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NURS2518 : The Older Client > week 10 : elimination > Flashcards

week 10 : elimination Flashcards

1
Q

elimination is…..

A

excretion

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2
Q

what is elimination about….

A

waste formation, waste excretion

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3
Q

what happens when you have a urinary tract problem

A

kidney is not working well

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4
Q

age related changes in the urinary tract

A

optimal blood perfusion tot he kidenys about 1 litre pre minute

by age 80, renal blood flow reduces to about 600 mL/minute

decreased functioning nephrons by about 50%

decreased bladder capacity ( from 300- 500 ml to 200-300 ml) leads to urinary frequency

decreased estrogen in post menopausal women affects the urinary structure ( estrogen receptors in the bladder)

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5
Q

true or false. Connective tissue replaces the smooth muscle in the bladder this is relevant to the age related changes in the urinary tract

A

true

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6
Q

weakening of the pelvic floor muscles is related in age changes in the urinary tract . true or false.

A

true

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7
Q

select all that is true

age related changes in the urinary tract

hypertrophy of the muscles in the urinary tract

reduced renal reserve- more susceptible to fluid and electrolyte imbalance and kidney damage due to medications and other external stressors

A

this is all true

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8
Q

what is the renal reserve?

A

extra execratory capacity

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9
Q

Is this true or false. Reduced secretion of anti-diuretic hormone so less able to concentrate urine

A

this si true

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10
Q

Increased time between urge to void and actual need to void is true in terms of age related changes in the urinary tract.

A

false. it decreases

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11
Q

Re-call the age age related changes in the urinary tract :
▪Reduced secretion of anti-diuretic hormone (ADH) so less able to concentrate
urine
▪ Decreased time between urge to void and actual need to void
what characteristics are there?

A

▪ Enlargement of the prostate gland in men, i.e. BPH (benign prostatic hyperplasia)

▪ Kidney filtration rate is less efficient (less efficient response to dehydration)

▪ Diminished thirst perception – directly affect the older adult’s hydration status

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12
Q

True or false. In the absence of disease, an older adult can produce urine sufficiently…

A

true

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13
Q

benign prostate hyperplasia what happens with older men?

A

as men get older ( this gets bigger inside) which indicates that it is higher risk for urinary infection

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14
Q

risk factors : impaired elimination
name 5 examples

A

age

neurologic impairment - brain or spinal cord trauma

cognitive impairment - lacks of perceptual ability to perceived the ned to urinate or defecate e.g : dementia

medical conditions - stroke, infections ( for example , UTI - very common among older adults and residents in personal care homes), arthritis etc.

adverse medications effects e.g opoids

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15
Q

Select all that is true amongst risk factors: impaired elimination

▪Lifestyle e.g. caffeine (irritate bladder), smoking (irritate bladder), alcohol
(sedation influences confusion, immobility; diuretic)
▪ Environment – hazards/obstacles which prevent older adult from getting to the bathroom safely
▪ Diminished mobility – slower movement, decreased strength/range of motion, use of devices, may need increased assistance from social support or health care worker
▪ constipation is normal

A

the last one is false, constipation is not normal, THIS IS ONLY A MYTH

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16
Q

name some issues of retention ( 2)

A

alteration in urinary elimination

urinary bladder fills but external sphincter does not open for release of urine : urine volume builds, leading to bladder distention; may be caused by certain medications and or psychosocial factors

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17
Q

True or false. Important : in the absense of risk factors, healthy older adults experience few negative consequences of urinary elimination.

A

true

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18
Q

alteration in bowel elimination could be one of the issues of retention ?

A

yes this is true

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19
Q

Issues of retention : retention of stool rectum leads to what ?

A

leads to drying and hardening of stool and then constipation

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20
Q

Sign of fecal impaction is series of small episodes of what ?

A

bowel incontinence

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21
Q

with fecal impaction, digital disimpaction (using fingers ) may be needed. is this true or false.

A

this is true.

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22
Q

True or false. Constipation is an age related change.

A

FALSE IT IS NOT!!! this is important, will be a question in the finals.

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23
Q

Retention : Possible complications
Stool retention :
this can lead to what ?

A

can lead to constipation, pain, loss of appetite, nausea, and vomiting.

24
Q

True or false. Retention : Possible complications : Stool retention

  • severe complication : ileus- loss of peristaltic activity
A

true

25
Q

True or false. Risk of bowel perforation is not life threatening, this is something we can manage.

A

false, this is life threatening.

26
Q

Retention: Possible Complications
Urinary Retention:
name the characteristics

A

▪ Pain, chronic bladder infection, and bladder distention

▪ Bladder distention can lead to “backflow” which can result in pyelonephritis (inflammation of the kidney secondary to
a bacterial infection) and renal failure

27
Q

Age-related Changes: Constipation (Retention)
Alteration in Bowel Elimination

define if this is true or false.

Age-related changes lead to the slowing of digested material through the GI Tract, i.e., atrophy of smooth muscles in the colon, reduced secretions, reduced tone of internal/external sphincters, and reduced neural impulses

A

this is true

28
Q

Age-related Changes: Constipation (Retention)
Alteration in Bowel Elimination:

Dietary patterns that include adequate ____ and ____ will minimize the risk for constipation.

A

fiber and fluid

29
Q

Risk factors: Constipation
name them

A

▪Poor diet (inadequate intake of bulk, fiber and fluid)
▪ Medications (including long-term laxative use)
Reality is a high percentage of PCH residents take
laxatives.
▪ Lack of activity (lack of mobility)
▪ History of constipation
▪ Poor oral health and ill-fitting dentures (decrease
intake)

30
Q

Interventions for Constipation : ( this is going to be in the final exam, so study!!! this )

precipitating factors : Physiological : dehydration , insufficient fibre intake, poor dietary habits

precipitating factors :
functional :
decreased physical activity
inadequate toileting
irregular defecation habits
irritable bowel disease

A

prevention : physiological : encourage fluid intake of 1,500 - 2,000 mL per day and fibre intake of 25-30 per day

prevention : functional : encourage physical activity tailored to the person; promote regular and consistent toileting daily , based on the person’s triggering meal ; assess and obtain information about functional factors related to constipation

31
Q

For the mechanical precipitating factors below: name the interventions for constipation

abscess or ulcer
fissures
hemorrhoids
megacolon
pelvic floor dysfunction
post surgical obstruction
prostate enlargement
rectal prolapse
rectocele
spinal cord injury
structures

A

assess and obtain information about mechanical factors related to constipation, and complete a physical assessment.

32
Q

Precipitating factors : of lack of abdominal muscle tone
obesity
recent environmental changes
poor dentition
what are the interventions for this that could be possible cause constipation

A

assess and obtain information related to constipation, and complete, a physical assessment.

33
Q

Precipitating factors : of Psychological :
avoidance of urge to defecate confusion, depression, emotional stress, what are the interventions for this, that could be possible cause constipation

A

assess and obtain information on psychological factors related to constipation.

34
Q

precipitating factors : of systemic : diabetic neuropathy, hypercalcemia, hyperparathyroidismm hypokalemia, porphyria, uremia, parkinson’s disease, cerebro-vascular disease, defective electrolyte transfer what are the interventions for this that could be possible cause constipation

A

assess and obtain information and dietary history on systemic factors related to constipation

35
Q

Precipitating factors : of pharmacological :
ace inhibtors
anatcids: calcium carbonate
aluminum hydroxide
antiarrhythmics
anticonvulants
antidepressants
anti-parkinson’s disease medications
calcium channel blockers
calcium blockers
diuretics
iron supplements
overuse of laxatives
non steroidal anti-inflammatory drugs
opilates
phenothiazines
sedatives

A

review medications and identify those associate with increase risk for constipation ( e.g long term use for laxative use ).

36
Q

types of urinary incontinence ( loss of control )

alteration in urinary elimination
:

what are the different types of incontinence ?

A

stress
urge
overactive bladder
functional
overflow
mixed
transient

37
Q

types of urinary incontinence ( loss of control )

stress
urge
overactive bladder

what is the description for these types of incontinence

A

description :
stress: leakage of small amounts of urine during physical movement ( coughing , sneezing, exercising )

urge : leakage of large amounts of urine at unexpected times, including during sleep

overactive bladder: urinary frequency and urgency, with or without urge incontinence

38
Q

types of urinary incontinence ( loss of control )

functional
overflow
mixed

A

functional : untimely urination because of physical disability, external obstacles, or cognitive problems that prevent person from reaching toilet.

overflow : unexpected leakage of small amounts of urine because of full bladder

mixed : usually occurrence of stress and urge incontinence together

39
Q

true or false. transient is a type of incontinence, define if this is a true description : leakage that occurs temporarily because of a situation that will pass ( infection, taking a new medication, colds with coughing )

A

this is true

40
Q

interventions for urinary incontinence : (behavioural)

name the categories

A

scheduled voiding
prompted voiding
pelvic floor exercises
bladder training

41
Q

interventions for urinary incontinence :
(behavioural)
define if this is true or false.
scheduled voiding: based on voiding patterns from bladder diary or common voiding patterns, typically every 2 to 4 hours, treat: urge and functional UI

A

true

42
Q

interventions for urinary incontinence :
(behavioural)

define if this is true or false.
prompted voiding : scheduled voiding with prompting and verbal reinforcement ( positive )

A

true

43
Q

interventions for urinary incontinence :
(behavioural)

define if this is true or false.
pelvic floor exercises (kegel): repeated voluntary contraindications, treat stress, urge, and mixed UI

A

this is true

44
Q

interventions for urinary incontinence :
(behavioural)

define if this sis true or false.

Bladder training: increasing and time between the urge to void and voiding, treat urge incontinence

A

this is true

45
Q

using a bladder diary is what ?

A

this is the gold standard for obtaining objective information about voiding patterns ( paper- based or app based )

46
Q

is this in the bladder diary ? bladder and bowel routines but also other related factors ( pain, difficulty stopping and starting )

A

yes this is included

47
Q

Character of the urine (colour, odour, sediment, clear) and Record of incontinence can also be included in the bladder diary . True or false.

A

this is true

48
Q

Interventions : urinary incontiennce
lifestyle modifications
define if these are true or false.
fluid intake, caffeine, weight reduction, smoking, bowel management, physical
activity.

A

all true

49
Q

NEVER refer to incontinence products as “diapers” (always maintain personhood). true or false.

A

true

50
Q

Interventions : urinary incontinence

In-dwelling (continuous), intermittent, or external condom catheters
▪ Higher risk of urinary tract infection with long-term use
▪ May be needed short-term: relieve urinary retention, close monitoring of urine
output or to assist with wound healing
▪ May be long-term for patients unable to excrete urine without an indwelling
or intermittent catheter secondary to neurological condition, blockage, etc.
are these true ?

A

yes this is true

51
Q

Diarrhea (Bowel Incontinence)
Alteration in Bowel Elimination:
name some characteristics

A

Frequent passing of watery, liquid, and loose stools
▪ Acute or chronic
▪ Acute diarrhea caused by a virus or bacteria
▪ Chronic diarrhea caused by an underlying disease, i.e. irritable bowel disease (covered in patho/pharm course).

52
Q

Are these true according to diarrhea ( bowel incontienence ) alteration in bowel elimination : ▪ Other causes: medications, lactose intolerance, post-surgery
▪ Clinical considerations:
- If possible, identify/treat underlying cause.
- Monitor input and output, lab values, and symptoms of
dehydration/electrolyte imbalance
- Delirium in an older adult may be caused by
dehydration/electrolyte imbalance secondary to diarrhea.

A

yes it is true

53
Q

a sign of fecal impaction is series of what ?

A

small episodes of bowel incontinence

54
Q

___ still is bypassing around hard impacted stool

A

liquid stool

55
Q

The CHAMMP tool has been developed by certified wound, ostomy, and continence nurses to assess continence and guide individualized interventions : now define what CHAMMP stands for

A

C: Continence
H: History (Medical/Surgical)
A: Assessment of Urinary Incontinence M: Medications
M: Mobility Status
P: Plan of Care

NURS2518 : The Older Client (13 decks)

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