Essentials Of Nursing Care: Health Differences (Nc2): Elimination

Front 1

P=regulate blood pressure
V=regulate blood volue
C=controle composition of blood
PVC

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3 basic homeostatic mechanisms of the urinary system

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1. routine/random
2. clean catch midstream
3. sterile

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3 types of urine sample

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The amount of urine a body should produce every 24 hours

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1500 ml (800 - 1200 ml)

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Hormone secreted by the anterior pituitary gland to tell the kidneys to reabsorb more H2O:

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ADH (anti-diuretic hormone)

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Needs to be administer slowly; retain solution for 5-10 minutes for cleansing, 30 minutes for a retention:

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enema

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Age child should have full urinary control of their bladder

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3-4 years

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An adult receiving a cleansing enema should receive how much fluid

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1000 ml

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absence of urine; <100mL/day

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Anuria

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Stop the flow for a few minutes when the client complains of cramping

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Appropriate in the administration of an enema

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Basic unit of the renal system is the

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nephron

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Blood in the urine is called

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hematuria

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Blood tests for renal funcitons are used to evaluate:

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how well the kidneys are working

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Diet high in fiber, fluid intake 2500-3000ml day, increases exercise, provide privacy- management of

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Bowel training program

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Capacity of bladder:

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600ml

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Given to expel flatus:

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Carminative enema

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Drugs that induce defecation

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Cathartics

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Certain types of fluids such as alcohol increase fluid output by inhibiting the production of

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anti-diurietic hormone

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Caffeine products such as coffee, tea & cola drinks also increase _________ production.

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urine

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CCMS checks for

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bacteria

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Cleaning around the urethral orifice regularly helps prevent

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infection

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Given primarily to prevent escape of feces during surgery, prepares intesting for diagnostic testing, or to remove fecal impactions:

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cleansing enema

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Will weaken the bowels natural responses, resulting in chronic constipation:

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continual use of laxatives

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Lower UTI; inflammation of bladder; more common in women or ppl with diabetes

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Cystitis

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Inflammation of the urinary bladder

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cystitis

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Endoscopic test; used for biopsy, removal of calculi, measures bladder capacity, stent placement top complications are 1) infection 2) perforation 3) hematuria

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cystoscopy

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Condition that results in insufficient ADH and a lot of urination

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Diabetes insipidus

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Blood BUN (blood, urea, nitrogen), creatinine level, electrolytes (salt & potassium) and radiologic:

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diagnositc tests for urinary systems

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Encourage fluids, bland foods, increase foods with soluble fiber, oatmeal, skinless fruits, and potatoes when you are having this elimination problem:

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diarrhea

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Difficult painful voiding is called

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Dysuria

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Discomfort in the pubic area and either an inability to void or frequent voiding of small volumes are clinical signs of

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retention

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Diseases of the kidney may affect the ability of the nephrons to produce

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urine

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Abnormal amounts of protein or blood cells may be present in the urine or kidneys may stop producing urine altogether, a condition known as

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renal failure

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Condition of producing a lot of fluid

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diuresis

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Increases urine formation by preventing the absorption of water and electrolytes from the tubules of the kidney into the bloodstream. Commonly prescribed for hypertension and cardiac disease:

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Diuretics

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Painful or difficulty voiding

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Dysuria

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Solution introduced into the rectum and large intestine to distend the intestine and irritate the intestinal mucosa:

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Enema

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Involuntary urination in children beyond the age when voluntary control is normal; causes - family hx of , difficult access to toilet facilities or home stresses:

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enuresis

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Glycoprotein hormone secreted by kidneys to stimulate RBC production when hypoxia is sensed:

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Erythropoietin

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Sphincter normally under voluntary control:

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External sphincter

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Disease, age, meds, foods, social/cultural factors, surgery, social/cultural issues; these factors affect

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urination

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Fetus begins to excrete urine between __________ weeks of development.

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11th and 12th

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Fluids and foods high in sodium can cause fluid retention as water is _______ to maintain the normal concentration of electrolytes.

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retained

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Common disturbance of urine elimination; voiding at frequent intervals; more often than normal.

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frequency

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These will cause the colonic movement to cease or slow down by blocking parasympathetic stimulation to the muscles of the colon:

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general anesththetics

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Inflammation of kidney; more frequent in children who have had a recent case of strep throat; MOST COMMON KIDNEY DISEASE

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glomerulonephritis

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This is important to maintain the stretch and contractibility of the detrusor muscle so the bladder can fill adeqately and empty completely:

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good muscle tone

Front 47

Assists in the bladder emptying

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abdominal muscle contraction

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Greatest hazard when insufficient water is taken with bulk-producing laxatives containing fibers, seeds, granules is that the drug may obstruct the

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esophagus

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During this, the container is held high above the rectum no higher than 18"

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high enema

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How long are the large intestine in an adult?

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125-150cm (50-60 in)

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How much fluid does a normal adult require in 24 hours?

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2600 ml

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H2O accumulates in kidney; urine flow is obstructed and backs up into the kidney; can happen during pregnancy:

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hydronephritis

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Solutions used in disposable enemas are

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Hypertonic

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Fleets enema are what type of solution?

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hypertonic

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Fleets enema adverse effect

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retention of sodium

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Tap water is what type of solution?

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hypotonic

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Tap water enema lowers osmotic pressure could have fluid and electrolyte _________ on the person.

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imbalance

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If a client is put onto a cold bedpan, the client will not defecate because the ________ sphincter muscle contracts.

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External

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Involunary, unpredictable passage of urine

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functional incontinence

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Impaired neurologic function can interfere with the normal mechanisms of urine

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neurogenic bladder

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Involuntary loss of urine occurring at somewhat predictable interval when a specific bladder

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reflex incontinence

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One experiences a loss of urine of less than 50 ml occurring with increased abdominal pressure ex: sneezing, coughing, laughing, lifting

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stress incontinence

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State of which one experiences a continuous and unpredictable loss of urine

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total incontinence

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Involuntary passage of urine occurring soon after a strong sense of urgency to void

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urge incontinence

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Increase in this means urine is more concentrated which may indicate fluid deficit/dehydration; excess solutes such as glucose in the urine

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increased specific gravity

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Measures accurate urinary output for critically ill patients

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indwelling catheter

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Irrigating a Foley with NS helps prevent

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drainage obstruction

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IV radio-opaque dye and series of x-rays of the kidneys

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intravenous pylogram

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These are caused by dehydration, infection, diet, urinary stasis:

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kidney stones/calculi

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Kidneys double in size between ages

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5 and 10

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Kidneys reach maturity between

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1st and 2nd year of life

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Kidneys, ureters, bladder x-ray

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KUB

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Solution no higher than 12" above the rectum:

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low enema

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Monitor fluid intake, positioning head of bed elevated to Fowlers position; these measures promote:

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normal voiding habits

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Anticholinergic, antispasmodics, atropine, belladonna, antidepressants, antipsychotics, antihistamines, antihypertensives; these medications cause:

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Medications that cause urinary retention

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Impared neurologic function can interfere with the normal mechanisms of urine elimination

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neurogenic bladder

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Voiding 2 or more times at night

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Nocturia

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Introduces oil into the rectum and sigmoid colon, softens feces and lubricates the rectum

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Oil retention enema

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Constipation is a big problem and need to increase water and fiber in diet; kidney function diminishes, nephrons decrease impairing filter abilities in this population:

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older adults

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Low amount of urine: 100-400ml/day

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oliguria

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Usually lasts 24-48 hours and is caused by direct handling of the intestines which temporarily ceases the intestinal movement:

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Paralytic ileus

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hereditary fluid filled sacs/cysts; treatement includes controlling BP

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Polycystic kidney

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Kidney function reaches maturity between

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1st and 2nd year

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Are able to hold urine beyone the urge to void

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18-24 months

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A = amount
C = clarity
C = color
C= concentration
O= odor
P= pH
S=STERILE
G=glucose
K= ketone
P=protein

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A= 1 1/2 - 2 l/day
C= clear
C= straw, yellow, amber
C= 1.005 - 1.030
O= slightly aromatic
P= 4.8-8 (6 is normal)
S= STERILE
G= no
K=no
P=no

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Pt.s who have nausea, cramps, colic, vomiting, or undiagnosed abdominal pain are not recommended to use

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cathartics

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Bacterial infection that can either start in the bladder and work up or can enter thru the bloodstream:

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pylonephritis

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Length of the average adult rectum:

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10-15 cm (4-6 in)

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Limit carbonated beverages, chewing gum, drinking with straws, cabbage, beans, and onions:

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reduce flatulence

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Involuntary loss of urine occurring at somewhat predictable intervals when a specific bladder volume is reached:

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Reflex

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Catheter inserted to femoral artery and ran to renal artery; successive x-rays are taken; assess blood flow to distant too insertion site after procedure and apply pressure to site; diagnostic test to measure profusion of kidneys:

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Renal arteriogram

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Used to detect renal disease, malignancy and trasnplant status; percutaneous--aided by US thru skin; incisional--surgical incision

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renal biopsy

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Secreated by kidneys when BP is too low to increase vasoconstriction and reaise BP

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renin

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Uses cystoscopy to complete an IVP; Dr. puts catheters into ureters and injects dye to assess kidney and ureter funciton

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retro-grade pylogram

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Serious consequence for the client whose urinary output falls below _____ ml/hr - damage to kidneys:

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10

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Voiding small amount frequently, bladder retention, restlessness, NOT hematuria:

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signs of urinary retention

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Specific gravity of urine is 1.035 means

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the urine is concentrated

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Spinal cord injuries and head injuries can decrease the sensory stimulation for

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defecation

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The adult urinary bladder holds __________ of urine before the micturation reflex is initiated.

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250-450 ml

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Toddlers have some control of defecation at age

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11.5 -12 months

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Urge to void when bladder has

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150-200 ml

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Urinary output ___________ a day necessary

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1200-1500

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Emptying bladder is impaired the urine accumulates and the bladder becomes distended

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urinary retention