Urine & Bowel Elimination Flashcards
(72 cards)
1
Q
Function of the kidney:
A
3 processes in your information:
Glomerular alteration, tubular reabsorption, tubular secretion
2
Q
What percent of cardiac output to the kidney determines urine output?
A
25% of cardiac output to the kidney determines our urine output.
Because if your cardiac output is less than your urine, the amount of urine is less as well.
3
Q
Functions of the kidney:
A
1) remove waste products from the blood and play a major role in the regulation of fluid and electrolyte imbalance (urine formation)
2) stimulates red blood cells production (erythropoietin)
3) major role in blood pressure control through the RAAS
4) produce prostaglandin (vasodilation)
5) Converts vitamin D into its active form of calcium & phosphate regulation
4
Q
Bladder:
A
Serves as a temporary reservoir for urine, the person feels a desire to void when the bladder fills to about 150- 250mL.
5
Q
What’s the difference between the ureter and urethra?
A
Ureter = carries urinary waste to the bladder
Urethra = transport urine from the bladder out of the body
6
Q
Discuss urinary and bowel elimination changes related to older adults
A
- Diminished ability of the kidney to concentrate urine (tubular reabsorption and tubular secretion)
- Decreased bladder muscle muscle tone may reduce bladder capacity
- Decreased bladder contractility may lead to urine retention and stasis
- Neuromuscular problems, degenerative joint disease, alteration in thought process and weakness may interfere with voluntary control.
- Medications prescribed for other health problems (diuretics, sedatives, tranquilizers)
- Some view themselves as old, powerless and neglected.
7
Q
Normal aging may affect urination in older adults
A
Yes, the body atrophies or shrinks
8
Q
When does urinary retention occur?
A
Occurs when urine is produced normally but is not excreted completely from the bladder. Factors associated with urinary retention include medications, an enlarged prostate, or vaginal prolapse.
9
Q
What’s a clean-catch midstream specimen?
A
Catch midstream urine, not first urine voided (considered sterile!)
10
Q
What’s a sterile specimen catheterization?
A
Patients can’t do it themselves, nurses get it by a straight catheter (considered sterile!)
11
Q
What’s Anuria?
A
24-hour urine output is less than 50 mL
12
Q
What’s dysuria?
A
Painful or difficulty urinating
13
Q
What’s urinary frequency?
A
Increased incidence of voiding
14
Q
Glycosuria
A
Presence of glucose in the urine
15
Q
What’s nocturia?
A
Awakening at night to urinate
16
Q
What’s oliguria?
A
24-hour urine output is less than 400 mL
17
Q
What’s polyuria?
A
Excessive output of urine (diuresis)
18
Q
Whats proteinuria?
A
Protein in the urine
19
Q
Whats pyuria?
A
Pus in the urine
20
Q
Whats urinary urgency?
A
Strong desire to void
21
Q
Whats urinary incontinence?
A
Involuntary loss of urine
22
Q
Questions to Assess usual patterns of urinary elimination:
A
How often do you urinate (pass your water) during the day?
Do you awaken at night to empty your bladder?
How would you describe your urine?
23
Q
Nursing process of assessment for urination
A
- Conduct a detailed health history & physical assessment
- Assessment of the bladder for distention = using a bladder scanner to assess the amount of urine in the bladder not excreted completely (urinary retention/ post-void residual)
- Check for inflammation in the urethral orifice
- Check for skin integrity from incontinence
- Assess hydration status
- Measure urine output
- Assess the patients urine through urinalysis (at least 10ml)
24
Q
• “It takes a while for the urine to come and sometimes I have to go every hour!”
• “I have to get up frequently at night to urinate.”
These are example statements of..
A
Urinary retention
Postvoid residual of 450 mL via bladder scanner
25
NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING URINARY ELIMINATION:
Nocturia, frequency, and urgency
Nursing strategies:
-Ensure easy access to the bathroom or commode.
-Discourage fluid intake at bedtime.
-Discourage alcohol use before bedtime.
-Evaluate medication regimen and schedule, particularly diuretics and drugs that produce sedation or confusion.
-Use a night light.
-Use clothing that is easily removed for voiding.
-Keep assistive ambulatory devices (walkers, canes, and the like) readily available.
-Evaluate gait and ability to ambulate safely.
-Assess for urinary tract infection.
26
NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING URINARY ELIMINATION:
Incontinence
Nursing strategies:
-Maintain a fluid intake
-Discourage use of alcohol, artificial sweeteners, and caffeine.
-Provide easy access to the bathroom.
-Assess factors that influence voiding.
-Use assistive devices when necessary (raised toilet seat, grab bars, walker).
-Use collection devices when necessary (urinal or bedpan).
-Ensure safety when ambulating (e.g., skid-proof slippers).
-Encourage use of whole, unprocessed, coarse wheat bran to prevent constipation and fecal impaction.
-Perform pelvic floor muscle training (PFMT) exercises several times daily.
-Encourage participation in a bladder retraining program.
27
NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING URINARY ELIMINATION:
Urinary tract infection
Nursing strategies:
-Maintain a liberal fluid intake
-Encourage shower instead of tub bath to decrease opportunity for bacteria in bath water to enter urethra.
-Encourage appropriate perineal care and frequent changing of incontinence briefs.
-Void at frequent intervals; every 2 hours if possible.
-Void immediately after sexual intercourse.
-Females should avoid use of potentially irritating feminine products, such as deodorant sprays, douches, and powders in the genital area.
28
UTIs that affect the upper urinary tract involving the kidneys and ureters are called…
Pyelonephritis
29
UTIs that affect the lower urinary tract and urethra are referred to as…
Cystitis
30
TREATMENT AND PATIENT EDUCATION TO PREVENT UTIs
-Drink six to eight 8-oz glasses of liquid daily.
- Do not postpone going to the bathroom; urinate when you feel the urge.
- Take enough time to fully empty the bladder when urinating.
- If you have female genitalia, dry the perineal area after urination or defecation from the front to the back (from the urethra toward the rectum.
- Void before and after sexual intercourse
- If you have repeat bladder infections and use a diaphragm, unlubricated condoms, or spermicide, talk with your health care professional about switching birth control methods; these methods can increase the chances of developing a bladder infection.
- Wear underwear with a cotton crotch and avoid clothing that is tight and restrictive on the lower half of the body.
31
When do we use urinary catheterization?
- Relieving acute urinary retention. Retention is often temporary and is common after surgery involving the lower abdomen, pelvis, bladder, or urethra, especially if ambulation is delayed, fluid intake is minimal, or epidural analgesia is used for pain control. Bladder outlet obstruction, including mechanical obstruction such as swelling at the meatus (which can occur after childbirth), or an enlarged prostate in males may cause retention.
-Some patients who are unable to use any other bladder management method, such as those with neurogenic bladder dysfunction related to a disability (e.g., spinal cord injury) or intractable urinary retention, require long-term use of an indwelling catheter.
-Obtaining a sterile urine specimen when the patient is unable to voluntarily void.
-Accurate measurement of urinary output in critically ill patients.
-Assist in healing open sacral or perineal wounds in incontinent patients.
-Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations.
-Provide improved comfort for end-of-life care.
-Prolonged patient immobilization (potentially unstable thoracic or lumbar spine, multiple traumatic injuries).
32
Types of catheters:
Intermittent urethral catheters (straight catheters)
- used to drain the bladder for short periods.
*Intermittent catheterization should be considered as an alternative to short-term or long-term indwelling urethral catheterization to reduce CAUTIs (catheter-associated UTI)*
Certain advantages to intermittent catheterization, including the lower risks of CAUTI and complications, may make it a more desirable and safer option than indwelling catheterization
33
What is the preferred catheterization method for patients with urinary retention and bladder-emptying dysfunctions and following surgical interventions ?
Intermittent catheterization is the preferred due to a lower risk of CAUTI.
34
When do we use an indwelling catheter (Foley catheter)?
If a catheter is to remain in place for continuous drainage; The indwelling urethral catheter is designed so that it does not slip out of the bladder. A balloon is inflated to ensure that the catheter remains in the bladder once it is inserted.
- Indwelling catheters are used for the gradual decompression of an overdistended bladder, for bladder drainage, and for continuous bladder drainage and irrigation.
35
CARING FOR PATIENTS WITH AN INDWELLING CATHETER
- Wash hands before and after caring for the patient.
- Use mild soap and water or a perineal cleanser to clean the perineal area thoroughly, especially around the meatus, daily and after each bowel movement. Rinse the area well.
- Do not use powders and lotions after cleaning.
- Do not use antibiotic or other antimicrobial cleaners or betadine at the urethral meatus.
- Cleanse the catheter by cleaning gently from the meatus outward.
- Make sure that the patient maintains a generous fluid intake, unless contraindicated by other health concerns. This helps prevent infection and irrigates the catheter naturally by increasing urine output.
- Encourage the patient to be up and about, as ordered.
- Note the volume and character of urine, and record observations carefully. Observe the urine through the drainage tubing and in the collection container.
- Note and record the amount of urine on the patient’s intake-and-output record every 8 hours.
- Empty the urine into a graduated container that is calibrated accurately for correct determination of output.
- When emptying the drainage bag, make sure the drainage spout does not touch a contaminated surface.
- Teach the patient the importance of personal hygiene—especially the importance of careful cleaning after having a bowel movement—and thorough, frequent hand hygiene.
- Promptly communicate any signs or symptoms of infection. These include a burning sensation and irritation at the meatus, cloudy urine, a strong odor to the urine, an elevated temperature, and chills.
- Remember to keep the collecting bag lower than the bladder to promote drainage.
- Patients who require long-term use of an indwelling catheter may experience self-care practice and catheter challenges. Patients need educational interventions to address fluid intake, bowel management, hygiene, and self-monitoring/management, including potential adverse events.
36
How often should you change an indwelling catheter?
-Change indwelling catheters only as necessary. The interval between catheter changes varies and should be individualized for the patient, based on clinical symptoms: catheter encrustations, obstruction, leakage, bleeding, and CAUTIs.
37
What are some characteristics of urine that alert for an infection?
Turbidity = cloudiness
38
Cystoscopy =
Inserting a scope in our urethra and trying to view the bladder visually
39
Intravenous pyelogram =
Insert IV and inject a dye. Dye goes through the bloodstream and will end up in your urinary system for elimination.
40
Retrograde pyelogram =
Insert a catheter and they inject a dye. Then the dye goes to the bladder and then to the ureter and then to the kidney.
41
Interventions focused on urine elimination:
- Maintaining normal voiding habits (go pee when you have to pee)
- Assist to void when there is an urge to void.
- Provide privacy and assure normal voiding position.
- Promoting fluid intake of at least 6-8 glasses daily.
- Avoid caffeine containing, high sodium, and high sugar beverages (all can cause dehydration)
- Encourage pelvic floor exercises such as kegels.
42
UTIs are the leading cause of of systemic infections in older adults.
True/False
TRUE!
- UTIs are the second most common type of infection in general
43
Women are more susceptible to UTIs
True/False
TRUE!
- people with female genitalia are more vulnerable due to shorter urethras and the close proximity of the vagina to the rectum
44
Treatment for UTIs include:
Antibiotics, fluids, assess characteristics of urine, dry from front to back, void immediately after intercourse, avoid baths, wear cotton underwear, not lotions or antibacterials to be used down there
45
What labs/ testing needs to be done if a UTI is suspected and when does it need to be done?
- urinalysis
- urine sample for gram stain (GS)
- urine sample for culture and sensitivity (C/S)
*BEFORE starting anti-infective therapy*
46
Whats transient urinary incontinence?
Appears suddenly and lasts for 6 months or less caused by treatable factors such as acute illness/ infection or medications such as diuretics.
47
Whats stress incontinence?
Occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure, occurs during coughing, sneezing, laughing, exercising, multiple childbirth obesity, and straining from chronic constipation.
48
What’s urge incontinence?
Involuntary loss of urine that occurs soon after feeling an urgent need to void
49
What’s overflow (chronic urinary retention) incontinence?
Involuntary loss of urine associated with over-distention and overflow of the bladder.
50
What’s functional incontinence?
Urine loss cause by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory or disorientation.
51
What’s reflex incontinence?
Experience emptying of the bladder without the sensation of the need to void caused by spinal cord injuries
52
What’s total incontinence?
Continuous and unpredictable loss of urine resulting from surgery, trauma, or physical malformation
53
Are disposable briefs first line method used for urinary incontinence?
No.
The use of briefs and others alike are not recommended until other factors such as functional ability of the patient, type and severity of incontinence, biological sex, available caregivers, failure of previous treatment and patient preferences.
*Disposable briefs, cause skin breakdown or incontinence associated dermatitis and may increase the risk of UTIs.
54
What type of catheter do we use in patients who may have a neurogenic bladder due to a spinal cord injury?
A subrapubic catheter is preferred over a Foley catheter for long-term urinary drainage for patients whom no other alternative is possible.
55
Functions of the colon:
- Absorption of water and electrolytes.
- bacteria (micro biome) acts on food residue (fiber) and produces vitamin K, some b-complex vitamins and short chain fatty acids.
- Propelling poop towards the rectum for elimination (defecation)
56
Bowel elimination changes affecting older adults:
– Slowing of GI motility
- May increase risk of constipation/fecal impaction
– Assess other factors of affecting bowel elimination, like food, fluids, lifestyle, medication’s.
– Decreased muscle tone, this may increase the risk of fecal incontinence
57
NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING BOWEL ELIMINATION:
Slowing of GI motility with increased stomach-emptying time…
• Encourage small, frequent meals.
• Discourage heavy activity after eating.
• Encourage a high-fiber, low-fat diet.
• Encourage adequate fluid intake.
• Discourage regular use of laxatives.
• Develop a daily routine to move bowels. The optimal time is usually 2 hours after awakening and after breakfast.
• Evaluate medication regimen for possible adverse effects.
58
NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING BOWEL ELIMINATION:
Decreased muscle tone/incontinence…
• Provide easy access to the bathroom.
• Use assistive devices when necessary (raised toilet seat, grab bars, walker).
• Ensure safety when ambulating (e.g., skid-proof slippers).
• Encourage participation in a bowel-retraining program.
59
NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING BOWEL ELIMINATION:
Weakening of intestinal walls with greater incidence of diverticulitis…
• Encourage a high-fiber diet and adequate fluid intake.
• Teach patients not to ignore the urge to have a bowel movement.
• Encourage regular exercise.
60
The nursing process: assessing for bowel elimination
- Conduct a detailed health history, physical assessment, and correlate findings with the results of diagnostic tests.
- assess abdomen in sequence from inspection, auscultation and palpation.
- check patient’s anal area each time you wash or assist with bowel movement (lesions, ulcers, fissures, hemorrhoids).
- note stool frequency, amount, and characteristics.
-check for any warning signs of more advanced disease, such as early colorectal cancer
61
How do you care for a patient with a colostomy / ileostomy?
Collaborate with the wound ostomy continents nurse
- Empty ostomy appliance when it is 1/3 full
- Assess the ostomy regularly, noting the size and the skin around it.
- Measure intake and output
- Explain each aspect of the care and encourage patients to participate
* for ileostomies, increase fluid intake and avoid certain foods that may cause blockage
62
How to care for a patient with flatulence…
– Patient should be evaluated for malabsorption if flatulence is associated with weight loss, fever, loss of appetite and change in bowels.
- Avoid gas producing/irritating foods, reframe from reclining after a meal. Instead take a short walk and change positions often while in bed
63
How to care for a patient with fecal incontinence…
Some nursing interventions include noting when incontinence is most likely to happen, keeping the skin dry and clean, changing bed, linens, and clothing as necessary, bowel training programs and consulting with provider for the use of fecal incontinence devices, suppositories, or daily cleansing enemas.
64
How to care for a patient with constipation…
-promoting regular bowel habits, such as timing, positioning, privacy, nutrition, and exercise.
65
How to care for a patient with diarrhea…
* diarrhea is the passage of more than three loose stools, a day associated with intestinal, cramping, nausea, and vomiting, and sometimes blood. Risk for diarrhea includes the use of antibiotics traveling and loss of fluids and electrolytes (dehydration)*
Interventions include following recommendations of CDC related to food, safety, replace with fluid and electrolytes such as Gatorade, identifying underlying causes, considering low residue/low fiber, food, avoid dairy, except for yogurt, and administer anti-diarrheal medication if not
contraindicated.
- The BRAT diet
66
What’s urosepsis?
A life-threatening condition that occurs when a urinary tract infection spreads to the kidney and causes sepsis.
*
67
True or false
If a urinary tract infection leads to urosepsis clients may have the same UTI symptoms, but with life-threatening concerns
TRUE!
Hypotension and difficulty breathing would be our concern
68
What are 3 way catheters used for?
Irrigation after surgery (no blood in the bladder, blood can form clots)
69
What are coude tip straight caths used for?
Enlarged prostates (their beneficial because of their curved tips)
70
What are Foley catheters used for?
Inserted to measure hourly output in ICU
71
What are straight catheters used for?
Urinary retention
72
Any catheter that is indwelling has a higher risk of infection
TRUE/FALSE
TRUE!
Indwelling catheters have a higher risk for UTI
