel, rectal, or anal surgery or injury, rectal or anal tumors, stricture or stenosis; pressure directly on colon wall
What are the points to remember when establishing a bowel training program
- plan program with the client
- increase fiber in diet gradually
- increase fluid intake to eight glasses of water per day
- establish a designated time for defecation
- privacy should be provided for the client
- the treatment plan should be staged
- the treatment may include a stool softener
- the plan should be modified based on client results
What are the managements for a bowel diversion
- stoma assessment and care
- pay strict attention to skin care/periostomal skin assessment
- monitor the amount and type of effluent (contents of what is coming out; dependent on what part of the bowel the stoma is placed in) - be attentive to client’s psychosocial needs
- be professional; show acceptance
- attend to odor control
- address client participation in ostomy care - client teaching for home care
- dietary changes associated with an ostomy
- changed when 1/3 full to prevent leaking
- be aware of when the patient has gas because it can fill with warm air and cap can pop off and cause a mess
What are the general dietary guideline for ostomies
- may begin with bland, low residue or soft diet for 1-2 months (to allow body to adapt)
- eat three or more meals at regular times
- drink additional fluids
- avoid chewing gum
- avoid foods that cause gas, odor, blockage or loose stool
- chew food well
- avoid excessive weight gain (can affect where the stoma is coming out of)
What do you include for the liquids that are consumed?
- includes anything that is liquid at room temperature
- juice
- water
- ice chips (melts to half its volume)
- drinks (coffee, soft drinks, tea)
- milk
- gelatin (Jell-O)
- broths
- ice cream
- frozen treats: popsicles, sorbet
- nutrition supplements like ensure or boost
What are the factors that can impact urinary elimination
- coronary artery disease
- dementia
- DM
- HTN
- immobility
