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Nursing 161 Unit 4 > Elimination > Flashcards

Elimination Flashcards

1
Q

What is the functional unit of the kidney?

A

Nephron

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2
Q

What are the components of the Urinary Tract?

A

Kidneys
Ureters
Urinary Bladder
Urethra

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3
Q

What are some terms used to describe Urinary Elimination?

A
  • micturition
  • voiding
  • urination
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4
Q

What is the average daily output of urine for an adult (14yrs+)?

A

1,500 mL

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5
Q

What is the average daily output of urine for a school age child, age 8-14 yrs?

A

800-1,400 mL

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6
Q

What is the average daily output of urine for a school age child, age 5-8 yrs?

A

700-1,000 mL

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7
Q

What is the average daily output of urine for a preschool age child, age 3-5 yrs?

A

600-700 mL

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8
Q

What is the average daily output of urine for a toddler, age 1-3 yrs?

A

500-600 mL

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9
Q

What is the average daily output of urine for an infant, age 2-12 mos?

A

400-500 mL

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10
Q

What is the average daily output of urine for an infant, age 10 days to 2 mos?

A

250-450 mL

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11
Q

What is the average daily output of urine for an infant, age 3-10 days?

A

100-300 mL

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12
Q

What is the average daily output of urine for an neonate, age 1-2 days?

A

15-60 mL

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13
Q

What are developmental factors regarding urinating that effect infants?

A
  • output
  • frequency
  • control
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14
Q

What are developmental factors regarding urinating that effect preschoolers?

A
  • independent toileting
  • modeling, reminders
  • instruction for wiping
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15
Q

What are developmental factors regarding urinating that effect school age children?

A
  • patterns
  • enuresis
  • nocturnal enuresis
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16
Q

-refers to a repeated inability to control urination

A

Enuresis

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17
Q

What are developmental factors regarding urinating that effect older adults?

A
  • patterns
  • muscle weakness
  • nocturnal frequency
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18
Q 
What is one thing that all these medications have in common:
Anticholinergics
Antidepressants
Antihistamines
Antihypertensives
Antiparkinsonism 
Beta-adrenergics
Opioids
A

They affect urinary elimination

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19
Q

What are some age-related changes regarding urination elimination?

A
  • Renal function declines
  • Impaired excretion of drugs
  • Bladder more fibrous
  • Autonomic regulation decreases
  • Age-related weakening
  • Risk for hyponatremia
  • Polyuria
  • Anuria
  • Oliguria
  • Inadequate kidney function
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20
Q

When assessing a patient for urinary issues, what needs to be assessed?

A
  • Skin assessment
  • Abdominal assessment
  • Urinary meatus assessment
  • Kidney assessment
  • Bladder assessment
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21
Q

Describe the characteristics of normal urine.

A 
Amount in 24 hours = 1,200–1,500 mL
Color, clarity = straw, amber, transparent
Odor = faint, aromatic
Sterility = no mircroorganisms present
pH = 4.5–8
Specific gravity = 1.010–1.025
Glucose = not present
Ketone bodies = not present
Blood = not present
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22
Q

When questing a client about elimination, what information do you need to gather?

A
  • Voiding pattern
  • Description of urine and any changes
  • Urinary elimination problems
  • Factors influencing urinary elimination
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23
Q

What are some diagnostic tests involved in assessing urinary elimination?

A
  • Characteristics, components
  • Ultrasound
  • Uroflowmetry
  • Cystometerography
  • Radiologic examinations
  • Cystoscopy
  • Noninvasive tests
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24
Q

What effect do Diuretics have on urinary elimination?

A
  • increase fluid excretion

- prevent fluid retention

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25
Q

What effect do Anticholinergics have on urinary elimination?

A

-reduce urgency, frequency

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26
Q

What effect do Cholingerics have on urinary elimination?

A
  • stimulate bladder contraction

- facilitate voiding

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27
Q

What are some terms to describe bowel elimination?

A

Feces
Stool
Defecation

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28
Q

What tends to occur with bowel elimination as we age?

A
  • increased constipation (management, gastrocolic reflex)

- leads to increase laxative use

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29
Q

How can bowel elimination be improved?

A
  • increase bulk in diet (cellulose, fiber)
  • increase fluids in diet
  • regular activity/exercise
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30
Q

What happens when the urge to defecate is ignored (by toddlers for example)?

A
  • continued water absorption

- makes stool harder, difficult to expel

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31
Q

What factors can affect bowel elimination?

A
  • early bowel training
  • medications
  • anethesia/surgical procedures
  • pathological conditions
  • pain
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32
Q
  • Rapid movement of fecal contents through large intestine
  • Cramps, increased bowel sounds
  • Fluid and electrolyte losses
  • Risk for skin breakdown
A

Diarrhea

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33
Q

When inspecting feces for abnormalities what should be observed?

A
  • Color
  • Consistency
  • Shape
  • Amount
  • Odor
  • Presence of abnormal constituents
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34
Q

What does GFS stand for?

A

Glomerular Filtration System

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35
Q
  • found in the nephrons of the kidneys

- a tuft of capillaries surrounded by Bowman’s capsule

A

Glomerulus

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36
Q

What are some of the causes of constipation in the older adult?

A
  • Impaired general health
  • Decreased physical activity
  • Loss of teeth
  • Lack of fresh fruits and vegetables
  • Self-limited fluid intake
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37
Q
  • Decreased frequency of defecation
  • Hard, dry, formed stools
  • Straining at stool; painful defecation
  • Rectal fullness, pressure, incomplete
  • Abdominal pain, cramps, distention
  • Diminished appetite or nausea
  • Headache
A

Constipation

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38
Q

What are some of the risk factors for constipation?

A
  • Insufficient fiber or fluid intake
  • Insufficient activity or immobility
  • Irregular defecation habits
  • Change in daily routine
  • Lack of privacy
  • Chronic use of laxatives or enemas
  • IBS
  • Pelvic floor dysfunction of muscle damage
  • Poor motility or slow transit
  • Neurologic conditions
  • Emotional disturbances
  • Medications
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39
Q

What are some of the signs and symptoms of constipation?

A
  • Less frequent than normal pattern
  • Frequent flatus
  • Abdominal discomfort
  • Diminished appetite
  • Straining
  • Passage of hard, dry stools
  • Distended abdomen
  • Impaction
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40
Q

What are some diagnostic examinations for bowel issues?

A

Barium enema
Sigmoidoscopy
Colonoscopy

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41
Q

-the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus

A

Colonoscopy

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42
Q
  • the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon
  • two types: flexible & rigid
A

Sigmoidoscopy

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43
Q

-a special x-ray of the large intestine, which includes the colon and rectum

A

Barium Enema

44
Q

What medications assist with constipation?

A

Laxatives

Stool Softeners

45
Q

-occurs when the client resists having bowel movements, causing impacted stool to collect in the colon and rectum

A

Encopresis

46
Q

-a mass or collection of hardened feces in the folds of the rectum

A

Fecal Impaction

47
Q

What are some symptoms of Fecal Impaction?

A
  • Passage of liquid fecal seepage without normal stool
  • Constipation
  • Rectal pain
  • Frequent nonproductive desire to defecate
  • Generalized feeling of illness
48
Q

What are some pathophysiological factors of impaired functioning of the anal sphincter?

A 
Neurologic causes
Local trauma
Physiologic causes
Psychologic causes
Age-related changes
49
Q
  • a urinary bladder disorder resulting from interruption of the reflex arc normally associated with voiding urine
  • absence of bladder sensation and over-filling of the bladder and inability to urinate voluntarily
A

Flaccid Bladder

50
Q
  • a technique used to void urine from the bladder of an individual who, due to disease, cannot do so without aid
  • executed by holding manual pressure just over the anterior surface of the skin, where the bladder is located
A

Credé’s Maneuver

51
Q

-incontinence that occurs when the client coughs, sneezes or jars the body, resulting in accidental loss of urine

A

Stress Incontinence

52
Q

-absence of control resulting in incontinence

A

Total Incontinence

53
Q

-involuntary loss of urine related to impaired function

A

Functional Incontinence

54
Q

-the strong, sudden need to urinate due to bladder spasms or contractions

A

Urge Incontinence

55
Q

Though urinary incontinence is not a consequence of aging, what percentage of older women experience it?

A

30%

56
Q

What percent of woman in nursing homes experience urinary incontinence?

A

50%

57
Q

What are the symptoms of urinary incontinence?

A
  • Inability to avoid urinating
  • Inability to urinate
  • Increased rate of urination
  • Leakage
  • Uncontrollable wetting
  • Frequent bladder infections
  • Developmental considerations
58
Q

What procedures or surgeries are available to client’s with urinary incontinence?

A

Indwelling urinary catheter
Intermittent straight catheterization
Remove or repair obstruction, calculi
Resection of prostate

59
Q

What do medications that are available for urinary incontinence help to achieve?

A
  • Promote contraction of detrusor muscle

- Promote emptying of bladder

60
Q

What combination of strategies is implemented to help with urinary incontinence?

A 
Education
Bladder training
Habit training
Prompted voiding
Pelvic muscle exercises
61
Q

What are the risk factors for BPH?

A
  • age
  • race
  • family history
  • diet (high in meat)
62
Q

What are some of the possible complications from BPH?

A

Diverticula
Hydroureter
Hydronephrosis

63
Q
  • balloon-like growths on the bladder commonly associated with a chronic outflow obstruction (such as benign prostatic hyperplasia)
  • usually found in pairs on opposite sides of the bladder, they are often surgically removed to prevent infection, rupture, or even cancer
A

Diverticula

64
Q

-a dilation of the ureter

A

Hydroureter

65
Q

-distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine distal to the renal pelvis

A

Hydronephrosis

66
Q

What are some diagnostic tests available for BPH?

A 
PSA
Cystoscopy
Post Void Residual ultrasound
IVP
Urodynamic studies
67
Q

Test for Prostate abnormalities:

  • blood test that measures an enzyme produced by the prostate gland
  • normally, small amounts enter the bloodstream from the prostate, but larger amounts enter the blood when the prostate gland is enlarged, infected, or diseased
A

PSA test (Prostate Specific Antigen)

68
Q

-a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument

A

Cystoscopy

69
Q

-an ultrasound is performed to measure the amount of urine that is left in the bladder after the client has made an attempt to empty it completely

A

Post Void Residual Ultrasound

70
Q

-an x-ray test in which a contrast agent is injected into a patient’s vein - the contrast agent acts to outline the patient’s kidneys, ureters, and bladder when x-rays are subsequently taken

A

IVP (Intravenous Pyelogram)

71
Q

-a means of evaluating the pressure-flow relationship between the bladder and the urethra for the purpose of defining the functional status of the lower urinary tract

A

Urodynamic Studies

72
Q

What are available minimally invasive surgeries for BPH?

A

Transurethral microwave thermotherapy

Transurethral needle ablation

73
Q
  • a non-surgical, minimally invasive therapy that can be performed under a local anesthetic on an outpatient basis
  • the treatment involves inserting a special microwave urinary catheter into the hyperplastic prostatic urethra
  • the microwave antenna within the catheter is then heated to destroy the surrounding prostatic tissue
A

Transurethral microwave thermotherapy (TUMT)

74
Q
  • is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate
  • a cystoscope is inserted through the tip of the penis into the urethra
  • the doctor then guides a pair of tiny needles into the prostate tissue that is pressing on the urethra, then radio waves are passed through the needles to create scar tissue
  • this scarring shrinks prostate tissue, opening up the urinary channel so that urine can flow more easily
A

Transurethral needle ablation

75
Q

What are invasive surgeries that are available to BPH patients?

A

Transurethral Resection of the Prostate (TURP)

Transurethral Incicsion of the Prostate (TUIP)

76
Q
  • a type of prostate surgery that relieves moderate to severe urinary symptoms caused by an enlarged prostate
  • a resectoscope is inserted through the tip of the penis and into urethra
  • the doctor trims away excess prostate tissue that’s blocking urine flow and increases the size of the channel that allows the client to empty their bladder.
A

Transurethral Resection of the Prostate (TURP)

77
Q
  • a type of prostate surgery that relieves moderate to severe urinary symptoms caused by prostate enlargement
  • a resectoscope is inserted through the tip of the penis and into urethra
  • the doctor cuts one or two small grooves in the bladder neck in order to open up the urinary channel, allowing urine to pass through more easily
A

Transurethral Incicsion of the Prostate (TUIP)

78
Q

What kind of CAM therapies are available to clients with BPH?

A

Phytotherapy

79
Q

the study of the use of extracts of natural origin as medicines or health-promoting agents
-aims to preserve the complexity of substances from a given plant with relatively less processing

A

Phytotherapy

80
Q

What tests and assessments are performed by the nurse to assess for BPH?

A

Digital rectal examination (DRE)
Health history
Laboratory tests
International Prostate Symptom Score

81
Q
  • hyponatremia and water intoxication (symptoms resembling brain stroke in an elderly presenting patient) caused by an overload of fluid absorption (e.g. 3 to 4 Litres) from the open prostatic sinusiods
  • this complication can lead to confusion, changes in mental status, vomiting, nausea, and even coma
A

TURP Syndrome

82
Q

-a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine

A

Urinary Calculi (aka kidney stones)

83
Q

-the formation of stony concretions (calculi) in the urinary system

A

Lithiasis

84
Q

-refers specifically to calculi in the kidneys

A

Nephrolithiasis

85
Q

-stones form not in the kidney but in the urinary tract

A

Uroliathisis

86
Q

What factors contribute to Uroliathisis?

A
  • Supersaturation
  • Nucleation
  • Lack of inhibitory substances in urine
  • Fluid intake
87
Q

What are renal calculi composed of?

A
  • Calcium oxalate and/or calcium phosphate
  • Uric acid
  • Struvite stones
88
Q

What are the risk factors for renal calculi?

A
  • most are idiopathic
  • prior personal or family history
  • dehydration
  • excess dietary intake (high protein, sodium, sugar)
  • loss of calcium from bones
89
Q

What symptom occurs when the urine is partially or gradually obstructed?

A

Dull, aching flank pain

90
Q

What symptoms occur with Bladder stones?

A

Dull suprapubic pain with exercise, voiding

91
Q 
Complications from kidney stones:
Kidneys produce urine behind obstruction
Pressure builds up
Colicky pain on affected side
Hematuria, UTI
A

Hydronephrosis

92
Q

What testing is available for diagnosing kidney stones?

A 
Urinalysis
Chemical analysis of any stones
24 hour urine collection
Serum calcium, phosphorus, uric acid
Kidneys, ureters, and bladder (KUB)
Renal ultrasonography
CT scan with/without contrast
IVP
Cystoscopy
93
Q

What medications will inhibit or prevent further lithiasis?

A

Thiazide diuretic

Potassium citrate

94
Q

What types of Lithotripsy are available for clients with renal calculi (though surgery depends on location, obstruction, renal function, UTI, overall health)?

A
  • Extracorporeal shock wave lithotripsy (ESWL)
  • Percutaneous ultrasonic lithotripsy
  • Laser lithotripsy
95
Q

-a procedure that uses shock waves to break a kidney stone(s) into small pieces so that they can more easily travel through the urinary tract and pass from the body

A

Extracorporeal shock wave lithotripsy (ESWL)

96
Q
  • a nephroscope is inserted into the renal pelvis, and ultrasonic waves are used to fragment the stone
  • the fragments are then removed through the nephroscope
A

Percutaneous ultrasonic lithotripsy

97
Q
  • a surgical procedure to remove stones from urinary tract, i.e., kidney, ureter, bladder, or urethra
  • Laser pulses delivered through a fiber optic are used to pulverize the stone, avoiding surgery
A

Laser Lithotripsy

98
Q

-an instrument inserted into an incision in the renal pelvis for viewing the inside of the kidney

A

Nephroscope

99
Q

What types of surgical interventions are available for clients with BPH?

A

Ureterolithotomy
Pyelolithotomy
Nephrolithotomy

100
Q

-an incision in the affected ureter to remove a calculus

A

Ureterolithotomy

101
Q

-an incision into and removal of a stone from the kidney pelvis

A

Pyelolithotomy

102
Q

-a procedure for removal of a staghorn calculus that invades the calyces and renal parenchyma

A

Nephrolithotomy

103
Q

What are type of medication is commonly prescribed for BPH?

A

Alphablockers

104
Q

What are examples of the types of Alphablockers that are prescribed for BPH?

A

Doxazosin
Terazosin
Tamsulosin

105
Q

What do Alphablockers do for the prostrate?

A

-they promote vasodilation to cause smooth muscles in the bladder outlet & prostate gland to relax = improved urinary blood flow and reduction of symptoms

106
Q

What is the most common type of kidney stone?

A

Calcium Phosphate and/or Oxalate 75-80%

107
Q

What is the second most common type of kidney stone - In men? In women?

A

In Men it is Uric Acid 15-20%

In Women it is Struvite 15-20%

Nursing 161 Unit 4 (4 decks)

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