Nursing 120- Test 3 - Waste Elimination - Olol

Front 1

Organs and Structures of the Urinary System

Back 1

-Kidneys
-Ureters
-Bladder
-Urethra
-All working together lead to the act of urination

Front 2

Factors Influencing Urination

Back 2

A. Disease Conditions
B. Sociocultural
C. Psychological Factors
D. Muscle Tone
E. Fluid Balance
F. Surgical Procedures
G. Medications
H. Diagnostic Examinations

Front 3

Disease Conditions

Back 3

Can affect urine production through:
-altered renal function
-altered act of elimination
-or both

Front 4

"Disease Conditions" categories

Back 4

a. Prerenal
b. Renal
c. Postrenal

*Know! Batchen hinted this would be test question

Front 5

Prerenal

Back 5

-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

Front 6

Renal

Back 6

-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

Front 7

Postrenal

Back 7

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

Front 8

Sociocultural

Back 8

1. Toileting privacy and practices
2. Social expectations influencing timing of elimination
3. Positioning during urination
4. Gender assistance for urination needs

Front 9

Psychological Factors

Back 9

1. Anxiety and emotional stress may increase urgency and frequency
2. Privacy
3. Inadequate time
4. Need for distractions to relax

Front 10

Muscle Tone

Back 10

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

Front 11

Fluid Balance

Back 11

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

Front 12

Surgical Procedures

Back 12

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

Front 13

Medications

Back 13

1. Diaphoresis (excessive sweating)
2. Urinary retention
3. Change in urine color

Front 14

Diaphoresis

Back 14

- decreased reabsorption of water & electrolytes
- Diuretics

Front 15

Urinary retention

Back 15

a. Antihistamines
b. antihypertensives
c. anticholinergics

Front 16

Change in urine color

Back 16

a. Pyridium (orange)
b. amitriptyline (green or blue)
c. levodopa (black or brown)

Front 17

Diagnostic Examinations

Back 17

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

Front 18

Alterations

Back 18

A. Urinary retention
B. Urinary tract infections
C. Urinary incontinence
D. Urinary diversions

Front 19

Urinary retention

Back 19

Marked accumulation of urine

Front 20

Urinary tract infections

Back 20

– 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

Front 21

Urinary incontinence

Back 21

– 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

Front 22

Urinary diversions

Back 22

- divert flow of urine from kidneys directly to abdominal surface

Front 23

Growth and Development

Back 23

A. Infants
B. Toddlers and young children
C. Adults
D. Older adults

Front 24

Urinary Elimination & the Nursing Process

Back 24

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

Front 25

Assessment of Urinary Elimination – Nursing History

Back 25

Nursing history
i. Pattern of urination
ii. Symptoms of alterations
iii. Factors affecting urination

Front 26

Assessment of Urinary Elimination – Physical Assessment

Back 26

Physical assessment
i. Skin and mucous membranes
ii. Kidneys
iii. Bladder
iv. Urethral meatus

Front 27

Assessment of Urinary Elimination – Visualization of Urine

Back 27

Assessment of urine
i. Intake and output
ii. Characteristics: color, clarity, odor
iii. Urine testing: specimen collection

Front 28

Assessment of Urinary Elimination – Common Lab and Diagnostic Tests

Back 28

1. Common urine tests
2. Diagnostic examinations

Front 29

Common urine tests

Back 29

i. Urinalysis
ii. Specific gravity
iii. Culture

Front 30

Diagnostic examinations

Back 30

i. Consents
ii. Allergies
iii. Pre- and post-procedure interventions

Front 31

Nursing Diagnoses

*Know! Bachen hinted this would be test question as in "Which nursing diagnosis is...?

Back 31

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

Front 32

Planning

Back 32

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

Front 33

Implementation: Health Promotion

Back 33

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

Front 34

Implementation: Acute Care

Back 34

1. Maintaining elimination habits
2. Medications
3. Urethral catheterization
4. Alternatives to urethral catheterization

Front 35

Urethral catheterization

Back 35

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

Front 36

Alternatives to urethral catheterization

Back 36

suprapubic catheters, condom catheters

Front 37

Implementation: Restorative Care

Back 37

1. Strengthening pelvic floor muscles
2. Bladder retraining
3. Habit training
4. Self-catheterization
5. Maintenance of skin integrity
6. Promotion of comfort

Front 38

Evaluation

Back 38

1. Client care
2. Client expectations

Front 39

Client care

Back 39

i. Effectiveness of nursing interventions
ii. Change in client’s voiding pattern
iii. Presence of urinary tract alteration
iv. Physical condition

Front 40

Client expectations

Back 40

i. Confirmation that expectations have been met
ii. Assistance with setting realistic goals

Front 41

Organs and Structures of the Gastrointestinal Tract

Back 41

A. Mouth
B. Esophagus
C. Stomach
D. Small Intestine
E. Large Intestine
F. Anus
G. End result of functions is defecation

Front 42

Small Intestine

Back 42

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)

Front 43

Large Intestine

Back 43

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.

Front 44

Factors Affecting Bowel Elimination

Back 44

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

Front 45

Common Problems

Back 45

A. Constipation
B. Impaction
C. Diarrhea
D. Incontinence
E. Flatulence
F. Hemorrhoids

Front 46

Constipation

Back 46

symptom not a disease

Front 47

Impaction

Back 47

results from unrelieved constipation

Front 48

Diarrhea

Back 48

increased number of stools and liquid, unformed feces

Front 49

Incontinence

Back 49

inability to control passage of feces and gas from the anus

Front 50

Flatulence

Back 50

Accumulation of air, stretching bowel wall causing distention

Front 51

Hemorrhoids

Back 51

Dilated, engorged veins in the lining to the rectum

Front 52

Alterations

Back 52

A. Bowel diversions: ostomies
B. Psychological considerations

Front 53

Bowel diversions: ostomies

Back 53

1. Loop colostomy
2. End colostomy
3. Double-barrel colostomy

Front 54

Psychological considerations

Back 54

1. Body image
2. Decreased social interactions

Front 55

Nursing Process and GI Elimination

Back 55

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

Front 56

Assessment of GI Elimination – Nursing History

Back 56

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

Front 57

Assessment of GI Elimination –Physical Assessment

Back 57

Physical examination
i. Mouth
ii. Abdomen
iii. Rectum
iv. Fecal specimens
v. Skin

Front 58

Assessment of GI Elimination –Visualization of Stool

Back 58

1. Color
2. Consistency
3. Form
4. Frequency

Front 59

Assessment of GI Elimination – Common Lab and Diagnostic Tests

Back 59

1. Common stool tests
2. Diagnostic exams

Front 60

Common stool tests

Back 60

i. Hemocult
ii. Guiac stain
iii. Cultures

Front 61

Diagnostic exams

Back 61

Colonoscopy

Front 62

Nursing Diagnoses

Back 62

1. Bowel incontinence
2. Constipation/Actual, Perceived, and Risk of
3. Diarrhea
4. Body image, altered
5. Alteration in skin integrity

Front 63

Planning

Back 63

1. Goals and outcomes
i. Client sets regular defecation habits
ii. Client implements a regular exercise program
2. Setting priorities
3. Continuity of care

Front 64

Implementation: Health Promotion

Back 64

1. Positioning
2. Privacy

Front 65

Implementation: Acute Care

Back 65

1. Medications
2. Enemas
3. Ostomy Care

Front 66

Medications

Back 66

i. Cathartics and laxatives
ii. Antidiarrheal agents

Front 67

Enemas

Back 67

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

Front 68

Ostomy Care

Back 68

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

Front 69

Implementation: Restorative Care

Back 69

1. Bowel training
2. Maintenance of proper fluid and food intake
3. Promotion of regular exercise
4. Hemorrhoid care
5. Maintenance of skin integrity

Front 70

Evaluation

Back 70

1. Client care
2. Client expectations

Front 71

Client care

Back 71

i. Effectiveness depends on success in meeting goals and expected
outcomes
ii. Minimal reliance on artificial means of defecation (enemas,
laxatives)

Front 72

Client expectations

Back 72

Freedom from pain as elimination needs are met

Front 73

The normal adult urine output is?

Back 73

1500 to 1600 ml/day

Front 74

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?

Back 74

Transfusion reactions, diseases of the glomeruli and systemic diseases such as diabetes mellitus

Front 75

Postrenal alterations result from obstruction to the flow of urine in the urinary collecting system cause by?

Back 75

Blood Clots

Front 76

The most common hospital-acquired (nosocomial) infections are?

Back 76

Urinary Tract

Front 77

Hospital acquired UTI's are often related to poor hand washing and?

Back 77

Improper catheter care

Front 78

The urine appears concentrated and cloudy because of the presence of white blood cells or?

Back 78

Bacteria

Front 79

Some medications change the color of urine. Pyridium colors the urine?

Back 79

Bright orange to rust

Front 80

To minimize nocturia, clients should avoid fluids:

Back 80

2 hrs before bedtime

Front 81

Maintaining a Foley catheter drainage bag in the dependent position prevents?

Back 81

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

Front 82

When applying a condom catheter, it is important to secure the catheter in the penile shaft in such a manner that the catheter is?

Back 82

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

Front 83

Most nutrients and electrolytes are absorbed in the

Back 83

Small intestine- specifically by the duodenum and jejunum

Front 84

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?

Back 84

Lactose intolerance

Front 85

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?

Back 85

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.

Front 86

These agents decrease intestinal muscle tone to slow passage of feces?

Back 86

Antidiarrheal Opiate agents.Opiates inhibit peristaltic waves that move feces forward, but they also increase segmental contractions that mix intestinal contents

Front 87

Diarrhea that occurs with a fecal impaction is the result of?

Back 87

Seepage of stool around the impaction- when there is continous seepage of diarrhea then impaction should be suspected

Front 88

A cleansing enema is ordered for a 55 yr old client before intestinal surgery. The max. amt given is

Back 88

750-1000 ml

Front 89

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?

Back 89

Stop the instillation and obtain vital signs, notify MD

Front 90

One of the greatest problems in caring for a client with an NG tube is?

Back 90

Maintaining comfort-

Front 91

The stool discharged from an ostomy is called?

Back 91

Effluent

Front 92

A nurse trained to care for ostomy clients is a (an)?

Back 92

Enterostomal therapist