Alterations in Elimination
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upset stomach/heart burn
Gastrocolic and Duodenocolic Reflex
When peristalsis is stimulated in the colon after the first meal of the day.
losing urine while exercising, coughing, sneezing etc....puts pressure on the bladder.
Bladder spasms caused by the detursor muscle resulting in strong sudden urge to urinate.
Neurological problem....where bladder contracts uncontrollably and person doesnt get the signal.
Mental issue that keeps a person from getting to the toilet on time.....mentally incapacitated or even arthritis.
inflammation of the urinary bladder
inflammation of renal parenchym and collecting system
thickening of the walls of the bladder from outflow being obstructed.
- involuntary delay in starting the urinary systen.
- 15+ seconds
- BPH sign
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
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
- Normal is 50-60 ml/hr
- Panic is 30 ml/hr for two consecutive hours. Call Dr....renal failure
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
Symptoms of urinary incontinence
Is it a normal part of aging?
- too much or too little urine,
- urge or no urge,
- intensity or cant get started,
- color change/cloudy
- CANT VOLUNTARILY CONTROL FLOW OF URINE
- Looks at this in urine:
WBC's in urine...normal range
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
Culture & Sensitivity normal range?
What does this tell you?
Looks at what bug you have and what it should be treated with.
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
IVP and cystourethrogram does what?
looks at size, shape and function of urinary system
Main cause of bladder dysfunction
- Detrusor muscle becomes unstable
- Pelvic Floor ligaments become weak
Causes of bladder dysfunction: Reversible
- vaginal atrophy
- bladder inflammation
- prostate enlargement
- mobility or environment problems
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
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
Medical and Nursing interventions for urinary incontinence
- Kegel exercise
- Bladder retraining
- Anticontinent devices
- Diet change
Adrenergic blockers help with what kind of incintonence
reflexive and overflow
Tricyclic antidepressants do what
decrease overactive bladder contractions...reflexive
Calcium channel blockers do what?
relax smooth muscles in the bladder....Urge incontinence
Pro banthine does what
stops painful bladder spasms and relaxes the bladder...urge incontinence
Problems with using valsalva maneuver with urinary incontinence
helps with incontinence by pushing down on the bladder.
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
- -Check patient regularly
Complications of altered bladder elimination:
Dont go enough get a UTI
Go too much....skin problems
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
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
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
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
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
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.
Nursing diagnosis for urinary tract infection:
- Impaired urinary elimination
- Deficient knowledge R/T methods of prevention and treatment protocols
- pain, burning, pruritis
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
Why are women at risk for UTI's?
- Shorter urethra 1 1/2 inches
- Proximity of vagina to rectum
- Recurrent infections
- Viral infections
- Post menopause
Why are post menopausal women susceptible to UTI's?
Reduced estrogen decreases vaginal lactobacilli which ward off infection.
Interventions for cystitis:
good hand hygiene, wipe front to back, void frequently, drink 2-3 litres water/day, avoid certain foods
Interventions for polynephritis:
Bladder irritating foods:
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
What causes Melena stools?
iron or Pepto Bismol
Red streaks in the stool means
Hematochezia....passage of fresh blood thru the anus.
Light or clay colored poop
lack of bile....gallbladder or liver disease
Sigmoidoscopy vs. Colonoscopy
Sigmoidoscopy only looks at sigmoid colon, where the colonoscopy looks at the entire large intestine
Looks at the anal cavity, rectum and sigmoid colon
Gas producing foods
- spicy foods
Galactosans (constipation causing foods)
- by products of milk....cheese!
- lean meat
Which nervous system speeds up digestion
- It controls every day digestion and peristalsis
Which nervous system slows down motility and can be constipating
How does secretion of toxins cause diarrhea?
the toxins produce swelling and inflammation....then diarrhea
Example toxins: E Coli and Shigella
What bacteria attach to the intestinal wall and cause ulceration, cell destruction and bleeding
- E coli
- C DIFFICILE
What virus attaches itself to the intestinal villi and destroys them leading to malabsorption
Cuz villi increase absorptive area of the intestine
Why may a person be incontinent?
- Communication problems
- Cant make it to the bathroom
- Neurological issues
Why are diabetics more at risk for UTI's?
cuz they have sugar in their urine...and bacteria loves sugar. Infection
Nursing Process....Asses pt for UTI
- Subjective info:
- Past history of UTI's
- Current Meds
- Bladder cancer
Nursing Process...assess pt for UTI
- Objective Information
- Urine color and odor
- Urinalysis C&S
Nursing Process....Dianose UTI
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
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
Nursing Process....Evaluation of treatment for UTI
- Look at labs again:
- Decrease in WBC and less or no bacteria in urine
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