Nursing Test VI

Urinary and Bowel Elimination

urinary system is comprised of

two kidneys, two ureters, urinary bladder, urethra

female urethra

shorter than a males which results in more frequent UTIs

males have a

prostate. women do not

duties of the kidneys and ureters

maintain composition and volume of body fluids. filter and excrete blood constituents, retain those that are needed.

nephrons

remove the end products of metabolism and regulate fluid balance. help to produce urine

urine from the nephrons

empties into the kidneys.

the bladder

smooth muscle sac innervated by ANS. reservoir for urine. composed of 3 layers of muscle tissue (detrusor muscle). sphincter guards opening between bladder and urethra.

the urethra

conveys urine from bladder to the exterior of the body. male functions as excretory and reproductive. no portion of female is external to the body.

when bladder training

ensure you give adequate time for patient to use bathroom

process of emptying the bladder

detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra

muscles of the perineum and external sphincter relax

muscle of abdominal wall contracts slightly

diaphragm lowers, micturition occurs

micturition

urination

antidiuretic hormone

small protein secreted by part of the pituitary gland

ADH helps by

helping the kidneys control the amount of salt in your body. controls blood pressure and the amount of urine that is made. less ADH gives your more urine. more ADH gives you less

too little water in the blood

brain detects water level

pituitary releases ADH

more water reabsorbed by kidneys

less water lost in urine

blood water level returns to normal

too much water in blood

hypothalamus detects water level

pituitary gland releases LESS ADH

less water reabsorbed by the kidneys

more water lost in urine

blood water level returns to normal

factors affecting micturition

developmental considerations, food and fluid intake, psychological variables, activity and muscle tone, pathological conditions, medications

diuresis

peeing more than normal

oliguria

less urine than normal

anuria

100 cc or less of urine

children

toilet training 2-3 y/o. enuresis (involuntary urinations)

nocturia

getting up in the night to urinate

effects of aging on urination

increased frequency, urine retention and stasis, voluntary control affected by physical problems as you age the bladder cannot contract as easily. cant pee and hold it, muscles are weak

Diseases associated with renal problems

congenital urinary tract abnormalities, polycystic kidney disease, UTI, stones, hypertension, DM, gout, connective tissue disorders

anura vs oliguria

anuria - less than 100cc

oliguria - less than normal

dysuria vs nocturia

dysuria - painful urination

nocturia - getting up to pee in the night

urinary incontinence is

treatable

urgency vs frequency

urgency - have to go but cant necessarily go

frequency - amount of times you go

distention vs retension

distention - expanding from pressure within

retention - when you cant empty all your urine

stress incontinence

loosing urine during a certain action like laughing or sneezing

diuretics effect of urination

prevent reabsorption of water and certain electrolytes in tubules

cholinergic meds effect on urination

stimulate contraction of detrusor muscle, producing urination

analgesic and tranquilizer effect on urination

suppress CNS, diminish effectiveness of neural reflex

anticoagulant pee color

red

diuretic pee color

pale yellow

phenazopyridine (pyridium) pee color

UTI medicine, bright orange

elavil (antidepressant) pee color

brown or black

iron tablets can turn stool

black

kidneys assessment

palpation of the kidneys usually performed by APRN in a more detailed assessment

urinary bladder assessment

palpate and percuss the bladder or use a bedside scanner

skin assessment

assess for color, texture, turgor, and excretion of wastes

urine assessment

assess for color, odor, clarity, and sediment

The older generation is more prone to

UTIs. allow ample time for them to go to the bathroom

which term describes a condition in which 24 hr urine output is less than 50 mL?

anuria

anuria is synonymous with

kidney shutdown or renal failure

dysuria is synonymous with

painful or difficult urination

glycosuria is

the presence of sugar in the urine

pyuria is

pus in the urine

true or false: normal, fresh urine has an ammonia odor

false

normal fresh urine has

an aromatic odor. as urine stands, it often develops an ammonia odor bc of bacteria action

if a patient cannot void what is the PRIORITY

palpation to assess for distention

measuring urine output

void into bedpan, urinal, or specimen container in bed or bathroom, pour urine into the appropriate measuring device, place calibrated container on a flat surface and read at eye level. note the amount of urine voided and record on the appropriate form, discard urine in the toilet unless specimen is needed.

KUB

views the urinary system, usually to detect renal calculi

routine urinalysis

dont need sterile gloves

sterile specimens from indwelling catheter

don’t drain the bag into something. get from the port on the side. can be drawn back with a syringe

24 hour urine specimen

have patient pee once without counting it, start on the next urination

when hanging a foley bag

dont put the bag on a moving part, on the patient, or anywhere above the bladder

suprapubic catheter is for

those with obstructions or those with prostate problems

nursing diagnoses with urinary function as the problem

incontinence, pattern alteration, urinary retention

nursing diagnoses with urinary function as the etiology

anxiety, risk for infection

planned patient goals for urination

produce enough urine to maintain fluid, electrolyte, acid-base balance. empty bladder completely w/o discomfort, provide care for urinary diversion and know when to notify physician. correct unhealthy urinary habits. develop plan to modify factors contributing to current or future urinary problems.

promoting normal urination

maintaining normal voiding habits, promoting fluid intake, strengthening muscle tone, assisting with toileting

patients at risk for UTIs

sexually active women, those who use diaphragms, post menopausal, indwelling catheters, DM, older adults

reasons for catheterization

relieving urinary retention, obtaining sterile urine specimen, emptying bladder for surgery(pre, intra, post), increasing comforting in terminally ill

if catheterized patient is complaining of abdomen pain

check catheter placement and check for kinks, also check for patency

patient education for urinary diversion

explain reasoning and rationale for diversion/treatment. demonstrate self-care. describe follow-up care and support resources. report where supplies can be obtained. verbalize related fears and concerns. demonstrate positive body image

the large intestine

primary organ in bowel elimination. extends from IC valve to anus. absorbs water, forms feces, expels feces.

peristalsis

under control of the nervous system. contractions ever 3-12 min. 1-4 full system sweeps per 24 hrs

narcotics can lead to

constipation

main concern with anyone who is bowel incontinent

skin breakdown

bowel infant considerations

characteristics of stool and frequency depend on formula or breast feedings

toddler bowel considerations

physiologic maturity is the first priority of bowel training

child, adolescent, adult bowel considerations

defecation patterns vary in quantity, frequency, and rhythmicity.

older adult bowel considerations

constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes

which food is recommended for an older adult who is constipated

fruit. these and veggies have a laxative effect on the system

constipating foods

cheese, lean meat, eggs, pasta

foods with a laxative effect

fruits and veggies, bran, chocolate, alcohol, coffee

gas producing foods

onions, cabbage, beans, cauliflower

aspirin-anticoagulants effect on stool

pink to red to black stool

antacids effect on stool

white discoloration or speckling in stool

antibiotics effects on stool

green-gray color stood

physical assessment of the abdomen.

I-contour, masses, scars, distention; A-BS in all 4 quadrants (hypo, hyper, normo, absent, infrequent)

physical assessment of the anus and rectum

inspect and palpate for: lesions, ulcers, fissures, inflammation, external hemorrhoids. ask patient to bear down. assess for appearance of internal hemorrhoids or fissures and fecal masses. inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence

with stool collection:

medical aesepsis imperative. do not contaminate outside of container with stool. obtain, package, label and transport according to agency policy. urine should not be in this specimen at all.

bowel diagnostic test (indirect)

CT, MRI, ultrasound, barium enemas, small bowel series

types of direct visualization studies (endoscopy)

EGD, colonoscopy, sigmoidoscopy, wireless capsule endoscopy

noninvasive procedures..

take precedence over invasive procedures

schedule of diagnostic tests

fecal blood occult test, barium studies, endoscopies

medications that cause diarrhea

amoxicillin, magnesium, metformin. diarrhea raises BP and heart rate

outcomes: normal bowel elimination

patient has formed BM every 1-3 days w/o discomfort. relationship between elimination, diet, fluid, and exercise explained. patient seeks medical eval if there are changes that persist

exercises promoting bowel habits

abdominal exercises, thigh strengthening

diarrhea nursing measures

answer call bells immediately, remove the cause of diarrhea, if impacted get order for examination, give special care around the region

high risks for constipation

bedrest with constipating meds

reduced fluids or bulk in diet

depression

CNS disease or local lesions causing pain while defacating

iron

narcotics

kayexalate cannot be given

with low potassium

kayexalate

binds to potassium, treats hyperkalemia

methods of emptying the colon

enemas. suppositories. intestinal lavage. digital removal.

enema bags

should be held 18 in above the body. may have to be clamped if the patient cannot tolerate

serious response when emptying the colon

vagal response. heart rate drops very low

bowel training

manipulate factors within a patients control (food, intake, exercise, time). eliminate at regular interval w/o laxatives. continue to help toileting. schedule around the same time (mornings are ideal)

types of ostomies

sigmoid, descending, transverse, ascending, ileostomy

colostomy care

keep pt free of odor, empty frequently. inspect stoma regularly, keep site clean and dry. measure I&O, explain aspect of care and self-care role. encourage to care for and look at ostomy