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When elimination becomes impaired, nurses need to?

facilitate bladder emptying through use of indwelling catheters, urethral or suprapubic (long term use)


Several areas in the brain are involved in bladder control

cerebral cortex, thalamus, hypothalamus and brainstem. There are two micturition centers in the spinal cord; one that coordinates inhibition of bladder contraction and the other that coordinates bladder contractility


Typically a sense of urgency occurs when the bladder fills to?



In older adults, the ability to hold urine between the initial desire to void and an urgent need to void decreases. Older adults are at increased risk for?, and manual dexterity

urinary incontinence due to chronic illness and factors that interfere with mobility, cognition, and manual dexterity


Factors that can impair elimination:

-Social expectations (“holding it” until break, et.)
-Anxiety/ stress
-Need for privacy
-Alcohol intake (decreases ADH increasing urine production)
-Caffeine intake (irritate bladder and can prompt unsolicited bladder contractions resulting in frequency, urgency, and incontinence).
-Conditions such as Diabetes, MS and Stroke can alter bladder contractility and the ability to sense bladder filling leading to bladder over activity or insufficient bladder emptying.
-Conditions such as Arthiritis, Parkinson’s disease, dementia, and chronic pain may interfere with timely access to a toilet.
-Spinal cord injury or intervertebral disc disease can cause loss of urinary control due to bladder over activity and impaired coordination between the bladder and urinary sphincter.
-BPH may cause obstruction of bladder outlet leading to retention.
-Trauma specifically to the lower abdomen or pelvic area may obstruct urine flow and require temporary use of an indwelling catheter.
-Anesthetic agents and other agents given during surgery can decrease bladder contractility and/or sensation of bladder fullness leading to urinary retention.
-Other medication issues contributing to altered elimination include: Diuretics: increase UOP by preventing reabsorption of water and electrolytes.
-Anticholinergics may increase risk of urinary retention by inhibiting bladder contractility.
-Hypnotics and sedatives decrease the ability to recognize/ act on urge to void
-Some drugs change the color of urine


Important to note that ANY TIME the sterile urinary tract is catheterized, there is increased risk for?



Urinary tract infections (UTIs) are usually caused by?

Escherichia coli.


Symptoms of a lower urinary tract infection (bladder) can include:

burning or pain with urination (dysuria), irritation of the bladder (cystitis) characterized by urgency, frequency, incontinence, suprapubic tenderness, and foul-smelling cloudy urine.


Most common urinary elimination problems involve the?

inability to store urine or fully empty the urine from the bladder, these issues can result from infection, irritable, or overactive bladder, obstruction of urine flow, impaired bladder contractility, or issues that impair innervation to the bladder resulting in sensory or motor dysfunction


Common forms of UI are?

urge or urgency UI (involuntary leakage associated with urgency) and stress UI (involuntary loss of urine associated with effort or exertion, on sneezing or coughing. Urinary incontinence associated with chronic retention of urine (formally called Overflow UI) is urine leakage caused by an overfull bladder


All specimens collected and sent for laboratory testing need to be labeled with?

the patient’s name, date, time, and type of collection


Patients with indwelling catheters require regular perineal hygiene, especially after a bowel movement, to reduce the risk for?



A critical part of routine catheter care is reducing the risk for CAUTI. A key intervention to prevent infection is?

maintaining a closed urinary drainage system. Another key intervention is prevention of urine back flow from the tubing and bag into the bladder


Prompt removal of an indwelling catheter after no longer needed is a key intervention that has proven to decrease the incidence and prevalence of?

HAUTI (hospital-acquired urinary tract infections) and is one of the ”never events” identified by the Centers for Medicare and Medicaid Services (CMS)


Teach patients about foods and fluids that cause bladder irritation and increase symptoms such as frequency, urgency, and incontinence. Teach patients to avoid common irritants such as?

artificial sweeteners, spicy foods, citrus products, and especially caffeine. Encourage patients with edema to elevate the feet for a minimum of a few hours in the afternoon to help diminish nighttime voiding frequency


Pelvic floor muscle training (PFMT) “Kegel” exercises involves teaching patients how to identify and contract the pelvic floor muscles in a structured exercise program. The exercises work by?

increasing the pressure within the urethra by strengthening the pelvic floor muscles and by inhibiting unwanted bladder contractions


Age influences bowel elimination

Older adults may have decreased chewing ability. Peristalsis declines and esophageal emptying slows. This impairs absorption by the intestinal mucosa. Muscle tone in the perineal floor and anal sphincter weakens, and may cause difficulty in controlling defecation


While individual fluid needs vary with the person, however, recommended fluid intake, again, is about?

2.5L daily. Fluid liquefies intestinal contents by absorbing into the fiber from the diet and creating a larger, softer stool mass. This increases peristalsis and promotes movement of stool through the colon


Physical activity promotes?



Prolonged emotional stress impairs the function of almost all body systems. During emotional stress, the digestive process is?

accelerated and peristalsis is increased


Constipation is a symptom, not a disease, and there are many possible causes.

Improper diet, reduced fluid intake, lack of exercise and certain medications can cause constipation. When intestinal motility slows, the fecal mass becomes exposed over time to the intestinal walls and most of the fecal water content is absorbed. Little water is left to soften and lubricate the stool. Constipation is a significant source of discomfort


Sigmoid colostomy:
Transverse colostomy:

Sigmoid colostomy: more formed stool.
Transverse colostomy: will be thick liquid to soft consistency.
Ileostomy: fecal effluent leaves the body before it enters the colon, creating frequent, liquid stools


Fluid homeostasis is the dynamic interplay of three processes:

Fluid intake and absorption, fluid distribution, and fluid output. To maintain fluid balance, fluid intake must equal fluid output. Because some of the normal daily fluid output (e.g., urine, sweat) is a hypotonic salt solution, people must have an equivalent fluid intake of hypotonic sodium-containing fluid (or water plus foods with some salt) to maintain fluid balance (intake equal to output)


Fluid intake occurs orally through drinking but also through eating because most foods contain some water. Food metabolism creates additional water. Average fluid intake from these routes for healthy adults is about?

2300 mL, although this amount can vary widely depending on exercise habits, preferences, and the environment. Other routes of fluid intake include intravenous (IV), rectal (e.g., enemas), and irrigation of body cavities that can absorb fluid.


Fluid output normally occurs through four organs:

skin, lungs, GI tract, and kidneys


The GI tract plays a vital role in fluid balance.

Approximately 3 to 6 L of fluid moves into the GI tract daily and then returns again to the ECF. The average adult normally excretes only 100 mL of fluid each day through feces. However, diarrhea causes a large fluid output from the GI tract


The kidneys are the major regulator of fluid output because they respond to hormones that influence urine production.

When healthy adults drink more water, they increase urine production to maintain fluid balance. If they drink less water, sweat a lot, or lose fluid by vomiting, their urine volume decreases to maintain fluid balance. These adjustments primarily are caused by the actions of antidiuretic hormone (ADH), the renin-angiotensin-aldosterone system (RAAS), and atrial natriuretic peptides (ANPs)


ADH regulates the osmolality of the body fluids by?

influencing how much water is excreted in urine. It is synthesized by neurons in the hypothalamus that release it from the posterior pituitary gland. ADH circulates in the blood to the kidneys, where it acts on the collecting ducts.


People normally have some ADH release to maintain fluid balance. More ADH is released if body fluids become more concentrated. Factors that increase ADH levels include?

severely decreased blood volume (e.g., dehydration, hemorrhage), pain, stressors, and some medications


The RAAS regulates ECF volume by?

influencing how much sodium and water are excreted in urine. It also contributes to regulation of blood pressure


Aldosterone circulates to the kidneys, where it causes?

resorption of sodium and water in isotonic proportion in the distal renal tubules. Removing sodium and water from the renal tubules and returning it to the blood increases the volume of the ECF


To maintain fluid balance, normally some action of the ?

RAAS occurs


ANP also regulates ECV by influencing?

how much sodium and water are excreted in urine. Cells in the atria of the heart release ANP when they are stretched (e.g., by an increased ECV). ANP is a weak hormone that inhibits ADH by increasing the loss of sodium and water in the. Thus ANP opposes the effect of aldosterone


Sodium imbalances:

contribute to cerebral dysfunction (confusion, lethargy)


Potassium imbalances:

Potentially life threatening cardiac dysrhythmias, cardiac arrest


Calcium imbalances:

neuromuscular excitability, hypercalcemia= lethargy