Urine & Bowel elimination

Question 1

The kidneys, ureter, bladder, and urethra are all part of what anatomy system?

Answer 1

Urinary system

Question 2

What is the function of the kidney’s

Answer 2

1. Remove waste products from the blood & regulate fluid and electrolyte balance
2. Stimulates RBC formation by secreting Erythropoietin
3. Major role in Blood Pressure control (RAAS)
4. Produces prostaglandins → vasodilation
5. Converts Vit. D into active form needed to absorb calcium Vit D2 → Vit D3

Question 3

What is the function of the ureter

Answer 3

Carries urinary waste to the bladder

Question 4

What is the function of the bladder

Answer 4

1. Serves as a temporary reservoir for urine
2. Desire/urge to void (micturate) when the bladder fills to ~150-200mL

Question 5

What is the function of the urethra

Answer 5

Transports urine from the bladder out of the body.

Question 6

Explain the anatomy / pathway of the large intestine

Answer 6

Begins in the Appendix → Cecum/ileocecal valve → Ascending Colon → Right Hepatic Flexure → Transverse Colon → Left Splenic Flexure → Descending Colon → Sigmoid Colon → Rectum → Anus

Question 7

What is the function of the large intestine

Answer 7

1. Absorption of water and electrolytes
2. Bacteria (microbiome) acts on food residue (fiber) and produces vitamin K, some B-complex vitamins, and short chain fatty acids
3. Propelling feces toward the rectum for elimination (defecation)

Question 8

Name some urinary elimination changes in older adults

Answer 8

■ Diminished ability of the kidneys to concentrate urine = more diluted urine
■ Decreased bladder tone, reduced bladder capacity = urgency is more frequent
■ Decreased bladder contractility = urinary retention or stasis
■ Neuromuscular problems, degenerative joint disease, alteration in thought process, weakness = interference with voluntary control
■ Medications may affect urinary elimination

Question 9

Name some bowel elimination changes in older adults

Answer 9

■ GI motility is slowed
■ Increased risk of constipation and fecal impaction
■ Decreased muscle tone
■ Increased risk of fecal incontinence

Question 10

What are some assessment techniques for urine elimination

Answer 10

• Bladder distention → Use bladder scanner for urinary retention/postvoid residual (PVR).
• Check for inflammation → Inspect urethral orifice for redness, swelling, or discharge.
• Skin integrity & hydration → Assess for incontinence-related skin breakdown.

Question 11

As a Nurse what are some nursing interventions for urine elimination

Answer 11

• Measure urine output → Monitor volume and frequency.
• Urinalysis (U/A) → Requires at least 10 mL of urine for routine testing.
• Clean-Catch Midstream Specimen → Reduces contamination for U/A.
• Sterile Specimen (Catheterization) → Collected via catheter for infection or diagnostic testing.
• 24-Hour Urine Specimen → Measures kidney function over a full day.
• Point-of-Care Urine Testing → Quick bedside tests for glucose, ketones, or infection markers.

Question 12

What are some assessment techniques for bowel elimination

Answer 12

■ Assess abdomen - auscultate for bowel sounds
■ Assess anal area for lesions, ulcers, fissures, hemorrhoids
■ Note stool frequency, amount, characteristics
■ Warning signs of disease: bleeding, changes in patterns, unable to empty bowels
■ Pain in lower left quadrant: possibly diverticulitis

Question 13

As a Nurse what are some nursing interventions for bowel elimination

Answer 13

1. Collect at least 1 inch of formed or 15-30 mL of liquid stool
2. Stool culture/ova and parasites
3. Occult blood (NSAIDs, Aspirins, steroids, Iron, and anticoagulants may produce false positives; Vitamin C may produce false negative)

Question 14

Color, odor, turbidity, specific gravity, constituents, and pH are all..

Answer 14

characteristic’s of urine

Question 15

Volume, color, odor, consistency, shape, and constituents are all…

Answer 15

characteristic’s of stool

Question 16

What does an upper UTI affect

Answer 16

kidneys and ureters

Question 17

What does a lower UTI affect

Answer 17

bladder and urethra

Question 18

What is the most common cause of a UTI

Answer 18

E. coli bacteria

Question 19

Create a care plan for a patient with a UTI

Answer 19

• Antibiotics – Primary treatment.
• Increase fluid intake – Helps flush bacteria.
• Monitor urine characteristics – Check for color, clarity, and odor.
• Hygiene practices:
  o Wipe front to back after using the toilet.
  o Void after sexual intercourse to clear bacteria.
  o Avoid baths (prefer showers).
  o Wear cotton underwear to reduce moisture buildup.

Question 20

Sexually active people with female genitalia and people who use diaphragms for contraceptive; post-menopausal people; people with an indwelling catheter, most common healthcare-associated infection (HAI) - catheter associated urinary tract infection (CAUTI); people with diabetes mellitus; older adults - bladder physiologic changes and enlargement of prostate as a person ages.

Are all..

Answer 20

Risk factors for a UTI

Question 21

How would you as a nurse assess for urinary incontinence

Answer 21

o Palpate for a distended bladder.
o Use a bladder scanner.
o Post-void residual (PVR):
 ≤ 50 ml → Adequate bladder emptying.
 > 100 ml → Incomplete bladder emptying.

Question 22

What are the different types of urinary incontinence

Answer 22

Transient, Stress, Urge, Functional, Reflex, Mixed, Total

Question 23

Define Transient incontinence

Answer 23

Transient: appears suddenly and lasts for 6 months or less, caused by treatable factors such as confusion due to acute illness / infection; medical treatment such as the use of diuretics

Question 24

Define stress incontinence

Answer 24

Stress: 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

Question 25

Define urge incontinence

Answer 25

Urge: involuntary loss of urine that occurs soon after feeling an urgent need to void Overflow (chronic urinary retention): involuntary loss of urine associated with overdistention and overflow of the bladder

Question 26

Define functional incontinence

Answer 26

Functional: urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory or disorientation

Question 27

Define reflex incontinence

Answer 27

Reflex: experience emptying of the bladder without the sensation of the need to void caused by spinal cord injuries

Question 28

Define mixed incontinence

Answer 28

Mixed: urine loss of two or more types of incontinence

Question 29

Define total incontinence

Answer 29

Total: continuous and unpredictable loss of urine resulting from surgery, trauma or physical malformation

Question 30

Create a care plan for a patient with urinary incontinence

Answer 30

Behavioral Techniques * Pelvic Floor Muscle Training (Kegels) – Strengthens pelvic and sphincter muscles. * Biofeedback – Uses devices to help patients recognize muscle contractions. * Electrical Stimulation – Electrodes stimulate muscles to contract. * Scheduled Voiding (Timed Voiding, Bladder Training) – Tracks voiding patterns, gradually increases time between voids, uses relaxation techniques, and may involve caregiver reminders. Lifestyle Changes * Weight Loss – Reduces intra-abdominal pressure and pelvic floor weakness. Pharmacologic Treatment * Medications: o Inhibit bladder contractions. o Relax bladder muscles. o Tighten muscles at the bladder neck and urethra. * Collagen Injections – Adds bulk around the urethra to help closure. Mechanical Treatments * Pessary – A stiff ring inserted into the vagina to reposition the urethra. * External Barriers – Foam pad seals the urethral opening to prevent leaks. * Urethral Insert – Small plug inserted into the urethra, removed for voiding

Question 31

What is a straight catheter

Answer 31

Single-use, inserted to drain urine and removed immediately.

Question 32

What is a foley catheter

Answer 32

Has a balloon to stay in place for continuous drainage. ● Higher risk for CAUTIs (Catheter Associated Urinary Tract Infections)

Question 33

What is a 3-way catheter

Answer 33

Has an extra tube for irrigation, often used after bladder surgery

Question 34

What is a lumen catheter

Answer 34

Refers to the number of channels (single, double, or triple lumen) in a catheter: * Single lumen – Drains urine (e.g., straight cath). * Double lumen – Drains urine and inflates a balloon (e.g., Foley). * Triple lumen – Drains urine, inflates a balloon, and allows irrigation (e.g., 3-way cath).

Question 35

What is a suprapubic catheter

Answer 35

● Long-term bladder drainage ● Inserted surgically through small incision above the pubic area ● Diverts urine from the urethra when injury, structure, obstruction, or surgery has compromised the passage of urine through the urethra. ● Increased comfort for pts. with limited mobility. ● Lower risk of infection than indwelling catheters.

Question 36

ADPIE for a patient with a urinary catheter

Answer 36

Diagnosis: ● Risk for infection related to placement of indwelling urethral catheter. Planning: ● The patient will demonstrate understanding of the importance of proper catheter care. ● The patient will be free from signs and symptoms of urinary tract infection (UTI). ● The patient will maintain a clean and functional urinary catheter without complications. Implementation: Perform proper catheter care: ● Cleanse the catheter insertion site daily using sterile technique. ● Use mild soap and water for cleaning the catheter, and wipe the area from the insertion site down the catheter tube (using one clean cloth for each stroke). ● Ensure the catheter tubing is not kinked or obstructed. ● Maintain the catheter bag below the level of the bladder to prevent backflow of urine. ● Empty the catheter bag when it is half full, ensuring proper hand hygiene before and after. Ensure sterile technique during catheter insertion and during any manipulations: ● When changing the catheter or performing dressing changes, use sterile gloves and equipment to prevent contamination. Monitor for signs of infection: ● Regularly assess the insertion site for redness, swelling, discharge, or pain. ● Check the urine for cloudiness, foul odor, or blood. ● Monitor vital signs, especially temperature, for signs of systemic infection. Encourage fluid intake (unless contraindicated): ● Ensure adequate hydration to flush the urinary system and prevent catheter blockages. ● Offer fluids regularly to maintain hydration. Educate the patient and family: ● Teach the patient the signs and symptoms of urinary tract infection (e.g., fever, dysuria, hematuria). ● Explain the importance of maintaining cleanliness and avoiding contamination at the catheter insertion site. ● Instruct on proper catheter care techniques if appropriate for home care.

Question 37

ADPIE for a patient with constipation

Answer 37

Diagnosis: ● Constipation related to insufficient dietary fiber, inadequate fluid intake, and lack of physical activity. Planning: ● The patient will have regular bowel movements (at least three times a week) without straining. ● The patient will report a reduction in abdominal discomfort and bloating. ● The patient will demonstrate knowledge of dietary and lifestyle changes to prevent constipation. Implementation: ● Encourage increased fluid intake (6-8 glasses of water per day), including herbal teas to promote motility. ● Promote a high-fiber diet (fruits, vegetables, whole grains, legumes); possible fiber supplement. ● Promote physical activity ● Administer medications as ordered ● Establish a regular bowel routine

Question 38

ADPIE for a patient with diarrhea

Answer 38

Diagnosis: ● Risk for Fluid Volume Deficit related to excessive loss of fluids through diarrhea Planning: ● The patient will maintain adequate hydration as evidenced by moist mucous membranes, normal skin turgor, and stable vital signs. ● The patient will consume an adequate amount of fluids to replace those lost through diarrhea. ● The patient will demonstrate understanding of fluid and electrolyte balance in managing diarrhea. Implementation: ● Monitor fluid balance ● Administer oral rehydration solutions (to replace fluids and electrolytes) ● Offer clear liquids (in small, frequent sips) ● Administer IV fluids if ordered ● Encourage a BRAT diet (Bananas, Rice, Applesauce, Toast) - bland, low fiber foods ● Monitor for electrolyte imbalances.

Question 39

ADPIE for a patient with flatulence and fecal incontinence

Answer 39

Diagnosis: ● Impaired Bowel Elimination related to difficulty controlling flatulence and fecal incontinence Planning: ● The patient will maintain regular and controlled bowel movements with fewer episodes of incontinence. ● The patient will identify triggers of flatulence and fecal incontinence and learn strategies to manage or avoid them. ● The patient will demonstrate improved control over bowel elimination with fewer episodes of incontinence. Implementation: ● Assess for triggers of incontinence (diet and activity) ● Encourage dietary modifications (balanced diet with adequate fiber intake) ● Promote regular bowel habits ● Teach pelvic floor exercise ● Administer medications for symptoms as ordered

Question 40

ADPIE for a patient with a colostomy/ileostomy

Answer 40

Diagnosis: ● Impaired Skin Integrity related to stoma output, leakage, and irritation at the stoma site Planning: ● The patient will maintain intact skin around the stoma site, with no signs of redness, breakdown, or infection. ● The patient will demonstrate proper stoma and skin care techniques to prevent irritation and complications. ● The patient will report improved comfort with the colostomy pouch system and a decrease in leakage or skin irritation. Implementation: ● Assess stoma and surrounding skin regularly (at least once per shift or more frequently if there are signs of irritation or leakage; check for signs of infection) ● Teach proper stoma care (gentle cleaning with warm water; proper fit, proper changing of appliance) ● Provide skin barrier protection ● Ensure proper pouch fitting ● Provide emotional support