a substance that causes evacuation of the bowel by softening stool and promoting peristalsis
a catheter which drains from a condom type devise that is worn over the penis, it is used on incontinent or comatose men who still have complete and spontaneous bladder emptying
a symptom of improper diet, reduced fluid intake, lack of exercise, and the effect of certain medications
can be identified by infrequent bowel movements, difficulty passing stool, excessive straining, inability to defecate at will and hard feces
an inflammation of the urinary bladder or ureters characterized by pain, urgency and frequent urination
the elimination of feces from the digestive tract through the rectum
an increase in the number of stools and the passage of liquid, unformed feces
BRAT diet: bananas, rice, apples, toast
an increase in urine formation
pain or burning during urination
incontinence of urine
waste products that reach the sigmoid portion of the colon
gas which has accumulated in the lumen of the bowel/GI tract causing distension
the number of repetitions in a fixed period
presence of sugar, specifically glucose in the urine
blood in the urine
dilated, engorged veins in the lining of the rectum
a collection of hardened feces wedged un the rectum, which cannot be expelled, results from unrelieved constipation
the inability to control urination or defecation
presence of excessive ketone bodies in urine
occurs as a result of uncontrolled diabetes, starvation or other metabolic condition in which fats are rapidly catabolized
a substance which causes an evacuation of the bowel by mild action
black tarry stool containing digested blood
the act of passing urine
excessive urination at night
blood that is not grossly apparent and appears from a nonspecific source with obscure S&S
diminished capacity to form urine
the rhythmic contraction of smooth muscle that forces food through the digestive tract
the presence of large proteins in urine
indication of glomerular injury
the presence of WBC's in urine
indication of UTI
when urine is retained in the bladder after voiding
occurs in OA bc the bladder does not contract effectively
the ability of the digestive system to hold food or fluid
inability to urinate or defecate
Retention with overflow
the pressure of retained urine after voiding
results in dribbling
a circular band of muscle fibers that closes a natural opening in the body
the external anal sphincter closes the anus
greater than nl amount of fat in feces
frothy foul smelling feces that floats
a urinary bladder catheter inserted through the skin above the pubic symphysis
feeing or need to void urine immediatly
the spread of bacteria into the bloodstream and kidneys
evacuating urine from bladder
Describe an individuals need for elimination.
regular elimination of urinary and bowel waste is essential for normal body fx, alterations can be a early signs or symptoms of problems with the GI or GU system
Determine how the following factors can influence urinary elimination.
Long term use of indwelling catheter
Increases fluid intake
Anxiety causes a sense of urgency and increased frequency of urination bc it often prevents a person from urinating completely and as a result the urge to void returns shortly
Longterm use of an indwelling catheter will cause muscle atrophy
Increased fluid intake increases urinary output
Diabetes Mellitus causes polyuria
Narcotic Analgesics decreases urine output
Review the anatomy and physiology of the renal system and the GI system.
Kidneys- reddish brown kidney shaped organs measuring approx 5"x3" that weighs about 12-150g; Waste products of metabolism that collect in the blood are filtered in the kidneys; the blood is filtered in the glomerular capillaries which are porous and permit filtration of water and substances such as glucose, amino acids, urea, creatinine and major electrolytes; only 1% of glomerular filtration is excreted as urine and the rest is reabsorbed into the plasma; nl urine output is 1500-1700ml/24h and the kidney produces renin and erythropoietin.
Ureters- urine enters the renal pelvis from collecting ducts where ureters join them to the bladder; they are lumens approx 10-12" long and approx 1/2" in diameter; urine drainage from the ureter to the bladder is normally sterile; peristaltic waves cause the urine to enter the bladder in spurts rather than steadily
Bladder- is a hollow, muscular organ that is both a reservoir for urine and the organ of secretion; when empty the bladder lies behind the pubic symphysis; in men it lies on the anterior wall of the rectum; in women in the anterior wall of the uterus and vagina; the bladder capacity is about 600ml and nl voiding is 200-300ml
Urethra- urine travels from the bladder through the urethra and passes outside the body through the urethral meatus; normally the turbulent flow of urine through the urethra washes it free of bacteria; in women the urethra is 1.5- 2.5" in length; in men the urethra is approx 8" in length
Mouth- digestion begins in the mouth where mechanical and chemical breakdown of nutrients occur (mastication); food is broken down so it can be swallowed; salivary secretions contain enzymes that initiate digestion of certain food elements; saliva softens the bolus of food for easier swallowing
Esophagus- food passes from the mouth through the esophagus to the stomach where it is now referred to as chyme
Small Intestine- during normal digestion, chyme leaves the stomach and enters the small intestine; it is a tube approx 1" in diameter and 20' long which contains 3 divisions, duodenum, jejunum and ileum; chyme mixes with digestive enzymes while traveling through the small intestine; it travels slowly to allow the absorption of nutrients and electrolytes; the enzymes (bile and amalyse) in the small intestine break down fats, protein and carbs into simple elements; nutrients are almost entirely absorbed by the duodenum and jejunum; the ileum absorbs certain vitamins, iron and bile salts
Large Intestine- large in diameter then the small intestine and is 5'-6' in length; it is divided into 3 parts, the cecum, colon and rectum; it is responsible for the absorption of water and primary organ for bowel elimination; unabsorbed chyme enters the cecum at the ileocecal valve where it travels through to the colon; as watery chyme enters the colon the water volume decreases as it moves along;the colon is divided into 4 parts, ascending, transverse, descending and sigmoid colon; 4 fx of the colon are absorption, protection, secretion and elimination; a large volume of water and significant amounts of Na and Cl are absorbed by the colon daily; the amt of water absorbed from chyme depends on the speed at which colonic contents move; alterations in colon fx can cause diarrhea, electrolyte imbalance or constipation; the colon eliminates waste products and gas
Rectum- waste products that reach the sigmoid colon are called feces; this is the final division of the GI tract; its normally empty of feces until defecation; when a fecal mass moves into the rectum, the walls distend and defecation begins
Identify and describe the characteristics of nl urine/feces.
Color- normal urine ranges from pale to amber, depending on its concentration; bleeding can cause it to look dark red if from the kidneys or ureters or bright red if from the bladder or urethra
Clarity- normal urine appears transparent at voiding; urine that stands in a container for several minutes appears cloudy; urine appears thick and cloudy as a result of bacteria
Odor- urine has a characteristic odor, the more concentrated the urine the stronger the odor; stagnant urine has an ammonia odor which is common for incontinent pt's; a sweet or fruity odor can indicate acetone as seen in diabetes mellitus or starvation
Color- adults its brown; infants its yellow; abnormal is white, clay, black, tarry or red
Odor- pungent, affected by food type
Consistency- soft or formed
Frequency- daily or 2-3x a week
Amount- approx 150g/d
Shape- resembles the diameter of the rectum
*from the pt's description, the nurse determines whether the stool is watery or formed, soft or hard as well as the typical color
Outline the methods to assess elimination.
Measuring Urine Output
URINALYSIS: a specimen of urine for lab testing; all are labeled with the pt's name, date and time of collection; the specimen should be examined within 2 hrs and it should be the first voided specimen in the morning to ensure uniform concentration of constituents
STERILE SPECIMEN: a method of collecting urine for a culture by obtaining the specimen from an indwelling catheter or a sterile collection bag; clean the port with an antimicrobial swab and withdraw 3-5ml of urine via the syringe
SPECIFIC GRAVITY: the weight or degree of concentration of a substance compared with an equal volume of distilled water; the concentration of dissolved substances in urine aids in the determination of a clients fluid balance; a specific gravity < 1.010 reflects an inability of the kidneys to concentrate urine or an insufficient secretion of ADH
MEASURING URINE OUTPUT: I&O measures the pt's average daily intake of fluids; urine output can be measured in a marked drainage bag, a urimeter or a graduated measuring receptacle; an hourly output of <30ml for more than 2 hrs is cause for concern; high volumes >2000ml/d should be reported to an MD
MIDSTREAM SPECIMEN: used to obtain a specimen relatively free of microorganisms growing in the lower urethra; used for C&S tests; the pt cleanses the external genitalia, begins to urinate allowing the initial urine to escape, then during the middle of the void they collect the specimen; the initial void cleanses the residual bacteria
STOOL SPECIMEN: the nurse is responsible to ensure proper technique is used and the sample is put in the appropriate properly labeled container which is transported to the lab in a timely manner; medical asepsis should be used during during the collection of a stool sample; the nurse collects about 1" of formed stool or 15-30ml of diarrheal stool
GUANIAC TEST: fecal occult blood test which measures for microscopic amounts of blood in the stool; helps to reveal visually undetectable blood
Describe the mechanisms associated with urinary retention and overflow.
URINARY RETENTION: is the marked accumulation of urine in the bladder as a result os the inability of the bladder to empty fully; urine continues to collect in the bladder, stretching its walls and causing feelings of pressure, discomfort, tenderness over the pubic symphysis restlessness and diaphoresis; in nl urination the bladder fills and receptors activate when a certain level of stretch has been reached; the micturition reflex occurs and the bladder empties; in urinary retention, the bladder becomes unable to respond to the micturition reflex and thus is unable to empty
URINARY OVERFLOW: as bladder retention progresses, overflow may develop; pressure in the bladder builds to a point where the external urethral sphincter is unable to hold back urine; the sphincter temporarily opens to allow a small volume of urine (25-60ml) to escape; as urine exits the bladder pressure falls enough to allow the sphincter to regain control and close
List and describe the types of urinary incontinence.
FUNCTIONAL: involuntary, unpredictable passage of urine in a pt with intact urinary and nervous system; can be caused by changes in the environment such as sensory, cognitive or mobility deficits
OVERFLOW: see description above; can be caused by reaction to drugs, diabetes, fecal impaction or prostate enlargement
REFLEX: involuntary loss of urine occurring at somewhat predictable intervals (large or small volume); can be caused by spinal cord dysfunction; the person is unaware of the full bladder and the need to void
STRESS: leakage of small volumes of urine caused by a sudden increase in intraabdominal pressure; can be caused by coughing, laughing, sneezing or lifting with a full bladder
URGE: involuntary passage of urine after a strong sense of urgency to void; can be caused by decreased bladder capacity, irritation to stretch receptors, infection or Etoh/caffeine ingestion
List four measures appropriate for promoting a pt's nl urinary elimination.
Stimulation of the micturation reflex
maintain elimination habits
Maintain adequate fluid intake
Identify techniques that may be used to stimulate the micturation reflex.
women void better sitting
men void better standing
leave the water running
stroke the inner thigh
place the hand in warm water
warm the bedpan
put warm water in the perineal area
Describe kegal exercises.
repetitive contractions of muscle groups to improve the strength of the pelvic floor muscles
pt begins exercises while urinating and continues to practice during non-voiding times
teach pt to tighten the urinary sphincter during urination to feel the sensations associated with urinary sphincter contraction (this stops the flow of urine), then hold the sphincter closed for 3-4 seconds 25-30 times 3-4 times a day for 6 mos
Outline measures to prevent UTI's.
good personal hygiene, cleansing the urethral meatus after each void and BM
intake 2000-2500 ml of fluids to dilute the urine and promote regular micturation which flushes the urethra of microorganism
acidifying urine inhibits the growth of microorganisms; meats, eggs, whole grain breads, cranberry juice and prunes increase urine acidity
Identify and describe factors that affect bowel elimination.
AGE: food passes quickly in infants and children; peristaltic action declines with age and esophageal emptying slows; older adults lose muscle tone in the perineal floor and anal sphincter
INFECTION: duodenal ulcers can cause Helicobacter pylori
DIET: the food we eat influences elimination; fiber provides bulk in fecal material, bulk forming foods absorb fluid thereby increasing stool mass; lactose intolerance causes diarrhea, gaseous distention and cramping
FLUID INTAKE: an inadequate intake of fluid or disturbances resulting in loss of fluid affects the character of feces; reduced fluid intake slows the passage of food through the intestine and can result in the hardening of stool content
PSYCHOLOGICAL FACTORS: if an individual becomes anxious, angry or afraid the stress response is initiated; the digestive process is accelerated and peristalsis is increased to provide nutrients needed for defense; side effects of increased peristalsis include diarrhea and gas
POSITION DURING DEFECATION: squatting is the normal position, for the pt immobilized in bed defecation is often difficult; in the supine position it is impossible to contract the muscles used during defecation
PAIN: normally defecation is painless, if a pt is in pain they are likely to suppress the urge to defecate to avoid pain
PREGNANCY: the fetus exerts pressure on the rectum
SURGERY & ANESTHESIA: causes temporary cessation of peristalsis
Describe the Valsalva maneuver and how it can be avoided.
voluntary contraction of abdominal muscles during forced expiration with a closed glottis
it can cause changes in HR and rhythm and is contraindicated for pt's with heart problems or perineal sx
it can be avoided by telling pt's to exhale during straining
List four causes of constipation.
irregular bowel habits
ignoring the urge to defecate
low fiber diet high in animal fat
low fluid intake slows peristalsis
lengthy bed rest or lack of physical exercise
heavy laxative use causes loss of normal defecation reflex
bowel obstruction, paralytic ileus or diverticulitis
neurologic conditions that block nerve impulses to the colon
Describe pt's at risk for developing constipation.
pt's with recent rectal, abdominal or gynecological sx
pt's w a hx of cardiovascular disease
those who have diseases causing elevated intra-ocular pressure (glaucoma) or increased intracranial pressure
Identify deviations associates associated with fecal impaction.
an inability to pass stool for several days despite to urge to defecate
when a continuous oozing of diarrheal stool develops bc liquid is seeping around the impacted mass
loss of appetite
abdominal distention, cramping and rectal pain
Identify 4 types of food high in fiber.
Explain how high fiber diets promote bowel elimination.
fiber promotes bulk in fecal material
bulk-forming food absorb fluids thereby increasing stool mass
the bowel walls are stretched, increasing peristalsis and initiating the defecation reflex
by stimulating peristalsis bulk foods pass quickly through the intestines, keeping the stool soft
ingestion of a high fiber diet improves the likelihood of a normal elimination pattern if other factors are nl
Indicate 2 problems associated with diarrhea.
excess loss of colonic fluid can result in serious fluid and electrolyte or acid base imbalances
the skin of the perineum and buttocks are exposed to irritating intestinal contents
Determine the possible cause of each fecal characteristic:
white or clay colored
black or tarry
narrow or pencil shapes
WHITE OR GRAY COLOR: indicates absence of bile
BLACK OR TARRY (MELENA): iron ingestion or upper GI bleeding
RED: lower GI bleeding or hemorrhoids
LIQUID CONSISTENCY: moving quickly through the GI tract, diarrhea, reduced absorption
NARROW/PENCIL SHAPE: obstruction, stenosis of the rectum
List factors to be included in a nursing hx for a pt with altered elimination.
Determination of the usual elimination pattern: frequency and time of day
Routines associated with normal elimination: laxative use, reading a book
Description of any recent changes in elimination: pt can best detect changes, very significant data
Diet hx: determines the pt's preference
Description of daily fluid intake: type and amount of fluid
Hx of exercise: type and amount
The use of artificial aides at home: enemas, laxatives or special foods that make them go
Hx of surgery or illness to the GI tract: helps explain symptoms
Presence and status of bowel diversion (ostomy): frequency of drainage and character of feces, appearance and condition of stoma, type of appliance used and method used to maintain ostomy's fx
Medical hx: medications which may alter defecation or fecal characteristics
Emotional state: stress?
Social Hx: do they have their own bathroom? what are their living arrangements
Mobility and dexterity: do they need assistance?
Outline 5 goals appropriate for a pt with bowel elimination problems.
understanding normal elimination
attaining regular defecation habits
understanding and maintaining proper fluid and food intake
achieving a regular exercise program
maintaining skin integrity
maintaining self concept
Determine 3 ways to promote regular bowel habits.
stimulate defecation reflex by assisting with squatting or proper position on bedpan
affect the character of feces with laxatives, enemas or alterations in diet
increase peristalsis with a high fiber diet
Identify 4 interventions that may assist in restoring self-concept in a pt with bowel elimination problems.
give the pt the opportunity to discuss concerns or fears about their problem
provide the pt and family with information to u/s and manage the elimination problem
give positive feedback when the pt attempt self care measures
help the pt to manage the condition but don't expect them to like it
acts by forming a gelatinous mass with water that adds bulk to the stool and stimulates peristalsis
indicated for pt's as a prophylactic measure to prevent constipation or for short term treatment of constipation
nursing implications include noting the reasons for the therapy, advise pt to add powder to 8oz of liquid and to wash it down with another glass of water or juice, advise pt to take exactly as directed and to ensure adequate fluid intake along with outer forms of fiber.