Quiz 6

A nurse is caring for a client who will perform female occult blood testing at home. Which of the following information should be included when explaining the procedure to the client? A. Eating more protein is optimal prior to testing B. One stool specimen is sufficient for testing C. A red color change indicates a positive test D. The specimen cannot be contaminated with urine

D

complications of constipation

-fecal impaction -hemorrhoids and rectal fissures -bradycardia, hypotension, syncope

nursing care for diarrhea

-help determine dn treat the cause -administer medications to slow peristalsis -provide perineal care after each stool, and apply a moisture barrier -after diarrhea stops, suggest eating yogurt to help re-establish an intestinal balance of beneficial bacteria

frequent urination

-may indicate medical problems -infection -diabetes

assess and monitor for fluid imbalance for diarrhea

-monitor intake and outtake -body weight -vital signs -skin turgor -moistness of mucous membranes

measuring intake and output (I&O)

-record all fluids the patient drinks or receives intravenously -fluid intake -fluid output -voided urine -urine from a catheter

A nurse is teaching a client who reports stress urinary incontinence. Which of the following instructions should the nurse include? (select all that apply) A. Limit total daily fluid intake B. Decrease or avoid caffeine C. Take calcium supplements D. Avoid drinking alcohol E. Use the Crede maneuver

B, D

valsalva maneuver

increase in pressure to expel feces by contracting the abdominal muscles (straining) while maintaining a closed airway (holding breathe)

intravenous pyelogram

-injection of contract media (iodine) for viewing of ducts, renal pelvis, ureters, bladder, and urethra -allergy to shellfish contraindicates the use of this contract medium

fluid and electrolyte disturbances

-metabolic acidosis from excessive loss of bicarbonate -monitor for manifestations of dehydration (weak, rapid pulse, hypotension, poor skin turgor, elevated body temp) -hypernatremia: muscle weakness, lethargy, swollen red tongue -hypokalemia: leg cramps, muscle weakness, nausea, vomiting, cardiac dysrhythmias -monitor for manifestations of electrolyte imbalance -replace fluid and electrolytes as prescribed

silicone catheter

-preferred for long term use -cause less tissue irritation and prevent encrustation

peristomal skin assessment

-the presence of enzymes in the effluent increases the likelihood of skin breakdown -assess the skin surrounding the stoma for redness, tenderness, skin breakdown, and/or drainage -cleanse the stoma and the surrounding area with a cleansing agent with a pH of 5.5

polyvinyl chloride catheter

-used for long term use -soften and conform to urethra

fluid intake and bowel elimination

2 L/day for females and 3 L/day for males from fluid and food sources

anuria

absence of urine or urine output less than 100 mL/24 hours

urinary retention symptoms

acute: -urinary hesitancy -dribbling -weak urine stream -urgent need to void -pain -discomfort -bloating in lower abdomen chronic: -urinary frequency (8+ times a day) -difficulty beginning stream -weak or interrupted stream -urgency -feels urge to void after voiding -mild and constant discomfort in lower abdomen

utilize an enterostomal therapy nurse

assist patients with ongoing care and consult for ostomy appliances

infrequent urination

may indicate dehydration

dysuria

painful or difficult urination

rectum

-6 in long -continuous with the anus -highly vascular folded tube -free of waste until just before defecation

carminative enema

-60 to 180 mL of solution instilled in the rectum to help expel flatus nd relieve bloating and distention -used after abdominal or pelvic surgery when peristalsis is slow to return and the client experiences pressure from gas

straight or indwelling catheter insertion sizing

-8 to 10 Fr for children -14 to 16 Fr for females -16 to 18 Fr for males -use silicon or teflon for clients who have latex allergies

alterations in urinary elimination

-UTIs -urinary retention -urinary incontinence -urinary diversion/urostomy

nephron consists of

-a bowmans capsule (double walled hollow capsule) enclosing a glomerulus -a series of filtrating tubules -a collecting duct

pregnancy and urinary elimination

-a growing fetus compromises bladder space and compresses the bladder -30 to 50% increase in circulatory volume, which increases renal workload and output -the hormone relaxin causes relaxation of the sphincter

signs of constipation

-abdominal bloating -abdominal cramping -straining at defecation -presence of dry, hard feces at defecation -irregular bowel movements, or reduced frequency from client's normal pattern

promoting regular bowel elimination

-adequate fiber in the diet -adequate fluid intake -adequate activity (walking 15 to 20 min/day if mobile and exercises in bed or chair (pelvic tilt, single leg lifts, lower trunk rotation)

promote adequate hydration

-adequate hydration promotes healthy urinary function and flushes the system of waste products -most people should drink eight to ten 8-ounce glasses of fluid daily unless health problems limit fluid intake -unfortunately, many people do not meet the recommended intake -water is the preferred fluid because soda, coffee, and tea often contain caffeine or additives that may cause diuresis and incontinence; however, the amount of fluid is more important than the type -if the patient will not or cannot drink water, provide the fluid he prefers

factors affecting bowel elimination

-age -diet -fluid intake -physical activity -psychosocial factors -personal habits -positioning -pain -pregnancy -surgery and anesthesia -medications

voiding

-also called urination or micturition -occurs when contraction of the detrusor muscles pushes stored urine through the relaxed internal urethral sphincter into the urethra -triggers conscious need to void -voiding may be voluntarily delayed by inhibiting release of a second, external urethral sphincter -when the person is ready, signal in the brain tells external sphincter to relax -further contraction of the detrusor muscle normally forces out any urine remaining in the bladder -after the detrusor muscle relaxes, bladder begins to fill with urine again

indwelling catheters

-also known as Foley or retention catheter -used for continuous bladder drainage -double lumen tube (one for drainage, one to inflate the balloon) -most patients: 5 mL balloon -children: 3 mL balloon

large intestine

-also known as colon -larger in diameter than the small intestine but shorter in length -extends from ileum of small intestine to anus -contains seven segments

cognitive changes as a factor of urinary elimination

-alter perception of the urge to void -severe psychiatric conditions involving altered perception or ability to manage activities of daily living may lead to incontinence

providing privacy for urination

-although urination is a normal physiological process, most people consider it a private matter -taking a matter-of-fact approach confirms to patients that you are comfortable with this aspect of care -provide privacy when discussing or providing care related to urination -excuse visitors from the room, draw the dividing curtains in shared rooms, and close the door to the room

personal factors of urinary elimination

-anxiety -lack of time -lack of privacy -loss of dignity

caring for patients with a urinary diversion

-assess the stoma -assess the skin surrounding the stoma -use a moisture proof skin barrier -monitor amount and type of drainage -empty collection device frequently -provide psychosocial teaching and patient education

position that facilitates defecation

-assist to seated or squatting position -semi fowlers is preferred for those on bed rest

bowel training program for bowel incontinence

-assists patients to have regular, soft, formed stools -use for patients with chronic constipation, impaction, or bowel incontinence -provide privacy during designated times for defecation (usually after meals) -gradually increase fiber in diet -increase fluid intake to 8 glasses of water per day -establish a designated time for defecation

bradycardia, hypotension, syncope

-associated with the valsalva maneuver (occurs with straining/bearing) -instruct clients not to strain to have bowel movements -encourage measures to treat and prevent constipation

risks and complications of urinary catheters

-bacteriuria and UTIs -provides entry for pathogens from external environment -risk of urethral injury if the catheter is too large and forced when inserted or not lubricated correctly

helping patients adapt to the diversion

-be attentive to psychosocial needs -modify diet -enterostomal therapy where nurse addresses participation in ostomy care

constipation

-because frequency of bowel elimination varies, constipation is usually defined as a decrease in the frequency of bowel movements resulting in the passage of hard, dry stool -can be a temporary problem -older clients susceptible bc bowel tone decreases with age -chronic constipation lasts 3 months or longer -assist to a position that facilitates defecation -allow uninterrupted time

diagnostic tests

-bedside sonography with a bladder scanner -kidneys, ureters, bladder x ray -intravenous pyelogram -renal scan -renal ultrasound -cystoscopy -urodynamic testing

fecal impaction

-breaking up hardened mass into pieces and manually extracting -administer an oil-retention enema at least 30 minutes before digital removal to soften stool and decrease discomfort -prescription required for digital removal since it stimulates the vagus nerve and causes the heart rate to slow

nutritional factors of urinary elimination

-caffeine acts as a diuretic and increases urine production -limit caffeine before bedtime to correct urinary production -consuming large amounts of alcohol impairs the release of ADH, resulting in increased production of urine -diet high in salt causes water retention and decreases urine production

conditions that may require a bowel diversion

-cancer -ulceration -trauma -inadequate blood supply

soapsuds enema

-castile soap in tap water or normal saline -irritant to promote bowel evacuation

seven segments of large intestine

-cecum -ascending colon -transverse colon -descending colon -sigmoid colon -rectum -anus

age and urinary elimination

-children achieve a full bladder by 4 or 5 -the prostate can enlarge in older adult males, causing urinary retention and urgency and leading to incontinence and UTIs -childbirth weakens the pelvic floor and puts clients at risk of prolapse which leads to stress incontinence (kegels help) -post menopause: decrease perineal tone due to reduced estrogen levels, causes urgency, stress incontinence, UTIs

types of enemas

-cleansing enemas -retention enemas -return flow enemas

dietary teaching for diarrhea

-clear liquid diet for electrolyte replacement fluids -sips of clear liquid -limit fiber intake and caffeinated products -clear broth and gelatin -children: follow BRAT diet (banana, rice, applesauce, toast) -infants continuing breast milk -> protective effect against enteritis -avoid foods that are spicy, high fat, large amounts of raw fruits and veg -resume normal diet gradually

nursing care

-closely monitor fluid status and elimination pattern -record food and fluid intake and output. for diarrhea, measure the volume of the stools -observe and document the character of bowel movements. carefully check for blood or pus. -promote regular bowel elimination through several measure

colostomy

-closer to the ascending colon = liquid and continuous drainage -closer to the sigmoid colon = solid feces -location determines the consistency of the feces, as well as the need to wear an ostomy appliance

indwelling fecal drainage device

-collect liquid stool from bedbound, immobilized, ill patients -soft, latex free catheter and collection bag -tube is inserted with ballon filled with water

freshly voided specimens

-collect the urine in the same manner as when you are measuring intake and output -pour the urine into a specimen container labeled with the patient's name, the date, and the time of collection -any facilities require packaging the container in a moisture-proof specimen-handling bag -follow agency policy on additional packaging -transport the specimen to the lab as soon as possible (according to agency policies) -if there is a delay in getting the specimen to the lab, most agencies recommend refrigeration

urine characteristics

-color: pale yellow two deep amber -clarity: freshly voided = translucent; if it sits for a period of time = cloudy -odor: has a scent -crystals, blood, mucous should be absent in freshly voided specimen

dipstick testing

-commonly performed at the bedside; microscopic examination is done in the lab -dipstick testing can determine pH and specific gravity and the presence of protein, glucose, ketones, and occult blood in the urine.

nursing interventions for those with urinary diversions

-consult a wound ostomy continence nurse to assist clients who have an incontinent diversion -monitor stoma and peristomal skin for indications of breakdown

four types of urinary diversions

-cutaneous ureterostomy -conventional urostomy -continent urinary reservoir -neobladder

urodynamic testing

-cystourethroscopy: visualizes inside of the bladder -uroflowmetry: measures the rate and degree of bladder emptying

cardiovascular or metabolic disorders as a factor of urinary elimination

-decrease blood flow through the glomeruli and thus impair filtration and and urine production -any condition that affects the nervous system control of the urinary system organs will impair urinary elimination -ex. after stroke or spinal cord injury, some patients may lose bladder control

complications of diarrhea

-dehydration -fluid and electrolyte disturbances -skin breakdown around the anal area

stool for occult blood

-detects blood from the GI tract -bleeding can indicate cancer -use to detect colorectal polyps which can be indicative of cancer -some foods can cause a false positive result -specimens are collected THREE times from THREE separate bowel movements

replacing and removing a bedpan

-determine a patient's level of comfort -identify factors that necessitate the use of a fracture pan -position the patient in semi fowlers or supine -place bedpan -remove bedpan -do not push or slide bedpan

applying an external (condom) catheter

-determine size of condom catheter -hand hygiene and don gloves -position patient supine -cleanse penis -apply skin prep and let dry -leave 1 to 2 in between end of penis and drainage tube on catheter -secure on penis -attach to drainage system; check for kinks -secure catheter tubing to thigh using leg strap or hypoallergenic tape

factors affecting urinary elimination

-developmental -personal -sociocultural -environmental -nutrition -hydration -activity level -medications -surgery and anesthesia -pathological conditions -cardiovascular and metabolic conditions -immobility and impaired communication -cognitive changes

factors effecting bowel age

-developmental stage -personal and sociocultural factors -nutrition/hydration/activity -medications -surgery and procedures -pregnancy -pathological conditions

medications as a factor of urinary elimination

-diuretics (sometimes called water pills) treat blood pressure, fluid retention, and edema by increasing elimination of urine -anticholinergic effects (medications given to relieve bladder spasms) inhibit the free flow of urine -nephrotoxic medications (damaging to the kidneys) include some antibiotics such as gentamicin, amphotericin, and high doses or long term use of aspirin and ibuprofen

medications and urinary elimination

-diuretics prevent reabsorption of water -antihistamines and anticholinergics cause urinary retention -chemo creates a toxic environment for the kidneys

preventing UTIs

-do not disconnect tubing to obtain specimen or measure urine -regularly check connections between catheter and drainage tubing and drainage tube and collection bag. -if system becomes disconnected, cleanse both ends with antiseptic before reconnecting -after bowel movement or catheter becomes soiled, cleanse with mild soap and water, dry well. -empty collection bag at least every 8 hours or more frequently if output is high -do not let spout touch surfaces-otherwise cleanse with antiseptic -keep collection bag below level of bladder, do NOT let bag touch floor. -teach patient signs and symptoms of UTI (cloudy, foul/strong smelling urine, chills or fever) -change indwelling catheter only when necessary. If sediment collects in tubing or not draining well. Check institution policy.

symptoms of UTIs

-dysuria -hematuria -chills and fever -foul smelling urine -urinary frequency -pain: back, sides, or under ribs -older adults: confusion, recent falls, anorexia, tachycardia, hypotension

psychosocial factors

-emotional distress increases peristalsis and exacerbates chronic conditions (colitis, Crohn's disease, ulcers, irritable bowel syndrome) -depression can lead to decreased peristaltic activity and constipation

promote normal urine production

-encourage oral intake 8-10 glasses water -monitor I & O at least every 8 hours -use calibrated measuring container to measure urine output. -observe urine color and other characteristics

hemorrhoids

-engorged, dilated blood vessels in the rectal wall from difficult defecation, pregnancy, liver disease, and heart failure -hemorrhoids can be itchy, painful, and bloody after defecation -use moist wipes for cleansing the perianal area, and apply ointments or creams as prescribed -use a sitz bath or ice pack to promote relief from hemorrhoid discomfort

nursing care for the urinary incontinent

-establish a toileting schedule -monitor and increase fluid intake during the daytime, and decrease fluid intake prior to bedtime -remove or control barriers to toileting -provide incontinence garments -apply an external or condom catheter for males -avoid the use of indwelling urinary catheters -provide incontinence care

procedure for fecal occult blood testing

-explain the procedure to the client -ask the client to collect a specimen in the toilet receptacle, bedpan, or bedside commode -don gloves -with a wooden applicator, place small amounts of stool on the windows of the test card or as directed -follow the facility's procedures for handling -apply a label to the cards and send them to the laboratory for processing -alternatively, place a couple drops of developer on the opposite side of the card. a blue color indicates the stool is positive for blood

procedure for collecting stool for culture, parasites, and ova

-explain the procedure to the client -ask the client to collect the specimen in the toilet receptacle, bedside commode, or bedpan -don gloves -use a wooden tongue depressor to transfer the stool to a specimen container -label the container with the client's identifying information -remove the gloves -perform hand hygiene -transport the specimen to the laboratory

incontinence

-fecal incontinence is the inability to control defecation, often caused by diarrhea -determine causes (medications, infections, or impaction) -provide perineal care after each stool, and apply a moisture barrier -provider can prescribe fecal incontinence pouch or other bowel management system to collect stool and prevent it from coming into contact with the skin

older adults and urinary elimination

-fewer nephrons -loss of muscle tone of the bladder leading to frequency -inefficient emptying of the bladder: residual urine increasing risk for UTIs -increase in nocturnia due to a decrease in bladder capacity -presence of chronic illnesses -factors that interfere with mobility and dexterity

diet and bowel elimination

-fiber requirement: 25 to 38 g/day -difficulty digesting foods (lactose intolerance) can cause watery stools -certain foods can increase gas (cabbage, cauliflower, apples), have a laxative effect (figs, chocolate), or increase risk for constipation (pasta, cheese, eggs)

function of the kidneys

-filter metabolic wastes, toxins, excess ions, and water from blood (if kidney function is impaired, these substances reach toxic levels and damage body cells) -regulate blood volume, blood pressure, electrolyte levels, and acid base balance -secondary function: produce erythropoietin, secrete renin, and activate vitamin D3

small intestine

-folded, twisted, coiled tube that connects the stomach and the large intestine -1 inch in diameter and 20 ft long -takes up most space in abdomen -most digestion and absorption occurs in the small intestine -divided into duodenum, jejunum, and ileum

constipation and diarrhea

-for healthy clients, they're not serious -for older adults and clients with pre-existing medical problems, constipation and diarrhea can have a significant impact on the client's health

causes of constipation

-frequent use of laxatives -advanced age -inadequate fluid intake -inadequate fiber intake -immobilization due to injury -sedentary lifestyle -pregnancy -medication effects

cleansing enema equipment

-gloves -lubricant -absorbent, waterproof pads -bedpan, bedside commode, toilet -IV pole -enema bag with tubing or prepackaged enema -solutions and additives

psychosocial needs

-goals is for patient to be able to care for the ostomy and resume normal life -first step is for patient to adjust to the presence of an ostomy

pregnancy and bowel elimination

-growing fetus compromising intestinal space -slow peristalsis -straining increasing the risk of hemorrhoids

managing common alterations in diarrhea

-hand hygiene -monitor stools to quantify diarrhea -assess and monitor for fluid imbalance -prompt hygiene care -monitor for alterations in perineal skin integrity -provide perineal care -proper dietary teaching -antidiarrheal medications

response to enema is affected by

-height of the solution container -speed of the flow (a slow, steady instillation rate decreases cramping and increases the patient's ability to retain the solution) -concentration of the solution -resistance of the rectum (muscle tone or history of constipation) -hypotonic and isotonic solutions are easier to retain

loop colostomies

-help resolve a medical emergency and are temporary -a loop of bowel is supported on the abdomen with a proximal stoma draining stool and a distal stoma draining mucus -constructed in the transverse colon

ostomy care procedure

-if a wound ostomy continence nurse is not available, educate the client about stoma care -perform hand hygiene -put on gloves -remove the pouch from the stoma -inspect the stoma (should be moist, shiny, pink) -use mild soap and water to cleanse the skin, then dry it gently and completely -moisturizing soaps can interfere with adherence of the pouch -apply paste if necessary -measure and mark the desired size for the skin barrier -if necessary, apply barrier pastes to creases -apply the skin barrier and pouch -fold the bottom of the pouch and place the closure clamp on the pouch -dispose of the used pouch

maintaining free flow of the urine

-if collection bag needs to be higher than bladder, clamp tubing -check tubing frequently to ensure urine is freely flowing -if not, check patient is not lying on tubing -prevent dependent loops in tubing

monitor the amount and type of effluent

-ileostomy effluent should be liquid and contain enzymes -ostomy lower in the GI tract should be more solid and contain fewer enzymes

urinary retention

-inability to empty the bladder completely etiologies include: -obstruction -inflammation and swelling -neurological problems -medications -anxiety

nursing care for constipation

-increase fiber and water consumption (unless contraindicated) before more invasive interventions -give bulk-forming products before stool softeners, stimulants, or suppositories -enemas are a last resort for stimulating defecation -encourage regular exercise

managing common alterations in defecation

-increase intake of high fiber foods -increase fluid intake -increase activity/exercise -provide privacy -position that facilitates defecation -allow uninterrupted time -offer laxatives when lifestyle changes are ineffective

developmental factors of urinary elimination

-infants have no voluntary control; 8 to 10 wet diapers a day -toilet training in children: between 18 and 36 months, depends on family and culture -older adults: renal blood flow decreases with age, leading to decrease in glomeruler filtration; loss of elasticity in bladder decreases potential volume --> increased need to urinate, especially at night; loss of muscle tone means decreases ability of bladder to empty complete --> bladder infections

periurethral collagen injections to the bladder neck

-injection of collagen or silicone implants into the urethral wall to impede urine flow -consult home care services to provide intermittent catheters, portable commodes, or stool risers -suggest installing handrails to assist clients who have bathroom needs

assessing the urine

-interpreting intake and output -measuring intake and output

stress incontinence

-involuntary loss of urine with increased intra abdominal pressure in the absence of an overactive bladder -causes: pregnancy, childbirth, obesity, chronic constipation, coughing/sneezing, exercise

anatomy of kidneys

-kidneys are retroperitoneal (located against the posterior abdominal wall behind the peritoneum) -shape of a kidney bean -nephron is basic structural and functional unit of the kidney -each kidney has two ureters that transport urine from renal pelvis to urinary bladder -the urinary bladder stores urine -the urethra transports urine

return flow enema

-known as Harris Flush -help a patient expel flatus and relieve abdominal distention -approx 100 to 200 mL of tap water or saline is instilled into the rectum

urinary incontinence

-lack of voluntary control over urination -urinary incontinence will affect about two-thirds of older adults, to at least some degree associated with: -skin impairment, obesity -UTIs -self-rated poor health -reduced mobility -depression -increased caregiver burden

medications and bowel elimination

-laxatives: soften stool -cathartics: promote peristalsis -laxative overuse: chronic use of laxatives causes a weakening of the bowel's expected response to distention from feces, resulting in the development of chronic constipation

overflow incontinence

-leakage of urine with distended bladder -causes include: fecal impaction, neurological disorders, enlarged prostate

expected findings for urinary incontinence

-loss of urine when laughing, coughing, sneezing -enuresis (bed wetting) -bladder spasms -urinary retention -frequency, urgency, nocturne

unconscious reflex incontinence

-loss of urine when the person does not realize the bladder is full and has no urge to void -causes: CNS disease, surgery, damage from radiation

hydrogel coated catheter

-made of either latex or silicone -cause less urethral trauma during insertion and resist encrustation -can remain in place up to 12 weeks

client education for the urinary incontinent

-maintain regular bowel movements -try to empty bladder completely with each void -keep an incontinence diary -perform kegel exercises -perform bladder compression techniques (Crede, valsalva, double voiding, splinting) to help manage reflex incontinence -avoid caffeine and alcohol consumption because these can irritate the bladder and increase diuresis and the urge to urinate -adverse effects of medications can affect urination -conduct vaginal cone therapy to strengthen pelvic muscle (for strength incontinence)

colostomy irrigation

-may be indicated for constipation -stoma above the descending colon has liquid output so irrigation is not indicated -can sit on or in front of a bedside commode or side lying position in bed -check temp of water, not too cold or hot -fluid flow should be 10 to 15 minutes or as long as can be tolerated -height of container should be patients shoulders -takes 6-8 weeks to achieve bowel regulation with irrigations

antidiarrheal meds

-may be used to slow peristalsis -not recommended for acute diarrhea -usually reserved for chronic diarrhea

immobility and impaired communication as a factor of urinary elimination

-may interfere with ability to get to the bathroom in time or to communicate the need for assistance -may result in urination in inappropriate settings or at inappropriate times

interpreting intake and output of urine

-measuring urine output is essential for monitoring fluid status -kidneys produce 50 to 60 mL of urine per hour -urinary output fluctuates

urinary elimination

-micturition (known as voiding) -normal urination patterns: kidneys produce 50-60 mL of urine an hour; most void 5 or 6 times a day depending on their fluid intake -characteristics of urine: check specific gravity (1.002 to 1.030), assess color, clarity, odor, crystals, blood, or mucus

neobladder

-mimics the function of a urinary bladder -a portion of intestine is made into a pouch or reservoir that is connected to the urethra -urine passes through the urethra, similar to the normal passage of urine -the patient voids by bearing down or applying manual pressure over the bladder (Credé's maneuver), but may also need to perform intermittent self-catheterization to fully empty the bladder -requires no external stoma or bag -urinary incontinence is fairly common after surgery, but typically resolves within the first 6 months

conventional urostomy (ileal conduit, bricker's loop, ileal loop, Kock pouch)

-most common type of urinary diversion because it is the simplest to perform surgically and eliminates the need for intermittent catheterization -uureters are implanted into a loop of the ileum (the last segment of the small intestine) where urine drains freely into the stoma bag -the downside is urine can back up into the kidneys, causing infection or stone formation over time

assist with positioning for urination

-most men stand to void and may have difficulty voiding in other positions -whenever possible, assist the patient to the bathroom to use the toilet and allow him or her to assume the preferred position -women generally find an upright seated or squatting position to be the most comfortable position for voiding -if a female patient must remain in bed, provide a bedpan -place her in a semi-Fowler's position to urinate unless contraindicated

facilitate toiling routines for urination

-most patients void on awakening, after meals, after drinking a large volume of fluid, before bedtime, or during the night for some -identify your patient's pattern and stick to it as much as possible -if you anticipate a change in the pattern for elimination, inform the patient

upper gastrointestinal tract

-mouth -pharynx -esophagus -stomach

pathological conditions and elimination

-neurological and cognitive conditions -pain or immobility that leads to sluggish peristalsis and pathological conditions of the GI tract

modifying diet for ostomy

-no longer have sphincter control -exclude foods that cause gas, odors, or blockages

pain and bowel elimination

-normal defecation is painless; discomfort due to conditions (hemorrhoids, fissures, perianal surgery) can lead to suppression of the urge to defecate -opioid use contributes to constipation

positioning and bowel elimination

-normal: squatting -immobility: can result in difficulty contracting gluteal muscles and defecating

assessment for urinary elimination

-nursing history -physical examination -diagnostic procedures -assessing the urine -

prevent transmission of infections

-observe standard precautions -wear gloves -hand hygiene before and after providing care

a urinary catheterization is performed for

-obtaining a sterile urine specimen -drain the bladder for surgical or diagnostic procedures, or when unable to empty bladder after voiding -prevent or treat bladder overdistention -measure post void residual urine if a bladder ultrasound device is not available or results are inconclusive -protect excoriated skin from contact with urine -reduce need for unnecessary movement of dying patients

UTIs

-occur when microorganisms, usually Escherichia coli (E. coli), which normally lives harmlessly in the colon, enter the urethra and begin to multiply, overwhelming the normal flora -an infection limited to the urethra is called urethritis -types: urethritis, cystitis, pyelonethritis, catheter associated UTI -complications: can lead to prostatitis, epidymitis, cystitis, pyelonephritis, bacteremia -risk factors: sexual activity in women, use of spermicidal contraceptive gel, older women, pregnant women, enlarged prostate glands, kidney stones, indwelling catheters, diabetes, immunocompromised, those with a history of UTIs -diagnostic tests: midstream clean catch, dipstick for leukocytes, blood, estrace, nitrates

cystitis

-occurs when bacteria travel up the urethra into the bladder, causing a bladder infection -if not treated promptly, the infection may progress superiorly (upward) to the ureters or kidneys (pyelonephritis)

pregnancy and elimination

-often experience constipation, decreased appetite, irregular food intake -increased pressure of the uterus and increased blood volume of a normal pregnancy increase the risk for hemorrhoids

meeting needs of older adults

-older adults are more susceptible to developing constipation as bowel tone decreases with age -therefore, they are more at risk for developing fecal impaction -adequate fluid, fiber intake, and exercise decrease the likelihood of developing constipation or fecal impaction -older adult clients are less able to compensate for fluid lost due to diarrhea -monitor older adults who have diarrhea for diarrhea-associated complications (electrolyte imbalances, dehydration, skin breakdown)

fluid intake

-oral fluids -semiliquid foods -ice chips -IV fluids -tube feedings -irrigations instilled

urinalysis

-overall screening test and an aid to diagnosing renal, hepatic and other diseases -requires a freshly voided specimen -non-sterile

self catheterization

-patients use a clean technique -goals is to completely empty the bladder and prevent UTIs -indicated in patients with spinal cord injuries or neurological disorders

assessment/data collection for constipation and diarrhea

-perform a routine physical examination of the abdomen (bowel sounds, tenderness) -check for fluid deficit -inspect skin integrity around the anal area -collect a detailed history of diet, exercise, and bowel habits -monitor for constipation -monitor for diarrhea -perform specimen collection for diagnostic testing as indicated -perform a digital rectal examination for impaction

cleansing enema procedure

-perform hand hygiene -prepare and warm the enema solution -pour the solution into the enema bag, allowing it to fill the tubing, and then close the clamp -provide privacy -provide quick access to a commode or bedpan -place absorbent pads under the client to protect the bed linens -position the client on the left side with the right leg flexed forward -put on gloves -lubricate the rectal tube or nozzle -slowly insert the rectal tube 3 to 4 inch; for a child, 2 to 3 inches -with the bag level with the hip, open the clamp -raise the bag 12 to 18 in above the anus, depending on the level of cleansing desired -slow the flow of solution by lowering the container if the client reports cramping, or if fluid leaks around the tube at the anus -if using a prepackaged solution, insert the lubricated tip into the rectum and squeeze the container to instill all of the solution -ask the client to retain the solution for the prescribed amount of time, or until the client is no longer able to retain it -discard the enema bag and tubing -assist the client to the appropriate position to defecate -remove the gloves -perform hand hygiene -for clients who have little or no sphincter control, administer the enema on a bedpan -document the results and the client's tolerance of the procedure

diagnostic procedures for urinary elimination

-performed in the operating room, procedures suite, or radiology department -nurses prepare the client for the procedure, assist with specimen collection, deliver aftercare, sometimes assist the physician -blood studies: blood urea nitrogen (BUN) and creatinine levels are commonly measured to assess renal function and hydration -visualization studies of the urinary system: tend to be invasive and therefore require a signed consent form

intermittent urinary catheterization

-periodic catheterization to empty the bladder -reduces the risk of infection from indwelling catheterization -temporary intervention for clients at risk for skin breakdown nursing actions: -adjust the frequency of catheterization to keep output at 300 mL or less -explain the procedure client education: -follow a toileting schedule according to the pattern with which they have no incontinence

factors affecting urinary elimination

-poor abdominal and pelvic muscle tone -acute and chronic disorders -spinal cord injury -age -pregnancy -diet -immobility -psychosocial factors -pain -surgical procedures -medications

ileostomy

-portion of the ileum is brought through a surgically created opening in the abdominal wall (called stoma or ostomy) -drainage liquid and continuous -patient must wear an ostomy bag at all times to collect drainage

delivering an enema

-position in left, side lying with left knees flexed (SIMs) -insert 3 to 4 inches of tubing into rectum -height of the container - lower, then slowly raise level -speed of flow -monitor the patient -instruct patient to hold the solution 5-15 minutes -provide perineal care -keep bedpan or commode nearby -DO NOT administer enema with patient sitting on the toilet -do not force the tube -container should be at level of patients hips (lowering the container slows the force of instillation, decreases pressure, cramping, discomfort, and reflex expulsion of solution -slowly raise the level 12-18 inches above the hips -monitor for pain or discomfort. if pain, stop and alert provider -leaving in too long can cause fluid and electrolyte complication -retaining hypotonic solutions can cause dehydration related to large amounts of fluid moving from capillary bed to bowel -excessive retention of hypotonic fluids can cause fluid overload

ostomy care equipment

-pouch system (skin barrier and pouch) -pouch closure clamp -barrier pastes (optional) -gloves -washcloths -towel -warm water -scissors -pen

goals of nursing care for a patient with an indwelling catheter

-prevent UTIs -maintain free flow of urine -prevent transmission of infections -promote normal urine production -maintain skin and mucosal integrity

managing common alterations in bowel incontinence

-prevent impaired skin integrity -external collection devices -indwelling drainage devices -bowel training program

caring for patients with urinary incontinence

-prevent skin breakdown -perineal skin care -lifestyle modifications -bladder training -scheduled voiding -kegel exercises -intermittent self catheterization -supportive interventions -surgical interventions -pharmacological interventions and medical devices

promoting regular defecation

-privacy -correct position: seated upright -timing: often occurs after meals -fluid intake -proper diet: fresh fruits, vegetables, whole grains, fiber -exercise: 3 to 5 times a week, range of motion for clients on bedrest

personal factors and elimination

-privacy is important -having sufficient time is important

defecation

-process of elimination of waste -when fecal matter reaches the rectum and causes it to distend, 1) stretch receptors are stimulated to start contraction of the sigmoid colon and rectal muscles and 2) internal and external sphincters relax -sensory impulses transmitted to the CNS produce a conscious urge to defecate, causing voluntary contractions of diaphragmatic and abdominal muscles to increase downward pressure, while at the same time relaxing the internal and external sphincters -this allows feces to be propelled through the anus -if signal to defecate is ignored, reflexive contractions ease for a few minutes until mass peristalsis occurs again

cleansing enemas

-promote removal of feces from the colon -used to treat severe constipation or impaction -used to clear the colon in preparation for visualization procedures such as a colonoscopy -used to empty the colon when starting a bowel training program -used to clear the colon for surgeries of the lower GI tract and for some pelvic surgeries

considerations of urinary diversions

-promoting healthy urinary elimination -I&O -bladder retraining for treating urge incontinence -specimen collection -straight or indwelling catheter insertion -closed intermittent irrigation -routine catheter care -condom catheter application

promoting normal urination

-provide privacy (curtains, doors) -assist with positioning (men --> standing, women --> seated upright_ -facilitating toileteting routines: identify the client's pattern -nursing measures (ex. pour warm water over the area, running water) -promote adequate fluids -assist with hygiene

urinary output fluctuates depending on

-quantity of the fluids that the patient drinks -ability of the heart to circulate blood -kidney functioning (ability of the patient to void; amount of fluid being excreted) -high fever

foods that cause a false positive in an stool occult blood test

-red meat -chicken -fish -horseradish -turnips -citrus fruits -raw vegetables -high doses of Vitamin C -salicylates -NSAIDS -iron

silver alloy catheter

-reduce risk of CAUTI for up to 14 days -not routinely used fro short term catheterization because of cost

nutrition and elimination

-regular intake of food promotes peristalsis -people who eat on a regular schedule are likely to develop a regular pattern of defecation -fluids: a minimum of 6 to 8 glasses of water a day to develop a regular bowel function; inadequate fluid intake or fluid loss as in vomiting or diarrhea slows peristalsis and leads to hard, dry stools that are hard to pass -physical activity: stimulates peristalsis and bowel elimination

personal habits and bowel elimination

-reluctance to use public toilets -false perception of the need for "one a day" bowel movements -lack of privacy when hospitalized

culture and sensitivity urine testing

-requires a sterile specimen from a straight catheter or indwelling urinary catheter using surgical asepsis (sterile technique) -used to identify bacteria or yeast which may indicate a urinary tract infection.

cutaneous ureterostomy

-reroutes the ureter(s) directly to the surface of the abdomen, forming a small stoma -this procedure has limited use because it provides a pathway for pathogens on the skin to enter the kidney -stomas are small and difficult to fit with a collection appliance

flatulence

-results from distention of the bowel from gas accumulation (can cause cramping or a feeling of fullness) -check for abdominal distention and the ability to pass gas through the anus -encourage ambulation to promote the passage of flatus

types of bedpan

-rounded bedpan (wide rounded end goes towards back of patient) -fracture bedpan (wide, rounded end towards from of patient)

normal saline enema

-safest due to equal osmotic pressure -volume stimulates peristalsis

maintain skin and mucosal integrity

-secure tubing to patients thigh using securement devices (prevents traction on bladder and urethral meatus) -assist with routine hygiene care as needed -avoid using powders or lotions in perineal area -monitor urethral meatus and upper drainage tube -encrustation at meatus irritates mucosa and may indicate need to change catheter

loop colostomy

-segment of the bowel is brought out of the abdominal wall -posterior wall still intact -rod is placed under the bowel to keep it from slipping back into the abdomen -anterior wall is incised and mucosal surface is visible and open to air -has a functioning proximal and distal end with limited drainage -irrigations occur every day

transient incontinence

-short term incontinence expected to resolve spontaneously -causes include: UTI, medications

types of catheter materials

-silver alloy -teflon bonded latex -polyvinyl chloride -silicone -hydrogel coated

continent urinary reservoir (ileal reservoir, Indiana pouch)

-similar to the ileal conduit, except urine drains into a pouch made from a portion of the large intestine -the stoma on the abdomen contains a valve to keep urine from leaking -the patient inserts a catheter into the stoma to drain urine through the valve -unlike the ileal conduit, no external bag is needed; this means minimal risk of leaking and odor -a second valve prevents reflux of urine back into the kidneys

straight catheters

-single-lumen tube that is inserted for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure post-void residual volume, or to relieve temporary bladder distention) -after the bladder is empty or the sample obtained, the catheter is removed and the patient resumes voiding independently

routine catheter care

-soap and water, washcloth, gloves -use soap and water at the insertion site -cleanse the catheter at least three times a day and after defecation -monitor the patency of the catheter (for reports of fullness, check for kinks and sediment in the tubing; make sure bag is at level below the bladder)

ostomies

-some bowel disorders prevent the expected elimination of stool from the body -bowel diversions through ostomies are temporary or permanent openings (stomas) surgically created in the abdominal wall to allow fecal matter to pass

specimen collection equipment

-specimen container -soap/cleansing solution or wipe -clean gloves -specimen label -fecal occult blood test cards -wooden applicator or tongue depressor -developer solution -stool collection container (bedside commode, bedpan, receptacle in toilet)

tap water or hypotonic solution enema

-stimulates evacuation -never repeated due to potential water toxicity

caring for patients with a bowel diversion

-stoma assessment -peristomal skin care -monitor the amount and type of effluent (output, fecal matter) -help patients adapt to the diversion -colostomy irrigation

fecal impaction

-stool becomes wedged in the rectum, and can involve diarrhea fluid leaking around the impacted stool -administer enemas and suppositories or stool softeners as prescribed to promote relief of fecal impaction -if necessary, manually remove fecal impactions that do not respond to other interventions -use a gloved, lubricated finger for digital removal of stool -loosen the stool around the edges and then remove it in small pieces, allowing the client to rest as necessary -when evacuating the rectum, be careful to avoid stimulating the vagus nerve -stop the procedure if the heart rate drops significantly or the heart rhythm changes

laboratory studies of feces

-stool for occult blood -stool for culture, ova, and parasites -use medical asepsis while wearing gloves -label specimens and transport promptly to the lab

diagnostic procedures

-stool samples should come from fresh stools -avoid contaminating with water or urine -fecal occult blood test

types of catheters

-straight -indwelling -suprapubic

sociocultural factors and elimination

-stress has a major influence on the mobility of the GI tract -causes diarrhea or constipation

surgery and anesthesia as a factor of urinary elimination

-surgery can have various effects on the urinary tract -anesthetic agents can decrease blood pressure and glomureler filtration, thus decreasing urine formation -spinal anesthesia decreases the patients awareness of the need to void, which may lead to bladder distention

bowel diversion

-surgically created opening for elimination of digestive waste products -a client with a bowel diversion does not eliminate through the anus -temporary bowel diversions may be done to allow part of the intestine to rest and heal -ileostomy -colostomy

urinary diversions

-surgically created opening for elimination of urine -a patient with a urinary diversion does not eliminate urine via the urethra -urine bypasses the bladder and is expelled through the stoma or ostomy -patient no longer has voluntary control of urination -urine constantly flows through the stoma and is collected in a pouch the patient wears -urostomies are used to treat patients who have urinary system defects or trauma -primary risks associated with urinary diversions are infection and permanent kidney damage, which can occur from hydronephrosis (distention of the kidneys with urine, resulting from obstruction of the ureter)

urinary diversion/ostomy

-surgically created opening for elimination of urine -urostomies are used to treat patients who have conditions such as birth defects, cancer, trauma, or disease of the urinary system -a patient with a urinary diversion does not eliminate urine via the urethra; instead, urine bypasses the bladder and is expelled through the stoma or ostomy

solutions and additives

-tap water or hypotonic solution -soapsuds -normal saline -low volume hypertonic -oil retention -medicated enema

types of cleansing enemas

-tap water or hypotonic solution -soapsuds -normal saline -low volume hypertonic -oil retention enemas -carminative enema -medicated enema -return flow enema

clean catch

-the client must cleanse the genitalia before voiding and collect the sample in midstream because the initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum -a midstream sample is free of these contaminants -sterile

hydration factors of urinary elimination

-the kidneys "spare water" when a person is dehydrated, such as after heavy exercise and or when fluid intake is inadequate -this causes urine to be concentrated and low in volume

specific gravity

-this is an indicator of urine concentration, and it can be measured with a reagent strip -specific gravity is usually tested in the laboratory, but it is a nursing responsibility in some settings

double barrel colostomies

-two abdominal stomas: one proximal and one distal -proximal stoma drains stool -distal stoma leads to inactive intestine -after injured area of the intestine heals, the colostomy is often reversed by reattaching the two end

double barrel colostomy

-two separate stomas -proximal stoma is the functioning end which drains fecal matter -distal stoma drains mucous

diagnostic procedures for urinary incontinence

-ultrasound -voiding cystourethrography -urodynamic testing -electromyography

functional incontinence

-untimely loss of urine with no urinary or neurological cause -causes: immobility, pain, problems in thinking/communicating

structures of the gastrointestinal tract

-upper gastrointestinal tract -small and large intestine -rectum and anus

types of urinary incontinence

-urge -stress -mixed -unconscious (reflex) -functional -transient -overflow

caring for patients with urinary retention

-urinary catheterization -monitor for bladder distention -measure Post Void Residual -apply heat to lower abdomen -pour warm water over perineum or sitz bath

nursing history of urinary elimination

-urination patterns -appearance of urine -changes in urination patterns or appearance -use of urination aids -lifestyle questions -if has any urinary diversions

fluid output

-urine output -gastrointestinal fluid loss (ex. emesis) -diarrhea

oliguria

-urine output less than 400 mL/24 hours (in adults) -less than .5 to 1 mL/24 hour (in children)

bladder retraining for treating urge incontinence

-use timed voiding to increase intervals between urination -work towards 4 hr intervals -assist clients to perform relaxation techniques -offer incontinence undergarments while clients are retraining -provide positive reinforcement as clients remain continent -perform pelvic floor (kegel) exercises -do not ignore the urge to urinate -eliminate or decrease caffeine drinks -take diuretics in the morning

subrapubic catheter

-used for continuous urine drainage when the urethra must be bypassed (e.g., after gynecological surgery or where there is prostatic obstruction) -a suprapubic catheter is inserted through an incision above the symphysis pubis -often sutured in place, but may occasionally be a double-lumen catheter held in place by a balloon -remain until clients have a post-void residual volume of 50 mL nursing actions: -monitor output and for any manifestations of infection -keep catheter patent at all times -determine clients' ability to detect the urge to urinate

Post Void Residual

-usie a bladder scanner -place the bladder scanner on the lower abdomen- 2.5-4 cm above the symphysis pubis aimed slightly downward toward the coccyx -the volume of urine will be displayed on the scanning device -take several readings to ensure accuracy -apply heat to lower abdomen to relax the muscles near the bladder

causes of diarrhea

-viral gastroenteritis -bacterial gastroenteritis -antibiotic therapy -inflammatory bowel disease -irritable bowel syndrome

sterile specimen

-you can obtain a sterile urine specimen by inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter -you may need to clamp the drainage tube for 15-30 minutes to obtain a fresh specimen in the tube if the urine is not flowing briskly -a needleless syringe (access device) is inserted into a specimen port on the drainage tube to aspirate the amount of urine needed -do not take the specimen from the collection bag because that urine may be several hours old.

external fecal collection devices

-you may apply an external fecal incontinence pouch to protect perianal skin or to collect large female samples -common approach for clients with uncontrolled diarrhea -pouch collects fecal drainage, keeps feces away from skin

24 hour urine

-you must use a large container and preserve all urine voided in the 24-hr time period -occasionally, you will be asked to store each voiding in a separate container -to begin collecting, have the patient void and record the time. -discard this first voiding, but save all urine for the next 24 hr -be sure to inform the patient and all staff about the collection -post signs in prominent locations, such as the client's bathroom or entry door, to remind staff of the ongoing test and alert them to not discard urine

changing an ostomy appliance

1. assess the type of stoma, location, color, shape, and size 2. assess the peristomal skin 3. determine changing schedule-Pouch-usually every 3-5 days; skin barrier-usually every 3-7 days 4. assess patient's ability or willingness to participate in the task 5. auscultate for bowel sounds 6. measure the amount of liquid output in a graduated measuring container 7. a silicone based adhesive remover can be used to remove an appliance 8. a skin cleansing agent with a pH of 5.5 can be used to cleanse the stoma and surrounding skin 9. measure and cut wafer barrier to be slightly larger than the stoma 10. ostomy skin care products can be used to prevent or treat excoriated skin 11. remove and discard the appliance by applying a silicone based adhesive remover 12. patient should be given written material/hand outs on self care of an ostomy 13. allow patient to examine the ostomy site using a mirror

stoma is permanent size by

6-8 weeks

A client who has an indwelling catheter reports a need to urinate. Which of the following actions should the nurse take? A. Check to see whether the catheter is patent B. Reassure the client that it is not possible for them to urinate C. Recatheterize the bladder with a larger-gauge catheter D. Collect a urine specimen for analysis

A

A nurse is caring for a client who has a prescription for a 24 hour urine collection. Which of the following actions should the nurse take? A. Discard the first voiding B. Keep the urine in a single container at room temperature C. Dispose of the last voiding D. Ask the client to urinate into the toilet, stop midstream, and finish urinating into the specimen container

A

A nurse is preparing to administer a cleansing enema to an adult client in preparation for a diagnostic procedure. Which of the following steps should the nurse take? (Select all that apply) A. Warm the enema solution prior to instillation B. Position the client on the left side with the right leg flexed forward C. Lubricate the rectal tube or nozzle D. Slowly insert the rectal tube about 2 in E. Hang the enema container 24 in above the client's anus

A, B, C

A nurse is reviewing factors that increase the risk of UTIs with a client who has recurrent UTIs. Which of the following factors should the nurse include? (Select all that apply) A. Frequent sexual intercourse B. Lowering of testosterone levels C. Wiping from front to back to clean the perineum D. Location of the urethra closer to the anus E. Frequent catheterization

A, D, E

A nurse is providing dietary teaching for a client who reports constipation. Which of the following foods should the nurse recommend? A. Macaroni and cheese B. One medium apple with skin C. One cup of plain yogurt D. Roast chicken and white rice

B

While a nurse is administering a cleansing enema, the client reports abdominal cramping. Which of the following actions should the nurse take? A. Have the client hold their breath briefly and bear down B. Clamp the enema tubing C. Remind the client that cramping is common at this time D. Raise the level of the enema fluid container

B

A nurse is assessing a client who has had diarrhea for 4 days. Which of the following findings should the nurse expect? (Select all that apply) A. Bradycardia B. Hypotension C. Elevated temperature D. Poor skin turgor E. Peripheral edema

B, C, D

A nurse is preparing to initiate a bladder-retraining program for a client who has incontinence. Which of the following actions should the nurse take? (Select all that apply) A. Restrict the client's intake of fluids during the daytime B. Have the client record urination times C. Gradually increase the urination intervals D. Remind the client to hold urine until the next scheduled urination time E. Provide a sterile container for urine

B, C, E

stool for culture, ova, parasites

Pinworms are an intestinal parasite that are small, white, thread-like worms spread through human-to-human transmission (ingesting infectious pinworm eggs or scratching the anal area with eggs that are attached to fingers). Pinworms live in cecum-come to anal area to deposit eggs during night and migrate back up through rectum during day. Assess child-check buttocks; check presence of eggs with tape-applied in morning against anal opening-tape examined on slide. Cotton tipped swab gently into rectum (about an inch) for specimen to be examined on slide.

surgery/procedures and elimination

abdominal or pelvic surgery may lead to paralytic ileus (cessation of bowel peristalsis)

nephrostomy

an incontinence urinary diversion in which the surgeon attaches a tube from the renal pelvis via a stoma to the surface of the abdominal wall

paralytic ileus

an intestinal obstruction caused by reduced motility following bowel manipulation during surgery, electrolyte imbalance, wound infection, or by the effects of medication

monitor stools to quantify diarrhea

assess frequency, amount, color, consistency of stools to determine the severity of the diarrhea

assist with hygiene for urination

because soap is drying to the genital mucosa, also offer a moist washcloth or towelette for washing hands after toileting

hematuria

blood in the urine

developmental stage and elimination

bowel elimination patterns change throughout the lifespan

constipation

bowel pattern of difficult and infrequent evacuation of hard, dry feces

diarrhea

bowel pattern of frequent loose or liquid stools

colostomy near the rectum

can often be controlled through diet and irrigation so an appliance doesn't need to be worn

mixed incontinence

combination of urge and stress incontinence

a healthy stoma ranges in color from __________ to ___________ and is shiny and moist

deep pink, brick red

ultrasound and urinary incontinence

detects bladder abnormalities and/or residual urine

pathological conditions as a factor of urinary elimination

disorders of the urinary system that affect urinary elimination include: -infection or inflammation of the bladder, ureters, or kidneys -renal calculi (kidney stones) or tumors (obstruct the normal flow or urine) -hypertrophy of the prostate gland due to benign or cancerous lesions, which interferes with flow of urine from bladder into urethra

colostomies

end in the colon

ileostomies

end in the ileum

promoting healthy bowel elimination

equipment: -bedpans (fracture pan for supine clients and clients in body casts or leg casts), regular pan for seated clients, bedside commode, toilet procedure: -encourage the client to set aside time to defecate (after meal works best) -if not contraindicated or restricted, encourage the client to drink plenty of fluids and to consume a diet high in fiber to prevent constipation -wear gloves when addressing toiling needs -provide privacy -assist the client to a sitting position whether using a regular bedpan, commode, or toilet -for clients using a fracture pan, raise the head of the bed to 30 degrees -if the client cannot lift their hips, roll the client onto one side, position the bedpan over the buttocks, and roll the client back on the the bedpan -encourage the client to decrease stress when sitting or rising by using an elevated toilet seat or a footstool -never leave a client lying flat on a regular bedpan -after the client defecates, provide skin care to the perianal area

physical exam for urinary elimination

examining: -kidneys -bladder -urethra -skin surrounding the genitals

polyuria

excessive urination

nocturia

frequent urination after going to bed

antibiotics

gentamicin, cephalexin, trimethoprim/sulfamethoxazole, ciprofloxacin for infection nursing actions: administer medication with food to decrease gastrointestinal distress client education: -antibiotics might change the urine's odor -complete the full course of therapy even if manifestations resolve -take trimethoprim/sulfamethoxazole with 8 oz. of water -trimethoprim/sulfamethoxazole and ciprofloxacin can increase sensitivity to the sun -monitor for loose stools and a rash

voiding cystourethrography

identifies the size, shape, support, and function of the urinary bladder, obstruction (such as in the prostate), residual urine

clients with persistent bowel incontinence require special care to prevent ____________ ______________ _____________ because of moisture an activity of enzymes in stool

impaired skin integrity

hormone replacement therapy

increases blood supply to the pelvis

pallor or dusky blue stoma

indicates ischemia

black-brown stoma

indicates necrosis

age and bowel elimination

infants -breast milk stools: watery and yellow brown -formula stools: pasty and brown toddlers -bowel control at 2 to 3 years adolescents -increased secretion of gastric acids -accelerated growth of the large intestine older adults -decreased peristalsis -relaxation of sphincters

urge incontinence

involuntary loss o urine with a strong urge to void

enuresis

involuntary loss of urine

ostomies are created in either the

large intestine or the small intestine

amitriptyline

makes pee blue or green

riboflavin

makes pee bright yellow

levodopa

makes pee dark

phenazopyridine

makes pee orange or red

medicated enema

may be used to instill antibiotic to treat infections in the rectum or anus or for medications for treatment of intestinal worms and parasites

electromyography

measures the strength of pelvic muscle contractions

frequency

need to urinate at short intervals

bedside sonography with a bladder scanner

noninvasive portable ultrasound scanner for measuring bladder volume and residual volume after elimination

tricyclic antidepressants

notriptyline has anticholinergic effects that help relieve urinary incontinence nursing actions: -monitor for dizziness -evaluate blood pressure for orthostatic hypotension -do not administer to clients taking an MAOI client education: -change positions slowly

teach the patient how to open and close the ostomy pouch

one of the first steps in ostomy care taught to the patient

urinary antispasmodics or anticholinergic agents

oxybutynin and dicyclomine decrease urgency and help alleviate pain from a neurogenic or overactive bladder nursing actions: -ask clients about a history of glaucoma (these medications increase intraocular pressure) -monitor for dizziness, tachycardia, and urinary retention client education: -report dysuria, palpitations, and constipation -dizziness and dry mouth are common with these medications

proteinuria

protein in urine

pyuria

pus in urine

teflon bonded latex

reduce friction and tissue irritation during insertion and when in place

diarrhea

response to infection or unusual foods and serves as a mechanism to rid the body of pathogens or troublesome food

end stomas

result of colorectal cancer or some types of bowel disease

feces

semisolid mass of fiber, undigested food, inorganic matter

sociocultural factors of urinary elimination

some patients will state personal, social, cultural, religious requirements for toiling assistance to be given by someone of the same gender or will wait for a visit from a family member to help with their voiding

common urine studies

specimens -freshly voided specimens -clean catch -sterile specimen -24 hr urine studies -urinalysis -dipstick (bedside testing) -culture and sensitivity -specific gravity

physical activity and bowel elimination

stimulates intestinal activity and increases skeletal muscle tone needed for defecation

urgency

sudden, almost uncontrollable need to urinate

surgery and anesthesia and bowel elimination

temporary slowing of intestinal activity (rationale for auscultating bowel sounds before advancing diet)

urodynamic testing

test for bladder muscle function by filling the bladder with CO2 or 0.9% sodium chloride and comparing pressure readings with reported sensations

phenazopryidine

this bladder analgesic treats the manifestations of UTIs nursing actions: -this medication will not treat infection but will help relieve bladder discomfort -monitor for decreases in HgB and Hct -hepatic disorders and renal insufficiency are contraindications client education: -take the medication with food -the medication turns urine orange -notify the provider if jaundice occurs

colonoscopy

use of a lighted instrument by the provider to visualize and collect tissue for biopsy or remove polyps from the sigmoid colon and rectum

sigmoidoscopy

use of a lighted instrument by the provider to visualize and collect tissue for biopsy or remove polyps from the sigmoid colon and rectum client preparation: -protocols vary with the provider and the facility, but generally include clear liquids only and a bowel cleanser -clients receive moderate (conscious) sedation and can not drive home afterwards

cytoscopy

use of a lighted instrument to visualize, treat, and obtain specimens from the bladder and urethra

fractured bedpan

used for -fractured pelvis -total hip replacement -lower back surgery -casts -splints -braces on lower extremities -obesity

low volume hypertonic enema

used if the patient can't tolerate high volume enemas

oil-retention enemas

used to assist a patient to pass hard stool or before digital removal of stool

ostomy in an ascending or sigmoid colon

used to control bowel evacuation and may eliminate the need for a pouch

renal ultrasound

view of gross renal structures and structural abnormalities using high-frequency sound waves

renal scan

view of renal blood flow and anatomy of the kidneys without contrast

kidneys, ureters, bladder xray

xray to determine size, shape, and position of these structures