Elimination

A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching? A. "I only need to catheterize myself twice every day." B. "I carry a water bottle with me because I drink a lot of water." C. "I use a suppository every night to have a bowel movement." D. "I do wheelchair exercises while watching TV."

A. "I only need to catheterize myself twice every day." Rationale: The client has paralysis from the level of the defect down. In the majority of cases, this condition affects bladder and bowel continence. Catheterization should be performed every 4hr. Infrequent emptying of the bladder can result in stasis and urinary tract infections.

A nurse is providing teaching to a client who takes opioid pain medication and has a new prescription for docusate sodium. Which of the following statements by the client indicates an understanding of the teaching? A. "It might take up to 3 days for the medication to work." B. "I will take the medication for diarrhea." C. "I should drink 4 ounces of water when I take the medication." D. "I can take this medication along with mineral oil."

A. "It might take up to 3 days for the medication to work." Rationale: The client understands docusate sodium is a stool softener and the therapeutic effect might take up to 3 days to achieve..

A nurse is caring for a client who has nausea and a prescription for metoclopramide intermittent IV bolus every 4hr as needed. The client asks the nurse how metoclopramide will relieve her nausea. Which of the following explanations should the nurse provide? A. "The medication relieves nausea by promoting gastric emptying." B. "The medication works by decreasing gastric acid secretions." C. "The medication relieves nausea by slowing peristalsis." D. "The medication works by relaxing gastric muscles."

A. "The medication relieves nausea by promoting gastric emptying." Rationale: Reglan is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Reglan works by promoting gastric emptying

A nurse is teaching a client who has constipation. Which of the following should the nurse discuss as causes of constipation? (Select all that apply.) A. Excessive laxative use B. Ignoring the urge to defecate C. Inadequate fluid intake D. Increased fiber in the diet E. Increased activity

A. Excessive laxative use B. Ignoring the urge to defecate C. Inadequate fluid intake Rationale: Excessive laxative use is correct. Chronic use of laxatives causes the large intestine to lose muscle tone and become less responsive to stimulation by laxatives. Ignoring the urge to defecate is correct. Anything that prevents the client from responding to the urge to defecate and disrupts regular habits can cause alterations in bowel habits, such as constipation .Inadequate fluid intake is correct. Reduced fluid intake slows the passage of food through the intestine and can result in hardening of stool. Increased fiber in the diet is incorrect. Increased fiber promotes more efficient bowel emptying. Increased activity is incorrect. Increased activity promotes bowel emptying.

A nurse is teaching a client who has constipation about a high-fiber diet. Which of the following foods should be included as sources of fiber? (Select all that apply.) A. Kidney beans B. Blackberries C. Refined cereals D. Whole wheat bread E. Lean turkey

A. Kidney beans B. Blackberries D. Whole wheat bread Rationale: Kidney beans is correct. Kidney beans should be included in the teaching as a source of fiber. Blackberries is correct. Blackberries should be included in the teaching as a source of fiber. Refined cereals is incorrect. Whole grain cereals, not refined cereals, should be included in the teaching as a source of fiber. Whole wheat bread is correct. Whole wheat bread should be included in the teaching as a source of fiber. Lean turkey is incorrect. Lean turkey is a source of complete protein, but should not be included in the teaching as a source of fiber.

A nurse is administering a tap water enema to a client who is constipated. During the administration of the enema, the client states he is having abdominal cramps. Which of the following actions should the nurse take to relieve the client's discomfort? A. Lower the height of the solution container. B. Encourage the client to bear down. C. Allow the client to expel some fluid before continuing. D. Stop the enema and document that the client did not tolerate the procedure.

A. Lower the height of the solution container. Rationale: If nausea or cramping occurs, the flow of water should momentarily be slowed or stopped by lowering the device or clamping the tubing. This allows the intestinal spasm to pass while leaving the catheter in place. The nurse should then continue administering the enema at a slower rate once the cramping has passed.

1. A nurse is implementing a bowel training program for a client. For the program to be effective, the nurse should take the client to the toilet at which of the following times? A. When the client has the urge to defecate B. Every 2 hr while the client is awake C. Immediately before the client has a meal D. After the client feels abdominal cramping

A. When the client has the urge to defecate Rationale: When on a bowel training program, the nurse should take the client to the toilet when the client recognizes the urge to defecate. A bowel training program focuses on identifying times in the client's bowel pattern to promote self-control of defecation.

Factors Affecting Urinary Elimination - Medications

ANS diuretics

Risk Factors For Urinary Incontinence

Age Obesity Smoking Inactivity Pregnancy Depression Neurological Disorders Medications

Risk Factors for Urinary Retention

Age, Male, Previous Problems, Urinary Incontinence, Voluntary Urinary Retention, Infection, Surgery, Cognitive Impairment, Neurological Disease, Constipation, Immobility, Chronic Pain, Emotional Distress, Medications

A nurse is providing instructions for a 52-year-old client who is scheduled for a colonoscopy. The client reports that the has not had the procedure before and is very anxious about feeling pain during the procedure. Which of the following responses by the nurse is appropriate? A. "Don't worry; most clients dislike the prep more than the procedure itself." B. "Before the examination, your provider will give you a sedative that will make you sleepy." C. "I know you're anxious, but this procedure is recommended for people your age." D. "After you have signed the consent form, we can talk more about this."

B. "Before the examination, your provider will give you a sedative that will make you sleepy." Rationale: This therapeutic response appropriately addresses the client's concerns. The client is seeking information and this response provides the client with accurate information. It can also lead to further discussion about the procedure.

A nurse is caring for a client who reports taking bisacodyl to promote a daily bowel movement. Which of the following assessment questions should be the nurse's priority? A. "What do your bowel movements look like?" B. "How long have you been taking the bisacodyl?" C. "Do you take the bisacodyl with a glass of milk?" D. "How often do you have a bowel movement?"

B. "How long have you been taking the bisacodyl?" Rationale: The greatest risk to this client is injury from dependency on laxatives, as bowel tone can be lost; therefore, the priority question the nurse should ask the client is how long he has been using bisacodyl.

A nurse is teaching a client who has a new prescription for docusate. Which of the following information should the nurse include in the teaching? A. "Do not take this medication before bedtime." B. "Take the medication with a full glass of water." C. "Expect abdominal pain with this medication." D. "Take this medication on an empty stomach."

B. "Take the medication with a full glass of water." Rationale: The nurse should instruct the client to take this medication with a full glass of water, unless contraindicated, to reduce the risk for constipation.

A nurse is caring for a client who has a prescription for a stool test for guaiac. The nurse understands the purpose of the test is to check the stool for which of the following substances? A. Steatorrhea B. Blood C. Bacteria D. Parasites

B. Blood Rationale: A guaiac test detects the presence of occult or hidden blood in the stool. The guaiac test is an extremely useful diagnostic screening test for the presence of colon cancer and gastrointestinal ulcers.

A nurse is preparing to administer bisacodyl suppository to a client. Which of the following actions should the nursetake? (Select all that apply.) A. Don sterile gloves. B. Lubricate index finger. C. Use a rectal applicator for insertion. D. Position client supine with knees bent. E. Insert suppository just beyond internal sphincter.

B. Lubricate index finger. E. Insert suppository just beyond internal sphincter. Rationale: Don sterile gloves is incorrect. The nurse should wear clean gloves for the procedure. Gloves prevent the transmission of pathogens by direct and indirect contact. The nurse should wear clean gloves when touching blood, body fluid, secretions, excretions, most mucous membranes, nonintact skin, and contaminated items or surfaces. Lubricate index finger is correct. The rounded end of the suppository is lubricated with a sterile water-soluble lubricating jelly. Use a rectal applicator for insertion is incorrect. The nurse should administer the suppository with the dominant index finger, which is lubricated. The nurse should not use an applicator to insert a suppository. Position client supine with knees bent is incorrect. To avoid the rupturing the rectum, the client is positioned on the left lateral side. Insert suppository just beyond internal sphincter is correct. The nurse should gently retract the buttocks with the nondominant hand. Insert the suppository gently through the anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place.

Gastric Reflux

Backflow of gastric contents into the esophagus

A nurse is teaching an older adult client who reports constipation. Which of the following instructions should the nurse include in the teaching? A. Bear down hard when defecating. B. Drink four to five glasses of water daily. C. Increase dietary intake of raw vegetables. D. Limit activity.

C. Increase dietary intake of raw vegetables. Rationale: The client should increase dietary intake of raw vegetables to help provide fiber in the diet, which will increase stool bulk and move the stool through the colon to prevent constipation.

A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following findings should indicate to the nurse the client's peristalsis is returning? A. Hypoactive bowel sounds in two quadrants B. Request for a cup of tea and some toast C. Passage of flatus D. Abdominal distention

C. Passage of flatus Rationale: Passing flatus and belching indicate the return of peristaltic activity

oliguria

Decreased urine output

Factors Affecting Urinary Elimination - Muscle Tone

Detrusor Muscle

Factors Affecting Urinary Elimination - Fluid/Food Intake

ETOH = fluid output Salty Foods = Fluid retention

T/F: Urinary incontinence is a normal part of aging.

False

Constipation

Hard, slow stools that are difficult to eliminate; often a result of too little fiber in the diet

Prevention of Incontinence

Healthy Weight High Fiber Diet Adequate Fluid, NOT EXCESS No Smoking Kegels

Peristalsis

Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.

Nonpharmacologic Therapy for Incontinence

Kegels Scheduled Bathroom Trips Pads/Briefs Catheter

Factors Affecting Urinary Elimination - Surgical/Diagnostic Procedures

Post-op swelling bleeding spinal anesthesia

Factors Affecting Urinary Elimination - Psychosocial Factors

Privacy positioning time anxiety

Obstruction

Something blocking the way of the the natural process of elimination

Diagnostic Tests

Urinalysis Blood Tests 24 Hour Urine Collection Bladder Scan

Factors Affecting Urinary Elimination - Pathological Conditions

Urinary production circulatory flow of urine

Process of Urination

Urine collects in the bladder Stimulates stretch receptors in the bladder wall Receptors transmit impulse to spinal cord Internal urethral sphincter to relax Urge to void Conscious brain will relax the external sphincter

Anuria

absence of urine production

Antidiarrheals

control loose stools and relieve diarrhea by absorbing excess water in the bowel or slowing peristalsis in the intestinal tract

Polyuria

excessive production of urine

Diarrhea

frequent passage of loose, watery stools

Flatus

gas expelled through the anus

Gastrocolic reflex

increased peristalsis of the colon after food has entered the stomach

Cystoscope

instrument used for visual examination of the bladder

Calculi

kidney stones

Creatinine

nitrogenous waste excreted in the urine

Peritoneal

pertaining to the peritoneum; lining of the abdominal cavity

Hernia

protrusion of an organ or part through the tissues and muscles normally containing it

bulk forming laxatives

psyllium, methylcellulose, polycarbophil

Impaction

results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel

Striae

stretch marks

Meconium

the first bowel movement of the newborn

Bowel Incontinence

the inability to control the excretion of feces

Ileus/paralytic ileus

the partial or complete blockage of the small and/or large intestine

hemodialysis

the process by which waste products are filtered directly from the patient's blood

Borborygmus

the rumbling noise caused by the movement of gas in the intestine

detrusor muscle

the smooth muscle layers of the bladder

A nurse is caring for an older adult client who reports taking bisacodyl tablets daily. Which of the following responses should the nurse make? A. "Irregular bowel movements are an indication of poor intestinal health." B. "Excessive laxative use may cause an electrolyte imbalance." C. "Chronic use of laxatives can lead to a tear in the rectal mucosa." D. "Decrease your intake of foods high in fiber."

"Excessive laxative use may cause an electrolyte imbalance." Rationale :Bisacodyl is a stimulant laxative that acts by stimulating intestinal motility and increasing the amount of water and electrolytes within the intestines; therefore, chronic use of laxatives can lead to fluid and electrolyte imbalance.