NURM-102 Elimination Exam Review

Detrusor muscle

Contracts to relax the internal sphincter

Anuria

24-hour urine output under 50 mL

• Can indicate failure

Dysuria

Painful/difficult urination

• Usually with UTI or trauma

Nocturia

Awakening at night to urinate, usually after 40 y/o

Oliguria

24-hour output below 400mL

• Not as severe as anuria

Pyuria

Pus in the urine, indicates infection

Urinary incontinence

Any involuntary loss of urine

Malodorous and cloudy urine indicates…

Infection

Normal urine pH

5-6

Blood Urea Nitrogen

Elevates with kidney disease or dehydration

• Evaluates kidney function and hydration

• 6-20mg/dL in adults normal

• Decreased = Dehydration

• Elevated indicates renal disease/reduced renal blood flow

Urine culture

Checks for infection to diagnose UTI

Normal specific gravity of urine

1.015-1.025

Functional incontinence

Caused by inability to reach toilet due to environmental barriers, physical limitations, memory loss or disorientation

• Nothing wrong with urinary system

Urge incontinence

Involuntary loss soon after feeling an urgent need to void

• Typically due to overactive bladder syndrome

Stress incontinence

Due to weakened pelvic floor muscles or deficient urethral sphincter

• Happens with intra-abdominal pressure

Risk factors in urine loss

Childbirth, menopause, obesity, or straining (constipation)

Transient incontinence

Happens suddenly due to short-lived/temporary problem

Interventions for FUNCTIONAL incontinence

Prompted/scheduled voiding

Interventions for URGE incontinence

Bladder retraining

• Hold urine for increasing increments of 30 minutes

• Goal of 2 hours

External urinary sheath

AKA the condom cath

• Self-adhesive but trim them pubic hairs

Valsalva maneuver

Bearing down

Barium enema

Douche with barium contrast and X-ray

• Finds tumors, polyps and inflammation

Palpable mass in LLQ can indicate…

Constipation

Stimulant laxatives

Promotes peristalsis by irritating mucosa or stimulates nerve endings

Saline laxatives

Draws water into intestine and stretches it to contract

Bulk forming laxative

Absorbs water into intestine to increase fecal bulk and peristalsis

Emollients

Lowers surface tension and promotes water accumulation in intestine and stool

Impaction

Lodging of stool in rectum due to unrelieved constipation

• Liquid seeps around rock-like blockage, continual liquid stool

Renin and ACE regulate…

Blood volume and pressure

Urinalysis

• Checks pH, proteins, glucose, ketones, blood and specific gravity in urine

Urge incontinence is caused by…

Overactive bladder

E. coli

Bacteria from GI tract that most commonly causes bladder infection

Intermittent catheters

Straight cath

• Most common for bladders that retain to prevent UTI

Hook catheter drainage bag to…

Moveable part of bed frame (NOT side rails)

Why should you not leave a urine specimen out?

Becomes alkaline as it sits

Mid-Stream/Clean-Catch

Patient just pees in the cup themselves

• Only if pt can do pericarp, hold cup and close it without breaking sterile field

Sterile specimens can also be obtained from

Straight cath

Indwelling catheter removal

Remove as soon as possible

• Maintain sterility

Constipation

Makes stool dry, hard and ball-shaped

• Rectal fullness/pressure with straining and pain during defecation

• Palpable mass in LLQ

Opioids

Cause constipation

Types of laxatives

• Stimulants

• Saline

• Bulk forming

• Emollients

Stimulant laxative EXAMPLES

• Dulcolax

• Senokot

• Ex lax

Saline laxative EXAMPLES

• Magnesium citrate

• Milk of Magnesia

• Lactulose

Bulk-forming laxative EXAMPLES

• Metamucil

• Citrucel

You must take enough _____ with bulk forming laxatives.

fluid

Emollient laxative EXAMPLES

• Colace

• Surfak

Cleansing enema

WARM solution

• Tap water, normal saline, hypertonic solution, soap suds

Tap water enema

Large volume, hypotonic solution (doesn’t pull much fluid)

• Hold for 15 minutes and evacuate stool

Normal saline enema

Large volume, isotonic (pulls nothing)

• Hold for 15 min and evacuate

Hypertonic solution enema

Small volume/fleets

• Irritation leads to contraction

• Hypertonic pulls in fluid

Soap suds enema

Added to large volume enemas

• Extremely mild, irritates without damaging intestinal mucosa

What does diarrhea cause?

Dehydration and electrolyte (potassium) depletion

When are meds NOT given for diarrhea?

If an infection is present (so that diarrhea clears it out)

Anti-diarrheal meds

• Opioids

• Somato-statins

• Absorbents

Anti-diarrheal opioid

Decreases GI motility

• Lomotil

Somato-statin anti-diarrheal med

Decreases smooth muscle contraction

Absorbent anti-diarrheal med

Coats walls of GI tract

Causes of BOWEL incontinence

• Loss of sphincter control

• Progressive dementia

• Neuromuscular impairment

• Spinal cord injury

Bowel training program

• Set up routine based on patterns of incontinence

• Offer diet/hot fluids and prune juice prior to schedule

• Assist to bathroom/proper positioning