elmination bowel/urine

Bowel Elimination

Every individual has different factors influencing their bowel elimination patterns. Only the patient can define what is normal for them.

Assessment Questions

Last BM, Consistency (hard/ soft), Color, Normal or not

Common Bowel Problems

constipation, impaction, diarrhea, incontinence, flatulence, hemorrhoids

Bristol Stool Form Scale

used to identify changes in stool consistency

Stool Type

Type 1 or 2 - Constipation; Type 3 or 4 - Healthy Stools; Type 6 or 7 - Diarrhea

Bowel Diversions

Surgical procedure, patients need increased fluids due to increased risk for dehydration.

Ileostomy

Type of Ostomy involving the Small Intestine, located on the Right side (lower region), resulting in completely watery/liquid stool.

Colostomy

Type of Ostomy involving the Large intestine, located on the Left side, resulting in more formed than liquid stool (not like regular).

Peristomal Skin Care

Stoma must be clean, dry, intact, and not red.

Wafer

Goes around outside the stoma.

Pouch management

Bags vary (roll with clips/ Velcro).

Laxative

Medications that affect elimination.

Fiber/Bulk Forming Laxative

Uses water from colon to make stool larger.

Osmotic Laxative

Keeps water in colon to soften stool.

Lubricant Laxative

Coats stool making it easier to pass.

Ambulation

Lack of movement prone to more elimination issues.

Normal Flora Support

Antibiotic use can use for yogurt with live cultures or prebiotics to keep digestive system healthy.

Enemas

Used for cleaning out colon for constipation, pre-test prep, help remove high potassium.

Upper GI/ EGD (endoscopy)

Visualizes esophagus, stomach, duodenum; NPO 6 hrs prior.

Lower Scope/ Colonoscopy

Visualizes large intestine, colon, rectum, anus; bowel prep, clear liquid day prior, avoid red, purple, containing seeds.

Fecal Occult Blood Test (FOBT)

Detects blood in stool; sample tested on card.

Barium Swallow Test

Visualizes upper area blockages; drink contrast dye and x-rays are done.

NG tube placement

Used to decompress the stomach by removing contents or air.

Homeostasis

Eliminates toxins/waste and provides acid-base balance in body.

Kidney Structure

Bean shapes located on either side of vertebrae column; cortex contains nephrons.

Nephrons

Site where removal of water, salt, sugars, and toxins occurs.

Ureters

Two (one from each kidney), 10-12 in. in length, passes waste to bladder.

Bladder

Hollow muscular organ that contains folds called ruga which allow it to expand to hold urine.

Urethra/Meatus

Females= 1.5 in long, males= about 8 in long passes through prostate gland.

UTI

Lower Tract infection commonly health acquired; caused by poor hygiene or E. coli; treated with antibiotics.

Pyelonephritis

Upper Tract inflammation of kidneys caused by bacterial infection.

Bacteremia/Urosepsis

Systemic infection in bloodstream that can be fatal; requires antibiotics.

CAUTI

Increases morbidity rate; preventable; caused by insertion or lack of proper hygiene.

Incontinence

Loss of urine

Urge/Urgency

sudden need to go w/o feeling need beforehand

Stress Incontinence

urine leakage when running, coughing, sneezing or bouncing

Nocturia

waking up throughout night to urinate

Retention

inability to void or incomplete emptying of bladder (Acute: blockage/ Chronic: disease processes, enlarged prostate, or medications)

Automatic Dysreflexia (AD)

Urgent emergent situation cause by uncontrolled sympathetic response

Risk Factors for AD

patients with spinal cord injury between C1 and C2 who lack urge/sensation to empty bladder

Trigger for AD

distended bladder or blockage

Nursing Action for AD

Notify provider ASAP

Signs/Symptoms of AD

Elevation in normal BP, heartrate, severe sweating, extreme anxiety, constriction of peripheral blood vessels

Potential Consequence of AD

Stroke, retinal hemorrhage, cardiac arrest, or pulmonary edema

Internal Pouch/STOMA

Bladder removed and replaced with an internal pouch. Stoma created on outside

Ileal Pouch

Bladder removed and replaced with ileal pouch

Nephrostomy Tube

Tube is place into renal pelvis, sutured into skin and drains into bag

Goal Setting for Urinary Elimination

minimal urinary elimination amount for a pt. should be 30mL/hr

Clean catch

pt. voids a little, cleanses, void more, stops, catches sample in cup, remove and finishes voiding

Sterile Specimen

can be collected from foley catheter or through sterile straight cath (requires order)

Post-Void Residual (PVR)

The amount of urine that remains in bladder after voiding

Cystitis

inflammation of bladder

Dysuria

painful urination

Oliguria

low urine output <30mL/hr for more than 2 hrs

Polyuria

excessive urine output

Hematuria

blood in urine