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Nur 333 fundamentals 2 > wk 6: bowel & urinary elimination > Flashcards

wk 6: bowel & urinary elimination Flashcards

1
Q

bacteremia

A

bacteria in blood stream

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2
Q

bacteriuria

A

bacteria in urine
strong indictor of UTI
does not mean there is a UTI though

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3
Q

catheter associated UTI

A

major risk with indwelling catheters
longer a catheter is in, the higher the risk
costly
prevent with hygiene
focus on early recognition and prompt treatment
sterility on insertion is important

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4
Q

catheterization

A
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5
Q

cystitis

A

infection in bladder

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6
Q

dysuria

A

painful urination

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7
Q

hematuria

A

blood in urine

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8
Q

micturition

A

“to urinate”
involves bladder, urinary sphincters and CNS

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9
Q

nephrostomy

A

artificial opening between kidney and skin to allow for urinary diversion

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10
Q

pelvic floor muscle training

A
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11
Q

postvoid residual (PVR)

A

done after urinating to see how much urine is left in the bladder
within 10 minutes

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12
Q

proteinuria

A

protein in urine

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13
Q

pyelonephritis

A

upper UTI that is in the kidneys

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14
Q

suprapubic catheter

A

surgically inserted catheter through the skin of the lower abdomen

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15
Q

ureterostomy

A

creation of a stoma for a ureter or kidney. The procedure is performed to divert the flow of urine away from the bladder when the bladder is not functioning or has been removed

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16
Q

(urinary) voiding involves

A

bladder contraction, urethral sphincter and pelvic floor muscles

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17
Q

impulses from the brain respond to the urge to urinate by doing what?

A

the CNS sends message
external sphincter relaxes
bladder empties

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18
Q

what factors influence urinary elimination ?

A

growth and development
sociocultural factors
psychological factors
personal habits
fluid intake
pathological conditions
surgical procedures
diagnostic examinations

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19
Q

urinary changes in older adults lead to decreased…

A

amount of nephrons
bladder muscle tone
bladder capacity
time between initial desire to void and urgent need

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20
Q

urinary changes in older adults leads to increased…

A

bladder irritability
bladder contractions
risk of incontinence

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21
Q

what are the three most common urinary elimination issues?

A

urinary retention
UTI
incontinence

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22
Q

urinary retention

A

inability to fully empty bladder
-acute or chronic
-Dx with post void residual (PVR)
-pressure/tender/discomfort/diaphoresis

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23
Q

UTI

A

characterized along urinary tract

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24
Q

who is at risk for a UTI

A

indwelling catheter
any instrumentation in urinary tract
urinary retention
urinary or fecal incontinence
poor perineal hygiene
females
frequent sexual intercourse
uncircumcised

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25
Q

S/Sx of a UTI

A

foul smelling urine
cloudy urine
dysuria
hematuria
cystitis
fever
urgency
frequency
incontinence
suprapubic tenderness

elderly -> neurologic Sx or falls

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26
Q

what are the three types of urinary incontinence ?

A

stress-increased urine w/ laugh, cough, sneeze
urgency - older adults, decreased time to urinate
overflow- related to urinary retention, bladder so full they become incontinent

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27
Q

urinary incontinence is what ?

A

involuntary loss of urine
-can be multifactorial

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28
Q

incontinence risk factors

A

common in women and elderly
obesity
multiple pregnancies/ vaginal births
neurologic disorders
medication therapy
confusion
dementia
immobility
depression

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29
Q

what are some key components that need to be discussed or looked over during a urinary assessment?

A

assess understanding/expectations of Trx
professionalism
assess pts autonomy with voiding, personal hygiene
cultural / personal considerations
PMHx SHx
medications
normal elimination patterns
sleep/ activity/ nutrition

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30
Q

what are some patterns for urination that we need to look over?

A

frequency
times of voiding
normal amount with each void
H/o recent changes

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31
Q

CVA tenderness indicates what?

A

pyelonephritis, kidney pain

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32
Q

why is urine I&O documentation important?

A

evaluates bladder emptying
renal function
fluid & electrolyte balance
HCP order or nursing judgement

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33
Q

what is a normal urine output?

A

> 30mL / Hr

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34
Q

what are some characteristics of urine?

A

color
clarity
odor

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35
Q

what is a normal urine color

A

pale straw color to amber

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36
Q

what is a normal urine clarity?

A

transparent at first void

37
Q

what does a thick and cloudy urine clarity indicate?

A

bacteria and WBC
(or its an early morning void)

38
Q

what is a normal odor of urine?

A

odorless or ammonia smell

39
Q

if hourly urine output is critical may need to use what?

A

foley bag with urometer

40
Q

how often should a foley bag be emptied?

A

AT LEAST once a shift
usually Q4-8hr

41
Q

what are some other ways to collect urine?

A

speci-hat
female urinal
male urinal

42
Q

considerations when dealing with urine testing

A

know how to collect urine
must be freshly voided urine
dont take from catheter bag
label appropriately
send as soon as you receive (unless timed test)
know if you need a preservative or not

43
Q

culture and sensitivity of urine

A

-done if urinalysis comes back irregular
-must be clean catch urine specimen
-send to lab within 30 minutes
-preliminary report available within 24 hrs
-MUST use sterile specimen cup

44
Q

abdominal XR- KUB

A

determines size, shape, symmetry, location of structures within the urinary tract

-> detect urinary calculi

45
Q

what are some nursing problems related to urinary elimination?

A

impaired urinary elimination
urinary retention
incontinence
impaired comfort or pain
impaired skin integrity or risk for impaired skin integrity
knowledge deficit
body image disturbance
risk for infection

46
Q

what is an adequate fluid intake for a normal patient?

A

2300 mL

47
Q

what kind of patient should you encourage to try double voiding?

A

pt with urinary retention

pee -> wait -> try again

48
Q

types if urethral catheters

A

single lumen (in and out)
indwelling (can take temp)
3-way/ 3 lumen (bladder irrigation)
coude tip (curved)
suprapubic
external catheters (condom cath, purewick)

49
Q

where is the suprapubic catheter placed? why would it be placed?

A

in the bladder through the abdominal wall

-sutured in place
-used when there is a blockage of urethra or the indwelling causes irritation

50
Q

catheter care

A

regular peri-care
regular cath care with baths
secure catheter to prevent pulling
empty bag when it is half full
no kinks in tubing
bag below bladder
do not have bag touching floor
maintain closed drainage system
accurate monitoring of output
timely removal

51
Q

what are some considerations/ tasks to do before inserting a catheter

A

peri-care
use castle wipes or CHG wipes

*should also be done every shift

52
Q

post-removal of catheter care

A

they should void within 6-8 hours
monitor ability to void
measure output
educate patient

53
Q

what are some factors that influence a patients bowel eliminations?

A

age, diet, fluid intake, physical activity, psychological factors, personal habits, positioning during defication, pain, pregnancy, surgery& anesthesia, medications, diagnostic testing

54
Q

older adults complications regarding bowel elimination/GI

A

trouble chewing
esophageal emptying slows
impaired absorption
weakened sphincters
decreased: hydrochloric acid, absorption of vitamins, peristalsis, sensation to defecate, lipase to aid in fat digestion

55
Q

what are some common bowel elimination problems?

A

constipation, impaction, diarrhea, bowel incontinence, flatulence, hemorrhoids

56
Q

constipation

A

Sx not Dz
< 3 BM a week
dry hard stool with discomfort

57
Q

what are some causes of constipation?

A

irregular bowel habits
improper diet
reduced fluid intake
lack of exercise
stress
certain medications
advanced age
ignoring the urge to defecate
GI disorders

58
Q

why are older adults at risk for constipation?

A

lack of muscle tome
slowed peristalsis
lack of exercise
inadequate fluid intake
too many dairy products
lack of fiber
medications

59
Q

what are some complications of constipation?

A

hemorrhoids
anal fissures
fecal impaction
rectal prolapse

60
Q

what are some things you can do to prevent constipation?

A

high fiber foods
goof fluid intake
stay active
manage stress
dont ignore the urge to go
create a schedule

61
Q

what are the four different types of laxatives and cathartics ?

A

bulk form
emollient or wetting
osmotic
stimulant cathartics

62
Q

what kind of laxative is it okay to take consistantly?

A

bulk forming

63
Q

what position do you place a patient in when they are receiving an enema ?

A

left lateral sims

64
Q

if patient complains of cramping or pain while receiving an enema what do you do ?

A

low the bag to slow down the rate

if abdomen is rigid -> STOP

65
Q

what are some potential complications related to enemas ?

A

fluid and electrolyte imbalance
tissue trauma
vagal nerve stimulation
abdominal pain / cramping
pain
perforation

66
Q

what patients are most at risk for a fecal impaction ?

A

debilitated
confused
unconscious patients

67
Q

how do you know if someone has a fecal impaction?

A

be performing a digital exam

68
Q

impaction symptoms

A

-inability to have BM despite urge to
-oozing of liquid stool
-loss of appetite
-N/V
-abdominal distension
-cramping
-rectal pain

69
Q

diarrhea

A

loose watery BM

70
Q

common causes of diarrhea

A

food borne pathogens
food intolerances or allergies
surgery
diagnostic testing
enteral feedings

71
Q

what are some common complications associated with diarrhea ?

A

skin irritation
dehydration
nutritional concerns

72
Q

how do antidiarrheal agents work?

A

decreased intestinal muscle tone to slow the passage of feces

-body absorbs more water
*before you use, determine cause of diarrhea

73
Q

when is it not a good idea to use an antidiarrheal agent?

A

if the patient has C-diff or a bacterial infection

74
Q

nursing care for diarrhea

A

identify problem
soft easily digestible foods
maintain fluid and electrolytes
prevent spread

75
Q

who is at risk for C diff?

A

pt on Abx
elderly
immunocompromised
long term care facility
GI procedures
previous C diff

76
Q

what are some complications of c diff ?

A

dehydration
kidney failure
toxic megacolon
bowel perforation
death

77
Q

what are some preventions you can implement as a nurse to prevent C diff or the spread of it

A

-soap and water
-avoid unnecessary Abx use
-clean surfaces with bleach
-place in isolation (contact D or spore)

78
Q

how do you treat C diff?

A

fluids and good nutrition
Abx
fecal implantation
probiotics

79
Q

bowel incontinence

A

inability to pass gas or feces from the anus

80
Q

causes of incontinence

A

muscle/ nerve damage
impaired anal sphincter function
constipation
diarrhea
large volume of stool
rectal prolapse

81
Q

risk factors for bowel incontinence

A

age
female
nerve damage
dementi
physical disability

82
Q

what are some treatments for bowel incontinence

A

anti-diarrheals
bulk laxatives

83
Q

what are some prevention measures for bowel incontinence

A

reduce constipation
control diarrhea
avoid straining

84
Q

symptoms of flatulence

A

abdominal distension
cramping
bloating
pain

85
Q

causes of flatulence

A

constipation
food intolerance
GI diseases
stress

86
Q

nursing care for flatulence

A

avoid gassy goods
eat small/ more frequent meals
eat & drink slowly
limit cars
limit carbonated drinks
exercise daily
avoid straws
avoid lying down after eating
eat more insoluble fibers (whole wheat, bran, grain, oats)

87
Q

hemorrhoids

A

internal or external
engorged veins in lining of rectum
-pregnancy, liver Dz, CHF can cause them

88
Q

risk factors for colon cancer

A

African Americans
high amount of red meat or processed means
low fiber
obesity
50+
lack of physical activity
alcohol
tobacco
FHx
H/o inflammatory bowel disease

89
Q

colon cancer screenings

A

flex sig. scope every 5 years
colonoscopy every 10 years
scan every 5 yeas

Nur 333 fundamentals 2 (7 decks)

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