Elimination Flashcards
(84 cards)
1
Q
Anuria
A
When you do not urinate
2
Q
Dysuria
A
Painful urination
3
Q
Polyuria
A
Frequent urination
4
Q
Oliguria
A
Small amounts of urine
5
Q
Nocturia
A
Excessive urination at night
6
Q
Enuresis
A
Involuntary urination
7
Q
Retention
A
Inability to empty urine from bladder
8
Q
Glyscouria
A
Too much sugar in urine
9
Q
Urinary hesitancy
A
Urge to urinate, difficulty streaming
10
Q
Urinary frequency
A
Multiple episodes of urination with little urine production in short time periods
11
Q
Nephritis
A
Kidney infection
12
Q
Pyelonephritis
A
Renal pelvis infection
13
Q
Cystitis
A
Bladder infection
14
Q
Neoplasms
A
A new and abnormal growth of tissue is some part of the body, think prostate
Also, kidney or bladder tumors. Intestinal tumors-benign polyps/cancer
15
Q
Prostate neoplasm
A
Block urinary flow in men
16
Q
Intestinal tumors
A
Benign polyps/cancer
17
Q
Rena calculi
A
Kidney stones
18
Q
Renin
A
Hormone secreted by kidneys to control blood pressure. Released in response to decreased renal perfusion, decreased arterial BP, decreased Ecf, decreased serum Na+ concentration, and increased urinary Na+ concentration
19
Q
Erythropoietin
A
Hormone in kidneys released when hypoxia and low renal blood flow makes RBC from bone marrow. Erythropoietin deficiency occurs in kidney failure and leads to anemia (think chronic illness)
20
Q
Micturition reflex
A
Involuntary signaling between spinal cord and bladder
21
Q
External sphincter
A
Voluntary control of muscle to pee
22
Q
more FUNCTION OF KIDNEYS
A
activation of vitamin D
Regulation of acid balance
23
Q
External aids (elimination)
A
Bedside toilet
Urinals
Bedpan
Condom catheter
24
Q
Internal aids (catheter)
A
Foley
In and out catheter
CAUTI and catheter care
25
Diagnostic tests (urinary elimination)
Routine UA; urine culture, bladder scan (scans volume of urine in bladder); uroflowmetry (measure amount voided); IVP (looks at vessels in kidneys), renal arteriogrpahy/angiography - looks at blood vessels in kidneys; CT, MRI; renal scan; kidney Biopsy
26
Urinalysis
Color- amber yellow
Odor - aromatic
RBCs - 0-4
WBCs - 0-5
Protein - 0-trace
Glucose - none
Ketones - none
Bilirubin - none
Specific gravity - 1.003-1.030
pH - 4.0-8.0
27
Invasive procedures and surgical interventions (urinary elimination)
Dialysis
Procedures to remove urinary retention
Renal calculi
Nephrectomy
Prostate surgery
Bladder surgeries
Urinary surgery (suprapubic catheter, nephrostomy tube, ileal conduit)
28
BPH physical assessment
Medications (testosterone supp)
Past surgery or treatments of BPH
Distended bladder on palpation
Smooth, firm, elastic enlargement of prostate on rectal exam
Voluntary fluid restriction
Urinary urgency
Decreased force of urinary stream
Hesitancy starting stream
Dribbling
Retention
Incontinence
29
BPH: diagnostic tests
History and physical
*DRE (digital rectal exam)
UA & culture to r/o infection
Serum creatinine to r/o renal insufficiency
*PSA to r/o prostate cancer (increase)
*transrectal US w/ biopsy (TRUS)
cystourethroscopy
Uroflowmetry & post void residual
30
Hydropnephrosis
When both kidneys becomes stretched and swollen as result of build up of urine
31
Stress incontinence
Occurs after a sudden increase in intraabdominal pressure causes loss of urine; typically occurs during coughing, laughing, sneezing, common in women after vaginal delivery or multiple pregnancies
32
Urge incontinence
Occurs when involuntary urination is preceded by urinary leakage; often referred to as overactive bladder
33
Overflow incontinence
Occurs when pressure of urine in overfull bladder overcomes sphincter control
34
Reflex incontinence
Occurs when no warning or stress precedes periodic involuntary urination; occurs with spinal cord lesions above S2
35
Functional incontinence
Loss of urine resulting from cognitive, functional, or environmental factors; like dementia
36
Impaction
Mass of dry, hard stool that will not pass from colon or rectum
37
Encopresis paradoxical diarrhea
Voluntary or involuntary fecal soiling in children who have already been toilet trained. Usually a symptom of chronic constipation
38
Valsalva Maneuver
Act of bearing down and holding breath when attempting BM
-closes airway, -contracts abdominal muscles (increases intra abdominal & thoracic pressures)
Causes temporary decrease in HR & CO resulting in decrease BP. Can be fatal in pts with CHF & CAD
39
Flexiseal
Fecal continence device
Tube connected to drainage inserted in rectum. Can’t use if stool is firm-will clog tube. Great for liquid stool (C. diff!!) skin care is IMPORTANT. Leakage causes skin breakdown
40
Intussusception
Condition where part of intestine slides into an adjacent part of the intestine
41
Colitis
Chronic inflammatory condition of the intestinal tract- inflammation and ulcers in mucosa- can be caused by ulcerative colitis or Crohns disease
42
Diverticulitis
Acute inflammatory condition of the intestinal tract- diverticula are small pouches in mucosal wall become inflamed
43
Small bowel diarrhea
Large, loose stools
Periumbilical or RLQ pain
44
Large bowel diarrheas
Frequent, small, loose stools
Crampy, LLQ pain or cramping
45
Uroflowmetry
Tests amount of urine voided during urination
46
Intravenous pyelogram (IVP)
Contrast used to look at vessels in kidneys and ureters
47
Renal arteriography/angiography
Looks at blood vessels in kidneys
48
Cystoscopy
Views the bladder
49
C. diff
Antibiotic therapy can kill normal intestinal flora making person more susceptible to growth of C diff bacteria (broad spectrum antibiotics; clindamycin, cephalosporins, fluoroquinolones)
C diff impairs absorption by destroying cells. Causes inflammation in colon and produces toxins
50
C diff continued..
C diff symptoms develop over or during few months after a course of antibiotics
51
Mild to moderate C. Diff
Watery diarrhea three or more times daily for two or more days. Mild abdominal cramping and tenderness
52
Severe infection C diff
Watery diarrhea 10-15x daily
Abdominal cramping and pain, may be severe (loss of appetite, weight loss, swollen abdomen, kidney failure, increased WBC)
53
C diff signs and symptoms
Fever
Blood or pus in stool
Nausea
Dehydration
Loss of appetite
Weight loss
Swollen abdomen
Kidney failure
Increased WBC
54
C diff diagnostic tests
Stool specimen
Enzyme immunoassay
Polymerase chain reaction
Cell cytotoxicity
Flexible sigmoidoscopy
Colonoscopy
Imaging tests, abdominal X-ray-CT scan
55
C diff treatment
Immediate isolation (contact precautions. all objects in pt. room considered contaminated. STOP antibiotic that triggered infection asap. Standard treatment is another antibiotic to keep c diff from growing, and treat diarrhea and other issues.
56
C diff treatment medication
Metronidazole (Flagyl) by mouth, Vancomycin by mouth- severe and recurrent cases
Fidaxomicin (Dificid) effective and more expensive
Probiotics may be helpful in preventing antibiotic-induced diarrhea
57
C diff complications
Dehydration
Kidney failure
Toxic mega colon
Bowel perforation
Death
Surgery: removal of disease portion of the bowel may be only option for patients in severe pain
58
C. Diff nursing interventions
Push fluids (prevent dehydration)
Balanced nutrition: increase high complex dietary starches, BRAT diet (potatoes, noodles, rice, wheat, oatmeal and fruits and bananas to decrease diarrhea
59
Bowel incontinence
Common causes: obstetric, childbirth, aging, menopause, diarrhea, chronic constipation leading to fecal impaction
60
Bowel incontinence Assessment
Number of incontinent episodes per week. Stool consistency and volume. Degree of interference with work and social activities. Rectal exam may reveal: reduce anal muscle tone and contraction, impaction (stool above impaction can be liquid)
61
Bowel incontinence nursing interventions
High fiber diet. Increased fluid intake; no caffeine. Kegal exercises bowel training. Manual exam for impaction.
Manual removal of impaction.
Suppositories
Stool softeners
Laxatives (milk of mag, correctol, ex-lax, dulcolax, magnesium citrate, lactulose stimulates peristalsis
62
Age related issues with elimination
Infants and toddlers
-lack of sphincter control and muscle control until early childhood
Pregnant women
-have increased urination due to increased blood volume and fetus pressing on bowel and bladder
-fetus can interfere w/ peristalsis causing constipation
-pre-natal vitamins containing iron can cause constipation
63
Older adults elimination issues
Urine - have decreased renal blood flow , decreased functioning number of nephrons (decreased sized of kidneys and sclerosis)
Increased f/e imbalances
Decreased volume 2/2 loss of elasticity
Bowel: atrophy of smooth muscle in colon, decreased mucous, decreased tone of internal and external sphincters decreasing sensation of evacuation
64
Clinical manifestation BPH
Irritative symptoms - due to infection or inflammation: frequency & urgency, dysuria, bladder pain, Nocturia - usually first symptom noticed, incontinence
Obstructive symptoms - due to retention: decrease in force of stream of urine, difficulty intimating urination, intermittency, dribbling, straining
65
BPH complications
Acute retention
UTI & UTIs leading to sepsis
Residual urine
Alkalization of residual urine = stones in bladder
Hydronephrosis
Pyelonephritis and bladder damage if treatment is delayed of urinary retention
Most complications are from urinary obstruction. BPH can’t be prevented, but it can decrease symptoms: avoid antihistamines and decongestants, don’t drink fluids before bed, avoid alcohol and caffeine
66
BPH minimally invasive/out patient treatments
TUMT (probe 113 degrees F)
TUNA (needle low wave radio frequency)
Laser Prostatectomy (VLAP - visual laser ablation of prostate)
TUVP
Intraprosthetic urethral stents
67
BPH invasive treatments
TURP (resectoscope through the urethra), expect blood in urine post-op, usually continuous irrigation via indwelling catheter post-op
TUIP (small incision local anesthesia)
Open prostatectomy - retro public & perineal
68
TURP (transurethral resection of the prostate)
Continuous or intermittent bladder irrigation (CBI Murphey drop)
Close observation of drainage - increase bladder distinction causes pain and bleeding
Maintain catheter latency
Bladder spasms
Pain control: analgesics and decrease activity first 24 hours
Avoid straining w/ BMs, increase fiber diet and laxatives
69
Complications of TURP
Hemorrhage - bleeding should gradually decrease to light pink in 24 hours
Urinary incontinence - kegal exercises
Infections - increase fluids
Prevent DVT
SCD
Low dose heparin
Discourage sitting for prolonged periods
70
TURP: pre-op care
Restore urinary drainage (urologist, coudè or filiform catheter)
Antibiotics and high fluid intake 2-3 liters
Concerns of sexual functioning
71
TURP: post - op care
Watch for excessive bleeding, bladder spasms, incontinence, infection
Triple lumen catheter irrigation (expect blood clots for 24-36 hours; foley for 2-4 days)
Sterile NS continuous irrigation
Input and output must match
Pericare
Avoid activities that increase abdominal pressure-sitting or walking a long time, straining
Sphincter tone Kegels
72
TURP post-op care continued
It may take weeks to gain control of urine, competence can improve for up to 12 months
Retropubic approach: no enemas, or rectal temps, may insert lubricated opium suppository for spasms
High fiber diet and stool softener
73
Urinary incontinence
Involuntary and unpredictable leakage of urine or loss of bladder control
Occurs when bladder pressure exceeds urethral closure pressure
Prevalence high in women
- women hv shorter urethra, trauma to pelvic floor muscles after child birth, and menopausal changes
Women typical experience stress or urge incontinence
Common in men due to BPH
Men typically experience overflow incontinence caused by urinary retention
74
Transient urinary incontinence
Sudden arrival lasts 6 months or less and has reversible causes
Infection
Pharmaceuletics
Vaginitis
Urethritis
Confusion
75
Transient urinary incontinence causes
Delirium
Infection
Strophic urethritis
Pharmaceuticals
Psychologic
Excess urine output
Restricted mobility
Stool impaction
76
Urinary elimination diagnostic studies
Urinalysis
Renal function test
Post-void residual (PVR) measurement
Normal PVR 50-75 mL
Urine culture
77
Urinary elimination nursing interventions
Promote bladder health: adequate hydration (1-2 L/daily) emptying bladder with first urge, maintain normal weight, no smoking, limit caffeine, consistent exercise
Prevent infection, skin breakdown, f/e imbalance
Avoid substances that irritate bladder - spicy foods
Pharmacological agents - BP meds, antidepressants and tranquilizers
Incontinence management
Invasive procedure s
78
Urinary incontinence nursing interventions
Focused history and PE
Teach pt lifestyle changes (smoking, reduce weight, avoid substances that irritate bladder - caffeine, apartame, citric juices) adequate hydration
Prevent infection skin breakdown
Bladder voiding log documenting
Kegel exercises
Incontinence management
Scheduled voiding regimens
Bladder retraining - scheduled toileting with increasing voiding intervals
Maximize toilet access
79
Urinary retention
Inability to empty bladder or accumulation of an inability to urinate
Acute: MEDICAL EMERGENCY total inability to pee
Chronic: incomplete bladder emptying
80
Urinary retention caused by
Bladder outlet obstruction and deficient detrusor contraction
Ex. Pregnant women have retention of urine due to hard stool pressing against bladder
Obstruction from enlarged prostate
Medications
Post op after anesthesia or catheter use
Fear and anxiety
81
Urinary retention nursing intervention
Scheduled toileting
Double voiding
Catheterization
Intermittent
Indwelling
Drug therapy
Flomax
Surgical therapy
Tranurethral or open surgery for obstruction
Pelvic reconstruction for severe prolapse
82
Catheters use, Indwelling
Relief of urinary retention
Bladder decompression
Surgical repair of urethra
Accurate measurement of I&Os
Prevention of contamination of stage 3 and 4 pressure ulcers
Terminal illness making positioning or clothing changes painful
83
Catheter use, intermittent
Relief of urinary retention
Study of an atomic structures of urinary system
Collection of sterile urine sample
Instillation of medications into bladder
Measurement of residual urine after If ultrasound
84
Catheter complications
CAUTI
Bladder spasms
Periurethral abscess
Chronic pyelonephrititis
Urosepsis
