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Foundations of Nursing > Elimination > Flashcards

Elimination Flashcards

(72 cards)

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1
Q

What is the function of the kidneys?

A

Remove and filter waste from blood and produce urine

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2
Q

What is the function of the ureters?

A

Transport urine from the kidneys to the bladder

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3
Q

What is the function of the bladder?

A

store urine

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4
Q

What is the function of the urethra?

A

Transport urine out of the body

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5
Q

Micturition

A

urination

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6
Q

What is the minimum urine output?

A

30 mL/hour

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7
Q

Oliguria

A

<30 mL/hour urine output for 2 or more hours

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8
Q

Polyuria

A

urine output of 3L/24 hours (3,000 mL)

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9
Q

Anuria

A

no urine production

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10
Q

Incontinence

A

involuntary loss of urine

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11
Q

Functional Incontinence

A

loss of continence because of causes outside of the urinary tract

ex. sensory impairments, cognitive impairments, altered mobility, altered manual dexterity (arthritis), environmental barriers,

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12
Q

Stress Incontinence

A

involuntary leakage of small volumes of urine associated with increased intraabdominal pressure related to either urethral hypermobility or an incompetent sphincter

ex. coughing, laying down, laughing, exercising, walking, getting up

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13
Q

Overflow/Chronic Incontinence

A

involuntary loss of urine caused by an overdistended bladder

ex. distended bladder on palpation, nocturia, high postvoid residual, frequency, involuntary leakage

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14
Q

Urge/Urgency Incontinence

A

involuntary passage of urine associated with strong sense of urinary urgency

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15
Q

Transient Incontinence

A

caused by medical conditions that in many cases or treatable and reversible

ex. inflammation, medications, delirium, depression, fecal impaction, urinary retention, mobility impairment

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16
Q

Reflex Incontinence

A

occurs at predictable intervals when specific bladder volume is reached

ex. absent awareness of bladder filling and the urge to void, leakage of urine without awareness, may not completely empty the bladder because of dyssynergia of the urinary sphincter

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17
Q

Urinary Retention

A

Inability to partially or completely empty the bladder; Urine accumulates in bladder.

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18
Q

Urinary Tract Infection (UTI)

A

Infection in any part of the urinary system; May result from catheterization or procedure

Most common bacteria associated with UTIs: E.coli

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19
Q

Urinary Diversion

A

Diversion of urine to external source

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20
Q

What influences bladder function?

A

Brain structures

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21
Q

What are the factors influencing urination?

A
  • Disease conditions
  • Diagnostic examinations
  • Personal habits
  • Growth and development
  • Medications
  • Surgical/medical procedures
  • Sociocultural factors
  • Psychological factors
    (anxiety, stress, privacy)
  • Fluid intake/balance
    • Nocturia, polyuria,
      oliguria, anuria
    • Diuresis: increased
      or excessive
      production of urine;
      often produced as a
      treatment
    • Fever
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22
Q

Cultural Aspects

A
  • Each patient is unique
  • Some cultures prefer
    same gender
  • Privacy Important
  • Interpreter/ written in
    primary language
  • Hygiene: right hand or
    left hand?
  • Female circumcision
  • Family involvement
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23
Q

Nocturia

A

frequent urination at night

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24
Q

Diuresis

A

increased or excessive production of urine; often produced as treatment

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25
Pyuria
pus in the urine
26
Dysuria
painful or difficulty urinating
27
Post Void Residual (PVR)
amount of urine left in the bladder after urination
28
Bladder capacities:
- Ranges from 600 to 1,000 mL of urine - Adults normally void every 2 to 4 hours
29
Medications can cause
- urinary retention or overflow incontinence (anesthesia/opioids) - urgency and incontinence (Lasix) - change of the color of urine (pyridium) - diuretics
30
Physical Assessment/Recognizing Cues of urination
- urine: COCA - HPI - kidneys: flank pain with infection or inflammation - bladder: distended bladder rises above symphysis pubis - urethral meatus: observe for discharge, inflammation, and lesions - skin and mucosal membranes: assess hydration
31
Assessment/Recognizing Cues of urination through laboratory/diagnostic exams
- urinalysis - urine culture and sensitivity - cystoscopy - radiologic procedures - Kidneys, Ureter, Bladder (KUB) - Computerized tomography (CT) - Intravenous pyelogram (IVP) - Ultrasound
32
Assessment/Recognizing Cues: Look at urine
- intake and output - urine collection - random sample (routine urinalysis) - clean catch (sterile cup) - sterile (straight intermittent catheter and indwelling foley catheter) - timed
33
Assessment/Recognizing Cues: Urinary Retention
- distended abdomen - reports of pressure - restlessness - no UO or scant for hours
34
Interventions: Urinary Retention
- bladder scanner - postvoid residual
35
CAUTI
Catheter, Associated, Urinary, Tract, Infection - Hospital acquired - Does the patient really need this? - High risk for infection - portal of entry
36
Preventing CAUTI
- Use aseptic technique with sterile equipment - Secure indwelling catheters to the patient’s leg - Maintain closed drainage systems - Do not allow any obstruction of urine flow - Urine bag BELOW level of bladder - Urine bag NEVER touches the ground - Empty urine bag when ½ full, clean tip with alcohol - Perform perineal & catheter care
37
Indications for Urinary Catheter (not indwelling)
- Obtain sterile specimen (intermittent “straight cath”) - Hourly monitoring - Unable to void - Surgical procedures - Instillations of medications into the bladder
38
Inappropriate Indications for Urinary Catheter
- nurse convenience - incontinence
39
Assessment/ Recognizing Cues: UTI
- Frequency - Burning (dysuria) - Urgency - Foul smelling urine - Cloudy urine - Elderly-confusion
40
Interventions: UTI
- Patient teaching - Fluids - Voiding schedule - Women wipe front to back - Avoid tight clothing, bubble baths - Drink 6-8 glasses of water/fluids per day
41
Catheter Care Skills
- Keep meatus free of secretions/encrustation - Pericare and cleansing first 4” of catheter - Every 8 hours or less - After defecation - Some agencies use chlorhexidine (CHG) wipes - The skill can be delegated but the assessment can NOT be delegated (if pt has had surgery to the area or trauma…do NOT delegate)
42
Assessment/Recognizing Cues: Indwelling Catheter
- Assess COCA - Assess urethral meatus & catheter - Males - Assess patient for S/S of UTI - Assess patient’s knowledge for catheter care - Offer patient to perform self-care
43
Female External Catheter
Pros - no UTIs in study - no reported discomfort - no skin breakdown associated - better sleep (not wet at night) Cons - confused may remove may slip out of very thin women
44
Male External Catheter
Pros - independent - no suction required silicone gel brands do not require tape Cons - careful with uncircumcised men's foreskin - may leak - tape may cause injury Requires physician order
45
Plan of Care Problems (NANDA)
- Functional urinary incontinence - Stress urinary incontinence - Urge urinary incontinence - Overflow urinary incontinence - Risk for infection - Toileting self-care deficit - Impaired skin integrity - Impaired urinary elimination - Urinary retention
46
Plan of Care Implementations urination RESTORATIVE CARE
- Strengthening pelvic floor muscles - Health Promotion Education - Habit training - Catherization/Self- catheterization - Maintenance of skin integrity - Promotion of comfort
47
Implementation Care for Older Adults
- Offer toileting every 2 hours - Encourage to empty bladder before and after meals and at bedtime. - Encourage to ↑ fluid intake 6-8 glasses/day unless contraindicated. - No Fluids (except with meds) 2 hours before bedtime
48
Indications for Renal Dialysis
- renal failure that can no longer be controlled by conservative management - worsening of uremic syndrome associated with end stage renal disease - severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures
49
Plan of Care: Evaluation of Outcomes
- Evaluate whether the patient has met outcomes and goals. - Check how the patient reports progress made - Help the patient redefine goals if necessary - Revise nursing interventions as indicated
50
Bladder Scanner
- It is best practices to look for urinary retention - It avoids invasive and painful catherization - It uses portable ultrasound and tells the amount of urine in the bladder - Tells amount of urine in the bladder without catheterization
51
Plan of Care Implementations: Urination HEALTH PROMOTION
- Drink 6-8 glasses of water a day - Limit caffeine - To prevent nocturia, avoid drinking 2 hours before bedtime - Practice good voiding habits - Every 3-4 hours while awake, proper positioning - Empty completely - Keep bowels regular - Prevent UTI - Stop smoking
52
Factors affecting bowel elimination
- age - fluid intake - diet - psychological factors - personal habits - physical activity - position during defecation - pregnancy - pain - surgery and anesthesia - medications, laxatives, and cathartics - diagnostic tests
53
Constipation
infrequent stool, dry, hard stool difficult to eliminate
54
Impaction
collection of hardened feces wedged in rectum that can't be expelled
55
Diarrhea
increase in number of stools, passage of liquid, unformed feces
56
Inconstinence
inability to control passage of feces and gas
57
Flatulence
accumulation of gas in the intestines
58
Hemorrhoids
dilated, engorged veins in lining of rectum
59
Bowel Diversion
temporary or permanent artificial opening in the abdominal wall
60
Assessment/Recognizing Cues: Bowel Movement
Health History - Bowel habits - Medications - Recent illness - Stressors Physical assessment - Abdomen & GI tract Laboratory Diagnostics - Stool C&S - Fecal occult blood test (FOBT) - CT scan - Endoscopy - Magnetic Resonance - Imaging (MRI) - Barium Swallow/Enema
61
Plan of Care Problems: Bowel Movement
62
Related Factors of Constipation
- Sedentary lifestyle - Overuse of laxatives - Inadequate diet - Inadequate fluids - Pain - Psychological
63
Implementations of Bowel Movement
Health Promotion - Promotion of normal defecation - Establish a routine an hour after a meal or maintain the patient’s routine - Sitting position - Privacy - Positioning on bedpan
64
Bulking Form Laxative
absorbs liquid for soft stool; psyllium, methylcellulose
65
Emollient Laxative
detergent that softens stool; docusate sodium
66
Osmotics
draws water into the stool; saline, magnesium citrate, polyethyleneglycol
67
Stimulant
increases intestinal mobility; bisacodyl, castor oil
68
Anti-diarrheal
decreases muscle tone to the decreasing passage of feces; diphenoxylate (lomotil)
69
Enemas
- Cleansing - Tap water - Normal saline - Hypertonic solutions - Soapsuds - Oil retention - Others: carminative & Kayexalate
70
Enema Administration
- Sterile technique unnecessary - Wear gloves - Explain the procedure - Positioning
71
Digital Removal of Stool
- Use if enemas fail to remove an impaction - Last resort for constipation - Provider’s order needed - Risk for cardiac dysrhythmia have to be on their left side
72
Continuing and Restorative Care: bowel movement
- Bowel training - Training program - Diet - Promotion of regular exercise - Management of hemorrhoids - Skin integrity

Foundations of Nursing (6 decks)

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