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Elimination
| Question | Answer |
|---|---|
| Anuria | Failure of the kidneys to produce urine/inability to pass urine. |
| Dysuria | Painful urination. |
| Enuresis | Involuntary urination. |
| Hematuria | Presence of blood in the urine. |
| Oliguria | Significantly REDUCED urine output. |
| Nephropathy | Kidney disease, chronic (CKD) or acute; deterioration of kidney function - final stage is kidney failure |
| Nephrotoxic | Damaging/destructive to the kidneys. |
| Nocturia | Frequent urination in the night - typically waking up two or more times to urinate. |
| Nocturnal Enuresis | Involuntary urination at night (bedwetting). |
| Micturition | Urination |
| Polyuria | Excessive urination (more than 2.5-3L/day for adults); often accompanied by excessive thirst; common cause is DM (Diabetes Mellitus) |
| Proteinuria | Protein in the urine - caused by kidney damage, HTN (hypertension), UTI, certain medications, pregnancy (pre-clampsia), strenuous exercise, urine may appear foamy or frothy |
| Urgency | Sudden urges to urinate (unable to make it to the toilet in time). |
| How many mLs/hr output is critically low? | less than 30 ml/hr (NOTIFY PROVIDER) |
| How many mLs/hr output is normal? | 50-60mL/hour |
| What are possible causes of urinary retention? | Neurological problems, viral infections, anxiety, obstructions (kidney stones, tumor, blood clot, etc) |
| What meds cause urinary retention? | antidepressants |
| What conditions/medical problems cause urinary retention? | severe constipation, chronic health issues like neurological disorders (MS, Parkinson's, stroke), diabetes, enlarged prostate, obesity, etc. |
| What age groups have issues with urinary retention? | woman over 40 and older individuals over the age of 50 |
| What developmental factors effect urinary retention? | immature bladder/neuromuscular control and childbirth or age |
| Clean catch specimen definition. | midstream urine sample collected after handwashing and cleaning the genital area with provided wipes |
| Sterile urine specimen definition. | by insertion of sterile catheter through the urethra |
| Routine urinalysis definition. | (NOT FOR UTIs) Doesn't need to be midstream or clean technique, often used to check for KD, liver problems, and diabetes. |
| Bedside testing (dipstick) definition. | Performed at beside instead of sending a sample to the lab. |
| 24-hour urine definition. | Voiding and discarding the first morning urine and for the next 24 hours, all urine is collected in a container kept cool/refrigerated and sent to lab ASAP after the 24 hr mark. |
| What is a CAUTI? | Catheter-associated urinary tract infection |
| S/S of UTI | Dysuria, CVA (lower back) tenderness, urinary frequency, suprapubic pain/fullness, burning with urination, hematuria, fever, elevated WBCs, presence of E. coli in urine culture, increased ESR and elevated CRP (indicated inflammation) |
| Urge incontinence | involuntary loss of urination with strong urge to void |
| Stress incontinence | increased intra-abdominal pressure as with coughing/laughing |
| Mixed incontinence | combination of urge and stress |
| Unconscious incontinence | not realizing the bladder if full with no urge to void |
| Functional incontinence | no urinary/neurological cause (ie. immobility, pain, cognition, communication issues, etc) |
| Transient incontinence | short-term; resolves spontaneously (usually related to UTIs, meds, or URI/coughing) |
| Overflow incontinence | Leakage of urine with a distended bladder (fecal impaction, neurological disorders, enlarged prostate) |
| What are risk factors for urinary incontinence? | Advanced age + cigarette use + diabetes (these often suppress the immune system), history of UTIs, neurological disease (ie. stroke), obesity, reduced estrogen following menopause, reduced mobility, BPH (enlarged prostate) in men, and childbirth |
| What is a urinary diversion? | Urostomy; a surgically created opening for elimination of urine - the bladder is bypassed and urine expels through the stoma/ostomy - treated US defects, trauma, and pathological conditions |
| What is post-void residual (PVR)? | checks the amount of urine left in the bladder after the patient has voiding to the best of their ability |
| What is the upper GI tract versus lower? | Upper: mouth, teeth, pharynx, esophagus, and stomach (the LAST part of the upper GI tract) Lower: small and large intestines, rectum, and anus |
| Feces | stool, normally brown |
| Defecation | process by which the bowel eliminates waste |
| Valsalva maneuver | contracting the abdominal muscles (straining/bearing down) to expel feces |
| Impaction | Presence of a large/hard fecal mass in the rectum (often causes constipation) |
| Incontinence | inability to control defecation or urination |
| Bowel diversion | surgical opening created for elimination of feces |
| What causes light or clay-colored stool? | high-fat diet or gall bladder disease |
| What causes black tarry stool? | upper GI tract bleeding |
| What causes greenish-black stool? | patient may be taking iron supplements |
| What causes BRBPR (bright-red blood per rectum)? | lower GI bleed/hemorrhoids |
| What causes excessive amounts of mucus in stool? | seen with IBS or Crohn's disease (inflammatory bowel disease) |
| What is an example of undigested food? | when food travels rapidly through the GI tract - ie. corn |
| What is the difference between acute versus chronic diarrhea? | Chronic diarrhea must persist more than a month while acute is sudden onset and usually a response to infection, unusual foods, or intolerances |
| What are possible complications of acute diarrhea? | fluid/electrolyte imbalance, impaired skin integrity, psychosocial issues |
| Should antidiarrheals always be given with loose stool? | NO! The cause should always be determined first - if diarrhea is caused by a partial blockage, antidiarrheals could cause a complete blockage to occur |
| What is a fecal impaction? | fecal matter impacted in the GI tract resulting from acute/chronic constipation |
| What is the FIRST treatment given for constipation? | Bulk-forming laxatives FIRST. Then you could use stool softeners, stimulants, or suppositories. |
| What is the last resort treatment for constipation? | Enemas |
| Impactions that can be felt are in what part(s) of the digestive tract? | Lower GI |
| What are possible treatments for bowel impaction? | laxatives (oral then suppository then enema), digital removal, surgery (last resort) |
| What are normal stoma findings? | pink/beefy red, moist, shiny (indicated good blood flow and healthy tissue), tissue is intact, no breakdowns or excoriation |
| What are abnormal stoma findings? | pale, brown, black, dry, tough, swollen, skin irritation and/or breakdown (notify provider!!!) |
| How might stool from an ileostomy be different from a colostomy? | ileostomy is in the small intestine so stool will be less solid, while a colostomy comes from the large intestine and stool will be more solid |
| How do you appropriately remove stoma skin barrier/pouch? | Remove old appliances using a push-pull technique to reduce trauma to the skin, assess stoma, and clean surrounding skin with mild soap and water |
| What foods cause flatus and loose stools? | chocolate, dried beans, fried foods, spicy foods, raw fruits and veggies |
| What foods help prevent diarrhea/loose stools? | probiotics, yogurt, buttermilk, limit insoluble fiber intake, foods that help thicken stool, applesauce, bananas, cheese, pasta, rice, etc. |
| What foods increase risk of blockage? | stringy veggies, coconut, coleslaw, mushrooms, popcorn, seeds, berries, celery, and fresh tomatoes |
| What foods decrease odor for a colostomy/ileostomy? | yogurt, parsley, buttermilk, and probiotics |
| What is the minimum daily fluid intake (ounces)? | 64 fl oz/ 8 cups |
| What is a guaiac stool test? | AKA occult blood test - tests for the presence of blood in stool |
| What is an EGD? | Esophagogastroduodenoscopy - assesses upper GI tract |
| What is a barium enema used for? | used to diagnose and track progress of conditions such as Crohn's (a type of IBD), assesses bowel function |
| What are nursing considerations/precautions for Cipro? | Risk of tendon rupture/Achilles tendon, c. diff, sun sensitivity, and seizures |
| What are nursing considerations/precautions for Bactrim? | ensure there is no allergy to sulfa drugs, monitor kidney function, risk of hyperkalemia (electrolyte imbalance), and liver function |
| What are nursing considerations/precautions for Macrobid? | (Nitrofurantoin) give with food, may cause urine discoloration (dark yellow/brown), monitor for liver toxicity, c. diff ("super infection"), peripheral neurpathy, and pulmonary toxicity |
| What are nursing considerations/precautions for Pyridium? | azo dye which exerts local anesthetic or analgesic action on urinary tract mucosa through an unknown mechanism - can turn urine an orange-reddish color |
| What are the benefits of probiotics (can be given as supplement or yogurt)? | helps to re-establish the intestinal balance of good bacteria, decreases the risk of developing diarrhea or C. diff infection when taking antibiotics |
| What are the VARK learning methods? | visual, aural (hearing), reading/writing, and kinesthetic (physical movement of doing it) |
| What is Bloom’s taxonomy? | (lowest on the pyramid to highest) Remember, understand, apply, analyze, evaluate, and create |
| What are factors that can hinder client education and learning? | impaired cognition, fear, anxiety, depression, distractions, psychomotor deficits, physical discomfort (fatigue/pain), timing |
| What are the SMART goals of client teaching outcomes? | Specific, measurable, attainable, relevant, time-based. |
| How can you evaluate whether your teaching was effective? | oral questions, checklists, observation of performance, client reports/client records performance/results, tests/written exercises, teach back method |
| Frequency | Increased frequency of urination (more than 8 times over 24 hours). |
| Daily Urine Output | 1500-2000mL/day |
| Daily Voiding Frequency | 5-6x/day |
| Normal Specific Gravity (SG) | 1.002-1.030 |
| Excessive fluid intake does what to SG? | decreases it (<1.002) |
| Decreased fluid intake (dehydration) does what to urine and SG? | concentrated, darker urine and increased SG (>1.030) |
| Noninvasive Diagnostic Tests | Bloodwork, Urinalysis (UA - most common urinary lab test), Bladder Scan (bedside ultrasound), ultrasound, CT, and IVP (Intravenous Pyelogram) |
| Invasive Diagnostic Tests | Cystoscopy (to remove kidney stones stuck in ureter), Cystometry, Renal Biopsy, Retrograde Pyelogram |
| Acute v. Chronic Constipation | Acute is temporary while chronic lasts for more than 3 months, sometimes for years |
| Documentation of Education | "If you didn't chart it, you didn't do it" |
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