Alterations in Elimination

blood in urine

Burping

upset stomach/heart burn

difficulty swallowing

anal itching

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

• 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

4.6-8

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

Alkalitic is > 8 - kidney stones, kidney failure, UTI, vomitting

• too much or too little urine,
• NO!!!!!
• urge or no urge,
• intensity or cant get started,
• burning
• color change/cloudy
• odor
• CANT VOLUNTARILY CONTROL FLOW OF URINE

• Looks at this in urine:
• WBC
• Protein
• pH
• gravity

4,500-10,000

1.010-1.025

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

over 100,000

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

looks at size, shape and function of urinary system

• Detrusor muscle becomes unstable
• Pelvic Floor ligaments become weak

• UTI's
• vaginal atrophy
• bladder inflammation
• prostate enlargement
• confusion
• obesity
• mobility or environment problems
• medications

• labor or multiple pregnancies
• bladder inflammation from stones, infection, tumor, caffeine, citrus, sugar substitutes
• obesity cuz puts added pressure on the bladder

• Urethra doesnt close or open right
• pressure in the urethra must be greater than pressure in the bladder
• neurologic problems
• confusion

• Medications
• Kegel exercise
• Bladder retraining
• Anticontinent devices
• Diet change

reflexive and overflow

decrease overactive bladder contractions...reflexive

relax smooth muscles in the bladder....Urge incontinence

stops painful bladder spasms and relaxes the bladder...urge incontinence

bradycardia

helps with incontinence by pushing down on the bladder.

• -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

Dont go enough get a UTI

Go too much....skin problems

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

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

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:  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.

• Impaired urinary elimination
• Deficient knowledge R/T methods of prevention and treatment protocols
• pain, burning, pruritis

• Relaxed pelvic structure so the bladder doesnt fully empty.
• Decreased hydration bladder doesnt get flushed.
• Chronic diseases (stroke, diabetes)
• Decreased estrogen levels

• Shorter urethra 1 1/2 inches
• Proximity of vagina to rectum
• Pregnancy
• Recurrent infections
• Viral infections
• Post menopause

Reduced estrogen decreases vaginal lactobacilli which ward off infection.

good hand hygiene, wipe front to back, void frequently, drink 2-3 litres water/day, avoid certain foods

ANTIBIOTICS

• Citrus
• colas
• soda
• tea
• spices

larger girth is seen in pt with liver failure cuz fluids are being leaked in to the peritoneal cavity

iron or Pepto Bismol

Hematochezia....passage of fresh blood thru the anus.

Infection

lack of bile....gallbladder or liver disease

Sigmoidoscopy only looks at sigmoid colon, where the colonoscopy looks at the entire large intestine

Looks at the anal cavity, rectum and sigmoid colon

• cabbage
• onions
• cauliflower
• bananas
• apples
• beans
• spicy foods

• spicy foods
• excess sugar

• bran
• prunes
• figs
• chocolate

• by products of milk....cheese!
• eggs
• bananas
• lean meat
• pasta

• Parasympathetic
• It controls every day digestion and peristalsis

Sympathetic

the toxins produce swelling and inflammation....then diarrhea

Example toxins:  E Coli and Shigella

• Shigella
• E coli
• C DIFFICILE

Rotavirus

Cuz villi increase absorptive area of the intestine

• Communication problems
• Confusion
• Cant make it to the bathroom
• Neurological issues
• Laziness

cuz they have sugar in their urine...and bacteria loves sugar.  Infection

• Subjective info:
• Past history of UTI's
• Prego
• Std's
• Current Meds
• Bladder cancer

• Objective Information
• Fever
• Chills
• dysuria
• Urine color and odor
• Urinalysis C&S

• Lab results
• C&S and WBC

• Patient will....
• 1 Have relief from bothersome lower urinary tract symptoms
• 2 Not have upper urinary tract involvement
• 3 be learn prevention of recurrence

• Admin Antibiotics
• Pt teaching
• Increase fluids
• avoid caffein, spicy foods, alcohol
• wipe front to back
• pee regularly
• rid of foley
• peri care

• Look at labs again:
• Decrease in WBC and less or no bacteria in urine