~Elimination~

Study Guide – Elimination (Urinary & Bowel)

Page 1: Fundamentals of Elimination

Learning Objectives (Know These Themes)

Be able to:

• Explain how urine and feces are produced

• Identify expected vs. abnormal elimination findings

• Recognize conditions that alter elimination

• Understand diversions (urinary/bowel) and their purpose

• Identify diagnostic tests and the nurse’s role

• Describe nursing interventions that support elimination

• Practice within PN vs RN scope of practice

Scope of Practice (PN Focus)

• PN scope varies by state

• Often:

  • Assist RN with plan of care

  • Collect specimens

  • Perform focused assessments

  • Implement ordered interventions

• PN must know and follow state guidelines

⚠ Exam tip: If asked, PNs usually assist, implement, and report, not independently diagnose.

Urinary System

Functions

• Removes waste & excess fluid

• Regulates:

  • Electrolytes

  • Blood pressure

  • Red blood cell production

  • Bone health

Urinary Tract Order (TEST THIS)

Kidneys → Ureters → Bladder → Urethra

Kidneys

• Filter 120–150 quarts of blood/day

• Produce 1–2 quarts of urine/day

• Contain nephrons (filters)

Bladder & Urination

• Holds up to 2 cups

• Muscles involved:

  • Internal sphincter

  • External sphincter

  • Pelvic floor muscles

• Stretch receptors signal need to void

Urine Production

Normal Urine

• Color: Clear, light yellow

• Odor: Minimal

• Consistency: Clear

Abnormal Findings

Expected Urine Output (VERY TESTABLE)

• Infants: 2 mL/kg/hr

• Toddlers: 1.5 mL/kg/hr

• Teens: 1 mL/kg/hr

• Adults: 0.5 mL/kg/hr

Dietary Effects on Urine

• ↑ Fluids → ↑ urine, lighter color

• Alcohol & caffeine → diuretic

• Foods:

  • Beets → red urine

  • Asparagus → strong odor

  • Food dyes → blue/green

Age-Related Urinary Changes

• ↓ kidney function

• ↓ nephrons

• ↓ bladder tone → incontinence

• ↑ urinary retention risk

📌 Exam Question Answer:
✔ Loss of bladder tone leading to urinary leakage

Gastrointestinal (GI) System

GI Tract Order (TEST THIS)

Mouth → Esophagus → Stomach → Small Intestine → Large Intestine → Anus

Peristalsis

• Wave-like muscle contractions

• Moves food & stool forward

Feces Production

• Begins in the mouth

• Nutrients absorbed in small intestine

• Stool forms in large intestine

• Vitamin K produced by bacteria

• Stool stored in rectum

Bristol Stool Chart (MEMORIZE RANGE)

• Types 1–2: Constipation

• Types 3–4: Normal

• Types 5–7: Diarrhea

Dietary Effects on Stool

Foods that increase diarrhea:

• Alcohol

• Caffeine

• Dairy

• Greasy/fatty foods

• Fructose

• Spicy foods

• Artificial sweeteners

Age-Related GI Changes

• ↓ peristalsis

• ↓ bowel muscle tone

• ↑ constipation

• ↓ fluid & fiber intake

• Medications contribute

Expected Elimination

• Urine: clear, light yellow

• Stool: soft, formed, easy to pass

• Frequency varies by individual

Altered Urinary Elimination

Urinary Incontinence (UI)

Types (VERY TESTABLE):

Urinary Retention

• Incomplete bladder emptying

• More common in males (BPH)

• Findings:

  • Hesitancy

  • Weak stream

  • Distention

  • Leakage

📝 Difference

• Incontinence: involuntary leakage

• Retention: inability to fully empty bladder

Altered Bowel Elimination

Constipation

• < 3 BMs/week

• Hard, lumpy stool

• Risks:

  • Low fiber

  • Medications

  • Immobility

• Severe → fecal impaction

Diarrhea

• Loose, watery stools

• Risks: infection, antibiotics

• Watch for:

  • Dehydration

  • Fever

  • Blood in stool

Bowel Incontinence

• Urge incontinence most common

• Passive = no awareness

• Leads to skin breakdown & embarrassment

Medications That Affect Elimination

Increase Urine

• Diuretics:

  • Thiazide

  • Loop (Lasix)

  • Potassium-sparing

Cause Constipation

• Opiates

• Anticholinergics

• Iron

• Antidepressants

• Calcium channel blockers

Cause Diarrhea

• Antibiotics

• Magnesium antacids

Physiological Conditions

Dehydration

• Dark urine

• Dry mouth

• ↓ urine output

• Treatment: oral fluids or IV fluids

UTI

• Burning

• Urgency

• Frequency

• Treated with antibiotics

• Untreated → pyelonephritis

Kidney Stones

• Severe flank pain

• Hematuria

• Treated with fluids, pain meds, ESWL

Kidney Failure

• < 15% kidney function

• Dialysis or transplant

BPH

• Weak stream

• Retention

• Nocturia

• ↑ age risk

GI Conditions

• Diverticulitis: inflamed pouches

• IBS: pain + bowel changes

• Bowel obstruction: N/V, distention, NG tube

• Ileus: absent bowel sounds

• Ulcerative colitis: bloody diarrhea

• Crohn’s disease: skip lesions, malnutrition

Exam Power Tips

⭐ Memorize:

• Urinary & GI tract order

• Urine output values

• Incontinence types

• Bristol stool types

Constipation vs diarrhea differencesStudy Guide – Page 2: Urinary & Bowel Diversions, Diagnostics, & Nursing Interventions

URINARY DIVERSIONS

When Are Urinary Diversions Needed?

• Interrupted urine flow due to:

  • Injury

  • Birth defect

  • Tumor

  • Bladder malfunction

  • Obstruction (stone, inflammation)

✔ Can be temporary or permanent

Types of Urinary Diversions (VERY TESTABLE)

1. Urinary Catheterization (Most Temporary)

• Flexible tube drains urine

• Inserted:

  • Through urethra

  • OR surgically through abdomen

• Used for short-term urine drainage

2. Ureteral Stent

• Keeps ureter open

• Used when blocked by:

  • Stones

  • Scar tissue

  • Swelling/infection

• Usually temporary but may be long-term

3. Urostomy (Ileal Conduit)

• MOST COMMON surgical urinary diversion

• Uses a piece of small intestine

• Ureters → ileum → stoma → external pouch

• Urine drains continuously

• No bladder involved

⚠ Cutaneous ureterostomy: ureters attached directly to stoma

4. Nephrostomy

• Tube drains urine directly from kidney

• Inserted through back

• External collection bag

• Often temporary (post–kidney stone removal)

5. Continent Urinary Diversions

✔ Urine stored internally

Neobladder

• New bladder made from bowel

• Attached to ureters & urethra

• Client voids normally

• May need intermittent catheterization

Continent Cutaneous Reservoir

• Internal pouch in abdomen

• Attached to stoma with valve

• Must be emptied with catheter

6. Cystostomy

• Catheter inserted directly into bladder

• Through abdominal wall

• More invasive than urethral catheter

Complications of Urinary Diversions

• UTIs

• Kidney infections

• Skin irritation

• Psychosocial effects (depression, body image)

✔ Teaching focus:

• Hand hygiene

• Stoma care

• Infection signs

• Life activities usually resume normally

FECAL (BOWEL) DIVERSIONS

Indications

• Colon/rectal cancer

• Crohn’s or UC

• Obstruction

• Injury

• Diverticulitis

Types of Fecal Diversions (MEMORIZE)

Ileostomy

• Uses ileum (small intestine)

• Stool is:

  • Liquid

  • Continuous

• Temporary or permanent

• Colon may be removed/bypassed

Colostomy

• Uses colon

• Stool more formed

• Temporary or permanent

• Can be reversed

✔ Colostomy irrigation

• Bowel training technique

• Reduces need for pouch

• Helps prevent constipation

J-Pouch

• Internal pouch from ileum

• Connected to anus

• Stool exits through anus

• Often created with temporary ileostomy

Kock Pouch

• Continent ileostomy

• Internal pouch with valve

• Emptied with catheter

• No continuous drainage

Complications of Fecal Diversions

• Skin irritation

• Stoma prolapse/hernia

• Blockages

• Diarrhea

• Electrolyte imbalance

• Infection

OSTOMY CARE (Urinary & Fecal)

WOC Nurse Role

• Stoma care education

• Skin protection

• Supply access

• Troubleshooting

Key Teaching

• Clean with mild soap + water

• Pat dry

• No perfumes/chemicals

• Proper pouch fit = skin protection

• Report:

  • Pain

  • Color/odor change

  • Bleeding

URINARY DIAGNOSTIC TESTS

Urodynamic Testing (WHAT EACH MEASURES)

URINE SPECIMEN COLLECTION

Urinalysis

• Visual → Dipstick → Microscopic

• Tests:

  • pH

  • Protein

  • Glucose

  • Ketones

  • Blood

  • Leukocytes

  • Nitrites

⚠ Antibiotics → false negatives

Urine Culture

• Identifies bacteria

• Requires clean catch

• Incubated 24–48 hrs

• Susceptibility testing determines correct antibiotic

⭐ Exam phrase:
✔ Prevents antibiotic resistance

24-Hour Urine Collection

• Collect ALL urine for 24 hrs

• Refrigerate specimen

• Used to assess kidney function

• Avoid certain foods/meds

URINE COLLECTION METHODS

Clean Catch

• Midstream

• Front-to-back cleansing

• Avoid contamination

Catheterization

• Sterile technique

• Used when clean catch not possible

✔ Condom & female external catheters = clean technique only

GI DIAGNOSTIC TESTS

STOOL TESTS

FOBT

• Detects hidden blood

• Avoid:

  • Beets

  • Red meat

  • Vitamin C

  • NSAIDs

✔ Purpose: Blood may not be visible

Stool Culture

• Severe or persistent diarrhea

• Travel, antibiotics, contaminated food

• No dietary restrictions

NURSING INTERVENTIONS – URINARY

• Lifestyle changes

• Bladder training

• Pelvic floor (Kegels)

• Catheterization if needed

• Bladder scanning before catheter use

Catheter Types

• Straight (intermittent)

• Indwelling

• Condom (male)

• Female external catheter

⭐ CAUTIs = “never event”

NURSING INTERVENTIONS – BOWEL

Lifestyle

• High fiber

• Fluids

• Exercise

• Respond to urge

Enemas

• Cleansing vs retention

• Solutions:

  • Tap water (risk electrolyte imbalance)

  • Saline

  • Mineral oil

  • Sodium phosphate

Laxatives (MEMORIZE TABLE LOGIC)

SKIN CARE FOR INCONTINENCE (SELECT ALL APPLY ALERT)

✔ Clean with mild soap & water
❌ Avoid alcohol-based creams
✔ Pat dry
✔ Daily skin assessments
✔ Use barrier creams

NG TUBE DECOMPRESSION

• Used for bowel obstruction

• Measure: nose → ear → xiphoid

• Verify placement:

  • X-ray

  • pH

  • Capnography

EXAM POWER MOVES

🔥 Memorize:

• Diversion types & differences

• Which are continent vs incontinent

• Clean vs sterile technique

• Catheter types

• FOBT restrictions

• CAUTI prevention principles