Competency 15: Elimination (Urinary and Bowel)

What is the primary function of the urinary system?

To remove waste and excess fluid from the body and maintain fluid and electrolyte balance.

What are the four main structures of the urinary tract?

Kidneys, ureters, bladder, and urethra.

What is the correct pathway of urine through the urinary system?

Kidneys → ureters → bladder → urethra → outside the body.

What is the function of the kidneys?

Filter blood, remove waste, regulate fluid and electrolytes, help regulate blood pressure, and support red blood cell production.

What is the function of the ureters?

Transport urine from the kidneys to the bladder.

What is the function of the bladder?

Store urine until urination occurs.

What is the function of the urethra?

Carry urine from the bladder to the outside of the body.

How much urine can the adult bladder comfortably hold?

Approximately 300-400 mL.

What is the minimum expected urine output for an adult?

Approximately 0.5 mL/kg/hr, commonly at least 30 mL/hr.

What is the expected appearance of normal urine?

Clear, pale yellow, and without cloudiness.

What does dark yellow or amber-colored urine commonly indicate?

Concentrated urine, often associated with dehydration.

What is hematuria?

The presence of blood in the urine.

What is dysuria?

Pain or burning during urination.

What is nocturia?

Waking up during the night to urinate.

What is urinary urgency?

A sudden, strong need to urinate.

What is urinary hesitancy?

Difficulty starting the urinary stream.

What is enuresis?

Involuntary urination, commonly occurring during sleep.

What factors influence urine production?

Fluid intake, diet, medications, activity, age, and kidney function.

How does caffeine affect urinary elimination?

It can increase urine production and worsen urgency or frequency.

How can aging affect urinary elimination?

Decreased kidney function and bladder tone may contribute to retention, frequency, or incontinence.

What is urinary incontinence?

Involuntary leakage of urine due to loss of bladder control.

What is stress incontinence?

Urine leakage when coughing, sneezing, laughing, or exercising.

What is urge incontinence?

A sudden urge to urinate followed by leakage before reaching the toilet.

What is functional incontinence?

Inability to reach or use the toilet in time because of physical or environmental limitations.

What is reflex incontinence?

Involuntary leakage caused by neurological impairment and bladder reflex contractions.

What is overflow incontinence?

Leakage caused by an overfilled bladder that does not empty completely.

A client leaks urine when coughing. Which type of incontinence is suspected?

Stress incontinence.

A client with arthritis cannot unbutton their clothing quickly enough to use the toilet. What type of incontinence is this?

Functional incontinence.

A client experiences sudden urinary urgency and leaks before reaching the bathroom. What type of incontinence is this?

Urge incontinence.

What are Kegel exercises?

Exercises that strengthen the pelvic floor muscles to improve bladder control.

Which type of urinary incontinence commonly benefits from Kegel exercises?

Stress incontinence.

What is bladder training?

A scheduled toileting program that gradually increases the time between urinations.

What nursing interventions help prevent skin breakdown in clients with urinary incontinence?

Frequent cleansing, keeping skin dry, using barrier creams, and changing soiled briefs promptly.

What is urinary retention?

Inability to empty the bladder completely.

What are common manifestations of urinary retention?

Bladder distention, suprapubic discomfort, hesitancy, weak stream, and incomplete emptying.

What is postvoid residual (PVR)?

The amount of urine remaining in the bladder after voiding.

How does the nurse measure PVR noninvasively?

With a bladder scanner.

What is a common cause of urinary retention in older male clients?

Benign prostatic hyperplasia (BPH).

Why can urinary retention occur after surgery?

Anesthesia and opioids can interfere with bladder emptying.

A postoperative client has not voided and reports suprapubic discomfort. What should the nurse do first?

Assess bladder fullness, commonly with a bladder scan.

What complications can untreated urinary retention cause?

UTIs, bladder damage, overflow incontinence, and kidney dysfunction.

What is a urinary tract infection (UTI)?

An infection involving part of the urinary system, commonly the bladder.

What are common manifestations of a lower UTI?

Dysuria, frequency, urgency, and suprapubic discomfort.

Why are females at increased risk for UTIs?

Their shorter urethra allows bacteria to reach the bladder more easily.

What is pyelonephritis?

An infection of the kidney.

Which findings suggest that a UTI may have progressed to pyelonephritis?

Fever, chills, flank pain, nausea, and vomiting.

What is nephrolithiasis?

Formation of kidney stones.

What are common manifestations of kidney stones?

Severe flank pain that may radiate to the groin, hematuria, nausea, and urinary urgency.

Why does the nurse strain urine for a client with kidney stones?

To collect a stone for analysis.

What is extracorporeal shock wave lithotripsy (ESWL)?

A procedure that uses shock waves to break kidney stones into smaller pieces.

What does a urinalysis evaluate?

Urine appearance and chemical or microscopic findings such as protein, glucose, blood, leukocytes, and bacteria.

What is the purpose of a urine culture and sensitivity test?

To identify microorganisms and determine which antibiotics are effective.

When should a urine culture ideally be collected?

Before antibiotic therapy begins.

How is a clean-catch midstream urine specimen collected?

Clean the genital area, begin voiding into the toilet, and collect the middle portion in a sterile container.

Where should a urine specimen be obtained from an indwelling catheter?

From the disinfected catheter sampling port, never the drainage bag.

What is the first step in a 24-hour urine collection?

Have the client void and discard the first urine, then record the starting time.

What should the nurse do if a urine specimen is missed during a 24-hour collection?

Restart the collection according to facility policy.

What is cystoscopy?

Direct visualization of the urethra and bladder using a scope.

What is uroflowmetry?

A test measuring urine flow rate and volume.

What is the purpose of a bladder scan?

To estimate urine volume and assess for retention without inserting a catheter.

What is an intermittent urinary catheter?

A catheter inserted to drain the bladder and removed immediately afterward.

What is an indwelling urinary catheter?

A catheter that remains in the bladder for continuous drainage.

What is a catheter-associated urinary tract infection (CAUTI)?

A UTI associated with an indwelling urinary catheter.

What is the most important way to reduce CAUTI risk?

Avoid unnecessary catheterization and remove indwelling catheters promptly when no longer needed.

What technique is required when inserting an indwelling urinary catheter?

Sterile technique.

Where should the urinary drainage bag be positioned?

Below bladder level and off the floor.

Why should the catheter drainage system remain closed?

To reduce bacterial contamination and infection risk.

What should the nurse do if urine stops draining through a catheter?

Assess for kinks, obstruction, bladder distention, and other problems before following the prescribed intervention.

What is the purpose of bladder irrigation?

To maintain catheter patency and remove blood clots or debris when prescribed.

What is intake and output (I&O)?

Measurement of fluids entering and leaving the body.

What are examples of measurable fluid intake?

Oral liquids, IV fluids, tube feedings, and liquid medications.

What are examples of measurable fluid output?

Urine, emesis, liquid stool, and drainage from tubes or drains.

How is fluid balance calculated?

Total intake minus total output.

A client receives 1,500 mL of fluid and produces 1,000 mL of output. What is the fluid balance?

+500 mL.

What is an ileal conduit (urostomy)?

A urinary diversion using a segment of small intestine to drain urine through an abdominal stoma into a pouch.

What is a nephrostomy tube?

A tube that drains urine directly from the kidney into an external collection bag.

What is a neobladder?

A surgically created urine reservoir made from bowel tissue.

What is a continent cutaneous urinary reservoir?

An internal urine reservoir emptied periodically by catheterizing its stoma.

What is a cystostomy?

A surgically created opening into the bladder through the lower abdomen for catheter drainage.

What is the expected appearance of a healthy urinary stoma?

Pink to red and moist.

A urinary stoma becomes dusky or black. What is the priority nursing action?

Notify the provider promptly because impaired blood flow or tissue necrosis is possible.

What is the primary function of the gastrointestinal system?

Digest food, absorb nutrients and water, and eliminate waste.

What is the correct pathway of food through the GI tract?

Mouth → esophagus → stomach → small intestine → large intestine → rectum → anus.

What is peristalsis?

Wave-like muscular contractions that move food and waste through the GI tract.

Where does most nutrient absorption occur?

In the small intestine.

What is the main function of the large intestine?

Absorb water and electrolytes and form stool.

What is the function of the rectum?

Store stool until defecation.

What are expected characteristics of normal stool?

Soft, formed, brown, and easy to pass.

What is the purpose of the Bristol Stool Chart?

To classify stool consistency and identify constipation or diarrhea.

Which Bristol Stool Chart types are considered ideal?

Types 3 and 4.

Which Bristol Stool Chart types indicate constipation?

Types 1 and 2.

What factors influence bowel elimination?

Diet, hydration, activity, age, medications, stress, and medical conditions.

How does fiber promote bowel elimination?

It adds bulk and retains water in stool, promoting peristalsis.

How does immobility affect bowel elimination?

It decreases intestinal motility and increases constipation risk.

Which medications commonly cause constipation?

Opioids, iron supplements, anticholinergics, and some calcium channel blockers.

How can antibiotics affect bowel elimination?

They may disrupt normal intestinal bacteria and cause diarrhea.

What is constipation?

Infrequent, hard, difficult-to-pass stools.

What nursing interventions help prevent constipation?

Encourage fiber, adequate fluids, mobility, and regular toileting.

What is fecal impaction?

A hardened mass of stool that becomes lodged in the rectum or colon.

What finding may indicate fecal impaction despite apparent diarrhea?

Liquid stool leaking around the hardened stool mass.