Wk 11 - GI/GU Flashcards
What is the functional part of the kidneys?
Filters 180L/day and only 1% is excreted as urine
What is the functional unit of the kidneys?
the nephron
Kidneys
- F & E balance
- Drug Metabolism
- Bone health
- BP control
- Remove waste
- RBCs
Kidney Functions
Remove waste
serum (blood) lvls build up
elevated urea (BUN)/Cr
Drug Metabolism
may need to alter medication dosages
Fluid/Electrolyte Imbalance
F/E balance
Failure = retention/elevated electrolytes
Blood Pressure
Renin – vasoconstriction and fluid and Na+ retention
RBCs
erythropoietin
decreased production can lead to anemia
Bone Health
- bone disease
GU Function - Normal
- Micturition - “void”
- normal output of 30mL/hour minimum
- 1-2L/day
- clear/yellow urine
- continent
How bladder works?
- Bladder fills-sensory nerves signal the brainstem.
- Forebrain activity controls voluntary micturition.
- Afferent signals result in simultaneous contraction of the bladder and relaxation of the sphincter.
How does functional unit change with age?
nephron decreases with age
…
What are some changes that occur in the bladder with ageing?
- bladder capacity = hardening and less elasticity
- bladder strength
- may have difficulties emptying/emptying fully leaving a PVR of over 50 (which is the norm)
PVR
- post-void residual
- what is left in the bladder after peeing
Kidney Damage
- may produce back pain
- can lead to fluid retention
- can impact output (polyuria, oliguria, hematuria, dysuria, anuria)
Uria =
Poly =
Olig =
Heme =
Dys =
urine
lots
little
blood
difficult
Examples of impaired kidneys
- increased Ca reabsorption = decreased bone health
- too much Renin = HTN
- decreased RBC production = anemia
- F/E imbalance = edema
What can impact urination?
- Psychological factors
- Sociocultural factors
- Fluid balance
- Diagnostic examination
- Surgical procedures
- Pathological conditions
- Medications
UTI
Urinary tract infection
Urinary Incontinence
involuntary leakage of urine
Cystoscopy
diagnostic exam for looking in bladder
Nocturia
waking at night to urinate
Urinary retention
accumulation of urine caused by the inability of the bladder to empty
Urinary diversions
diversion of urine to external source
Renal failure
Continence can be related to
neurology or mobility
Common Alterations in GU
- Urinary tract infections
- Urinary incontinence
- Nocturia
- Urinary retention
- Urinary diversions
- Renal failure
Causes of urinary retention?
- prostate enlargement
- tumor
- etc.
Kidney damage can be caused by
- diabetes
- HR
- HTN
Cystitis
infection of the bladder/lower urinary tract
causes inflam
Pyelonephritis
aka pyelo infection of the kidney/upper urinary tract
Bacteremia
bacteria has spread to the blood stream - urosepsis
Risk factors of UTI
- delirium
- using a catheter
- pregnancy
- sex
- incontinence
- urinary retention
- low estrogen (post menopause)
- diabetes
- immobility
- surgery lower abdomen
CAUTI
Catheter Associated UTI
UTI S&S in Adults
- Dysuria
- Nocturia
- Urgency (due to cystitis)
- Frequency
- Hematuria or cloudy foul smell
- Fever/chills (later)
- N/V, fatigue (later)
- Pain back/side/groin - pyelonephritis
- Costovertebral angle (CVA) tenderness – pain with pressure to the kidney area - pyelonephritis
Dysuria
painful urination
Cystitis
inflamed bladder
Hematuria
blood in the urine - may or may not visible
What is most common HAI
UTI
UTI S&S in Older Adults
- May exhibit some/no signs & symptoms experienced in adults
- Change in LOC ***
- Confusion
- Delirium
- Agitation
- Behaviour change
- Falls
How do we test Urine directly?
- routine urine aka urinalysis (RU)
- culture and sensitivity (C&S)
- 24 hr. (kidney function)
RU
Routine Urine
C&S
Culture and Sensitivity
Non-invasive diagnostics
- bladder scan/PVR
- renal US
Invasive Diagnostics?
- cystoscopy
What would be important to check in lab results
- blood urea nitrogen (BUN)
- Creatine (Cr)
- estimated glomerular filtration rate (eGFR)
- can also check other blood work related to infection - WBC, platelets, RBC
UTI Treatment
- Fluids
- Antibiotics
UTI Prevention
- Adequate hydration
- Movement
- Incontinent care***
- Caution with indwelling catheter
eGFR
estimated glomerular filitration rate
BUN
blood urea nitrogen
GI System
- Mouth
- Esophagus
- Stomach
- Intestines
Mouth
- mastication
- mix w/ saliva
Esophagus
Peristalsis
moves food down
Stomach
stores and mixes
SI/LI
absorb water and nutrients
Mechanical/Chemical forces of Mouth
- Teeth
- Saliva
- Lips
- Tongue
- Epiglottis
Saliva
dilutes and softens
starts carb digestion
Secondary Peristalsis
food doesn’t go down and it relaxes below the food and contracts above to push it down
Tertiary Peristalsis
pain brought on by stomach acid
Stomach turns food into
chyme
Stomach empties 1st-last?
water
carbs
proteins
fats
Parts of Intestine
- Duodenum
- Jejunum
- Ileum
Duodenum
- Secretin (stimulates pancreas to release bicarb) and cholecystokinin (stim pancreas to release protease, amylase, lipase)
- With lots of fats more cholecystokinin is released getting more help from the gallbladder to release bile. - pancreatic duct- fats= emulsified fats (broken down into milky substance)
Jejunum
absorb carbs/protein
Ileum
absorbs water, vitamins, iron, fat, bile salts
Gastrocolic reflex
food causing peristalsis
Ileum connects to
cecum
Process of defecation
Distension causes relaxation of the internal anal sphincter and signals an awareness of the need to defecate.
At the time of defecation, the external sphincter relaxes and abdominal muscles contract to force the stool out.
How often should one defecate
after every meal
GI - Normal
- 3-4x/day
- colour (palate)
- consistency
- soft abdomen (should be)
- bowel sound (BS) x4 (5-30/min)
- tolerating food and fluids
Factors influencing defecation
- Diet - FIBER
- Fluid intake (or loss)
- Physical activity
- Personal bowel elimination habits
- Privacy
Age related changes in GI
Decreased:
- Saliva production
- Motility
- Parietal cells – decreases B12, Fe, Ca, folic acid absorption
- Sphincter tone
Degeneration of gastric mucosa
Atrophy of intestinal muscle
Norewalk
direct contact (person to person), indirect (from contaminated object), reservoir (food/water/infected human), vehicle transmission (food/water)
Rotavirus
viral infection, non-bacterial food borne illness
C.Diff
causes colitis
- “col”=colon & “itis”= inflammation.
Common GI Alterations - Acute Medica Concerns
- Pain
- Pelvic floor trauma
- Acute illness, surgery, anesthesia
- Medications
- Enteral feeding
Acute/Chronic Causes of Constipation
- dehydration
- medications (narcotics, polypharmacy)
- too much soluble fibre
- immobility (paralysis)
- poor water intake
- poor fibre intake
- many health conditions
Constipation
defined as any two of the following features:
- straining
- lumpy hard stools
- sensation of incomplete evacuation
- use of digital maneuvers
- sensation of anorectal obstruction or blockage with 1/4 of BMs
- decrease in stool frequency (less than 3 BMs/week)
Constipation S&S
- infrequent stools
- ## difficulty with stool passage
GI Complications
Constipation
- Hemorrhoids
- Anal fissure
- Fecal impaction
- Rectal prolapse
- Bowel obstruction
Diarrhea
- Dehydration
- IAD type irritation
- Electrolyte imbalances
- Decreased intake
What electrolyte are we worried about losing?
Potassium
Diarrhea
multiple loose stools/day
Acute: food, travel, viruses
Chronic: allergies/intolerances, medication, IBS
Colo-
large intestine
Ileo -
small intestine
Uro-
urinary
Ostomies - Bowel/bladder diversions
Colo- large intestine
Ileo- small intestine
Uro- urinary
Poop Colors
Any shade of brown - you’re good
A little green - okay!
Super green - you ate greens OR its passing too fast
Black - you ate licorice, iron supplements, or bismuth medications OR bleeding in upper intestinal tract
Pale, White, Clay-coloured - your bile duct may be blocked
Red - you ate red things OR hemorrhoids OR bleeding in lower intestine
Yellow - too much fat, malabsorption, celiac disease on your diet
GI Diagnostics
Fecal specimens
- Fecal occult blood (FOB), FIT now used for Ca screening (fecal immunochemical test)
- Culture & sensitivity (C&S)
- Ova & parasites (O&P)
x-ray, CT scan
Colonoscopy, endoscopy
CT+
CT w/ contrast
- hard on kidneys
Diff b/w colonscopy/endoscopy
Which end
Endosc. - through mouth
Colonsc. - through colon
GU Health Promotion
- Appropriate fluid intake- restrict 2-hour before H.S.
- Promoting patterns
- Kegel exercises
- Avoid or decrease food/fluid which may worsen symptoms
GI Health Promotion - Constipation Managment
Exercise
- ↑ colonic motor activity upon waking
Fluid
Fiber diet
- 25-30 g/day
- Less with diarrhea to decrease s/s
Medications
Do not overuse!
Cholecystokinin
is a peptide hormone involved in digestion
stimulates release of
- bile for gallbladder
- pancreatic enzymes for fat and protein digestion
