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Stack #161278
Urinary & Bowel Elimination, Sexuality
| Question | Answer |
|---|---|
| Urinary Elimination includes | Kidneys & Ureters, Bladder, Urether, Micturition |
| Factors Affecting Micturition | Developmental, Food & Fluid Intake, Psychological Variables, Activity and Muscle Tone, Medications, Pathologic Conditions |
| Pathological Conditions include: | Congenital urinary tract abnormalities; polycystic kidney disease; UTI; kidney stones (calculi); hypertension; diabetes; gout; connective tissue diseases |
| Elimination - Urinary | Elimination is a basic need that has to be med for all clients; It is one of the functional patterns of special concern to nurses |
| Nursing Process in Urinary Elimination | Assessment: voiding pattern; Physical exam of kidneys, urinary meatus, bladder; skin integrity, hydration, examine urine |
| Terminology: | anuria, dysuria, glycosuria, nocturia, oliguria, polyuria, protein uria, pyuria, urgency |
| Anuria | The absence of urine formation |
| Dysuria | Painful or difficult urination |
| Glycosuria | Excess sugar in the urine, often associated with diabetes mellitus |
| Nocturia | Excessive urinating at night; Nocturia could also be a sign of diabetes in the old or young |
| Oliguria | Less urination than normal |
| polyuria | Excessive passage of urine, as in diabetes; A person with polyuria makes large amounts of urine |
| Proteinuria | Excess protein in the urine |
| Pyuria | The presence of pus in the urine, usually a sign of urinary tract infection; may be present in the septic patient, or in an older patient |
| Urgency (Urinary) | An immediate unstoppable urge to urinate, due to a sudden involuntary contraction of the muscular wall of the bladder |
| Physical Exam | Right kidney at 12th rib, left kidney higher; difficult to palpate; bladder can rise to the umbilicus, when empty cannot be palpated; urine characteristics: Color, odor, clarity, sediment |
| Collecting Urine Specimens | Routine Urinalysis not sterile; do not put tissue in container; may use disposable collection bag for infants; clean catch - sterile, may require catheterization |
| from indwelling catheter | Use port, not bag; use a sytringe to withdraw 3-10 ml; tube may be clamped up to 30 min to accumulate urine; always wipe with antiseptic swab |
| 24-hour specimens | empty bladder then start collection time. Voids at the end of 24 hours. Measured in ml's; use gloves |
| Urine Characteristics | Color- usually pale yellow to amber; odor - ammonia smell is the result of interaction with bacteira; may be sweet or fetid; usually clear not cloudy; pH range 4.6-9. Affected by diet; |
| Specific Gravity | measures concentration of solids; range 1.010 - 1.025; Constituents: urea, creatinine, sodium, Fe. etc. |
| Abnormal Urine characteristics | Blood, pus, albumin, glucose, ketone bodies, casts, bacteria and bile |
| Medical Diagnostic Procedures | Cystoscopy, intravenous pyelography, retrograde pyelography, computed tomography (CT) scans, renal biopsy, ultrasound |
| Cytoscopy | scope in bladder |
| Intravenous Pyelography (IVP) | a radiological procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder. |
| Retrograde Pyelography | a urologic procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast (up from the bladder to the kidney) is opposite the usual flow of urine, hence the retrograde name. |
| Computer Tomography (CT) Scan | an x-ray procedure which combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. A CT scan is used to define normal and abnormal st |
| Renal Biopsy | the removal of a small piece of kidney tissue for laboratory examination |
| Ultrasound | diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions |
| Nursing Process - Analysis and Diagnosing | Incontinence: functional, reflex, stress, total urge; Urinary retention-acute, chronic; Impaired urine elimination (frequency, urgency, dysuria, nocturia) |
| Nursing Process: Outcome Identification and Planning | Produce urien output=fluid input; maintain fluid/electrolyte balance; empty bladder completely at regular intervals; report ease of voiding; maintain skin integrity; I=O; I should never be > O |
| Nursing Process - Implementation | Promote normal urination: schedule, privacy, position, hygiene; promote fluid intake - 2000-2400 ml/day; strengthening muscle tone; kegel exercises - contract pelvic floor 10secs, release & repeat up to 80x/day |
| Implementation, cont'd | Stimulatng urination - manual bladder compression, stroke inner thigh, run water; assist with toileting (toilet, bedpan, urinal, commode); preventing urinary tract infections: usually caused by e.coli entering urinary system; patient reports dysuria, freq |
| Nursing Process, Implementaiton, cont'd | drink 8-10 oz water qday; dry perineum from front to back; drink fl before sexual intercourse, void immediately after; shower rather than bathe; cotton crotch underclothing; drink cranberry juice; may be treated with hormone replacement creams |
| Nursing Process - Implementation, cont'd | Incontinence: Stress (coughing, sneezing, laughing) urge (urgency), mixed (stress & urge), overflow (signal to empty the bladder inactive or absent), functional (impairment of physical or cognitive functioning) |
| For Incontinence: | Kegel exercises, timed voiding, appropriate use of prescribed medications, catheters, drip collectors, absorbent products, fluid intake-watch for sufficiency and caffeine. |
| Catherization | Indwelling: Foley or retention: double lumen or triple lumen (irrigatiaon). Balloon, collecting device; intermittent: straight, not continuous; suprapubic - surgical incision, collecting device |
| Catherization 2 | Relieve urinary retention; obtain sterile urine specimen; measure postvoid residual (PVR); emptying the bladder before, during and after surgery; Hazard: Sepsis and Trauma |
| catherization Procedure | equipment: sterile disposable tray, 12-14F catheter wtih 5-10ml balloon; position: dorsal recombent of side-lying; in males, do not lubricate catheter, inject lubricant into penis; Sterile technique, after positioning and cleansing patient; test catheter |
| Catherization Procedure 2 | Antiseptic solution, Insertion:2-3 in females, 6-8 inches/male; inflate balloon; secure drainage bag tube to upper thigh females, upper thigh or lower abdomen males; attach drainage bag below level of bladder & never on floor; check for kinks/compression |
| Irrigating the bladder/catheter | First choice, natural irrigation through fluid intake; use a triple lumen catheter; use aspiration port for irrigation liquid |
| Purpose of Irrigating bladder/catheter | to maintain patency (free flow) |
| Catheterization - various | Always deflate balloon before removing an indwelling catheter; monitor I&O for 24hr after removal; immediately report absence of urinatiaon 8 hrs after removal; leg bags may be used for ambulatory patients w/indwelling catheters; |
| condom catheters - | Latex, levae 1-2 inches between penis and end of catheter, velcro strap |
| Urinary diversions | ileal conduit: ureters diverted to ileum, with surgically created opening on abdomen (STOMA). Requires external appliance for continuous drainage |
| Contenent Urostomy | Internal reservoir surgically created, requires regular catheterizations to drain; stoma care requires atention to skin, using skin protectants. |
| Nursing Process Evaluation | Did you meet the goals? Are there changes in the defining characteristics? |
| Bowel Elimination | Critical funciton- affects fluid/electrolyte balance, hydration, nutritional status, skin integrity, comfort, self-concept |
| Anatomy & Physiology | Large Intestine-Ileocecal valve to anus; 59 inches long; 1-3 inches in diameter; chyme (1500 mL/day, 800-1000 mL fluid absorbed in large intestine daily. |
| Anatomy & Physiology cont'd | Ascending Colon, hapatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, anus. Parasympathetic system stimulates movement, sympathetic system inhibits |
| A&P Cont'd | Peristalsis occurs q3-12 min/qday, with mass peristaltic sweeps occurring about 1hr after eating; it may take 72hrs to excrete waste from 1 meal; normal range of frequency of bowel movements is 2-3/day to 2-3/wk |
| Factors affecting bowel elimination: Devleopmental | infants pass stool with frequency dictated by type of food - bottle fed, 1-2/day, breast fed up to 10/day. by 1 year, stabilizes to 1/day |
| Bowel Eliination cont'd | Bowel training accomplished by 30 months; Elders: vulnerable to constipation, incontenence or diarrhea |
| Factors Affecting Bowel Elmination | Daily patterns-ignoring urge to defecate, privacy, position; Food/fluids: high fiber and 2-3L fluid per day optimal |
| Elimination | Food intolerances can cause gas or diarrhea; constipation can result from meat, cheese, eggs, pasta; laxative foods: prunes, bran, chocolate, spices, alcohol, coffee; gas producing: onions, beans, cabbage, cauliflower; regular exercise improves eliminatio |
| Factors affecting bowel elimination | Stress: acute-diarrhea, chronic constipation; Pathologic conditions: Diverticulitis, infection, malabsorption, cancer, diabetic neuropathy, hyperthyroidism, uremia |
| Factors affecting bowel elimination - 2 Medications: | cathartics & laxatives promote peristalsis, antidiarrheals inhibit. Antibiotics can cause diarrhea, opiods, FE, anticholinergics & antacids cause constipation; surgery-abdominal surgery can result in paralytic ileus, normal up to 48hr PO food/fluids w/he |
| Nursing Process: Assessment | History - usual pattern of elimination; any aids used; any changes in stool |
| Physical assessment | inspection, auscultation, then palpation. Listen in all 4 quadrants (may hear 5-30min) absent sounds for 5 min indicates paralytic ileus. palapte for distention. Inspect anus for abnormalities |
| Physical Assessment cont'd | Describe stool frequency, amount, color, consistency, Shape, presence of constituents (pus, blood, mucus, parasites) |
| Stool specimen collection | Use gloves, 2 tongue blades, 1 inch formed stool or 30 mL liquid stool sufficient. Immediately to lab or refrigerate. |
| Occult blood | Food restrictions meats, aspirin, anticoagulants. Use gloves, tongue blades, test card and solution. |
| Paralytic ileus | A section of the bowel that's not working |
| Diagnostic studies | endoscopies - require consents & fasting or bowel preparation; fluoroscopic & radiographic exams-may require drinking contrast material, or bowel preparation |
| Nursing Process: analysis and Diagnosing | Constipation - actual or risk for Diarrhea, Bowel incontinence |
| Nursing Process: Implementing (Promoting Regular bowel habits) | Assist patient about 1hr after meals; provide toilet, bedpan, commode in as close to sitting position as possible; provide privacy; provide 2-3l fl/day; provide highfiber foods; ambulate or exercise abdomen/thigh exercises at bedside |
| Nursing Process: Implementing (Preventing/treating constipation) | teach about fiber/fluids; teach about laxatives; |
| Nursing Process: Implementing | Preventing / Treating diarrhea |
| Nursing Process: Implementing (Administering and enema) | cleansing: water, saline, soap, hypertonic; retention: oil, carminative, medicated, nutritive; return-flow-to expel flatus |
| Adminsitering an enema | Equipment, patient positioning and privacy (left side); high volume 750-1000 ml/over 5-10 min. warmed to 110-degr.; lubricate rectal tube and insert 3-4inch; clamp tube to stop flow if crampign; encourage holding solution for 5-15min; patient hygiene; |
| Hypertonic solution | 70-130 mL. administer over 1-2 min Do not warm. left side position; oil retention: body temp, hold for 30 min if possible |
| Implementation - Nursing Process | Digital disimpaction - side lying, one finger well lubricated to manipulate stool into smaller pieces and remove; caution: can slow heart rate |
| Managing Bowel Incontinence | Scheduled toileting, especially following meals; skin care to peineal area; administer suppository or enema as physician order |
| Nursing Process: Evaluation | Is there a change in defining characteristics? Have goals been achieved? |
| Sexuality | The degree to which a person experiences male or femaleness, physically, emotionally and Mentally |
| Sexual Health | Integration of the somatic, emotional, intellectual and social aspects of sexual being in ways that are positively enriching and enhance personalitym, communication and love |
| Health concerns related to sexuality | sexually transmitted diseases; sexual dysfunctiona nd effect on self-concept; self care behaviors related to breasts, including mammograms, pap smears, prostate exams |
| Sexual Dysfuntions | Male: erectile failure - impotence, premature ejaculation, retarded ejaculation. Female: inhibited sexual desire - dysaperunia may occur in men as well; vaginismus, vulvodynia |
| Sexual Orientation | Heterosexual, homossexual, bisexual, transsexual, transvestite |
| Nursing Process in Sexual Health (Assessment) | Questions related to menarche/menopause, birth control, births, diseases, dysfunction, self-care practices, self concept, physical assessment |
| Nursing Process: Analysis & Diagnosing | Ineffective sexuality pattern; sexual dysfunction; rape-trauma syndrome |
| Nursing Process: O,I P | Examples: Communication with significant others; responsible self care practices |
| Implementation (Nursing Process) | Form a trusting relationship; offer education regarding prevention of STDs; self exam procedures; birth control; anticipatory guidance regarding possible medication side effects |
| Implementation cont'd | Plan for privacy with partner while hospitalized; provide a safe environment and counseling following rape |
| Teaching self-examination | Women: breasts monthly, palpate from outer edge in circular motion towards nipple. Feeling for lumps or tenderness; Men: Testes monthly; use thumb & fingers to feel for lumps or differences in texture. Palpate epididymus above testicle and spermatic cord |
| Teaching contraception | Describe effectiveness, side effecgts and complications |
| Evaluation | Is there an icnrease in knowledge; has there been a behavior change; has there been an improvement in self-concept or body image? |
| Sexual Harrassment | Unwelcome behavior that is sexual or gender-based in nature: 2 forms: quid pro quo; hostile environment |
Created by:
howardccnurs