wk 6: bowel & urinary elimination Flashcards
bacteremia
bacteria in blood stream
bacteriuria
bacteria in urine
strong indictor of UTI
does not mean there is a UTI though
catheter associated UTI
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
catheterization
cystitis
infection in bladder
dysuria
painful urination
hematuria
blood in urine
micturition
“to urinate”
involves bladder, urinary sphincters and CNS
nephrostomy
artificial opening between kidney and skin to allow for urinary diversion
pelvic floor muscle training
postvoid residual (PVR)
done after urinating to see how much urine is left in the bladder
within 10 minutes
proteinuria
protein in urine
pyelonephritis
upper UTI that is in the kidneys
suprapubic catheter
surgically inserted catheter through the skin of the lower abdomen
ureterostomy
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
(urinary) voiding involves
bladder contraction, urethral sphincter and pelvic floor muscles
impulses from the brain respond to the urge to urinate by doing what?
the CNS sends message
external sphincter relaxes
bladder empties
what factors influence urinary elimination ?
growth and development
sociocultural factors
psychological factors
personal habits
fluid intake
pathological conditions
surgical procedures
diagnostic examinations
urinary changes in older adults lead to decreased…
amount of nephrons
bladder muscle tone
bladder capacity
time between initial desire to void and urgent need
urinary changes in older adults leads to increased…
bladder irritability
bladder contractions
risk of incontinence
what are the three most common urinary elimination issues?
urinary retention
UTI
incontinence
urinary retention
inability to fully empty bladder
-acute or chronic
-Dx with post void residual (PVR)
-pressure/tender/discomfort/diaphoresis
UTI
characterized along urinary tract
who is at risk for a UTI
indwelling catheter
any instrumentation in urinary tract
urinary retention
urinary or fecal incontinence
poor perineal hygiene
females
frequent sexual intercourse
uncircumcised
S/Sx of a UTI
foul smelling urine
cloudy urine
dysuria
hematuria
cystitis
fever
urgency
frequency
incontinence
suprapubic tenderness
elderly -> neurologic Sx or falls
what are the three types of urinary incontinence ?
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
urinary incontinence is what ?
involuntary loss of urine
-can be multifactorial
incontinence risk factors
common in women and elderly
obesity
multiple pregnancies/ vaginal births
neurologic disorders
medication therapy
confusion
dementia
immobility
depression
what are some key components that need to be discussed or looked over during a urinary assessment?
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
what are some patterns for urination that we need to look over?
frequency
times of voiding
normal amount with each void
H/o recent changes
CVA tenderness indicates what?
pyelonephritis, kidney pain
why is urine I&O documentation important?
evaluates bladder emptying
renal function
fluid & electrolyte balance
HCP order or nursing judgement
what is a normal urine output?
> 30mL / Hr
what are some characteristics of urine?
color
clarity
odor
what is a normal urine color
pale straw color to amber
what is a normal urine clarity?
transparent at first void
what does a thick and cloudy urine clarity indicate?
bacteria and WBC
(or its an early morning void)
what is a normal odor of urine?
odorless or ammonia smell
if hourly urine output is critical may need to use what?
foley bag with urometer
how often should a foley bag be emptied?
AT LEAST once a shift
usually Q4-8hr
what are some other ways to collect urine?
speci-hat
female urinal
male urinal
considerations when dealing with urine testing
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
culture and sensitivity of urine
-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
abdominal XR- KUB
determines size, shape, symmetry, location of structures within the urinary tract
-> detect urinary calculi
what are some nursing problems related to urinary elimination?
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
what is an adequate fluid intake for a normal patient?
2300 mL
what kind of patient should you encourage to try double voiding?
pt with urinary retention
pee -> wait -> try again
types if urethral catheters
single lumen (in and out)
indwelling (can take temp)
3-way/ 3 lumen (bladder irrigation)
coude tip (curved)
suprapubic
external catheters (condom cath, purewick)
where is the suprapubic catheter placed? why would it be placed?
in the bladder through the abdominal wall
-sutured in place
-used when there is a blockage of urethra or the indwelling causes irritation
catheter care
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
what are some considerations/ tasks to do before inserting a catheter
peri-care
use castle wipes or CHG wipes
*should also be done every shift
post-removal of catheter care
they should void within 6-8 hours
monitor ability to void
measure output
educate patient
what are some factors that influence a patients bowel eliminations?
age, diet, fluid intake, physical activity, psychological factors, personal habits, positioning during defication, pain, pregnancy, surgery& anesthesia, medications, diagnostic testing
older adults complications regarding bowel elimination/GI
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
what are some common bowel elimination problems?
constipation, impaction, diarrhea, bowel incontinence, flatulence, hemorrhoids
constipation
Sx not Dz
< 3 BM a week
dry hard stool with discomfort
what are some causes of constipation?
irregular bowel habits
improper diet
reduced fluid intake
lack of exercise
stress
certain medications
advanced age
ignoring the urge to defecate
GI disorders
why are older adults at risk for constipation?
lack of muscle tome
slowed peristalsis
lack of exercise
inadequate fluid intake
too many dairy products
lack of fiber
medications
what are some complications of constipation?
hemorrhoids
anal fissures
fecal impaction
rectal prolapse
what are some things you can do to prevent constipation?
high fiber foods
goof fluid intake
stay active
manage stress
dont ignore the urge to go
create a schedule
what are the four different types of laxatives and cathartics ?
bulk form
emollient or wetting
osmotic
stimulant cathartics
what kind of laxative is it okay to take consistantly?
bulk forming
what position do you place a patient in when they are receiving an enema ?
left lateral sims
if patient complains of cramping or pain while receiving an enema what do you do ?
low the bag to slow down the rate
if abdomen is rigid -> STOP
what are some potential complications related to enemas ?
fluid and electrolyte imbalance
tissue trauma
vagal nerve stimulation
abdominal pain / cramping
pain
perforation
what patients are most at risk for a fecal impaction ?
debilitated
confused
unconscious patients
how do you know if someone has a fecal impaction?
be performing a digital exam
impaction symptoms
-inability to have BM despite urge to
-oozing of liquid stool
-loss of appetite
-N/V
-abdominal distension
-cramping
-rectal pain
diarrhea
loose watery BM
common causes of diarrhea
food borne pathogens
food intolerances or allergies
surgery
diagnostic testing
enteral feedings
what are some common complications associated with diarrhea ?
skin irritation
dehydration
nutritional concerns
how do antidiarrheal agents work?
decreased intestinal muscle tone to slow the passage of feces
-body absorbs more water
*before you use, determine cause of diarrhea
when is it not a good idea to use an antidiarrheal agent?
if the patient has C-diff or a bacterial infection
nursing care for diarrhea
identify problem
soft easily digestible foods
maintain fluid and electrolytes
prevent spread
who is at risk for C diff?
pt on Abx
elderly
immunocompromised
long term care facility
GI procedures
previous C diff
what are some complications of c diff ?
dehydration
kidney failure
toxic megacolon
bowel perforation
death
what are some preventions you can implement as a nurse to prevent C diff or the spread of it
-soap and water
-avoid unnecessary Abx use
-clean surfaces with bleach
-place in isolation (contact D or spore)
how do you treat C diff?
fluids and good nutrition
Abx
fecal implantation
probiotics
bowel incontinence
inability to pass gas or feces from the anus
causes of incontinence
muscle/ nerve damage
impaired anal sphincter function
constipation
diarrhea
large volume of stool
rectal prolapse
risk factors for bowel incontinence
age
female
nerve damage
dementi
physical disability
what are some treatments for bowel incontinence
anti-diarrheals
bulk laxatives
what are some prevention measures for bowel incontinence
reduce constipation
control diarrhea
avoid straining
symptoms of flatulence
abdominal distension
cramping
bloating
pain
causes of flatulence
constipation
food intolerance
GI diseases
stress
nursing care for flatulence
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)
hemorrhoids
internal or external
engorged veins in lining of rectum
-pregnancy, liver Dz, CHF can cause them
risk factors for colon cancer
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
colon cancer screenings
flex sig. scope every 5 years
colonoscopy every 10 years
scan every 5 yeas
