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Sem 1 Theory > Unit 4 - Elimination > Flashcards

Unit 4 - Elimination Flashcards

1
Q

What is the definition of elimination?

A

The removal, clearance, or separation of matter or the excretion of waste products.

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2
Q

The human body eliminates various forms of waste through what organs?

A
  • Skin
  • Kidneys
  • Lungs
  • Intestines
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3
Q

What is bowel elimination?

A

The passage of stool through the intestinal tract and dispelling the stool by means of intestinal smooth muscle
contraction.

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4
Q

What is urinary elimination?

A

The passage of urine through the urinary tract by means of the urinary sphincter and urethra.

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5
Q

What does the term continence mean?

A

Refers to the purposeful control of urinary or fecal elimination.

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6
Q

What are bowel movements?

A

May be referred to as stool or feces

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7
Q

What is defecation?

A

Bowel movements; the act of eliminating feces

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8
Q

What is micturition?

A

Urination

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9
Q

What is anuria?

A

Absence of urine

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10
Q

What is dysuria?

A

Painful urination

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11
Q

What is polyuria?

A

Multiple episodes of urination, as with diabetes.

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12
Q

What is urinary frequency?

A

Multiple episodes of urination with little urine produced in a short period of time.

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13
Q

What is urinary hesitancy?

A

The urge to urinate exists, but the person has difficulty starting the urine stream.

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14
Q

What is the scope of elimination?

A

Normal or expected physiological process of waste formation and excretion by the gastrointestinal and renal systems as well as problems associated with this process.

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15
Q

What is waste formation?

A

Very different between the renal and gastrointestinal systems. The kidneys are responsible for the removal of metabolic waste and other elements from the blood in the form of urine, and the gastrointestinal tract is responsible for the removal of digestive waste in the form of stool.

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16
Q

What is impairment of elimination?

A

It is part of the scope of elimination. A wide range of problems and conditions contribute to impaired elimination.

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17
Q

What is normal urinary elimination?

A

Involves the process of waste formation (production of urine), and the excretion of urine involving several specific structures.

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18
Q

What are the structures that are involved in urine excretion?

A
  • Kidneys
  • Ureters
  • Bladder
  • Urethra
    These all must function properly for normal urination to occur.
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19
Q

What is the formation of urine?

A

The formation of urine is complex and involves three main processes:
1. Glomerular filtration
2. Tubular reabsorption
3. Tubular secretion

The main functional unit of the kidney is the nephron – each kidney has more than 1 million nephrons. Each nephron iscomposed of two parts:
1. Blood vessels
2. Renal tubules

Optimal physiological effect of the kidneys depends on continuous perfusion of a large volume of blood (an average of 1 L per minute) to the kidneys and functioning nephrons.

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20
Q

Where does blood enter the kidney?

A

Blood enters the kidney through the renal artery. Upon entering the kidney, the renal artery branches into progressively smaller arteries called arterioles, and finally to a cluster of capillaries known as the glomerulus.

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21
Q

What is the glomerulus?

A

A semipermeable membrane that serves to filter blood into a C-shaped structure of the renal tubule known as the Bowman’s capsule. This process of glomerular filtration represents the beginning of urine formation.

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22
Q

What does the filtrate contain?

A
  • Water
  • Electrolytes
  • Waste
    All of which has been removed from the blood.
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23
Q

What is tubular reabsorption?

A

As the filtrate passes through a sequence of renal tubules (from the Bowman’s capsule to the proximal convoluted tubule, the Loop of Henle, and the distal convoluted tubule, a network of capillaries surrounding the renal tubules reabsorb most of the water, electrolytes, and other necessary
elements back into the blood.

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24
Q

What is tubular secretion?

A

Involves a secondary process for small amounts of select substances (ex. Potassium, hydrogen, ammonia, and drugs) to be moved from the blood in the capillaries surround the tubules into the tubules. The amount of water and electrolytes reabsorbed into the blood or excreted in the renal tubules is controlled by several hormones,
particularly:
* Aldosterone
* Antidiuretic hormone
* Parathyroid hormone
* Renin
* Atrial natriuretic factor

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25
Q

What is excretion of urine?

A

Urine formed in the renal tubules moves into the collecting duct and then into the renal pelvis, the ureter, and the
bladder where it is stored until urination occurs.

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26
Q

How many mL of urine can the bladder hold?

A

300 – 500 mL before the pressure increases enough for stretch receptors in the bladder to signal the need for
urination.

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27
Q

What prevents urine from leaking out of the bladder?

A

An internal sphincter, composed of smooth muscle, contracts involuntarily to prevent urine from leaking out of the bladder.

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28
Q

What is the external sphincter?

A

Located just below the internal sphincter and surrounding the upper part of the urethra, is composed of skeletal muscle and is voluntarily controlled.

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29
Q

What does the process of urination involve?

A

A series of nerve signals between the bladder and spinal cord to trigger the micturition reflex; thus causing the internal sphincter muscles to relax and bladder wall contraction. With the voluntary relaxation of the external
urinary sphincter, urine passes out of the body through the urethra. The external urinary sphincter must be under the individual’s control in order for urinary control (continence) to be successful.

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30
Q

What is digestion and the formation of stool?

A

The GI system has two overarching functions:
1. The breakdown and absorption of nutrients from foods ingested
2. Elimination of waste from this process

The GI system extends from esophagus to the anus.

31
Q

What is the first part of the GI tract involved in?

A

Esophagus, stomach, small intestines, is involved in the digestion and absorption of nutrients, a process that also involves other digestive organs, including the liver, gallbladder, and pancreas.

32
Q

What is the process of waste formation?

A

Occurs in the colon. Smooth muscles within the intestinal tract stimulates peristalsis, which helps to move the waste product known as stool or fecal matter.

33
Q

How long is the large intestine? What parts is the large intestine comprised of?

A

5 or 6 feet long and approximately 2 inches in diameter and has four parts:
1. Cecum (and appendix)
2. Colon
3. Rectum
4. Anus

34
Q

What is the function of the large intestine?

A

Is to absorb water and electrolytes as fecal matter moves through its walls.

Mucus in the intestines helps lubricate
the walls and aids in the expulsion of the stool.

If there is excessive peristalsis and the stool moves through the large intestines quickly, less water is absorbed resulting in loose stool.

If peristalsis is reduced, feces passes through the large intestines slowly resulting in greater water absorption and harder stool.

35
Q

What is the process of eliminating stool?

A

When the stool reaches the rectum, pressure stimulates the urge to defecate through stimulation of the internal smooth muscle and its stretch response. The urge to defecate can be
suppressed until an appropriate environment is obtained.

36
Q

What are the age related differences for infants, toddlers, and children?

A

Patterns of elimination change in the first few years of life. Infants and toddlers initially lack control over the sphincters and muscles that control urination and bowel elimination, but control is attained during early childhood as a normal developmental milestone.

37
Q

How old are children before they are able to identify the urge to urinate and defecate?

A

18-24 months of age.

38
Q

What are age related differences for pregnant women?

A

Pregnancy can affect elimination patterns because the presence of the fetus in the abdominal cavity affects both bowel and bladder function. As the fetus grows, the increased pressure placed on the bladder causes frequent
urination. Women who are pregnant also have a larger volume of urine because they have a larger blood volume during the gestation. The growing fetus can also interfere with intestinal peristalsis and can cause constipation. Use of prenatal vitamins with iron can also contribute to constipation in the pregnant female.

39
Q

What are the age related differences for older adults?

A

A number of physiological changes associated with aging
affect elimination.
* By age 80 years, renal blood flow reduces to an estimated 600 mL/minute, and the kidneys lose up to
50% of functioning nephrons for a variety of reasons, including changes in size of the kidney and sclerosis. This does not change the older adult’s ability to produce urine sufficiently to maintain normal composition of body fluids, although it represents reduced renal reserve, making the older adult more susceptible to fluid and electrolyte imbalances and kidney damage due to medications.
* The bladder retains tone with age, the volume of urine that can be held reduces, leading to urinary frequency.
* Muscles around the urethra become weak, thus increasing the risk of incontinence.
* Age related changes affecting bowel elimination include atrophy of smooth muscle layers in the colon and reduce mucous secretions.
* Reduced tone of the internal and external sphincter as well as reduced neural impulses (reducing the sensation of bowel evacuation) can make the older adult more susceptible to constipation or incontinence.

40
Q

What are the risk factors for altered urinary elimination?

A

Populations at risk for urinary incontinence include
* Children younger than age 3 years
* Elderly
* Pregnant women
* Women who are menopausal

41
Q

How does the prevalence of urinary incontinence change for women?

A

Ranges from 19% in women age 45 or younger to 49% in women age 80 years or older.

42
Q

Why are men more likely to experience urination difficulties as they age?

A

Because of changes (hyperplasia) in the prostate gland that may cause either urinary retention or increased urinary frequency due to incomplete emptying of the bladder.

43
Q

What are the reasons why incontinence increases with age in both genders?

A
  • Pelvic floor muscle weakness in women and neurologic problems in men
  • Medications such as diuretics can also contribute to the involuntary loss of urine in both men and women
44
Q

What are the individual risk factors associated with elimination?

A
  • Conditions that result in neurologic impairment
  • Altered mobility
  • Cognitive impairment
  • Immunologic impairment or infection
  • Persons with trauma to the brain or spinal cord may experience bladder and bowel impairment attributable to interruption of bowel and bladder
    innervation by the spinal cord. If messages cannot be sent along the nervous system pathways, the anus and the bladder are unable to function normally.
  • Several medical conditions can place an individual at risk for alterations in urinary elimination including:
    ➢ Cerebrovascular accidents (CVA’s)
    ➢ Spinal cord injury
    ➢ Diabetic neuropathy
    ➢ Dementia (including Alzheimer’s disease)
    ➢ AIDS or other autoimmune diseases
45
Q

What are conditions that are specific to the urinary system?

A
  • Urinary calculi
  • Enlarged prostate (benign prostatic hypertrophy)
  • Acute infection
  • Chronic infections
46
Q

What are some congenital defects that can impair urinary elimination function?

A
  • Spinal cord or brain defects
  • Bladder defects
47
Q

What are the risk factors for altered bowel elimination?

A
  • Bowel or fecal incontinence occurs in approximately 8% or 18 million Americans.
  • Occur in men and women from both acute neurologic injury and progressive neurologic changes with advanced age.
  • Excessive use of medication such as laxatives can contribute to incontinence issues in both genders.
  • Persons at highest risk for incontinence are those with cognitive impairment, those who are exposed
    to radiation for treatment purposes, and those who take multiple medications, consume excessive
    amounts of caffeine or have limited access to toilet facilities because of immobility or environmental or sociocultural factors.
48
Q

What are the risk factors that place individuals at risk for stool retention?

A
  • Lack of adequate fluids
  • Fiber
  • Exercise
  • Medications that dry the system such as diuretics, narcotics, antidepressants, and anxiolytics.
  • Pregnancy increases risk for stool retention because of the pressure of the fetus on the bowel.
49
Q

What medical conditions can place an individual at risk for alterations in

A
  • CVA’s
  • Spinal cord injury
  • Diabetic neuropathy
  • Dementia (including Alzheimer’s disease)
  • AIDS or other autoimmune diseases
50
Q

What are some conditions specific to the GI system associated with risk?

A
  • Irritable bowel syndrome
  • Chrohn’s disease
  • Food allergies or intolerance, such as Celiac disease
51
Q

What are some congenital defects that impair bowel elimination function?

A
  • Defects of the spinal cord or brain
  • Defect of the colon
  • Rectal defects
52
Q

What should be asked during an assessment history?

A
  • Ask about patterns of urinary and bowel elimination, including frequency, appearance of stool and urine, and associated symptoms.
  • Common symptoms directly related to elimination including alterations in elimination patterns, changes in appearance, frequency, or quality of stool or urine, or discomfort and difficulty associated with elimination.
  • A symptom analysis approach is helpful to fully understand the symptom.
  • Determine if there have been changes in diet, recent changes in health status (ex. Cognition, mobility, functional ability, or other medical conditions)
  • If new medications or changes in medications.
  • Voluntary or involuntary (incontinence) emptying of the bowel or bladder also must be assessed to determine the impact of the condition on the individual.
  • Adults of all ages should be asked about urinary continence because it is an underreported phenomenon.
53
Q

What are examination findings related to elimination?

A

Incorporates four examination techniques:
1. Inspection
2. Auscultation
3. Palpation
4. Percussion

54
Q

What is assessed during the inspection for elimination?

A
  • Abdomen is inspected for contour; abdominal or bladder distention is an abnormal finding.
  • Genitalia are also inspected to examine the urinary meatus for evidence of redness, lesions, or
    discharge. Discharge from the urinary meatus is an abnormal finding and may suggest infection, especially if the patient reports pain with voiding.
  • Observe the perianal area. The area should be free from redness or lesions. The presence of hemorrhoids or an anal fistula may be observed if the patient complains of pain with defecation.
  • Looking at a stool or urine sample if available. Urine should be clear and yellow with mild odor. Very dark urine is indicative of dehydration, may be
    a side effect of medication, or may indicate the presence of blood. Stool should be brown and formed. Stools that are black and tarry in appearance often signal GI bleeding. Loose stools
    or diarrhea may be associated with diet, inflammation, or infection.
55
Q

What is assessed during the auscultation of the bowel?

A

Limited to the abdomen to listen to bowel sounds. Should be heard in all four quadrants. An absence of bowel sounds may be associated with paralytic ileus, hyperactive bowel
sounds may be associated with GI inflammation or with an intestinal obstruction. Auscultation is not indicated for urinary assessment.

56
Q

What is palpation?

A

A physical examination technique for both urinary and bowel elimination. The abdomen should be soft and
nontender with palpation over the entire abdomen and over the urinary bladder. Abdominal or urinary distention is considered an abnormal finding and may be associated with
reduced peristalsis or retention of stool or urine. Rectal palpation is done to assess the rectal sphincter and to
examine for the presence of masses, lesions, or impacted stool. Digital palpation is also part of the prostate
examination. Although this is not directly an examination associated with elimination, prostate enlargement can result from a tumor (benign or malignant) or inflammation both can contribute to urinary retention.

57
Q

What is percussion?

A

Abdominal percussion may be performed to help identify masses or excessive intestinal gas. Direct fist percussion over the costovertebral angle (over the kidney) should be painless; if sharp pain is produced, it could signal the presence of a kidney infection.

58
Q

What are the diagnostic tests for elimination?

A

Classified into one of three categories:
1. Laboratory
2. Radiographic
3. Direct observation

59
Q

What are laboratory tests for elimination?

A
  • Urinalysis – one of the most common of all laboratory tests. Useful for screening a number of conditions not associated with a problem in elimination and is obtained with either a sterile urine specimen or a clean-catch specimen. Bacteria indicate infection, whereas blood may indicate
    damage from infection or trauma to the urinary system. Urinary analysis that indicates the presence of bacteria or blood components in the urine may
    require further assessment of the urinary tract by a physician specialist in the field of urology.
  • Renal function tests – assessing renal function include blood urea nitrogen, blood creatinine, and creatinine clearance tests. Creatinine and blood urea nitrogen are excreted entirely by the kidneys and therefore provide a measure of renal function.
  • Culture – urine and stool cultures are relatively common. When a urinary tract infection is suspected, a urine culture determines the presence and type of organism causing the UTI. Stool
    cultures are indicated when a parasitic infection is suspected.
  • Occult blood – when blood is suspected in stool, an occult blood test is indicated. Represents a basic screening that should be performed as part of a rectal examination. The presence of blood in the stool could be related to a GI bleed (inflammation and infection), hemorrhoids, or tumors.
60
Q

What is pathology as related to diagnostic tests?

A

A biopsy is a sample of tissue or cells that undergoes pathologic evaluation. A biopsy can be taken from the rectum, colon, bladder, or kidney. Biopsies provide information associated with tumors or with general organ function.

61
Q

What are radiographic tests and scans?

A

Numerous radiographic tests are used to assess elimination. Common radiographic tests include:
* X-rays
* Computerized tomography
* Magnetic resonance imaging
* Ultrasound

These are used to detect a variety of problems including the presence of an intestinal tumor, a congenital renal
abnormality, or kidney stones. Angiography is used to assess renal blood flow and can detect renal artery stenosis.

62
Q

What are direct observation tests?

A

The ability to directly observe internal organs can be accomplished with scopes.

Scopes can be used to visualize
the colon (colonoscopy), the sigmoid colon (sigmoidoscopy), the bladder (cystoscopy), or the urethra or
ureters (uroscopy).

Direct visualization of the colon is done for screening or diagnostic purposes for polyps, cancer, and inflammatory conditions such as Chrohn’s disease.

Direct visualization of the bladder or ureters is done with a special scope as part of diagnostic or surgical procedures.

63
Q

What are other diagnostic tests for elimination?

A

Several special tests are available to evaluate urinary elimination including:
* Bladder stress testing
* Uroflowmetry and other urine flow studies
* Postvoid residual measurement
This is done through use of bladder scans or post-void catheterization.

64
Q

What are methods primary prevention for elimination?

A

Occurs with individual application of prevention measures based on the person’s normal bowel and bladder habits. By maintaining healthy bowel and bladder function with the intake of a healthy diet and adequate fluids, each person can promote the elimination of stool and produce the quality and quantity of urine that supports a healthy urinary system.
Primary prevention through public education should occur regarding activities to promote bladder health such as:
* Encouraging adequate hydration
* Emptying the bladder with the first urge
* Maintaining normal body mass index
* Refraining from smoking
* Limiting intake of caffeinated beverages
* Adhering to regular elimination habits
* A consistent exercise program

65
Q

What are some environmental factors for primary prevention?

A

Avoidance of contaminated water and foods can assist in maintaining consistent bowel habits. Bacteria in water and food can cause diarrhea and colitis. Parasites can be present
in water or food that is not properly prepared. Parasites not only can cause elimination problems but also can affect overall health. Laboratory testing can determine if parasites are present in the GI system that may be causing problems with bowel elimination.

66
Q

How is maintaining hydration related to primary prevention?

A

Water is a key element for prevention for bowel and urinary elimination problems. Water is absorbed by the stool to soften it and promote intestinal motility. Water serves the urinary system in that it increases volume, reduces bladder irritation, and helps eliminate toxins from the body. Caffeinated fluids may cause difficulty in both bowel and bladder elimination as it may increase in frequency the
elimination. Any substances that irritate the bowel or bladder will cause alterations in normal elimination patterns.

67
Q

How is dietary fiber related to primary prevention?

A

Fiber intake has been shown to assist in the prevention of stool retention especially when implemented with adequate water intake and exercise. Fiber creates friction along the bowel surface that it can assist in the production of a bowel movement. Adequate fluid intake with the fiber is very important. Fiber should slowly be added to the diet to prevent abdominal discomfort and excessive gas formation
in the intestine. The American Dietetic Association recommends 14 g of fiber per 1000 kcal intake.

68
Q

How is maintenance of regular toileting practices related to primary prevention?

A

Maintaining a consistent time of defecation is important in the regulation of bowel movements. The use of familiar toileting facilities may also encourage defecation. To prevent urinary incontinence or retention, there should be timely and complete emptying of the bladder. Holding urine should be discouraged because this encourages bacterial growth in the bladder and consequent UTI’s.

69
Q

What are secondary prevention methods for elimination?

A

Two common screening tests associated with elimination are:
* Occult blood
* Colonoscopy
Both are considered effective for the detection of colon cancer. The U.S. Preventive Services Task Force
(USPSTF) recommends occult blood testing, sigmoidoscopy, or colonoscopy for adults beginning at age 50 years until 75 years of age. These tests allow for visualization of the colon and removal of precancerous
lesions, averting the development of colon cancer. Screening for occult blood is performed annually or as a
component of all digital rectal examinations. Screening associated with urinary elimination includes prostate cancer screenings. The USPSTF does not recommend routine
screening for bladder cancer.

70
Q

What are pharmacologic agents as collaborative interventions?

A
  • Antibiotics – infections of the kidney and urinary tract are treated with antibiotics. Antibiotics are usually selected based on the provider’s best
    judgement and based on the results of culture and sensitivity testing.
  • Diuretics – increase the volume of urine produced along with excreting sodium and potassium from the body by affecting the water resorption in the renal tubules.
    ➢ Loop diuretics prevent reabsorption ofmsodium in the Loop of Henle.
    ➢ Thiazide diuretics prevent sodium from being reabsorbed at the beginning of the distal convoluted tubules.
    ➢ Potassium sparing diuretics stop the extensive loss of potassium at the distal convoluted tubules. Excess use to treat certain conditions requires careful monitoring and frequent lab testing of the electrolytes.
  • Antispasmodics – often used to relieve smooth muscle spasms in the bowel or bladder. Bladder spasms can occur as a consequence of neurologic
    injury.
    ➢ Anticholinergics can reduce bladder spasms and can provide relief from urinary incontinence. Bowel spasms commonly occur with irritable bowel syndrome.
    ➢ Some antispasmodic medications, such as Imodium (loperamide), are effective for the treatment of diarrhea because they cause a reduction in peristalsis and slow the passage of stool
  • Agents to manage constipation – includes both prescribed and over-the-counter versions of laxatives, bulk-forming agents, bowel stimulants,
    lubricants, stool softeners, saline laxatives, and enemas. The drawback of using these medications is that the bowel can become dependent on laxatives and stimulants for the impulse to defecate.
  • Analgesics – are indicated for relief of mild discomfort to severe pain for select urinary or bowel elimination conditions. Examples: kidney stones,
    cystitis, UTI, bladder spasms, hemorrhoids, rectal fissures.
71
Q

What is incontinence management as a collaborative intervention?

A

The need for retaining the bowel and bladder is of paramount importance. Nursing actions that will promote urinary continence include:
* Regular toileting schedule
* Managing fluid intake
* Modifying the environment
* Avoiding indwelling catheters
* Providing high quality skin care and assessment
* Avoiding medications

Personal absorbent pads or bed-protecting pads may be used to catch episodes of incontinence in both mobile and immobile individuals.
Biofeedback may be used to assist the person in gaining improved control over the muscles of elimination. Biofeedback involves placement of sensors onto the affected area of the bowel so that the person can receive
feedback regarding which muscles are being used to control bowel function.

72
Q

What are invasive procedures and surgical interventions involving urinary elimination in regards to collaborative
interventions for impaired elimination?

A

….

73
Q

What are invasive procedures and surgical interventions involving bowel elimination?

A

…

74
Q

What are the interrelated concepts for elimination?

A
  • Nutrition
  • Cognition
  • Fluid and electrolytes
  • Mobility
  • Acid-base balance

Sem 1 Theory (12 decks)

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