Alterations in Elimination

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Alterations in Elimination
2013-02-10 11:57:08
Saddleback N170

Alterations in Elimination
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  1. Hematuria
    blood in urine
  2. Eructation
  3. Dyspepsia
    upset stomach/heart burn
  4. dysphagia
    difficulty swallowing
  5. Pruritis
    anal itching
  6. Gastrocolic and Duodenocolic Reflex
    When peristalsis is stimulated in the colon after the first meal of the day.
  7. Stress Incontinence
    losing urine while exercising, coughing, sneezing etc....puts pressure on the bladder.
  8. Urge Incontinence
    Bladder spasms caused by the detursor muscle resulting in strong sudden urge to urinate.
  9. Reflex incontinence
    Neurological problem....where bladder contracts uncontrollably and person doesnt get the signal.
  10. Functional Incontinence
    Mental issue that keeps a person from getting to the toilet on time.....mentally incapacitated or even arthritis.
  11. cystitis
    inflammation of the urinary bladder
  12. pyelonephritis
    inflammation of renal parenchym and collecting system
  13. hypertrophy
    thickening of the walls of the bladder from outflow being obstructed.
  14. hesitancy
    • involuntary delay in starting the urinary systen.
    • 15+ seconds
    • BPH sign
  15. overflow incontinence
    think you have gotten rid of all of your urine...but you havent. 

    • Normal is 50 cc
    • Problem is over 200 cc's left behind
  16. Normal oral intake
    PO and NPO
    • PO-1500+/ml per day or 30-60ml/hr
    • NPO-3000 ml/day or 125 ml/hr

    Drink 2-3 litres of water per day
  17. Output Normal
    Panic Value
    • Normal is 50-60 ml/hr
    • Panic is 30 ml/hr for two consecutive hours.  Call Dr....renal failure
  18. Normal pH range

    What happens if acidic?

    Acidic is <4.6 -painful urination, diabetic ketoacidosis, diarrhea

    Alkalitic is > 8 - kidney stones, kidney failure, UTI, vomitting
  19. Symptoms of urinary incontinence

    Is it a normal part of aging?
    • too much or too little urine,
    • NO!!!!!
    • urge or no urge,
    • intensity or cant get started,
    • burning
    • color change/cloudy
    • odor
  20. Urinalysis
    • Looks at this in urine:
    • WBC
    • Protein
    • pH
    • gravity
  21. WBC's in urine...normal range
  22. Normal gravity?
    What does this tell you?

    If it is low then urine is concentrated and may be in renal failure.

    If it is high, then the patient is dehydrated.???????

    This doesnt make sense to me
  23. Culture & Sensitivity normal range?
    What does this tell you?
    over 100,000

    Looks at what bug you have and what it should be treated with.
  24. What's PVR?
    a test to see if your bladder is clearing all of its urine.  Urinate...50cc's or less left is good. 

    Over 200 cc's is inadequate
  25. IVP and cystourethrogram does what?
    looks at size, shape and function of urinary system
  26. Main cause of bladder dysfunction
    • Detrusor muscle becomes unstable
    • Pelvic Floor ligaments become weak
  27. Causes of bladder dysfunction: Reversible
    • UTI's
    • vaginal atrophy
    • bladder inflammation
    • prostate enlargement
    • confusion
    • obesity
    • mobility or environment problems
    • medications
  28. Causes of bladder dysfunction:  Irreversible
    • labor or multiple pregnancies
    • bladder inflammation from stones, infection, tumor, caffeine, citrus, sugar substitutes
    • obesity cuz puts added pressure on the bladder
  29. Etiology of urinary incontinence besides muscle issues.....
    • Urethra doesnt close or open right
    • pressure in the urethra must be greater than pressure in the bladder
    • neurologic problems
    • confusion
  30. Medical and Nursing interventions for urinary incontinence
    • Medications
    • Kegel exercise
    • Bladder retraining
    • Anticontinent devices
    • Diet change
  31. Adrenergic blockers help with what kind of incintonence
    reflexive and overflow
  32. Tricyclic antidepressants do what
    decrease overactive bladder contractions...reflexive
  33. Calcium channel blockers do what?
    relax smooth muscles in the bladder....Urge incontinence
  34. Pro banthine does what
    stops painful bladder spasms and relaxes the bladder...urge incontinence
  35. Problems with using valsalva maneuver with urinary incontinence
  36. Crede method
    helps with incontinence by pushing down on the bladder.
  37. How do you protect the skin of an incontinent patient?
    • -Hygiene immediately
    • -Use absorptive pads to wick away moisture
    • -Let patient lay on top of a bad and naked to let skin dry
    • -Reposition
    • -Check patient regularly
  38. Complications of altered bladder elimination:
    Dont go enough get a UTI

    Go too problems
  39. Two types of bladder training...describe
    Habit-used for cognitively impaired.  Put on toilet on a schedule

    Prompted- ask if wet or dry and if they need to use a toilet.

    Want to set interval goals
  40. Patho of cystitis
    urothelial cells produce mucin which is a sugar that protects the bladder cells from urine.  Inflammation occurs and organisms are able to now invade the bladder
  41. Patho of polynephritis
    bladder doesnt fully empty, reflux of urine and organisms occurs and invades the renal pelvis, inflammation occurs, scar tissue builds and renal function can become impaired
  42. Cystitis

    May be asymptomatic

    Signs: Hematuria, bladder distention, cloudy or purulent urine

    Symptoms:  urgency, burning, freq urination, sm amts, back pain

    Cause:  bacteria, fungus, virus, parasite, bad wiping, foods, chem, drugs, radiation
  43. Polynephritis

    Signs:  fever, vomit, chills

    Symptoms: nausea, flank pain, abd pain, dysuria

    Cause:  inflammation or bacterial infection of renal pelvis due to cystitis not being cured
  44. Cystitis:

    Primary and contributing causes
    Primary:  E Coli causes 90% of cystitis.  From a disturbance in integrity of urothelial cells

    Contributing:  poor peri care, handwashing, careless insertion of catheter and cathers breakdown mucin barrier.
  45. Nursing diagnosis for urinary tract infection:
    • Impaired urinary elimination
    • Deficient knowledge R/T methods of prevention and treatment protocols
    • pain, burning, pruritis
  46. Why are the elderly at risk for UTI's?
    • Relaxed pelvic structure so the bladder doesnt fully empty.
    • Decreased hydration bladder doesnt get flushed.
    • Chronic diseases (stroke, diabetes)
    • Decreased estrogen levels
  47. Why are women at risk for UTI's?
    • Shorter urethra 1 1/2 inches
    • Proximity of vagina to rectum
    • Pregnancy
    • Recurrent infections
    • Viral infections
    • Post menopause
  48. Why are post menopausal women susceptible to UTI's?
    Reduced estrogen decreases vaginal lactobacilli which ward off infection.
  49. Interventions for cystitis:
    good hand hygiene, wipe front to back, void frequently, drink 2-3 litres water/day, avoid certain foods
  50. Interventions for polynephritis:
  51. Bladder irritating foods:
    • Citrus
    • colas
    • soda
    • tea
    • spices
  52. Why do you measure abdominal girth?
    larger girth is seen in pt with liver failure cuz fluids are being leaked in to the peritoneal cavity
  53. What causes Melena stools?
    iron or Pepto Bismol
  54. Red streaks in the stool means
    Hematochezia....passage of fresh blood thru the anus.
  55. Green-yellow poop
  56. Light or clay colored poop
    lack of bile....gallbladder or liver disease
  57. Sigmoidoscopy vs. Colonoscopy
    Sigmoidoscopy only looks at sigmoid colon, where the colonoscopy looks at the entire large intestine
  58. Proctoscopy
    Looks at the anal cavity, rectum and sigmoid colon
  59. Gas producing foods
    • cabbage
    • onions
    • cauliflower
    • bananas
    • apples
    • beans
    • spicy foods
  60. Diarrhea producing foods
    • spicy foods
    • excess sugar
  61. Laxative foods
    • bran
    • prunes
    • figs
    • chocolate
  62. Galactosans (constipation causing foods)
    • by products of milk....cheese!
    • eggs
    • bananas
    • lean meat
    • pasta
  63. Which nervous system speeds up digestion
    • Parasympathetic
    • It controls every day digestion and peristalsis
  64. Which nervous system slows down motility and can be constipating
  65. How does secretion of toxins cause diarrhea?
    the toxins produce swelling and inflammation....then diarrhea

    Example toxins:  E Coli and Shigella
  66. What bacteria attach to the intestinal wall and cause ulceration, cell destruction and bleeding
    • Shigella
    • E coli
  67. What virus attaches itself to the intestinal villi and destroys them leading to malabsorption

    Cuz villi increase absorptive area of the intestine
  68. Why may a person be incontinent?
    • Communication problems
    • Confusion
    • Cant make it to the bathroom
    • Neurological issues
    • Laziness
  69. Why are diabetics more at risk for UTI's?
    cuz they have sugar in their urine...and bacteria loves sugar.  Infection
  70. Nursing Process....Asses pt for UTI

    Subjective Information
    • Subjective info:
    • Past history of UTI's
    • Prego
    • Std's
    • Current Meds
    • Bladder cancer
  71. Nursing Process...assess pt for UTI

    Objective information
    • Objective Information
    • Fever
    • Chills
    • dysuria
    • Urine color and odor
    • Urinalysis C&S
  72. Nursing Process....Dianose UTI
    • Lab results
    • C&S and WBC
  73. Nursing Process....Planning for a UTI
    • Patient will....
    • 1 Have relief from bothersome lower urinary tract symptoms
    • 2 Not have upper urinary tract involvement
    • 3 be learn prevention of recurrence
  74. Nursing Process....Implement interventions for a UTI
    • Admin Antibiotics
    • Pt teaching
    • Increase fluids
    • avoid caffein, spicy foods, alcohol
    • wipe front to back
    • pee regularly
    • rid of foley
    • peri care
  75. Nursing Process....Evaluation of treatment for UTI
    • Look at labs again:
    • Decrease in WBC and less or no bacteria in urine