Concepts 2: Bowel and Urinary Elimination

Factors Affecting bowel elimination

-age/diet
-fluid intake
-physical activity
-psychological factors
-position during defecation
-meds
-pregnancy
-diagnostic studies
-surgery/anesthesia
-pain

constipating foods

-cheese
-lean meat
-eggs
-pasta

foods with laxative effect

-fruits/veggies
-bran
-chocolate
-alc
-coffee

gas-producing foods

-onions
-cabbage
-beans
-cauliflower

flatulence

accumulation of gas in intestines
(walls stretch)

impaction

unrelieved constipation; collection of hardened feces wedged in rectum a person can't expel

incontinence

inability to control passage of feces and gas to anus

hemorrhoids

dilated, engorged veins in lining of rectum

bowel diversion

temporary/permanent artificial opening in abdominal wall

types of bowel diversions

-colostomy
-ileostomy
-ileoanal pouch anastomose

bowel physical assessment

-mouth
-abdomen
-rectum

bowel lab tests

fecal specimens

bowel diagnostic exams

-direct and indirect visualization
-bowel prep

routine screening for

colorectal cancer

promotion for normal defecation

-sitting position
-privacy
-positioning on bedpan

positioning on bedpan

-prevent muscle strain and discomfort
-elevate bed 30-40
-wear gloves

cathartics

stronger and rapid effect on intestines than laxatives

suppositories act quicker than _____ _____

oral meds

antidiarrheal agent

opioids

types of enemas

-cleansing enemas
-oil retention
-carminative
-kayexalate

cleansing enemas

-tap water
-normal saline
-hypertonic solutions
-soapsuds

enema admin

-no sterile tech
-pt in SIMS position

digital removal of stool

-use if enema fails
-last resort for severe constipation

self-admin of enema position

side-lying

if pt has cardiac disease/ taking hypertensive meds:

obtain pulse rate

what causes sudden dec in pulse rate

manipulation of rectal tissue stimulates vagus nerve

bacteremia

presence of bacteria in blood

bacteriuria

bacteria in urine

cystitis

irritation/inflammation of bladder

dysuria

painful urination

hematuria

blood in urine

pyelonephritis

kidney infection begins in urethra/bladder

factors affecting urinary elimination: disease

urinary incontinence

factors affecting urinary elimination: sociocultural

can interfere with timely voiding and privacy

factors affecting urinary elimination: psychological

-anxiety/stress inc frequency voiding and impact bladder emptying
-depression dec urinary continence

factors affecting urinary elimination: fluid intake

-alc dec antidiuretic hormone= inc urine production
-caffeine/bladder irritants= unsolicited bladder contractions lead to frequency, urgency, and incontinence

factors affecting urinary elimination: surgical procedures

local trauma/surgery to low abdomen/pelvis obstructs urine flow

urinary retention in post-op

mech obstruction of low urinary tract and altered neural control of bladder and detrusor mechanism (due to analgesic drugs)

factors affecting urinary elimination: meds

-diuretics inc urine output (prevents reabsorption of water)
-anticholinergics inc risk urinary retention (inhibit cladder contractility)
-hypnotics/sedatives= urinary incontinence

factors affecting urinary elimination: diagnostic exams

-cystoscopy= localized trauma of urethra lead to transient dysuria and hematuria
-urinary catheter= risk for infection

urinary retention

inability to partially/completely empty bladder

UTI common causative pathogen

e. coli

urinary incontinence (UI)

involuntary loss of urine

nephrostomy

small tubes tunneled through skin into renal pelvis
drains renal pelvis when ureters are obstructed

ureterostomy

permanent incontinent urinary diversion created by transplanting ureters into closed part of ileum and bringing other end out on abdominal wall, forming stoma

alternative urinary elimination methods

-urethral catheter
-suprapubic catheter
-condom catheter
-dialysis
-peritoneal dialysis

dysuria

pain with voiding

hesitancy

delay in start of voiding

polyuria

excessive voiding

oliguria

dec output in relation to fluid intake

symptoms of urinary alterations

-urgency
-dysuria
-frequency
-hesitancy
-polyuria
-oliguria
-nocturia
-dribbling
-hematuria
-retention

urinalysis: pH

4.6-8.0

urinalysis: protein

8 mg/ 100 mL

urinalysis: specific gravity

1.005-1.030

urinalysis: RBC

up tp 2

urinalysis: WBC

0-4/ lower-power field

urinalysis: color

pale/straw-amber
(depends of concentration)

urinalysis: odor

ammonia odor

urinalysis: no

-glucose
-ketones
-bacteria
-casts
-crystals