elimination/Oxygenation

urinary tract

primary function is to eliminate waste and excess fluid from the body in the form of urine

• regulate electrolyte levels

• produces hormones important for blood pressure regulation

• develops red blood cells

• helps to keep bones strong.

  
  

what are some urinary tract functions?

1. kidneys

2. ureters

3. bladder

4. urethra

how does urine travel through the urinary tract?

1-2L

how much urine does the kidneys produce daily?

2c

amount of urine a bladder can hold?

150-200mL

when does the brain signal the bladder to urinate?

antidiuretics

minimize fluid loss by preventing urine production in the kidneys.

diuretics

increase urination by increasing urine production in the kidneys.

anuria

• extreme lack of urine production

• <100ml in 24hrs

oliguria

• between 100 ml and 500 ml in 24 hours

• abnormally low amounts of urine

dysuria

difficulty urinating

hematuria

blood in the urine

nocturia

medical condition defined as waking up two or more times during the night to urinate

suprapubic

discomfort or pressure felt in the lower abdomen, directly above the pubic bone

polyuria

• passing an abnormally large volume of urine

• greater than 2000 ml / 24 hr

urinary retention

a condition where you cannot fully empty all the urine from your bladder

Residual urine (post void residual)

the amount of urine left in the bladder after you finish urinating

30-60ml/hr

normal UOP

• stress incontinence

• urge incontinence

• reflex incontinence

• overflow incontinence

• functional incontinence

• bedwetting

types of urinary incontinence

stress incontinence

coughing, sneezing, laughing, or physical activity that increases pressure on the bladder

urge incontinence

strong urge to urinate, but leaking occurs before getting to the toilet

reflex incontinence

urinary leakage as a result of nerve damage

overflow incontinence

incomplete bladder emptying which results in the bladder overfilling when full

functional incontinence

physical inability to reach the toilet in time

• Fluid management

• Avoid caffeine and alcohol

• Bladder retraining

• Pelvic floor muscle exercises

• Normal position

• Running water

• Warm water over the perineum

incontinence treatment

• inability to urinate

• pain

• abdominal distention

• urinary frequency

• urinary hesitancy

• weak or slow urine stream

• urinary leakage.

symptoms of urinary retention

UTI

• Caused by bacteria entering the urinary tract.

• More common in women than in men because women have a shorter urethra.

• Symptoms include burning or painful urination and frequent urgency to urinate despite not having a lot of urine to pass.

  
  

pyelonephritis

UTI left untreated, may result in a kidney infection called

• sexual activity

• menopause

• urinary retention

• urinary obstruction

• frequent urinary catheter use

• diabetes

• urinary tract abnormalities.

what puts you at risk of developing a UTI?

renal calculi, nephrolithiasis, or urolithiasis

hard formations of minerals and salts that collect in the kidneys.

urinary diversion

• a surgical procedure that creates a new path for urine to leave or be stored in your body when the bladder is removed or cannot function normally

• types:

  • suprapubic catheter

  • indwelling catheter

suprapubic catheter

• Placed by surgeon

• Stitched in place

• Uses balloon

• Requires catheter care per policy

indwelling catheter

• Placed by nurse

• Uses a balloon

• Secured with leg strap

• Requires catheter care per policy

• Intermittent (straight or curved)

• Indwelling retention (foley)

• Suprapubic

• Condom

catherization types

normal

what does straw color urine indicate?

dehydration

what does amber color urine indicate?

overhydration

what does light straw color urine indicate?

medications

what does orange color urine indicate?

blood, injury, medications

what does red urine indicate?

• color

• odor

• consistency

• clarity

characteristics of urine

antibiotics

what do you treat a UTI with?

back pain

ss of kidney stones?

• pelvic floor exercises

• clamping foley; have them tell you when they need to urinate

• bladder swing (surgery for mothers

types of bladder retraining?

• have they had anything to drink?

• are they on dialysis?

• any antidiuretics?

questions to ask if pt is retaining urine?

to get around prostate

why is the purpose of a curved intermittent urinary catheter?

Retrograde urine flow

urine flows backward from the bladder toward the kidneys, known as vesicoureteral reflux

ileostomy

• Connects the ileum (the end of the small intestine) to the abdominal wall, bypassing the entire large intestine.

• Output is typically liquid or semi-liquid and continuous

urostomy

• Diverts urine away from the bladder by using a small piece of the intestine to create a conduit that exits through the abdominal wall.

• This is done when the bladder is diseased, removed, or not functioning

purewick

female version of a condom catheter?

• KUB (xray)

• IVP-Intravenous Pyelogram

• Ultrasound Renal & Bladder

• Cystoscope

diagnostic exams for urinary system analysis

clean catch urinalysis

directing them to pee in a specimen cup

sterile catch urinalysis

• in and out cath

• pull through foley cath port

• depends on facility policy

24 hour urine

• Discard this first voiding, but save all urine for the next 24 hr. rou

• Keep on ICE.

• Be sure to inform the patient and all staff about the collection.

• Post signs in prominent locations, such as the client’s bathroom or entry door, to remind staff of the ongoing test and alert them not to discard urine.

• ph

• protein

• glucose

• ketones

• blood

• specific gravity

• RBC

• WBC

what are we looking for on a routine urinalysis?

4.6-8.0 avg. 6

average urine ph?

• high ph due to the presence of bacteria

• WBC

• protein

• ketones

what would a UTI test result look like?

glucose, protein, ketones

biproducts of bacteria in urine?

burning, frequent urge to urinate, brain

lower UTI symptoms?

ECOLI

most common bacteria in UTI?

back pain

upper uti symptoms?

change in mood, agitation, confused, combative

What might be a sign of UTI in the elderly?

• Hand hygiene

• Maintenance of a closed system.

• Prevent pooling of urine in the drainage system.

• Avoid kinks in the tubing.

• Keep drainage bag below level of the bladder.

• Secure the catheter.

• Routine perineal hygiene.

UTI Infection Prevention

• Urinary Incontinence

• Infection

• Impaired Self Toileting

• Impaired Skin Integrity

• Urinary Retention

Nursing problems common to patients with urinary elimination problems?

liver, pancreas, gallbladder, mouth, esophagus, stomach, small intestine, large intestine, and anus.

what is the GI tract composed of?

epiglottis

prevents food and liquid from entering the airway and allows it to continue into the esophagus.

large intestine

liquid absorbed from the waste byproduct

small intestine

chemical breakdown and nutrient absorption

constipations

• Fewer than three bowel movements in a week.

• •A condition where the production of stool is slowed.

• Can result in dry and hard to pass bowel movements

• give a sensation of incomplete emptying or passing of stool

• minimum fiber diet

• little water

things that contribute to constipation

• Antacids

• Anticholinergics and antispasmodics

• Antiseizure medications

• Calcium channel blockers

• Diuretics

• Iron supplements

• Anti-Parkinson’s disease medications

• Narcotic pain medications

• Antidepressants

Medications That Can Slow Gastric Motility and Cause Constipation

Diverticulosis

• is a condition in which small sacs or pouches form in the colon.

• These sacs increase a client’s risk for diverticulitis as a result of food becoming trapped.

Irritable bowel syndrome (IBS)

• term used to describe abdominal pain and changes to bowel elimination patterns

• which can include diarrhea and/or constipation alone

Ulcerative colitis (UC)

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

• Onset is gradual and worsens over time, but there can be periods of remission that can last weeks or years.

Crohn’s Disease

• chronic disease that commonly causes inflammation of the small intestine, but it can also affect any part of the GI tract.

• Like UC, Crohn’s disease worsens over time but can have periods of remission.

Ileostomy-Colostomy

different types of bowel diversions

• cleansing enemas

• oil retention enemas

• kayexalate enema

different types of enemas

• Tap water

• Normal saline

• Hypertonic solutions

• Soapsuds

different types of liquids used in cleansing enemas

left lateral Sims' position with the right knee flexed toward the chest

what position do you lay pt in when administering rectal meds?

obtain pulse

before administering enema to cardiac disease pt what should done?

vagus nerve can cause a sudden decline in pulse rate

why is it important to obtain a pulse rate prior to administering enema

cathartics, suppositories laxative, antidiarrheal agents

medications for constipation

colonoscopy

a medical procedure that lets a doctor examine the inside of your large intestine and rectum using a thin, flexible tube with a camera

• Stool for occult blood

• Stool for fecal fat

• Stool for ova and parasites

stool sampling

the nose, oropharynx, larynx, trachea, bronchi, bronchioles, and lungs.

what is the respiratory system comprised of?

lungs

responsible for bronchodilation (expansion of the airway in the lungs) and bronchoconstriction (restriction of the airway in the lungs).

bronchodilation

expansion of the airway in the lungs

bronchoconstriction

restriction of the airway in the lungs

parasympathetic and sympathetic systems.

The lungs are also linked with the nervous system by both the

inhalation

the diaphragm and intercostal muscles contract when?

inhalation

negative pressure inside the lungs

exhalation

the diaphragm relaxes, the intercostal muscles contract,

Surfactant

keeps the alveoli from collapsing

•Decreased oxygen-carrying capacity

•Hypovolemia

•Decreased inspired oxygen concentration

•Increased metabolic rate

Physiological factors Affecting Oxygenation

• Pregnancy

• obesity

• neuromuscular disease

• musculoskeletal abnormalities

• trauma

• CNS alterations

Conditions affecting chest wall movement

anemia, paralysis, COPD, arthritis, cystic fibrosis, asthma

Influences of chronic diseases of the respiratory system

• Nutrition

• Hydration

• Exercise

• Smoking

• Substance abuse

• Stress

• Environment

Factors Influencing Oxygenation

•Tachypnea and tachycardia

•Restless and anxious

•Pale skin and mucous membranes

•Use of accessory muscles, nasal flaring

early Signs of Hypoxia

•Stupor

•Cyanotic

•Bradypnea

•Hypotension

•Cardiac dysrhythmia

late Signs of Hypoxia

Hypoxia

Inadequate tissue oxygenation at the cellular level

• nasal canula

• simple mask

• non-rebreather

common ways to deliver oxygen