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ATI Module
Elimination (Exam 2-3)
| Question | Answer |
|---|---|
| urinary tract, which consists of | the kidneys, ureters, bladder, and urethra, before exiting the body |
| the kidneys regulate | electrolyte levels and production of red blood cells, produce hormones that are important for blood pressure regulation, and help to strengthen bones. |
| urine is transported to the bladder by ureters, which are thin, muscular tubes. Each kidney has one ureter. urine reaches the bladder | Once the bladder reaches capacity, receptors inside the bladder send signals to the brain to let the client know it is time to empty the bladder |
| The amount of urine produced is determined by | kidney function |
| Three sets of muscles work together to prevent accidental urination | urethra, internal sphincter, pelvic floor muscles, along with the external sphincter, helps to support the urethra. |
| urethra | connects to the bladder at the bladder neck |
| The bladder neck consists of an internal sphincter (the second muscle), which holds | urine inside the bladder |
| correct order in which they produce and transport urine along the urinary tract. | - Kidney - Ureters - Bladder - Urethra |
| Urine production is driven by | renal filtration and tubular reabsorption and vary based on several factors, including how much liquid and food a client consumes. |
| In a healthy person, urine is usually a | light-yellow color, clear, and without cloudiness |
| Observing the amount and characteristics of urine is an important assessment skill, because | deviations from the client’s norm may suggest health issues such as dehydration or kidney dysfunction |
| deviations in the color and odor of urine can related to diet | larger amount of fluid- greater urine volume and clearer, less odorous urine Blackberries, beets, and rhubarb- urine a reddish color food dyes- blue/ green Aloe or fava beans -Dark brown urine Asparagus- urine slightly green/ increase its odor |
| Age influences urine production | Expected urine output (mL/kg/hr) is highest in infancy and then decreases with increasing age toward adult values |
| Although urination is an expected physiological process, aging can alter | urinary frequency and bladder function. kidney function declines due to loss of kidney tissue and nephrons and reduced blood flow, contributing to decreased urine production. Loss of bladder tone. |
| Loss of bladder tone | may lead to issues such as urinary leakage, urinary incontinence, or urinary retention. |
| The digestive system consists of the | liver, pancreas, gallbladder, and a series of hollow organs that originate at the mouth and terminate at the anus. These organs, which include the mouth, esophagus, stomach, small and large intestines, and anus, make up the gastrointestinal (GI) tract. |
| correct order in which food or liquid contents are transported through the gastrointestinal tract. | - Mouth - Esophagus - Stomach - Small intestine - Large intestine - anus |
| The Bristol Stool Chart is a tool used to describe stool consistencies: | it places stool on a continuum from constipation (types 1 and 2) to expected or ideal stools (types 3 and 4) to diarrhea (types 5 to 7). |
| The Bristol Stool Chart Type 1: | Separate, hard lumps |
| The Bristol Stool Chart Type 2: | Solid, Lumpy |
| The Bristol Stool Chart Type 3: | solid, smooth with cracks |
| The Bristol Stool Chart Type 4: | Soft, snake-like |
| The Bristol Stool Chart Type 5: | Soft blobs, clear edges |
| The Bristol Stool Chart Type 6: | Mushy, fluffy pieces |
| The Bristol Stool Chart Type 7: | Watery, no solid pieces |
| These factors include the following foods and beverages, which are known to increase the risk of diarrhea. | Alcohol Caffeinated beverages and foods Dairy Foods that are high in fat or are highly greasy Beverages that contain fructose Spicy foods Apples, peaches, and pears sweeteners, such as sorbitol, mannitol, xylitol, and maltitol |
| aging influences the function of the digestive system. With age, esophageal | contractions decrease, but the passage of food or liquid from the mouth to the stomach does not change |
| changes in lifestyle often linked to aging can affect bowel movements, including | inactivity, decreased fluid and fiber intake, and ingestion of medications, such as some antihypertensives and antacids. |
| Decreased stomach elasticity reduces | the stomach’s ability to expand and slows gastric emptying |
| Decreased lactase levels increase the likelihood of | lactose intolerance |
| Bacterial overgrowth in the small intestine impairs | nutrient and vitamin absorption |
| Decreased peristalsis in the large intestine | slows stool transit, leading to constipation |
| Rectal enlargement contributes to | retained stool and increased straining during defecation. |
| Stress incontinence associated with | pressure-raising activities such as coughing, sneezing, laughing, or exertion may occur. |
| Females often experience incontinence due to | pregnancy, childbirth (pelvic floor weakness), and physical activities that raise abdominal pressure. |
| Males are more likely to face incontinence from | an enlarged prostate, prostate surgery, or conditions causing urinary retention and overflow. |
| Stress incontinence is often experienced during | activities that increase intra-abdominal pressure, such as coughing or exercising. |
| Reflex incontinence can occur when | nerve pathways responsible for signaling the need to urinate are impaired. |
| Urge incontinence is characterized by | a strong, immediate desire to urinate, leading to involuntary loss of urine. |
| Overflow incontinence may be caused by | an obstruction or a bladder that cannot contract properly. |
| Functional incontinence is related to | difficulties with mobility or dexterity, rather than an issue with the urinary system itself. |
| Incontinence Interventions can include | lifestyle modifications, (diet, exercising, reduce caffeine/alcohol/quitting smoking) pelvic floor muscle exercises bladder training medications medical devices (pessaries, urethral plugs) surgery |
| Interventions for skin protection due to incontinence | Products such as pads, incontinence briefs, and waterproof undergarments can help absorb any leaking urine and keep it away from the skin, reducing irritation and odor. In addition, some cleansing products and skin-protective barrier creams |
| If not addressed, urinary retention can lead to | urinary tract infections, bladder damage, hydronephrosis and kidney dysfunction, and overflow urinary incontinence |
| Findings associated with urinary retention include | difficulty urinating, pain/suprapubic discomfort, abdominal distention, urinary frequency, urinary hesitancy, weak or slow urine stream, and urinary leakage (overflow). |
| Interventions to resolve urinary retention | Initial management is urinary catheter drainage (indwelling urinary catheter, clean intermittent self-catheterization, or suprapubic tube as indicated). Subsequent evaluation/treatment is directed by the cause (obstructive, neurological, pharmacological) |
| Pelvic floor weakness, nerve injury, caffeine, and functional barriers contribute to | Urinary Incontience |
| Prostate enlargement, prolapse, obstructive conditions, and medications such as opioids impair emptying, resulting in | Urinary Retention |
| The risk of constipation increases with | low fiber intake, inadequate fluid intake, sedentary lifestyle, and certain medications (opioids, iron). |
| Constipation is more common in clients who have | neurological disorders |
| Constipation Manifestations that require medical attention include | abdominal pain, rectal bleeding, vomiting, low back pain, unexplained weight loss, inability to pass flatus, and abdominal mass |
| constipation is chronic, fecal impaction can occur and lead to | complications (bowel obstruction, perforation) |
| fecal impaction happens more often in clients who are | immobile or have a nervous system injury |
| Interventions to treat constipation include | eating a high-fiber diet, staying well hydrated, engaging in regular exercise, scheduled toileting/bowel training, and, when needed, using stool-softening medications. |
| If the constipation has advanced to an impaction, treatment options include | manual removal (disimpaction) when stool is palpable in rectum, rectal enemas/suppositories for impaction in the lower bowel, and oral bowel-cleansing solutions for stool higher in the colon once mechanical obstruction has been excluded |
| primary intervention for constipation | dietary fiber intake |
| Secondary intervention for constipation | hydration status, as adequate fluid intake is essential for softening stools and promoting bowel movements. |
| Acute Diarrhea | (14 days or fewer) |
| persistent Diarrhea | lasting longer than 2 weeks but less than 4 weeks |
| Chronic Diarrhea | lasting longer than 4 weeks |
| Risk factors and frequent causes for diarrhea include | infection, medication use (antibiotics), GI disorders (irritable bowel syndrome), and diet/exposures (high-risk foods, untreated water, travel, milk/milk products that contain lactose). |
| Findings with diarrhea include | frequent, loose/watery stools with an urgent need to defecate, plus abdominal cramping, bloating, and nausea |
| Persistent or chronic diarrhea Findings with diarrhea include | electrolyte disturbances, and malabsorption/malnutrition can occur and can be life-threatening if severe |
| In adults, manifestations that require medical follow-up | include fever (39° C [102.2° F] or higher), vomiting that prevents oral hydration, diarrhea lasting longer 2 days or six or more bowel movements a day, severe abdominal pain, presence of blood or black feces, immunocompromise, or findings of dehydration |
| Clinical findings of dehydration cause concern include | dry mucous membranes/decreased tears, decreased urine output (oliguria/anuria), urine that is very concentrated or dark in color, sunken or recessed eyes, prolonged capillary refill time, tachycardia. Decreased skin turgor |
| Decreased skin turgor | meaning the skin does not return to its original state after being pinched upward—is a classic finding of dehydration. |
| f the client is experiencing uncomplicated, acute watery diarrhea, short-term use of over-the-counter | antidiarrheal medications (loperamide or bismuth subsalicylate) may be used to reduce the stool frequency, but should be avoided if there is blood in the stool or high fever |
| Bowel incontinence may result from | nerve damage, weak pelvic floor/anal sphincter muscles, or decreased physical mobility |
| passive incontinence | leakage of feces occurs without the person being aware |
| Bowel incontinence can lead to | perianal skin irritation and is associated with reduced self-esteem and well-being. |
| factors can increase the risk of altered urinary and bowel elimination patterns | Age, sex, medications, and psychological stress due to lack of privacy are all factors that can influence urinary and bowel elimination |
| By 1 year of age- urinary tract infections (UTIs) are more likely to develop in | females than in males due to improper wiping techniques. |
| Prior to age 1- urinary tract infections (UTIs) are more likely to develop in | males who have not been circumcised are more likely to develop UTIs compared to males who have been circumcised |
| Hospitals may not allow clients enough time to completely finish urinating or defecating due to routine nursing interventions | scheduled tests, such as computed tomography (CT) or magnetic resonance imaging (MRI); or visits from family or friends |
| Three categories of diuretics | thiazide diuretics, loop diuretics, and potassium-sparing diuretics |
| Thiazide diuretics | Chlorthalidone Hydrochlorothiazide Metolazone Indapamide |
| Loop diuretics | Torsemide Furosemide Bumetanide |
| Potassium-sparing diuretics | Amiloride Triamterene Spironolactone |
| some medications and other dietary supplements can slow gastric motility and cause constipation, including Aluminum | Containing antacids |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including Anticholinergics and antispasmodics | Medications used to treat muscle spasms |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including Antiseizure meds | seizures |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including calcium channel blockers | medications used to primarily treat elevated blood pressure |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including Diuretics | Which increase urine production |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including Oral iron supplements | used to treat certain forms of anemia |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including Antiparksinsonian medications | parkison |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including Opiates | used to treat pain |
| Some medications and other dietary supplements can slow gastric motility and cause constipation, including some anidepressants | depression |
| Medications, especially systemic antibiotics and magnesium-containing antacids/laxatives can | increase gastric motility and cause diarrhea |
| Antibiotics may | disrupt the normal intestinal microbiota and allow overgrowth of pathogens, leading to chronic diarrhea |
| Magnesium hydroxide products act | osmotically to increase stool water and frequency and can cause loose stools/diarrhea when used as antacids or laxatives. |
| Medications That Can Affect Elimination Patterns: Urinary Elimination | 5-Alpha reductase inhibitors Antihistamines Alpha-blockers Anticholinergics/antispasmodics Antidepressants Antidiuretics Antihypertensives Antiparkinsonian med Antipsychotics Decongestants Diuretics Estrogens OTC cold med Opioids Benzodiazep |
| Medications That Can Affect Elimination Patterns: Bowel Elimination | Anticholinergics/antispasmodics Antiseizure Antidepressants Antihypertensives Antipsychotics Bile acid sequestrants Calcium channel blockers Diuretics Oral iron supplements Opioids Antacids containing aluminum and calcium |
| Dehydration occurs when | fluid loss exceeds fluid intake (negative fluid balance). |
| Clients with certain chronic conditions | such as diabetes mellitus, kidney disease, or cystic fibrosis, are at an increased risk. |
| Manifestations of dehydration include | increased thirst; dry mouth, mucous membranes, or tongue; fatigue; fever; dizziness; dark-colored urine; and reduced or absent urine or sweat. Infants may have dry diapers for more than 3 hr or cry without tears. |
| If severe, dehydration can be life-threatening and require immediate medical attention for | rehydration with intravenous (IV) fluids; mild cases are generally treated with oral fluid replacement. |
| UTIs are more common in females, and if left untreated may result in | a kidney infection called pyelonephritis |
| UTIs can occur at any age, but females are at higher risk because | they have a shorter urethra than males. |
| Manifestations of UTIs include | burning or painful urination (dysuria), suprapubic discomfort, and urgency/frequency with small volumes |
| confirm the diagnosis and identify the causative bacteria to guide therapy | A urinalysis and urine culture |
| If the UTI is left untreated | present with severe lower back/flank pain, fever, nausea, vomiting, or blood in the urine (hematuria). This is usually indicative of a kidney infection (pyelonephritis), which can lead to serious complications. |
| Kidney stones (renal calculi, nephrolithiasis, or urolithiasis) are | hard mineral formations that collect in the kidneys. |
| Kidney stones are more likely to develop in | males than in females, as well as in clients who have had kidney stones in the past or who have a family history of kidney stones |
| Conditions that increase the risk of developing kidney stones include | inadequate hydration/low urine volume, inflammatory conditions, cystic kidney disease, gout, hypercalciuria (excessive calcium in the urine), hyperparathyroidism (a condition that causes too much calcium in the blood), obesity, and recurrent UTIs |
| Certain medications increase risk | (diuretics), and excessive calcium intake (including calcium-containing antacids) can promote hypercalciuria. |
| Manifestations of kidney stones include | sharp back/flank pain, which can travel along the side of the abdomen to the lower abdomen or to the groin; hematuria; urinary frequency/urgency; and dysuria. Nausea, vomiting, and fever or chills suggest infection or obstructive pyelonephritis. |
| Kidney stones Interventions are based on the | size, location, and type of stone present. small enough to pass (filter the urine so type of stone) stone is large or is obstruction- extracorporeal shock wave lithotripsy (ESWL), or it may need to be physically removed from the urinary tract |
| extracorporeal shock wave lithotripsy (ESWL) | used to break up the stone |
| Kidney failure means | the kidneys cannot filter the blood well enough to keep the body in balance |
| A simple way to measure the kidneys’ ability to filter waste is the | estimated glomerular filtration rate (eGFR) |
| eGFR can be calculated from | routine blood tests (creatinine) |
| routine blood tests (creatinine) | estimates how much blood the kidneys filter each minute, adjusted for body size |
| Chronic kidney disease (CKD) typically progresses | over time through defined stages. When eGFR falls below 15 mL/min/1.73 m² or treatment with dialysis is required, CKD has progressed to kidney failure. |
| As kidney function declines | wastes and extra fluid accumulate, contributing to reduced urine production (oliguria), difficult-to-control hypertension, heart disease, anemia, itching (pruritus), and musculoskeletal discomfort |
| Major risk factors for CKD and eventual kidney failure include | diabetes mellitus, hypertension, heart disease/heart failure, family history of CKD, and lifestyle/metabolic factors such as obesity, smoking, dyslipidemia, and insulin resistance. |
| interventions to assist the kidneys can include | hemodialysis or peritoneal dialysis. If the kidneys are too impaired to function at all, a kidney transplant will be needed. |
| BPH | Prostate Enlargement |
| BPH is a | noncancerous condition that narrows the urethra, increasing urinary retention |
| A primary risk factor for developing BPH is | age, and age-related hormonal changes are thought to contribute to BPH |
| As men age, the prostate keeps growing because | a hormone in the prostate called dihydrotestosterone (DHT) |
| Manifestations of BPH include | urinary frequency, urinary urgency, frequent nighttime urination (nocturia), a weak or slow urinary stream, urinary incontinence, or urinary retention |
| BPH left untreated, it can lead to | complications such as UTIs, bladder or kidney disease, or bladder stones. |
| BPH Treatment depends on the | severity of findings and may include close monitoring over time, medications, and surgical interventions |
| Physiological Conditions That Alter Urinary Elimination Patterns | Dehydration, UTI, Kidney Stones, Kidney Failure, Prostate Enlargement (BPH), |
| Conditions That Alter Bowel Elimination Patterns | Diverticulitis, Irritable Bowel Syndrom (IBS), Bowel Obstruction, Ileus, Ulcerative Colitis, Crohns Disease |
| Diverticulosis inflammation does not result from a single cause. Instead, it results from several interrelated factors | Changes in the balance of usual gut bacteria can irritate the bowel, and some clients may have ongoing low-grade inflammation in the colon that puts them at higher risk for an episode. |
| Diverticulosis inflammation occurs, clients may experience | fever; changes in bowel habits, such as constipation or diarrhea; and left lower-quadrant abdominal pain. If severe, the colon can perforate or tear, causing an intra-abdominal infection in the abdomen called peritonitis. |
| Preventive measures after an episode of Diverticulosis | such as consuming a high-fiber diet, can reduce the risk of recurrent diverticulitis |
| Treatment for Diverticulosis depends on the | severity of the illness |
| mild diverticulitis can be treated | at home. Providers usually recommend resting, drinking clear liquids at first, and then slowly returning to regular foods as manifestations improve. Many clients do not require antibiotics if they are otherwise healthy and their symptoms are mild |
| Antibiotics are used for Diverticulosis when the client is | sicker, not getting better, has more severe manifestations, or has health problems that make it harder for their body to fight infection, such as having a weakened immune system (immunocompromised) |
| For serious cases of Diverticulosis, such as when there is an abscess, a perforation (a tear in the colon), or findings of a more dangerous infection | clients need hospital care, IV fluids, stronger antibiotics, and sometimes surgery. |
| IBS with constipation (IBS-C) occurs when | most of the daily bowel movements are hard or lumpy |
| IBS with diarrhea (IBS-D) occurs when | most of the daily bowel movements are loose and watery |
| IBS with mixed bowel habits (IBS-M) is a | combination of both diarrhea and constipation elimination throughout the day |
| Irritable bowel syndrome (IBS) occurs when the | gut and brain do not communicate as expected, which makes the intestines oversensitive (pain with normal stretching) and can cause irregular movement (too fast or too slow). gut–brain interaction disorder |
| Some Irritable bowel syndrome (IBS) trigger or worsen manifestations | Changes in gut bacteria, mild immune activation, and a leaky intestinal lining, along with stress and certain foods |
| Risk factors for IBS include | a family history, female gender, stressful events, postinfectious onset after a GI infection, coexisting digestive disorders, and conditions such as anxiety, depression, and fibromyalgia. |
| Findings depend on the kind of IBS, but may include | abdominal pain, bloating, mucus in the stool, and a sense of incomplete bowel emptying |
| IBS Treatment starts with | diet and lifestyle. Clients should be encouraged to increase their intake of soluble fiber (such as psyllium) and, when manifestations persist, to make simple dietary changes to limit foods that trigger manifestations |
| Bowel obstruction Manifestations include | nausea, vomiting, abdominal pain and distention, and severe constipation |
| critical factor in reducing morbidity and mortality Bowel obstruction | Prompt diagnosis |
| preferred imaging to identify the site/cause and guide treatment decisions for Bowel obstruction | Computed tomography (CT) |
| Hospital admission and early surgical assessment for bowel obstructions are recommended to determine | the obstruction’s type, severity, and cause |
| Bowel obstruction Initial supportive care includes | IV fluids, electrolyte correction, and placing a nasogastric (NG) tube when the client has persistent vomiting, profound distention, or has a high risk of aspiration. |
| A mechanical blockage— | most commonly postsurgical adhesions, and less commonly hernias that trap a loop of bowel, tumors narrowing the lumen, inflammatory strictures (Crohn disease), twisting, volvulus or gallstone ileus |
| volvulus or gallstone ileus | —creates a transition point where bowel proximal (above) to the blockage distends with fluid and gas while the distal (below) bowel decompresses. |
| Ileus can be caused by several factors, including | recent abdominal or retroperitoneal surgery, trauma, severe illness or infection (sepsis/peritonitis), medications (especially opioids), electrolyte disturbances (hypokalemia), and postoperative complications (pneumonia/abscess). |
| Ileus Manifestations include | an inability to tolerate food, nausea and vomiting, slow-onset abdominal distension and bloating, and inability to pass flatus. Bowel sounds are diminished or absent. |
| distinguish ileus from a mechanical bowel obstruction | Imaging. With an ileus, x-rays or CT scans usually show generalized intestinal swelling, with air seen throughout the bowel, even into the colon and rectum, without a clear area where the bowel is blocked. |
| In a mechanical obstruction, imaging typically shows a | more obvious blocked area where the bowel changes from swollen to collapsed, indicating a true blockage. |
| Treatment of ileus requires | - client receives nothing by mouth (NPO) decompress the stomach with an NG tube when needed; provide IV fluid therapy correct electrolytes underlying cause (reduce opioids, treat infection). after NPO 7day NPO total parenteral nutrition (TPN). |
| Ulcerative colitis (UC) Onset is | gradual, and the condition may worsen over time. However, clients also experience periods of remission that can last weeks or years |
| Ulcerative colitis (UC) Risk factors include | family history, Jewish ancestry, environmental influences, and an overactive intestinal immune system. |
| Manifestations of UC include | include diarrhea with blood or pus, abdominal discomfort/pain, fatigue, nausea, fever, and iron-deficiency anemia. |
| Interventions for Ulcerative colitis (UC) initially focus on | medications to induce remission, followed by maintenance medications. |
| If medications alone are unsuccessful at keeping a client in remission of Ulcerative colitis (UC) or cancerous lesions develop | surgery may be warranted. At times, surgery to remove the entire colon is required. |
| Crohn’s disease begins | gradually and can worsen over time. However, clients can experience periods of remission. |
| Risk factors for developing Crohn’s disease include | a family history of Crohn’s disease, autoimmune disorder, and tobacco use, although no definitive cause has been identified |
| Crohn’s disease can cause | intestinal obstruction (from strictures), fistulas (tunnels that pass from the wall of the intestine to another organ), abscesses, ulcers, fissures or tears in the anus, malnutrition, and inflammatory processes elsewhere in the body. |
| Manifestations of Crohn’s disease include | diarrhea, abdominal pain or cramping (often right lower-quadrant when ileum is involved), weight loss, anemia (iron or B12 deficiency), fatigue, fever, joint pain (arthralgias), nausea/vomiting, and painful bumps under the skin. |
| Crohn’s disease Flares are treated with | short courses of corticosteroids to quickly reduce inflammation and are not intended for long-term use |
| For Crohn’s disease maintenance, providers use | steroid-sparing medicines, such as immunomodulators, and, when the disease is moderate–severe or refractory, biologic/targeted therapies |
| Crohn’s disease Surgery treats | complications (strictures/obstruction, fistulas, abscess, perforation) or medication failure, often followed by a plan to reduce recurrence. |
| Crohn’s disease support includes | nutrition (iron/B12 when the ileum is involved). |
| suspected bowel obstruction. Place the nursing and interprofessional actions in the correct order. | first assess for abdominal distention, pain, nausea, and vomiting notifies the provider so that imaging, typically a CT, can be ordered initiates NPO status IV fluids and electrolyte correction preparing for possible NG tube insertion |
| urinary diversion | When the expected flow of urine from the body is interrupted |
| Six types of urinary diversions | Urinary Catheterization, Ureteral Stent, Urostomy, Nephrostomy, Continent, Urinary Diversion, Cystostomy, |
| Urinary catheterization, ureteral stent, nephrostomy, and cystostomy are typically | temporary diversions for draining urine due to blockages or injury |
| Ileal conduit/urostomy (using a piece of small intestine) and cutaneous ureterostomy are | permanent external diversions that require a stoma and an external pouch. |
| Neobladder and continent cutaneous reservoir are | internal continent diversions made from bowel, allowing urine storage and scheduled drainage by the client (either via urethra or a stoma). |
| Fecal or Bowel Diversions | ileostomy, colostomy, J pouch, and Kock pouch. |
| Ileostomy and colostomy are both | external stomas—ileostomy uses the end of the small intestine, and colostomy uses the colon; both require an external pouch for stool collection. |
| The J pouch | s an internal reservoir made from ileum and connected to the anus, allowing more normal elimination (no external pouch). |
| The Kock pouch | is also an internal reservoir from ileum, but it empties through a stoma by intermittent self-catheterization, so there’s no external pouch needed either. |
| ileostomy and colostomy are | incontinent with an appliance |
| the J pouch and Kock pouch are usually | continent solutions with different methods for emptying. |
| J- Pouch | An internal pouch formed with the ileum |
| Kock Pouch | A continent ileostomy system |
| Colostomy | Use of part of the colon to form a stoma through the abd wall that allows for the passage of body waste |
| Ileostomy | A fecal diversion that uses the ileum, the terminal end of the small intestine |
| Complications of Fecal Diversion | peristomal skin irritation; stoma issues, such as hernias, prolapse, or narrowing (stenosis); blockages; diarrhea; bleeding; electrolyte imbalances; infections; and leakage. Vigilant assessment, correct pouch fit, and timely referral mitigate risks |
| Types of Diagnostic Tests of the Urinary System: Uroflowmetry | Measures urine flow rate and volume |
| Types of Diagnostic Tests of the Urinary System: Postvoid residual measurement | Measures the amount of urine left in the bladder after voiding |
| Types of Diagnostic Tests of the Urinary System: Cystometric test | Measures bladder capacity, or the amount of fluid or pressure inside the bladder as it is filling, and its final capacity when the urge to urinate begins |
| Types of Diagnostic Tests of the Urinary System: Leak point pressure measurement | Measures bladder pressure when the bladder begins to leak |
| Types of Diagnostic Tests of the Urinary System: Electromyography | Calculates electrical impulses of the nerves and muscles of the bladder and sphincters |
| Types of Diagnostic Tests of the Urinary System: Video urodynamic test | Takes pictures and video of the bladder while it is filling and emptying |
| Types of Diagnostic Tests of the Urinary System: Video urodynamic test | Takes pictures and video of the bladder while it is filling and emptying |
| Types of Diagnostic Tests of the Urinary System: Cystoscopy | Uses an optical instrument to view the lining of the urethra and bladder (lower tract) |
| Types of Diagnostic Tests of the Urinary System: Ureteroscopy | Uses an optical instrument to view the lining of the ureters and kidneys (upper tract) |
| Types of Diagnostic Tests of the Urinary System: Pressure flow study | Measures how much pressure is needed in the bladder for urination to be initiated, and the flow rate of urination at that pressure |
| Urinalysis is a | lab test commonly used by providers to evaluate for a variety of disorders, including bladder infections, UTIs, kidney infections, kidney disease, and diabetes. |
| Urinalysis Visual examination of the urine includes | assessing its overall appearance for clarity, color, and any unusual odor. |
| Urinalysis This test includes | visual examination of the urine, dipstick testing, and microscopic examination. |
| Dipstick evaluation uses a | thin plastic strip, known as a reagent strip, that contains several chemical indicators for testing. The strip is quickly placed into the urine, removed and placed on its side on a clean surface, and then observed for changes in color |
| Reagent strip evaluation tests are used to determine the | acidity or pH level of the urine. They may also assess for urine concentration and the presence of protein, glucose, ketones, bilirubin, leukocyte esterase, nitrites, and blood |
| Microscope examination further evaluates | the urine sample for white blood cells or leukocytes for infection; red blood cells for indications of kidney disease or bladder cancer; bacteria, which may indicate infection; casts, which are proteins that may result from kidney problems; and crystals |
| A urine culture is used to | evaluate urine for the presence of bacteria and yeast that may cause a UTI. It is commonly ordered with an urinalysis and is considered the gold standard for identifying the causative micro-organism when infection is suspected. |
| most commonly used approach because it is noninvasive and correlates well with catheterized or suprapubic specimens | The clean-catch midstream method |
| 24-hr urine collection, in which | all urine is collected over a 24-hr period, in a special collection container and kept cold (refrigerated or on ice). |
| 24-hr urine collection allows the provider to evaluate amounts of | pecific chemicals over a full day, which can be helpful in determining kidney function, kidney stone risk, and other conditions requiring timed measurements (24-hr protein, creatinine clearance, stone risk profile). |
| Two methods are used to collect urine specimens: | clean-catch midstream, which clients usually perform themselves, and catheterization. |
| straight (intermittent) catheter | (not connected to a collection bag), the nurse should keep the urine collection container close to the catheter tip to prevent urine from leaking onto the client’s bed. Once specimen collection is complete, the nurse removes the catheter. |
| indwelling catheter is used | catheter is kept in place by the balloon. For indwelling catheters, collect the specimen from sampling port, clamp distal to the port to allow fresh urine to collect, disinfect the port, transfer urine into a sterile container, then unclamp the tubing. |
| Types of Diagnostic Tests of the Gastrointestinal System: Celiac disease testing | Diagnoses celiac disease by blood tests and small-bowel biopsy via upper endoscopy |
| Types of Diagnostic Tests of the Gastrointestinal System: Colonoscopy | Screening procedure for colon or rectal cancer; can also be used to evaluate for causes of GI bleeding, changes in bowel habits, abdominal pain, and unexplained weight loss; allows biopsy and polyp removal during the same procedure |
| Types of Diagnostic Tests of the Gastrointestinal System: Endoscopic retrograde cholangiopancreatography (ERCP) | Diagnoses problems associated with pancreatic and bile ducts such as gallstones, infections, pancreatitis, and pancreatic masses |
| Types of Diagnostic Tests of the Gastrointestinal System: Flexible sigmoidoscopy | Evaluates the rectum and left colon for causes for rectal bleeding, bowel habit changes, pain, weight loss, and for cancer screening |
| Types of Diagnostic Tests of the Gastrointestinal System: Lower GI series (barium enema) | X-ray/fluoroscopy of the large intestine using barium to evaluate for bleeding, changes in bowel habits, chronic diarrhea, unexplained weight loss, abdominal pain, cancer, diverticula, fistulas, polyps, or ulcers |
| Types of Diagnostic Tests of the Gastrointestinal System: Upper GI endoscopy (esophagogastroduodenoscopy [EGD]) | Visualizes the esophagus, stomach, and upper intestine to evaluate persistent heartburn, bleeding, nausea and vomiting, pain, issues with swallowing (dysphagia), unexplained weight loss, ulcers, cancer, precancerous conditions, celiac disease |
| Types of Diagnostic Tests of the Gastrointestinal System: Upper GI series | X-ray/fluoroscopy with barium to evaluate for nausea and vomiting, abdominal pain, difficulties with swallowing (dysphagia), unexplained weight loss, cancerous growths, and injuries to the esophagus, reflux, hernias, scarring, or ulcers |
| A fecal occult blood test (FOBT) check for the | presence of small amounts of occult blood in stool that cannot be seen with the naked eye |
| how to collect a stool specimen for a stool culture | -first places the collection container in the toilet -bowel movement into the collection container - uses the collection spatula to transfer the stool specimen into the test container. - labels the specimen container with the required information |
| perform bladder irrigation | a prescribed solution is connected to a urinary catheter as ordered by the client’s provider |
| Bladder Irrigation is intervention is intended to prevent | blood clots from forming in the bladder or to remove any clots/tissue/sediment that may be present and to maintain catheter patency so urine can drain freely |
| Bladder training assists with | etraining the bladder by setting a schedule to use the bathroom. This technique focuses on accident avoidance in clients with overactive bladders by gradually increasing the time between bathroom visits to urinate. |
| Successful bladder training programs focus on | attempting to urinate at set, scheduled times with or without the urge and slowly increasing the time between these sessions. |
| Successful bladder training programs generally involve three steps | - current pattern or schedule. - elimination journal - attempts to extend the time between bathroom trips—first by about 5 to 15 min, and then advancing the time slowly. - appropriate elimination schedule encouraged to maintain it. |
| Bladder scanning is a | technique that nurses commonly utilize to determine the need for catheterization. |
| Four kinds of urinary catheters are used: | straight (intermittent) catheters, indwelling catheters (urethral or suprapubic), condom catheters (external male), and external female catheters. |
| Straight or intermittent catheters are used as | as needed to empty the bladder, and then removed when bladder emptying is complete |
| Key nursing actions that lower the likelihood of CAUTI include | -clear clinical reason - sterile technique and equipment, keeping the drainage system closed and free of kinks - collection bag positioned below the bladder, -cleaning hands before and after handling any part of the catheter or drainage setup. |
| Laxatives- Classification: Bulk forming | Methylcellulose Psyllium Polycarbophil |
| Laxatives- Classification: Bulk forming- Mechanism of Action | Softens stool by absorbing water/retaining water; increases stool bulk and promotes peristalsis. |
| Laxatives- Classification: Bulk forming- Therapeutic Response | Bowel movement in 12 to 72 hr |
| Laxatives- Classification: Surfactant | Docusate sodium Docusate calcium |
| Laxatives- Classification: Surfactant- Mechanism of Action | Softens stool by lowering stool surface tension to allow water and lipids to penetrate. |
| Laxatives- Classification: Surfactant- Therapeutic Response | Bowel movement in 12 to 72 hr |
| Laxatives- Classification: Stimulant | Bisacodyl Senna Castor Oil |
| Laxatives- Classification: Stimulant - Mechanism of Action | Stimulates peristalsis and increases intestinal secretion; decreases water reabsorption. |
| Laxatives- Classification: Stimulant - Therapeutic Response | Suppository: 15 to 60 min Oral: 6 to 12 hr |
| Laxatives- Classification: Osmotic | Magnesium sulfate Magnesium citrate Sodium phosphate Polyethylene glycol Lactulose Magnesium hydroxide |
| Laxatives- Classification: Osmotic Mechanism of Action | Retains water osmotically, softening the stool and promoting peristalsis. |
| Laxatives- Classification: Osmotic Therapeutic Response | Oral: Within 24 to 72 hr Rectal/enema: Acts rapidly, within minutes |
| Nasogastric (NG) tubes are | flexible tubes that are inserted into a nostril and advanced down to the stomach to remove gastric contents and decompress the upper GI area |
| NG tubes are most frequently placed for | bowel obstructions to reduce abdominal distention and subsequent nausea and vomiting, thereby decreasing the risk of aspiration. |
| NG tubes also may be used for | enteral feedings and/or medication administration (called nasoenteric tubes), but these uses are distinct from decompression and are not performed at the same time |
| NG tube length should be measured from | the tip of the client’s nose to the tragus of the ear, to the xiphoid process, which is a standard estimation method to approximate the required length. |
| Do not use the NG tube until placement is verified. Current safety guidance supports a combination of evidence-based methods— | typically abdominal/chest X-ray (the initial gold standard and required before using the tube for enteral medications or nutrition or any time placement is uncertain), pH testing of gastric aspirate (an acidic pH supports gastric placement |
| constipation | Difficulty moving the bowels due to hardened stool. |
| Crohn’s disease | A chronic disease that causes inflammation in the GI tract but commonly affects the small intestine. |
| diarrhea | Frequent, loose, watery stools occurring throughout the day. |
| diverticulitis | An inflamed pouch or sac in the colon that is the result of stool becoming trapped. |
| diverticulosis | A condition in which small sacs or pouches form in the colon |
| dysuria | Pain or discomfort with urination often due to infection or injury. |
| false positive | A false positive test result incorrectly indicates that a condition or attribute is present. |
| functional incontinence | Physical inability to reach the toilet in time. |
| irritable bowel syndrome (IBS | A gastrointestinal condition characterized by abdominal pain and changes to bowel elimination patterns that can include diarrhea and/or constipation. |
| nocturnal enuresis | Nighttime bedwetting that is common in children but may occur in adults who have consumed too much alcohol or caffeine at night, or as a result of certain medications. |
| overflow incontinence | Incomplete bladder emptying which results in the bladder overfilling when full resulting in urine leakage. |
| peristalsis | Contractions that occur throughout the digestive system that move food along a pathway to be digested. |
| reflex incontinence | Urinary leakage as a result of nerve damage. |
| stress incontinence | Coughing, sneezing, laughing, or physical activity that increases pressure on the bladder resulting in urine leakage |
| ulcerative colitis (UC) | A chronic disease that causes inflammation and ulcerations of the large intestine or colon. |
| urge incontinence | A strong need or urge to urinate or defecate, but leakage occurs before getting to the toilet. |
| urinary hesitancy | Urinary hesitancy is a difficulty when urinating that causes a weak trickling stream of urine and a need to strain |
| urinary incontinence (UI) | The inability to control urination resulting in its involuntary passage and can be caused by many factors. |
| urinary retention | Incomplete emptying of the bladder. |
| urinary urgency | A strong desire to urinate. |
| urination | The process of the elimination of urine through the urethra and out of the body. |
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