Elimination and Inflammatory Response

Elimination

• Elimination is the process of removing waste, minerals, and electrolytes from the body through:
  • Urination
  • Sweating
  • Defecation (bowel movements)

Bowel Elimination

• Digestion begins in the mouth with saliva, which starts to break down food due to its acidic nature.
• As food moves through the stomach, feces begin to form.
• The GI tract absorbs fluid, nutrients, electrolytes, minerals, and water.
• The consistency of feces depends on the location in the GI tract: liquidy at the beginning, more solid as it moves lower.

Urinary Elimination

• Blood runs through the kidneys, which remove electrolytes and water that the body needs while retaining waste.
• Carcinogens in the bloodstream (e.g., from smoking) end up in the urine in the bladder.
• The bladder is a smooth muscle that can be easily manipulated.
• Females who smoke have a higher risk of bladder cancer.
• Normal bladder capacity: 300-500 mL of urine.
• Once this limit is reached, nerve sensors signal the need to eliminate.
• Potty training involves learning to control bladder and ureter sphincters (voluntary muscles).
• Urine is continuously created as blood runs through the kidneys.
• The body tries to maintain homeostasis with electrolytes and minerals.

Kidney Issues

• Signs of renal system issues (e.g., kidney infection, acute kidney disease):
  • Decreased urination
  • Edema
  • Cloudy, foul-smelling urine
  • Hematuria (blood in urine, possibly orange-tinged)
• Decreased urination is called A-Anuria.
• Excess urination is called Halyuria.
• Painful urination is called Dysuria.
• If a patient with a urinary catheter has less than 200 mL of urine in 24 hours, it indicates possible kidney failure.

Age-Related Differences

• Toddlers/children: Lack control over sphincters, hence the need for potty training.
• Pregnant women: The baby sits on the bladder and colon, causing:
  • Frequent urination
  • Constipation
• Older adults:
  • Constipation (due to less fluid intake)
  • Incontinence (sphincter muscles weaken)

Valsalva Maneuver

• The Valsalva maneuver involves holding breath and bearing down during bowel movements.
• It can be affected by a herniated disc pushing on the colon.

Incontinence

• Urinary Incontinence: Inability to control sphincters, leading to involuntary urination.
  • Increases risk of skin breakdown (urine is acidic) and falls.
  • Associated with UTIs and unsteady gait.
  • Can be caused by age, pregnancy, vaginal birth, or cesarean section (stress incontinence from laughing, coughing, sneezing, jumping).
• Fecal Incontinence: Inability to control bowel movements.
  • Can be caused by poor nutrition, tumors, blockages, or hemorrhoids.

Stool Color

• Dark, tarry, black stool indicates possible blood.
• Bright red stool indicates fresh blood, likely from the lower colon (possible cancer in the rectum or hemorrhoid).

Alzheimer's and Incontinence

• Alzheimer's disease can lead to incontinence depending on the affected brain area.
• Patients may forget how to use sphincters or become impacted.

Urinary Retention

• Inability to release urine.
• Treated with catheters (straight or Foley).
  • Straight catheters are single-use.
  • Foley catheters have a balloon to stay in place.
• Causes:
  • Benign Prostatic Hyperplasia (BPH): Enlarged prostate strangles the urethra.
  • BPH can affect erection and ejaculation.

Retention of Stool

• Often due to lack of hydration, leading to impaction.
• Digital breaking up of stool in the rectum may be necessary.
• Excessive hydration can also cause discomfort.

Complications

• UTIs: Cause burning, discomfort, and inflammation.
• Neoplasms: Tumors in the bladder can cause issues.
• Organ failure: Especially kidney failure.

Impact of Incontinence

• Involuntary release of urine or feces leads to:
  • Skin breakdown
  • Changes in daily activity
  • Changes in social relationships (depression, seclusion, isolation)

Urinary Retention Details

• The external sphincter does not open, or there is a blockage, leading to increased bladder volume and distension.
• Backflow up the urinary tract can cause dilation of ureters and renal pelvis, pyelonephritis (kidney infection), and renal atrophy.

Bowel Retention Details

• Can happen when children tighten sphincters, losing the urge to defecate.
• Leads to dried, harder stool, constipation, and impaction.
• Dietary fiber is essential for clean bowel system.

Assessment

• Inspect the abdomen for distension.
• Auscultate for peristalsis (should be constant), 30 seconds each quadrant. If no peristalsis, listen for 2 minutes.
• Palpate gently if bowel sounds are present; avoid if there is a suspected blockage.
• A firm, distended abdomen indicates a problem.

Diagnostic Testing for Urine

• Urinalysis: Checks for protein, sugar, etc.
• Blood tests: BUN (blood urea nitrogen), creatinine for kidney function.
• Urine culture to check for infection.

Other Diagnostic Tests

• Radiographic testing including cystoscopy (camera in the urethra).
• Colonoscopy for the colon.
• Looking for cancerous tumors or polyps.
• Polyps always removed because can turn cancerous.

Questioning Patients About Bowel Habits

• Stool consistently coming out like streamers may indicate cancer or blockage.
• Ask about natural bowel habits and any deviations.

Levels of Prevention

• Primary Prevention: How to prevent a condition from arising.
  • Example: Car accident: wearing a seatbelt, taking driving classes, stopping at lights.
  • For bowels, focuses on environmental factors, hydration, dietary fiber, physical activity.
• Secondary Prevention: Screening to detect issues early.
  • Example: Cancer: Mammograms and screenings due to family history.
• Tertiary Prevention: Managing an existing condition.
  • Example: Broken leg: treatment and care for recovery.

Maintaining Optimal Health

• Physical activity is essential for movement and metabolism.
• Regular toileting practices and addressing body image issues related to incontinence.

Collaborative Interventions

• Strategies might include pharmacological agents (but be aware of side effects like retention with steroids).
• Avoid stopping steriods altogeher, taper the dose to avoid adverse effects.
• Invasive procedures include catheters and surgical interventions for tumor removal.
• For bowel issues, surgical interventions address fissures or leakage.

Diarrhea

• Results in electrolyte and acid-base imbalances.
• Pedialyte or Gatorade can help restore electrolytes.
• Dehydration can lead to lethargy and sunken fontanelles in pediatric patients.

Mobility Issues

• Impaired mobility (e.g., Parkinson's) affects urinary and bowel elimination.

Question 1

• The maneuver that can assist in passage of stool but also stimulate the vagus nerve and cause bradycardia is called Valsalva.

Question 2

• What is the key element for prevention of bowel and urinary elimination problems? Water and Fiber. Water and Fiber.

Question 3

• Pain produced by percussion over the costal vertebral angle may indicate the presence of infection in the Kidney.
• Kidneys are located in the flank area.

Diagnosing Kidney Issues

• Kidney stones (renal calculi) are made of calcium and can cause blockages.
• Overuse of medication can also affect the kidneys.

Inflammation

• Inflammation is a protective response involving tissue injury and immunological defense against infection or tissue injury.
  • Acute: short term.
    • Scratch, UTI, Kidney infection.
  • Chronic: Long term.
    • Arthritis. Asthma. Rheumatoid Arthritis.

Cell Function and Injury

• White blood cells come together to protect the injured area, and not allow to spread any place else.
• They band together, fight/ eat bacteria.
  swelling is caused by white blood cells surrounding, and they protect the injured area.
• Red blood cells bring platelets/oxygen/ Red Blood Cells/ Glucose.

Glucose

• Glucose Gives glucose for restoring/ healing process.

The process of Chronic Inflammation

• Chronic: Have to remove the necrotic Tissue. (Dead Tissue= Gows Fast).
• Healthy or Damaged tissue is repairable.
• Disrupted by the reinjury of inflammation.

C reacte protein vs CRP

• On labs it shows like blood test
• Increased erythrocyte/ Red blood cells.

Autoimmune

• Chronic: Long Term
  • Colitis, Chron's disease. HIV/Aids
• Acute- Not as long
  • Allergies- Kicking in the HIstamine.

Consequences of Excessive or ineffective inflammatory response

• Excessive and ineffective inflammatory responses can lead to:
  • Tissue damage
  • Systematic pathology (arteriosclerosis, chronic renal disease, neurological disorders)

Risk Factors for Inflammatory Response and Autoimmune Disease

• Consequences of Excessive/ ineffective Inflammatory Response
  • Underinsured/ uninsured.
• Who's at Risk
  • An autoimmune Disease / genetic, Hygiene Practices, Environmental Factors ( Finances)

Inspection

• You inspect your body for infections/ inflammation when you have a sprained ankle. The best way to help this is at home:
• Rice : Rest. Ice, Compression, Elevation.
• If you are putting ice on their feet. It has to be barrier protection. Cannot be directly cold. Cause heat to skin.
• 24---18 fever/ inflammation.

Tests

• Blood Test. White blood cell counts, MRI, XRAY, PET Scan. Colonoscpoy.

• A PET Scan helps determine the cancer cells in your body, It lights up if you have cancer! In comparison, a tumor has abnormal edges, not rounded.

Prevention

Primary Prevention

• Reduce risk for injury + infection. Maintain Good Hygiene Equipment. Properly storing preparing food. Don't eat the food if it seems bad.
• Make sure to keep food at a temperature so there are no bacteria forming. When you cook something and leave it on counter, make sure to put it away soon because bacteria is growing. Primary vs Secondary vs tertiary
  • Eat the left overs around 3-5 days but don't push the 7 days. So you wanna to know, you gotta know. If it does not smell right throw it out.
  • Secondary: No screening: Rice. Immoblitzation Devices.

Compartmental syndrome - if they dont move fingers.

• Blood test: Is the white blood cell, If somebody has sling their arms must move.
  Stress system, Sleep + Rest.
  Smoking- Foreign thins.

Other notes on patient risk

• Steroids/ Medications side effect to keep in mind
• Cirosious: Only happens with heavy drinker
  It does not only happen with heavy drinking. It can happen when a person has fatty liver.
• This happens to some on that are overweight, If fat is in the liver, its is going produce and pump out bail, You physically see jaunice . Fatty liver is kinda like scars. You can lose the fat f you lose weight and stay on a healthy diet.
  It the person comes over and says lower back then think of urination, Blockages coming from kidney, Kidney stones.
• If any every have A kidney store: Most pain ever.