ATI Elimination

light yellow urine

light yellow urine

healthy

dark yellow or amber color urine

need to increase fluid intake

dark brown colored urine

dehydration and kidney or liver issues

red tint urine

blood in urine

Expected urine production tends to ______ with age

decrease

other causes of red urine

consumption of foods such as blackberries, beets, and rhubarb

What foods can increase urine production in kidneys?

Alcohol, caffeinated beverages, foods high in sodium

Foods that increase risk of diahreha

• Alcohol

• Caffeinated beverages and foods

• Dairy

• Foods that are high in fat or are highly greasy

• Beverages that contain fructose

• Spicy foods

• Apples, peaches, and pears

• Products that contain sweeteners, such as sorbitol, mannitol, xylitol, and maltitol

Stress incontinence:

Coughing, sneezing, laughing, or physical activity that increases pressure on the bladder, resulting in urine leakage.

Urge incontinence:

A strong need or urge to urinate, but leaking occurs before the client gets to the toilet.

Reflex incontinence:

Urinary leakage as a result of nerve damage.

Overflow incontinence:

Incomplete bladder emptying that results in the bladder overfilling when full, leading to urine leakage.

Functional incontinence:

Physical inability to reach the toilet in time. This may be due to a physical impairment such as being wheelchair bound or having arthritis of the hands, which can hinder the fine motor skills needed to unbutton clothing.

Nocturnal enuresis

(nighttime bedwetting): Common in children but may occur in adults who have consumed too much alcohol, who consume caffeine at night, or who take certain medications.

Transient incontinence

sudden onset, lasting less than 6 months

Urinary retention

condition in which bladder does not completely empty with urination. Can be caused by prostate enlargement or a cystocele (prolapsed bladder)

Findings associated with urinary retention

difficulty urinating, pain, abdominal distention, urinary frequency, urinary hesitancy, weak or slow urine stream, and urinary leakage.

Constipation

fewer than three bowel movements in a week. Stools are hard, lumpy, and difficult to pass

Interventions to treat constipation

high-fiber diet, staying well hydrated, exercise, bowel training, and medications to soften stools

Diarrhea

frequent loose, watery stools throughout the day. It can be acute, persisten, or chronic

Risk factors for diarrhea include

infection, medication use, GI disorders, and diet

If diarrhea is persistent _____________ can occur

dehydration and malabsorption (and both can be life-threatening if severe)

In children, bowel incontinence is referred to as

encopresis

Bowel incontinence can lead to

skin irritation, poor self-esteem and decreased well-being.

After age 1, are UTIs more common in males or females and why

females due to improper wiping techniques and shorter urethras than males

Prior to age 1, are circumsized or uncircumsized males more likely to develop UTI

males who have not been circumcised are more likely to develop UTIs

UTI’s left untreated for too long, may result in

a kidney infection called pyelonephritis

Manifestations of UTI include

burning or painful urination and urgency to urinate, despite not having a lot of urine to pass

Are kidney stones more commin in males or females?

males (finally, a win for the ladies)

Conditions that increase the risk of developing kidney stones include

• inflammatory conditions

• cystic kidney disease

• gout

• hypercalciuria (excessive calcium in the urine)

• hyperparathyroidism (a condition that causes too much calcium in the blood)

• obesity

• frequent UTIs

Manifestations of kidney stones

• sharp back pain, which can travel along the side of the abdomen, to the lower abdomen, or to the groin

• blood in the urine

• urinary frequency

• painful, burning urination

• fever; chills; nausea, vomiting

Kidney failure is defined as

the loss of 15% of expected kidney function

interventions to assist the kidneys can include

hemodialysis or peritoneal dialysis

Benign prostatic hyperplasia (BPH)

is a noncancerous condition that causes constriction to the urethra, increasing urinary retention. More common as males get older.

Manifestations of BPH may include

urinary frequency, urinary urgency, frequent nighttime urination, weak or slow urinary stream, urinary incontinence, or urinary retention

Diverticulosis

condition in which small sacs or pouches form in the colon. increases a client’s risk for diverticulitis

Diverticulitis

an inflamed pouch or sac forms as a result of stool becoming trapped

Irritable bowel syndrome (IBS)

abdominal pain and changes to bowel elimination patterns that can include diarrhea, constipation, or a mixture of both.

IBS symptoms may include

abdominal pain, bloating, mucus in the stool, and incomplete bowel emptying.

IBS interventions

dietary changes (increased consumption of fiber, probiotics, and avoiding irritants such as gluten), reducing stress and anxiety, getting adequate sleep, exercise, or medications.

Bowel obstruction symptoms

nausea & vomiting, abdominal pain and distention, and severe constipation

Intervention for bowel obstruction

nasogastric (NG) tube insertion. Can relieve distention, nausea & vomiting through bowel decompression, allows for accurate emesis output assessment, and significantly decreases the risk for aspiration​​​​​​​.

Ileus (paralytic ileus)

condition where the flow of intestinal contents decreases or stops

Ileus symptoms

inability to tolerate food, nausea and vomiting, slow-onset abdominal distension and bloating, and inability to pass flatus. Bowel sounds are diminished or absent

Ileus treatment

healthcare professionals ensure the client receives nothing by mouth (NPO), decompress the stomach with a nasogastric (NG) tube, and provide intravenous (IV) fluid therapy

Ulcerative colitis (UC)

chronic disease that causes inflammation and ulcerations of the large intestine or colon.

Manifestations of UC

diarrhea with blood or pus, abdominal discomfort, fatigue, nausea, fever, and anemia

UC treatment

medications. if medications do not work, surgey may be nessecary

Crohn’s disease

is a chronic disease that causes inflammation in the GI tract

is like ulcerative colitis, but also commonly affects the small intestine (treated similary to UC as well)

Manifestations of Crohn’s disease

diarrhea, abdominal pain or cramping, weight loss, anemia, fatigue, fever, joint pain, nausea, and painful bumps under the skin.

Urinary Catheterization

urinary catheter placed into the bladder to allow urine to drain. flexible tube can be placed into the bladder through the urethra or through a surgically created opening in the lower abdomen. can be temporary

Ureteral Stent

can be a temporary but can also be used for longer period of time. The primary purpose is to allow passage of urine when a ureter is blocked. This can happen for many reasons, such as obstruction from a stone or mass, postoperative scar tissue, or inflammation and swelling from an infection.

Urostomy (ileal conduit)

a surgically created diversion that uses part of the small intestine.

a section of the small intestine is removed from the GI tract and repositioned with one end attached to the ureters, and the other attached to the wall of the abdomen, where a stoma is created to allow urine to pass into a pouch attached to the abdominal wall.

Nephrostomy

A nephrostomy tube drains urine directly from the kidney into an external pouch.

A tube is surgically inserted through the skin on the back and into the kidney. This procedure is usually performed following the removal of kidney stones. This type of diversion is usually temporary and is removed once the kidney has healed.

Neobladder

a reservoir surgically created from a piece of bowel; it is used to store urine before it is expelled from the body. Like the bladder, the neobladder is attached to the ureters and the urethra and placed in the pelvis. Sometimes the neobladder may not fully empty, so the client may need to use a catheter to empty the reservoir.

Continent cutaneous reservoir

similar to the neobladder, but is placed in the abdomen rather than the pelvis. The reservoir is attached to the ureters at one end and the client’s stoma on the other end. A valve is utilized so the urine cannot flow out on its own but instead needs to wait until a catheter is placed.

Cystostomy

similar to urinary catherization, but is more invasive. a catheter is inserted directly into the bladder and attached to a drainage bag outside the client’s abdomen.

Cystometric testing involves measuring bladder capacity, the pressure of the bladder during filling, and the final capacity when the urge to urinate begins.

Ileostomy

a temporary or permanent fecal diversion that uses the terminal end of the small intestine, called the ileum.

Permanent ileostomies are created when the entire colon, including the rectum and anus, must be removed or bypassed. The surgeon redirects the ileum through a surgically created opening (stoma or ostomy) in the abdominal wall to allow for the drainage of stool.

Resersible ileostomies: reversed by removing the ileum from the abdominal wall and reattaching it to the colon so bowel contents can continue to pass through the colon. allow colon time to heal.

Colostomy

part of the colon is used to form a stoma through the abdominal wall, allowing for the passage of body waste. These diversions can be temporary, to allow healing and rest for the colon, or they can be permanent.

J-Pouch

A J-pouch is an internal pouch formed with the ileum. This internal reservoir connects to the anus after removal of the rectum and colon. Body waste collects in the reservoir. Then, instead of passing through the colon and rectum, it directly passes through the anus during a bowel movement.

J-pouches are usually created at the same time an ileostomy is created, so that the internal reservoir system can heal prior to its use. Once healed, the surgeon will reverse the ileostomy and connect the ileum to the J-pouch.

Kock Pouch

continent ileostomy system. Using the ileum, the surgeon forms an internal pouch with a valve, so that intestinal contents do not escape the ileostomy. To empty the pouch, a catheter is placed through the ileostomy stoma, and the contents are drained. The catheter is removed once emptying is complete.

dysuria

Pain or discomfort with urination often due to infection or injury.

Urinalysis

lab test that includes visual examination of the urine, dipstick testing, and microscopic examination

Urine visual examination

TACO

type, amount, color, odor

Dipstick evaluation

dip reagent strip, that contains several chemical colors for testing, into the urine.

Microscope urine evaluation

further evaluates the urine sample for white blood cells, red blood cells bacteria, casts (proteins that may result due to kidney problems) and crystals

Supplies for urinalysis

a sterile specimen container for urine collection, gloves, a waterproof pad, and sanitary wipes for the client.

Urine culture

used to evaluate urine for the presence of bacteria and yeast that may cause a UTI.

commonly ordered in addition to a urinalysis to confirm the presence of bacteria in urine revealed on the urine reagent strip.

When collecting a urine culture…

must be a clean collected specimen (genitals are wiped with a laboratory-approved sanitary wipe before)

instruct the client to begin urinating into the toilet, stop quickly, and then continue to urinate into the collection container.

nurse should ask the client about the use of antibiotics, as they may alter the result and delay treatment

24 hour urine collection

urine is collected over a 24-hour period, placed in a special container, and refrigerated. Can be done at home. allows the provider to evaluate the amounts of chemicals that are in the urine over a 24-hour period

Clean catch urine collection method

• used for collecting a urine sample for urinalysis and/or urine culture to evaluate for UTIs.

• The nurse must ensure that all supplies are gathered and explain the procedure to the client.

• The nurse needs to gather a urine specimen container, sanitary wipes, client label, specimen bag, and gloves. The nurse then instructs the client how to obtain the urine sample

Catheterization

• Requires sterile technique for insertion

• must be order by client’s provider

• ensure client does not have a betadine or iodine allergy

A fecal occult blood test (FOBT)

checks stool for the presence of blood. ensure client doesn’t eat beets, red meat,

FOBT procedure

• done at home

• bowel movement into a container and use collection spatula to place the specimen on the appropriate container.

• mails it to lab

Stool culture

test used to find organisms in the stool that may be the cause of severe or persistent diarrhea​​​​​​​.

Stool culture procedure

done at home. no dietary restrictions. bowel movement into a container and use collection spatula to place the specimen on the appropriate container. mails it to lab

Bladder irrigation

• intervention that promotes elimination.

• a prescribed solution is connected to a urinary catheter

• intended to prevent blood clots from forming in the bladder or to remove any clots that may be present.

• uncomfortable, but should not be painful

bladder irritants

coffee, tea, carbonated beverages, alcohol, spicy food, and chocolate

Bladder training

setting a schedule to use the bathroom. reteaches the bladder when to send messages to the brain, thus avoiding accidents​​​​​​​.

Bladder scanning

Use to determine need for catheterization. Uses ultrasound device over the client’s bladder see if enough urine is present to warrant a catheter. reduces the need for unnecessary catheterization and potential catheter-related infections

Straight or intermittent catheters

• used as needed to empty the bladder, then removed when bladder emptying is complete.

• Clients with paraplegia will often utilize intermittent catheters

Benefits of external catheters

• less invasive

• lower risk of CAUTI

Condom catheters

• for male clients with incontinence

• condom-like device is placed on the penis, with a collection system attached to a urine bag.

• Care must be taken to ensure no leakage of urine occurs around the device, the client is clean and dry, and the catheter is changed daily

female external urinary catheter

• uses a soft, flexible wick connected to wall suction to pull urine into a drainage canister.

Only catheters that require clean technique

Condom catheters and female external catheters (rest all need sterile)

Indwelling catheters

• have a small inflatable balloon at the end of the catheter to hold the catheter in place inside the bladder for continuous drainage.

• A collection system is attached to a urine collection bag that is affixed to the client’s leg to avoid pulling the catheter with the inflated balloon out of the bladder.

• Must clean area where the catheter exits the body daily with soap and water

enema

instillation of a liquid solution through the anus to relieve constipation or cleanse the bowel in preparation for diagnostic testing, procedure, or surgery

Rectal tube

• devices placed into the rectum to prevent incontinent clients from soiling themselves.

• typically used in intensive care units to assist with protecting the client’s skin from breakdown when there is no bowel control.

When might a urinary diversion be required?

if urine is blocked, if the urethra is damaged from either injury or a birth defect, because of tumors, or in case of bladder malfunction.

Stoma care

• washing the stoma with mild soap and warm water only and patting the site dry

• avoiding perfumes and other chemicals

When would nasogastric tubes be used?

most frequently placed due to bowel obstructions to reduce abdominal distention and subsequent nausea and vomiting.

When placing NG tube…

• encourage the client to sit up

• The tube should be measured from the tip of the client's nose to the tragus of the ear to the xiphoid process.

• The tube should be advanced as the client swallows or takes sip of water.

• Once it is placed, the nurse should use two methods (X-ray, Capnometer, or pH level) to verify correct placement, ensure the tube is taped in place to secure, and confirm that it is attached to suction as ordered by the provider.

Skin care for incontinence

• ensure the skin is clean and dry after the client has urinated or had a bowel movement

• skin should be cleaned with a mild soap, rinsed well, and gently patted dry

• Soap-free skin cleansers that do not cause dryness or skin irritation may also be used

• The skin should be kept moist by using alcohol-free moisturizing creams.

• The use of skin barriers, such as ointments, pastes, and sealants, may also protect the client’s skin from breakdown by providing a protective covering or barrier over the client’s skin.

Medication that increases risk for constipation

Medications used to treat pain, such as narcotics, can slow gastric motility and increase the risk of constipation.

Risk factors for persistent diahreha

dairy, antibiotics, histroy of IBS

When performing an enema, the nurse should instruct the client to…

lie on their left side and place their right leg up to their chest

Vitamin K is natrually produced in the

large intestine

Complications of fecal diversions

hernia, electrolyte imbalance, blockage, prolapse, diarrhea, and infection.

What might be used if a kidney stone is blocking a ureter?

Ureteral stent placement allows the passage of urine when a ureter is blocked from either a stone, mass, scar tissue, inflammation, or infection.

A nurse is teaching a newly licensed nurse about urinary retention. Which of the following clients should the nurse include as having an increased risk for this condition ?

client with enlarged prostate