USCR Elimination

Question 1

What is elimination?

Answer 1

Excretion of waste products by the skin, kidneys and intestines.

Question 2

What to look for in an assessment for elimination?

Answer 2

Client’s Health History
Interview (BCF data: subjective)

Physical Examination
(objective data)

Diagnostic and laboratory studies

Question 3

Urinary elimination depends on what 4 urinary tract organs?

Answer 3

Kidneys (filter urine)
Ureters
Bladder
Urethra

Question 4

factors influencing urination?

Answer 4

Age
Psychosocial factors*
Fluid and food intake
Medications
Muscle tone and activity
Pathological conditions
Surgical and diagnostic studies

Question 5

What to look for in bladder assessment?

Answer 5

empty bladder
distended bladder
urinary retention
retention with overflow
incontinence

Question 6

What is a distended bladder?

Answer 6

full, palpable bladder

Question 7

What is urinary retention?

Answer 7

inability to void or empty bladder completely

Question 8

what is retention with overflow?

Answer 8

small amount of urine escapes bladder despite retention

Question 9

what is incontinence?

Answer 9

involuntary urination)

(symptom of something else going on)can be due to physiological, neurological disorders

Question 10

normal frequency of urine elimination?

Answer 10

5-7 times/day

Normal urine output= 1500-1600 mL/24 hours; about 500 mL/4 hours; at least 30 mL/hr

Question 11

What is dysuria?

Answer 11

painful or difficult urination (UTI is most common cause of dysuria)

Question 12

what is urgency?

Answer 12

increased urge to void

Question 13

what is hematuria?

Answer 13

blood in urine

Question 14

what is nocturia?

Answer 14

excessive urination during the night

Question 15

what is hesitancy?

Answer 15

inability to induce urinary flow

Question 16

what is dribbling?

Answer 16

inability of urinary sphincter to contract completely resulting in drops of urine

Question 17

what is polyuria?

Answer 17

increased urination (>3L of fluid in 24hr) usually seen in diabetes mellitus water follows glucose out during filtration, too much glucose to reabsorb=incr water loss=incr urine); or diabetes insipidus (disorder of urine concentration).

Question 18

What to look for in assessment of urine?

Answer 18

colour (straw colour –> tea colour)
clarity (clear –> cloudy –> turbid)
odour (no smell –> strong nitrate)
quantity (drips –> 1L+)

Question 19

Urine test?

Answer 19

Sterile container for C&S (culture & sensitivity)
Culture to identify microorganism
Sensitivity to identify antimicrobial/antibiotic the microorganism is sensitive to.

dipstick

Question 20

action demand for urine?

Answer 20

Maintain normal urinary
elimination by:

assuming normal positioning for urination,
   e.g. standing for men 
 squatting for women

Taking time to void
voiding when the urge arises (don’t ignore it).
maintaining privacy if required
practicing proper hygiene (wipe front to back) to prevent UTI.
drinking at least 2 L of fluid to prevent UTI and ensure quantity of urine.
voiding immediately after sexual intercourse to prevent UTI.

Question 21

what is bowel elimination?

Answer 21

Elimination of the waste products of digestion from the body is essential to health

Question 22

factors affecting bowel elimination?

Answer 22

age
diet
fluid intake
activity
psychological factors
defecation habits
medication 
diagnostic procedures
anaesthesia and surgery 
pathological conditions
pain
Food and fluid intake 
Exercise
Laxatives

Question 23

what is constipation?

Answer 23

<3 stools/week

Question 24

what is impaction?

Answer 24

unrelieved constipation

Question 25

what is diarrhea?

Answer 25

increased frequency of defecation | risk of dehydration

Question 26

what is fecal incontinence?

Answer 26

large amount of loose, water stools (IBS) chronically loosing too much fluid

Question 27

what is flatulence?

Answer 27

passing gas

Question 28

what are hemorrhoids?

Answer 28

dilated, engorged veins in lining of rectum can cause discomfort and pain + bleeding

Question 29

What to look for in abdominal assessment?

Answer 29

Look (slightly convex, distended, smooth) Listen (auscultate) Feel (palpate for masses or tender areas) Before doing physical assessment, make sure to have a detailed health history; that is, the patient’s assessment of their normal frequency, stool characteristics (formed, hard, liquid), pain (location, type) and self-care habits (fiber, fluids, laxatives, exercise).

Question 30

abdominal assessment?

Answer 30

``` Abdomen: distended soft/hard pain sounds ``` ``` Abdominal quadrants Right upper Left upper Right lower Left lower ```

Question 31

bowel sounds?

Answer 31

Are heard in all quadrants Usually are high pitched Occur irregularly 5-35 times per minute **Bowel sounds are auscultated before palpation of abdomen. Can anybody tell me why that is? when you start palpating, you are stimulating the bowel and you will get a false auscultation reading

Question 32

stool assessment?

Answer 32

color, consistency, shape, odor, frequency 3x/week-3x/day is normal range to go melenia: black tarry stool = bleeding in upper intestinal track grey/white stool: obstruction of bowel tract

Question 33

stool laboratory tests?

Answer 33

ova & parasites Culture will produce many bacteria; labs looking for those that may cause pathological conditions. Sensitivity of pathogen to specific antibiotics.

Question 34

Test for occult blood?

Answer 34

Hemoccult: test specifically for occult or hidden blood in the stools, which is the result of GI bleeding that is not visible to the naked eye.

Question 35

what is documented in client chart?

Answer 35

Last BM recorded Medications taken for BM Enema given

Question 36

action demand for dedication?

Answer 36

Promote normal defecation by: ``` taking time to defecate responding to the urge to defecate eating a diet high in fibre drinking at least 2000 mL fluid/day exercising daily avoiding the regular use of laxatives ```

Question 37

functions of the skin?

Answer 37

Protects from injury and passage of micro organisms Regulates body temperature Secretes sebum – softens & lubricates skin Transmits sensations – pain, temperature, touch & pressure Produces vitamin D

Question 38


FACTORS AFFECTING SKIN INTEGRITY?

Answer 38

``` immobility (pressure sores) inadequate nutrition, hydration fecal and urinary incontinence decreased mental status diminished sensation excessive body heat advanced age ```

Question 39

Skin Assessment?

Answer 39

``` colour turgor intact cleanliness/odour texture temperature (warm/cold) moisture edema ```

Question 40

Skin Assessment?

Answer 40

``` changes in skin e.g. colour texture edema itchiness any lesions changes in lesions or moles ```

Question 41

Self Care Practices for sun?

Answer 41

``` How much time in the sun? Use of sun screen? Use of sun lamps? Wears hat in sun? Hygiene practices at home: -frequency of bath -type of soap -moisturizer ```

Question 42

Action demand for skin?

Answer 42

Maintain elimination processes through good skin integrity by: practicing proper hygiene, e.g. don’t use rough soaps, moderate water temperature. eating a well balanced diet, e.g. protein builds tissues. doing regular exercise. drinking adequate fluid intake (2 L / day).

Question 43

action demand for sun protection?

Answer 43

``` Protect the skin from sun and cold: SUN sunscreen at least 15 SPF and containing both UVA and UVB protection wear hat in the sun cover arms and legs stay indoors when sun is strongest ```

Question 44

action demand for cold weather?

Answer 44

wear warm clothing cover face, ears prevent metal from touching skin

Question 45

what is menstruation?

Answer 45

A discharge of blood, secretions, and tissue debris from the shedding of the endometrium from the non-pregnant uterus that recurs at approximately monthly intervals.

Question 46

what to look for in menstruation assessment?

Answer 46

Duration of period = average 3-5 days Regular periods = average 28 days intervals Menarche = first menstruation (onset) Menopause = period which marks the permanent cessation of menstrual activity.

Question 47

menarche?

Answer 47

first menstruation (onset)

Question 48

menopause?

Answer 48

period which marks the permanent cessation of menstrual activity

Question 49

menstruation assessment?

Answer 49

colour = bright red --> brown amount = spotting --> heavy odour = slight smell

Question 50

what is amenorrhea?

Answer 50

absence or suppression of menstruation (including pregnancy, lactation, & menopause or illness/ pathology)

Question 51

what is dysmenorrhea?

Answer 51

pain associated with menstruation

Question 52

menorrhagia?

Answer 52

abnormally heavy or prolonged bleeding, interfering with normal ADL (soaking more than 1 sanitary pad per hour for several hours); may show signs of anemia

Question 53

metrorrhagia?

Answer 53

bleeding between periods

Question 54

self care practices for menstruation?

Answer 54

Hygiene Comfort measures Exercise Sex when menstruating

Question 55

products that can cause vaginal infection?

Answer 55

``` Use of: major causes of infections deodorized tampons, pads douches vaginal sprays bubble bath super-absorbent tampons (Toxic Shock Syndrome) ```

Question 56

toxic shock syndrome?

Answer 56

``` S & S: A sudden high fever. Low blood pressure (hypotension) Vomiting or diarrhea. A rash resembling a sunburn, particularly on your palms and soles. Confusion. Muscle aches. ``` can cause death!