Bowel and urinary elimination

anatomy of the urinary tract and gender variations

kidneys, ureter, bladder, urethra
women's urethras are shorter than mens

process of urination including the neurophysiology involved

kidneys filter blood where they convert waste productions and fluid into urine, then the urine is transported via ureter to the bladder, the bladder is hollow and stretches to fit the urine, once the bladder reaches capacity, receptors inside the bladder send signals to the brain to indicate the bladder should be emptied, the urine is then expelled through the urethra

normal urine characteristics

light-yellow color without cloudiness

urinalysis findings

in depth information from blood to protein to white blood cells and bacteria present

as age increases, kidney function ______ with the loss of ______ and _____ and ______ in the blood supply

decrease; tissue; nephrons; reduction

as you age you also loose _____ _____ in your bladder

muscle tone

psychosocial influences on urinary elimination

emotional stress and anxiety, having to use a public toilet, lack of privacy during hospital stays, not having enough time to urinate (timed bathroom breaks)

relation of fluid balance or status to urinary elimination

if fluids and the concentrations of electrolytes and solutes are in the equilibrium, and increase in fluid intake increase urine production

urinary incontinence

inability to control urination, resulting in involuntary passing of urine

urinary retention

bladder does not completely empty with urination

UTI

causes pain and burning sensation when urinating

physical assessment of the bladder and bladder ad scanning to detect urinary retention and significant findings

inspecting abdominal area looking for bladder distention, bladder scanning is used to measure bladder volume and residual volume after urination, if there is urinary retention it may signal need for an intermittent catheter

random nonsterile specimen

explain procedure, label the container with client's indentifying information and follow the facilities policy for specimen transportation

clean-catch midstream

educate the client on technique, after thorough cleaning of the urethra meatus, the client catch the urine sample mid-stream

sterile specimen

obtain straight from catheter using surgical asepsis

time urine specimen

collect for 24 hours or other duration, discard after 1 void, collect all other urine, refrigerate, label, and transport specimen

functional incontinence

loss of urine due to factors that interfere with responding to the need to urinate (cognitive, mobility)

overflow urinary incontience

frequent loss of small amount of urine due to obstruction or impaired detrusor muscle

stress urinary incontience

loss of small amount of urine due to increase in abdominal pressure without bladder muscle contracting (laughing or sneezing)

urge urinary incontience

inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle with increased bladder pressure

reflex urinary incontinence

involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, can also occur due to impaired nervous system

signs and symptoms associated with UTIs

pain when urinating, blood in urine, lower back or abdominal pain, feeling of not fully emptying bladder

common etiologic or risk factors for UTI

history of UTIs, frequent sex, dehydration, kidney stones, increase in age, enlarged prostate, urine retention

common etiologic factors for the various types of urinary incontinence

poor abdominal or pelvic floor muscle tone, acute and chronic disorders, spinal cord injury

common etiologic factors for toileting self-care deficit

diminished strength or endurance, pain or discomfort, impaired mental ability, depression anxiety

common etiologic factors for urinary retention

loss of muscle tone, blockage in any part of the elimination system, swelling, enlarged prostate

evidence based nursing interventions to prevent or manage the various types of urinary incontience

toileting schedule, monitor and increase fluids intake during the day (reduce a few hours before bedtime) remove or control barriers, provide incontience care

reason for intermittent cath

temporary intervention for clients at risk for skin breakdown when all other options have failed

reasons for a short term indwelling

acute urinary retention or bladder outlet obstruction, accurate urine measurements, bladder irrigation, patients requiring an epidural

reason for a long term indwelling

urinary incontinence, critically ill patients, used when other methods have not been effective or practical, a wound or opening that could be contaminated by urine

anatomy of GI system

mouth, pharynx, esophagus, stomach, small intestine, large intestine, anal canal

how does age affect bowel elimination

decreased peristalsis and relaxation of sphincters

how does diet affect bowel elimination

difficulty digesting food, food that increase gas or constipation or runny stools; fiber requirement 25-38 g/day

how does fluid intake affect bowel elimination

2L/day for women, 3L/day for males, reduction of fluid intake can lead to constipation

how does physical activity affect bowel elimination

stimulates intestinal acitivity

how does physiological state affect bowel elimination

emotional distress increases peristalsis and exacerbates chronic conditions, depression can decrease peristalsis

how does physical activity affect bowel elimination

physical activity increases intestinal activity

how does psychological state affect bowel elimination

emotional distress increases peristalsis and exacerbates chronic conditions; depression can decrease peristalsis

how does personal habits/preferences affect bowel elimination

personal habits/preferences: reluctance to use public toilets, one-a-day bowel movements mentality, lack of privacy

how does pain affect bowel elimination

if it hurts, they may not want to go.. or put off eliminating

how does pregnancy affect bowel elimination

compromised intestinal space, slower peristalsis, straining increases risk of hermorrhoids

how does surgery and anesthia affect bowel elimination

temporary slowing of intestinal activity

how does infections affect bowel elimination

can cause runny stools

how does medications affect bowel elimination

can cause constipation

how does diagnostic testing affect bowel elimination

anxiety

normal and abnormal fecal characteristics

brown, soft-firm, easy to pass; hard, dry, painful

inspection of the abdomen and rectum as it relates to bowel elimination

check for bowel sounds and tenderness, check for hemorrhoids or any other significant irritations that could impact passing stool through the rectum

auscultation of the abdomen and significance of normal and abnormal bowel sounds in relation to bowel eliminations and GI function

auscultation is the first step of abdominal assessment, normal bowel sounds mean digestion/peristalsis is working, no bowel sounds mean it is not

describe the nurse's role in patient prep and collection of fecal specimens

educate the patient on the procedure and how to provide for the procedure, obtain sample, package and label sample properly, send to lab

fecal impaction

large lump of dry, hard stool that stays stuck in the rectum

flatulence

the accumulation of gas

hemorrhoids

swollen veins in the anus and lower rectum

bowel diversion

allows stool to safely leave the body when- because of disease or injury- the large intestine is removed and or needs time to heal

constipation

stool moves too slowly through digestive

risk for constipation

older aged, hydration levels, medications, physical activity, etc.

perceived constipation

impression of infrequent or difficult passage of hard, dry feces without cause

diarrhea

frequent loose/liquid stools

bowel incontience

inability to control defecation

toileting self-care deficit

impaired ability to perform own toileting activities

intervention to promote bowel elimination for patients with constipation

increase water and fiber consumption, increase physical activity, stool softeners or stimulants, last resort-enemas

intervention to promote bowel elimination for patients with diarrhea

rehydrate, eat foods that do not cause loose stools, electrolytes, promote skin integrity with creams and such

intervention to promote bowel elimination for patients with bowel incontience

change diet, wear absorbent pads, meds, pelvic floor exercises

discuss role of antibiotics use on development of C. Diff infection and identify the nurse's role in prevention, early detection, and prevention of the spread infection

antibiotic- vancomycin, kills bacteria causing infection
prevention- use appropriate hygiene; early detection-fever, severe cramping, early testing etc; prevention of spread- practice contact transmission precautions

fecal impaction signs and symptoms and appropriate intervention and nursing care

large lump of dry, hard stool that stays stuck in the rectum; sign/symptoms- abdominal cramping and bloating, rectal bleeding, leaking of stool around the impaction

purposes for enema administration

promote defecation, cleansing, expel flatus, instilling a medication

isotonic enema solutions

does not pull electrolytes from the body or shift fluids out of the colon

hypotonic enema solutions

exert osmotic pressure, causing water to move from the colon to the interstitial space

hypertonic enema solutions

sodium phosphate, pull fluid from the interstitial space into the colon

possible complications associated hypotonic and hypertonic enema solution

hypotonic: water toxicity or circulatory overload
hypertonic:dehydration