EXAM 2 Urinary + Bowel UNFINISHED

Urinary: Newborns

GFR lower than adults = not much urine

limitations b/c kidney not fully developed

urine may be cloudy at first in first 24hrs

Urinary: Toddlers + Preschoolers

control develops at 2-5yrs

potty training is key

School Age

bedwetting (Nocturnal enuresis) esp. in deep sleep

• not problem until age 7

What does musty odor urine indicate?

Infections

Transparent urine

overhydrated

no electrolytes in you

Light yellow

lemonade color

good

Darker yellow

still hydrated but starting to head the wrong direction

Orange/Amber

mildy dehydrated

Burnt orange

dehydrated

need water + electrolytes

worry about kidneys

Brown urine

liver faliure

certain astipsychotic drugs

certain antibiotics

Green/blue urine

drugs w/ phenol

dyes in food

biliverdin

Purple urine

porphyria (rare metabolic disorder)

What do we not want in our urine?

white spots = WBCs = UTIs

blood

protein

What happens if you have too little urine?

renal faliure

Creatinine

kidney function, if low or high = renal failure

Lab tests

urinalysis

BUN (blood urea nitrogen)

creatinine

GFR culture

occult blood

Radiographic tests and scans

x-rays

CT

MRI

ultrasound

Direct observation tests

colonoscopy

cystoscopy = look at bladder

uroscopy = look at uretur

Urinary incontinence

involuntary leakage of urine

common in older adults esp. women b/c childbearing not natural w/ aging

bladder pressure > urethral closure pressure

Urinary Incontinence Gender Differences

Men= common with BPH, prostate cancer, or overflow

Women = stress and urge incontinence (abdominal pressure from laughing, coughing)

DRIP

D = delirium, dehydration, depression

R = restricted mobility, rectal impaction

I = infection, inflammation, impaction

P = polyuria (diabetic), polypharmacy (lasiks)

transient urinary incontinence

comes and goes (e.g lasiks, antihistamines)

functional urinary incontinence

fractured hip

Urinary Incontinence Risk Factors

older

women

obesity = increase in abdominal pressure

pregnancy = baby on bladder

spicy foods

Lasiks

Urinary Incontinence Nursing Care

toilet training = schedule

Kegels

skin care = avoid urine on skin

timing fluids, can decrease at night but don’t completely stop

Kegels

exercises that increase pelvic muscles, tightens up sphincter

Urinary retention

chronic or acute

sphincter not open, blockage of urethra, bladder muscle not empty fully

accumulation of urine bc pt can’t empty bladder fully = infection

increased urine volume and bladder distention

what does Urinary retention do to the kidneys?

Backflow to upper urinary tract goes to kidneys = damages it

Urinary Retention Diagnostic Tests

postvoid residual assessment = bladder scan or test urine

urinalysis

labs

PSA = prostate issues

imaging scans

Bladder Scan

pt supine

need to know if women had a hysterectomy bc remove of uterus

Straight caths shouldn’t be inserted if patient only has ___ cc of urine

150 cc

should be atleast 300cc

Urinary Retention Management 1st choice is..

straight cath!

b/c we want to treat ASAP by completely emptying bladder

Urinary Retention Management other choices

bladder training (e.g kegels, schedule)

positioning (e.g fowlers for gravity)

Urinary Retention Med Treatment

To increase bladder strength

• alpha-adrenergic blockers

• antibiotics

Urinary Retention Surgery Treatment

remove obstructions

resection prostate if BPH

correct a cystocele or rectocele

cystocele

prolapsed bladder

supportive muscles and connective tissue between bladder and vaginal wall weaken and stretch

Straight catheter

single-use, single lobe

removed immediately after draining the bladder

Indwelling (foley) catheter

remains in place for continuous drainage using an anchoring balloon, 2 lobe

Long-term or semi-permanent

severe or immobility

Triple-lumen catheter

three-way indwelling catheter that adds an extra channel to flush the bladder

post-urological or prostate surgery to continuously irrigate the bladder and wash out blood clots or debris

UTIs: Urinary tract Infection

most common bacterial infection (e.coli) in women b/c of short urethra

from contamination of procedure or catheterization

could be fungal

major risk for septic

10^5 or more of e.coli or symptoms need treatment

Pts at risk of UTIs

diabetics = bc sugar in urine

kidney issues = protein or sugar in urine

not finishing antibiotics for full time

traveling to countries

Urosepsis

systematically spread UTI

life threatening need emergency treatment

UTI Risk Factors

BPH

tumors

not being sterile with catheters

kidney stones

HIV

diabetes

obesity

CAUTI (catheter-associated urinary tract infections)

most common HAI

often untreated or unrecognized

Keys to Catheter Care

frequent perineal care

frequent emptying bag

no lotion or powder near

prevent movement of catheter

UTI Signs

Frequent urination

Strong urgency to void

incontinence

painful urination

back pain (bc traveled to kidneys)

fever

sepsis

UTI Signs in Older Adults

often absent

non-localized abdominal pain

cognitive impairment = start getting confused

fever not likely

Before getting a sample from a catheter…

don’t get from old, get from new one

Antibiotics in Urinary

uncomplicated cystitis = short term e.g 3 days

complicated = long term e.g 1-2 weeks

prophylactic or suppressive antibodies

Urinary analgesic

Phenazopyridine

in combo w/ antibiotics

soothing effect

stains urine reddish orange

BPH

Benign Prostatic Hyperplasia

non-cancerous enlargement of the prostate gland

common in aging men

grows larger with age, squeezing the urethra and blocking urine flow from the bladder

BPH Risk Factors

Age

• rare b4 40

• >50% men in 60s have symptoms

• 80% over 70yrs will have

genetic

metabolic syndrome = increased cholesterol, increased blood sugar

caffeine and coffee intake

obesity

Primary Prevention of BPH

exercising

proper diet = watch cholesterol levels and blood glucose

BPH Signs

urethal compression (obstructions)

increased resistance to urinary flow = more pressure

decreased bladder capability bc bladder tired from pressure

weak stream

more time to void

urinary retention may become chronic

Diverticula

urine acends from bladder to kidneys

BPH Lifestyle Changes

avoid spicy food, alc, caffeine

small amounts of fluid throughout day

avoid OTC and antihistamines

BPH Med Treatments

1. alpha-adrenergic blockers

2. 5-Alpha reductase inhibitors

OTC could worsen

• (e.g pseudoephedrine, phenylephrine)

• antihistamines,antidepressants, phenothiazines

• anabolic steroids

alpha-adrenergic blockers for BPH

relax smooth muscle of prostate and bladder

e.g Tamsulosin (Flomax)

Doxazosin (Cardura)

5-alpha reductase inhibitors

decrease prostate size

decrease PSA levels

e.g finasteride (proscar)

dutasteride (avodart)

NOT FOR PREGNANT WOMEN

Which is the least invasive surgery for BPH?

laser enucleation

Transurethral surgery/ TURP

Transurethral resection of the prostate

• scoop out inhibition, no surgical incision

most often done

risk of TURP syndrome = sexual dysfunction

Open Radical Surgery

most invasive

surgical incision

Urinary Post-Op surgery

urine will be red at first, will eventually not (red-pink-normal)

prophylactic antibiotics

prevent blood clots

Expected outcomes after post-op

urinary continence 8 weeks after catheter removal

afebrile with wbc within normal

Bowel: Newborn and infants

meconium stool normal @ first

soft and liquidy transitions to firmer when infant starts solid food

odor faint until solid food

meconium stool

tar looking, black

Breastfed stool

color mustard yellow w/ seedy appearence

Formula-fed

tan to yellow-green

Bowel: Toddlers

some control 1.5-2yrs

successful training by 3-4 yrs

intussusception most common bc intestinal obstruction in >3yrs

intestinal obstruction

when the intestine folds over each over

intussusception

jelly-like stool

Older adults

constipation is common

muscle weakness

gastrocolic reflex

gastrocolic reflex

gas pain

What happens if older adults consistently use laxatives?

chronic constipation, interefere w/ electrolyte balance, reduce absorption of vitamins

Type 1 Stool

hard lumps like nuts (hard to pass)

not good, dehydrated, constipated

can have diarrhea with this

Type 2 Stool

lump sausage

dehydrated

Type 3 Stool

sausage w/ cracks on surface

Good!

Type 4

smooth and soft sausage

Good!

Type 5

soft blobs w/ clear-cut edges (passed easily)

loss of electrolytes

Type 6

fluffy mushy

loss of electrolytes

Type 7

straight liquid

loss of electrolytes

Direct visualization

e.g colonoscopy

Indirect Vizualization

e.g x-ray

Bowel preperation

making sure the bowel is cleaned out before an examination

What do you need to do before a Double-contrast barium enema study?

An MRI, bc barium stains will show up on MRI if not done first