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92 Cards in this Set

  • Front
  • Back
Organs and Structures of the Urinary System
-Kidneys
-Ureters
-Bladder
-Urethra
-All working together lead to the act of urination
Factors Influencing Urination
A. Disease Conditions
B. Sociocultural
C. Psychological Factors
D. Muscle Tone
E. Fluid Balance
F. Surgical Procedures
G. Medications
H. Diagnostic Examinations
Disease Conditions
Can affect urine production through:
-altered renal function
-altered act of elimination
-or both
"Disease Conditions" categories
a. Prerenal
b. Renal
c. Postrenal

*Know! Batchen hinted this would be test question
Prerenal
-Decrease circulating blood flow to & through kidneys resulting in decreased blood flow to renal tissue: oliguria, anuria
-Causes may include: dehydration, hemorrhage, congestive heart failure
Renal
-Result from factors that cause injury directly to glomeruli or renal tubule, interfering with normal filtering, reabsorptive, and secretory functions
-Causes may include: transfusion reactions, diseases of the glomeruli, systemic diseases such as diabetes mellitus
Postrenal
Result from obstruction to the flow of urine in the urinary collecting system caused by calculi, blood clots, or tumors anywhere from the calyces to the urethral meatus
-Urine can be formed but cannot be eliminated by normal means
-Causes may include: Lesions of peripheral nerves leading to bladder causing loss of bladder tone, reduced sensation of bladder fullness, and difficulty in controlling urination, i.e. diabetes, multiple sclerosis, benign prostatic hypertrophy, cognitive impairment
Sociocultural
1. Toileting privacy and practices
2. Social expectations influencing timing of elimination
3. Positioning during urination
4. Gender assistance for urination needs
Psychological Factors
1. Anxiety and emotional stress may increase urgency and frequency
2. Privacy
3. Inadequate time
4. Need for distractions to relax
Muscle Tone
1. Weak abdominal & pelvic floor muscles impair bladder contraction & control
2. Control of micturition related to muscle wasting in mobility, stretching during childbirth, menopausal muscle atrophy, or traumatic injury
Fluid Balance
1. Kidneys maintain delicate balance between retention & excretion of fluids
2. Ingestion of certain fluids directly affects urine production and excretion
3. Febrile conditions affect urine production
Surgical Procedures
1. Stress of surgery can trigger general adaptation syndrome (GAS) & altering state of fluid balance
2. Anesthetics and narcotics may alter glomerular filtration rate, reducing urine output
3. Surgery of lower abdominal & pelvic structures can cause impairment through trauma (surgery & manipulation)
4. Diversions created based on diseases
Medications
1. Diaphoresis (excessive sweating)
2. Urinary retention
3. Change in urine color
Diaphoresis
- decreased reabsorption of water & electrolytes
- Diuretics
Urinary retention
a. Antihistamines
b. antihypertensives
c. anticholinergics
Change in urine color
a. Pyridium (orange)
b. amitriptyline (green or blue)
c. levodopa (black or brown)
Diagnostic Examinations
1. Intravenous pyelogram – limit fluid intake
2. Laxatives to clean bowel for diagnostic test limits fluid available for urine production
3. Diagnostic tests of urinary system using direct visualization can cause localized edema leading to spasms and temporary obstruction
Alterations
A. Urinary retention
B. Urinary tract infections
C. Urinary incontinence
D. Urinary diversions
Urinary retention
Marked accumulation of urine
Urinary tract infections
– bacterial, can lead to urosepsis
- Infection Control and Hygiene
i. Urinary system is considered sterile
ii. Correct aseptic and/or sterile technique for care & procedures
iii. Client education about correct perineal cleansing & wiping (women, front to back)
iv. Catheterization and other procedures requires maintenance of sterile fields and use of aseptic technique
Urinary incontinence
– involuntary loss of urine that is sufficient to be a problem
i. Functional, overflow, reflex, stress, urge
ii. Not just a problem for elderly
iii. May impair body image
iv. Can lead to social isolation
v. Embarrassment of problem contributes to undertreatment and underreporting
vi. Can lead to skin breakdown
Urinary diversions
- divert flow of urine from kidneys directly to abdominal surface
Growth and Development
A. Infants
B. Toddlers and young children
C. Adults
D. Older adults
Urinary Elimination & the Nursing Process
1. Assessment of Urinary Elimination –
A. Nursing History
B. Physical Assessment
C. Visualization of Urine
D. Common Lab and Diagnostic Tests
2. Nursing Diagnoses
3. Planning
4. Implementation:
a. Health Promotion
b. Acute Care
c. Restorative Care
5. Evaluation
Assessment of Urinary Elimination – Nursing History
Nursing history
i. Pattern of urination
ii. Symptoms of alterations
iii. Factors affecting urination
Assessment of Urinary Elimination – Physical Assessment
Physical assessment
i. Skin and mucous membranes
ii. Kidneys
iii. Bladder
iv. Urethral meatus
Assessment of Urinary Elimination – Visualization of Urine
Assessment of urine
i. Intake and output
ii. Characteristics: color, clarity, odor
iii. Urine testing: specimen collection
Assessment of Urinary Elimination – Common Lab and Diagnostic Tests
1. Common urine tests
2. Diagnostic examinations
Common urine tests
i. Urinalysis
ii. Specific gravity
iii. Culture
Diagnostic examinations
i. Consents
ii. Allergies
iii. Pre- and post-procedure interventions
Nursing Diagnoses

*Know! Bachen hinted this would be test question as in "Which nursing diagnosis is...?
1. Disturbed body image
2. Pain
3. Impaired skin integrity
4. Incontinence
5. Risk for infection
6. Toileting self-care deficit
7. Impaired urinary elimination
8. Urinary retention
Planning
1. Goals and outcomes
2. Client will void within 8 hours after catheter removal
3. Client’s bladder is not distended on palpation
4. Setting priorities
5. Continuity of care
Implementation: Health Promotion
1. Client education
2. Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake
3. Promoting complete bladder emptying
4. Preventing infection: hygiene and acidifying urine
Implementation: Acute Care
1. Maintaining elimination habits
2. Medications
3. Urethral catheterization
4. Alternatives to urethral catheterization
Urethral catheterization
i. Requires a physician’s order
ii. Introduction of a rubber or plastic tube through the urethra and into
the bladder
iii. Types – Indwelling, in-and-out catheter
iv. Insertion – strict sterile technique
v. Drainage systems
vi. Routine care: hygiene, fluids
vii. Prevention of infection
viii. Irrigations and instillations
ix. Removal
Alternatives to urethral catheterization
suprapubic catheters, condom catheters
Implementation: Restorative Care
1. Strengthening pelvic floor muscles
2. Bladder retraining
3. Habit training
4. Self-catheterization
5. Maintenance of skin integrity
6. Promotion of comfort
Evaluation
1. Client care
2. Client expectations
Client care
i. Effectiveness of nursing interventions
ii. Change in client’s voiding pattern
iii. Presence of urinary tract alteration
iv. Physical condition
Client expectations
i. Confirmation that expectations have been met
ii. Assistance with setting realistic goals
Organs and Structures of the Gastrointestinal Tract
A. Mouth
B. Esophagus
C. Stomach
D. Small Intestine
E. Large Intestine
F. Anus
G. End result of functions is defecation
Small Intestine
1. From pylorus to ileocecal valve
2. Digestion completed and most nutrients absorbed
3. Absorption achieved through the large surface area
created by the villi and microvilli (fingerlike projections)
Large Intestine
1. From cecum through to the anus
2. Includes the ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, and anus
3. Absorbs H2O and electrolytes, forms feces, and stores it until defecation.
Factors Affecting Bowel Elimination
A. Age
B. Diet
C. Fluid intake
D. Physical activity
E. Psychological factors
F. Personal habits
G. Position during defecation
H. Pain
I. Pregnancy
J. Surgery and anesthesia
K. Medications
L. Diagnostic tests
Common Problems
A. Constipation
B. Impaction
C. Diarrhea
D. Incontinence
E. Flatulence
F. Hemorrhoids
Constipation
symptom not a disease
Impaction
results from unrelieved constipation
Diarrhea
increased number of stools and liquid, unformed feces
Incontinence
inability to control passage of feces and gas from the anus
Flatulence
Accumulation of air, stretching bowel wall causing distention
Hemorrhoids
Dilated, engorged veins in the lining to the rectum
Alterations
A. Bowel diversions: ostomies
B. Psychological considerations
Bowel diversions: ostomies
1. Loop colostomy
2. End colostomy
3. Double-barrel colostomy
Psychological considerations
1. Body image
2. Decreased social interactions
Nursing Process and GI Elimination
A. Assessment of GI Elimination – Nursing History
B. Assessment of GI Elimination – Physical Assessment
C. Assessment of GI Elimination – Visualization of Stool
D. Assessment of GI Elimination – Common Lab and Diagnostic Tests
E. Nursing Diagnoses
F. Planning
G. Implementation: Health Promotion
H. Implementation: Acute Care
I. Implementation: Restorative Care
J. Evaluation
Assessment of GI Elimination – Nursing History
1. Elimination pattern
2. Characteristics of stool
3. Routines
4. Use of medications or enemas
5. Presence of bowel diversion
6. Changes in appetite
7. Diet and fluid intake
8. Prior medical history and use of medications
9. Emotional state
10. Exercise patterns
11. Presence of discomfort
12. Social history
13. Mobility and dexterity
Assessment of GI Elimination –Physical Assessment
Physical examination
i. Mouth
ii. Abdomen
iii. Rectum
iv. Fecal specimens
v. Skin
Assessment of GI Elimination –Visualization of Stool
1. Color
2. Consistency
3. Form
4. Frequency
Assessment of GI Elimination – Common Lab and Diagnostic Tests
1. Common stool tests
2. Diagnostic exams
Common stool tests
i. Hemocult
ii. Guiac stain
iii. Cultures
Diagnostic exams
Colonoscopy
Nursing Diagnoses
1. Bowel incontinence
2. Constipation/Actual, Perceived, and Risk of
3. Diarrhea
4. Body image, altered
5. Alteration in skin integrity
Planning
1. Goals and outcomes
i. Client sets regular defecation habits
ii. Client implements a regular exercise program
2. Setting priorities
3. Continuity of care
Implementation: Health Promotion
1. Positioning
2. Privacy
Implementation: Acute Care
1. Medications
2. Enemas
3. Ostomy Care
Medications
i. Cathartics and laxatives
ii. Antidiarrheal agents
Enemas
i. Types: tap water, saline, hypertonic, soapsuds, oil retention, other
ii. Administration: client preparation, equipment
iii. Digital removal of stool
iv. Insertion and maintenance of a nasogastric tube for gastric
decompression

NEVER used to irrigate a colostomy
Ostomy Care
i. Effluent – stool discharged from an ostomy
ii. Irrigation – NEVER use an enema
iii. Pouching – collection bag
iv. Skin barriers and care – wafers, pastes, powders, liquid film
v. Nutritional considerations – initially low-fiber diets, later normal foods and high-fiber diets to promote stool formation
Implementation: Restorative Care
1. Bowel training
2. Maintenance of proper fluid and food intake
3. Promotion of regular exercise
4. Hemorrhoid care
5. Maintenance of skin integrity
Evaluation
1. Client care
2. Client expectations
Client care
i. Effectiveness depends on success in meeting goals and expected
outcomes
ii. Minimal reliance on artificial means of defecation (enemas,
laxatives)
Client expectations
Freedom from pain as elimination needs are met
The normal adult urine output is?
1500 to 1600 ml/day
Renal alterations result from factors that cause injury directly to the glomeruli or renal tubule, interfering with their normal filtering, reabsorptive, and secretory functions. Selected causes include?
Transfusion reactions, diseases of the glomeruli and systemic diseases such as diabetes mellitus
Postrenal alterations result from obstruction to the flow of urine in the urinary collecting system cause by?
Blood Clots
The most common hospital-acquired (nosocomial) infections are?
Urinary Tract
Hospital acquired UTI's are often related to poor hand washing and?
Improper catheter care
The urine appears concentrated and cloudy because of the presence of white blood cells or?
Bacteria
Some medications change the color of urine. Pyridium colors the urine?
Bright orange to rust
To minimize nocturia, clients should avoid fluids:
2 hrs before bedtime
Maintaining a Foley catheter drainage bag in the dependent position prevents?
urinary reflux- the drainage bag should never be raised above the level of the client's bladder. Urine in the bag and tubing can become a medium for bacteria, and infection is likely to develop if urine flows back into the bladder
When applying a condom catheter, it is important to secure the catheter in the penile shaft in such a manner that the catheter is?
Snug and secure, but does not cause constriction to blood flow-care must be taken to ensure that whatever type or size of condom catheter is used, blood supply to the penis is not impaired
Most nutrients and electrolytes are absorbed in the
Small intestine- specifically by the duodenum and jejunum
During the nursing assessment the client reveals that he has diarrhea and cramping every time he has ice cream. he attributes this to the cold nature of the food. However the nurse begins to suspect that these symptoms might be associated with?
Lactose intolerance
The nurse is assessing a 55-year old client who is in the clinic for a routine physical. The nurse instructs the client to obtain fecal occult blood testing (FOBT) when?
as part of a routine exam. for colon cancer-can be done at home or bedside. Also called guaiac test. Measures microscopic amts of blood in feces.
These agents decrease intestinal muscle tone to slow passage of feces?
Antidiarrheal Opiate agents.Opiates inhibit peristaltic waves that move feces forward, but they also increase segmental contractions that mix intestinal contents
Diarrhea that occurs with a fecal impaction is the result of?
Seepage of stool around the impaction- when there is continous seepage of diarrhea then impaction should be suspected
A cleansing enema is ordered for a 55 yr old client before intestinal surgery. The max. amt given is
750-1000 ml
During the enema the client begins to complain of pain. The nurse notes blood in the return fluid and rectal bleeding. The nurses's actions are to?
Stop the instillation and obtain vital signs, notify MD
One of the greatest problems in caring for a client with an NG tube is?
Maintaining comfort-
The stool discharged from an ostomy is called?
Effluent
A nurse trained to care for ostomy clients is a (an)?
Enterostomal therapist