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208 Final Exam - Chap 45/46
Bladder and Bowel
69
Nursing
Undergraduate 2
12/10/2012

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Cards

Term
Urinary Elimination
Definition
depends on the function of the kidneys, ureters, bladder, & urethra
Term
Physiology - Urinary Elimination
Definition

The kidneys form the urine.

The ureters carry urine to the bladder.

The bladder acts as a reservoir for the urine.

The urethra is the passageway for the urine to exit the body.

Term
Physiology - Continence in the Adult
Definition

Anatomic integrity of the urinary system

Nervous control of the detrusor muscle

Competent sphincter mechanism

Term
Physiology - Urinary Incontinence
Definition

Uncontrolled loss of urine 

Abnormalities of one or more factors

Term
Physiology of Urine Formation
Definition

Normal glomerular function- Urine formation starts at glomerulus where blood is filtered

 

GFR-(Glomerular filtration rate)- amt of blood filtered by glomeruli in a given time

 

Normal GFR- 125ml/minute, however only 1 ml per minute becomes urine, most is reabsorbed

Term
Reabsorption
Definition
refers to the passage of a substance from the lumen of the tubules  through the tubule cells and into the capillaries
Term
Tubular Secretion
Definition
passage of a substance from the capillaries through the tubular cells and into the lumen  of the tubule
Term
Proximal Convoluted Tubule
Definition
80% of electrolytes, glucose, amino acids, protein, reabsorbed Hydrogen & creatinine are secreted into filtrate
Term
Loop of Henle
Definition
Important in conserving water, reabsorption continues, Descending loop-reabsorption of H2O, Ascending loop- reabsorption of Na & Cl
Term
Structures of the Upper Urinary Tract
Definition

Kidneys 

Nephrons

Parenchyma

Hilus of kidney

Renal pelvis

Ureter

Term
Structures of the Lower Urinary Tract
Definition

Bladder

Detrusor (smooth muscle bundles in the upper portion of the bladder)

Urethra (sphincter mechanism)

Pelvic muscles (slow-twitch fibers and fast-twitch fibers)

Term
Urethra - Female
Definition

Urine travels from the bladder through the urethra & passes outside the body through the urethral meatus

 

Lined by mucus membranes, bacteriostatic, forms mucus plug

 

Women-1.5-2.5 inches (4-6cm) long, external sphincter allows voluntary flow of urine, prone to infection

Term
Urethra-Men
Definition

Men-Urethra is both a urinary canal and a passageway for secretions form reproductive organs

8 inches (20cm) in length

Term
Nervous Control of the Detrusor Muscle
Definition

Central nervous system

Peripheral nervous system

Sympathetic nervous system

Parasympathetic nervous system

Micturition (peeing) center

Term
Urethral Sphincter Mechanism
Definition

Urethral compression

Bladder filling

Urinary storage

Urethral tension

Supportive structures

 
Term
Act of Urination
Definition

Coordination of cerebral cortex, thalamus, hypothalamus, & brain stem

Normally holds about 600ml

Desire to void when bladder contains a smaller amount (150-200ml in adult)

As bladder volume increases, bladder walls stretch, sending sensory impulses to micturition center

Internal sphincter relaxes so urine can enter urethra
As bladder contracts, nerve impulses travel up spinal cord to the cerebral cortex making you are aware of the urge to void
Term
Factors Influencing Urination
Definition

Disease

Growth & Development

Sociocultural factors

Psychological Factors

Muscle Tone

Fluid Balance

Surgery

Medications

Term
Growth and Development Factors
Definition

Infants & young children cannot effectively concentrate their urine

Older adult: difficulty with urination, GFR declines. Kidney’s ability to concentrate urine declines

Nocturia, urinary frequency

BPH in men

Residual urine (UTI’s)

Term
Sociocultural Factors
Definition

Private toilet facilities (American) communal (Europe)

Social expectations influence time of urination

Must consider cultural, social and gender habits

Term
Psychological Factors
Definition

Anxiety and emotional stress may cause sense of urgency and increase frequency of urination

Need to relax to void

Term
Muscle Tone Factors
Definition

Weak abdominal & pelvic floor muscles impair bladder contraction and control of external sphincter

Prolonged immobility, stretching of muscles, menopausal muscle atrophy, damage from trauma, long term catheter use

Term
Fluid Balance Factors
Definition

Ingested fluids increase body’s circulating plasma volume which increase urine output

 

Increased urine formation: coffee, tea, cola drinks 

 

Caffeine is a bladder irritant as well as a diuretic

 

Alcohol inhibits the release of ADH resulting in increased water loss in urine

Term
Surgical Factors
Definition

Triggers General Adaptation Syndrome ( Increase water reabsorption, reduces urine output

 

Stress response causes increased aldosterone resulting in decreased urine output

 

Anesthetics & narcotics slow GFR decreasing urine output, risk for urinary retention with spinal anesthesia (post-op patients may require hourly urine outputs or if unable to void after surgery, straight catheterization)

 
Term
Medication Factors
Definition

Diuretics prevent reabsorption of water and certain electrolytes to increase urine output

 

Urinary retention caused by antihistamines (Sudafed), antihypertensives (Aldomet), & beta blockers (Inderal)

 

Change color of urine-Pyridium

Term
Alterations in Urinary Elimination
Definition

Urinary Retention

 

Urinary Tract Infections

 

Urinary Incontinence

 

Urinary Diversions

Term
Urinary Retention
Definition

Marked accumulation of urine in bladder as a result of the inability of the bladder to empty

 

Bladder not able to respond to micturition reflex and empty

 

Retention with overflow may develop, small amt of urine escapes, bladder spasms

 

S&S of bladder distention- discomfort, diaphoresis, restlessness

Term
Lower Urinary Tract Infection
Definition

7 million office visits a year

 

Most common nosocomial infection on U.S.

 

Most from catheterization or surgery

 

Bacteria in the urine may lead to the spread of organisms into bloodstream (Urosepsis)

Term
UTI Symptoms
Definition

Pain or burning on urination (dysuria)

 

Fever, chills, n/v, malaise (later signs)

 

Hematuria-irritation of bladder & urethral mucosa resulting in blood-tinged urine

 

Pyelonephritis-infection spreads up to kidney-flank pain, fever

Term
Urinary Incontinence
Definition

Functional

Overflow

Reflex

Stress

Urge - oversensivity

Term
Types of Incontinence - Overflow
Definition

Urethral blockage

 

Bladder unable to empty

Term
Types of Incontinence - Stress
Definition

Relaxed pelvic floor

 

Increased abdominal pressure

Term
Types of Incontinence - Urge
Definition

Bladder oversensitivity from infection

 

Neurologic disorders

Term
Urinary Diversions
Definition

Urinary stoma to divert urine from kidneys directly to abdominal surface

 

Ileal Conduit

 

Continent Pouch – must be catheterized every q hrs.

 

Ureterostomy

 

Nephrostomy

Term
Reasons for Diversions
Definition

Cancer (Bladder, Prostate, Pelvis, Cervix)

 

Radiation injury

 

Vesicovaginal fistula

 

Neurogenic bladder

 

Chronic cystitis

 

Painful Bladder Syndrome/Interstitial Cystitis

Term
Nursing Process - Alterations in Urinary Function
Definition

History

 

Physical Assessment

 

Assessment of Urine

 

Diagnostic Tests

 

Invasive

Term
Physical Assessment
Definition
inspection, percussion, palpation
Term
Assessment of Urine
Definition
color, clarity, odor
Term
Diagnostic Tests
Definition

KUB

 

IVP 

 

renal ultrasound

 

renal CT scan

Term
Invasive
Definition

cystoscopy

 

arteriogram

 

urodymanics

Term
Lifestyle and Prevention
Definition

Initiate pelvic muscle exercise regimen

 

Bladder training for urge incontinence

 

Management of urinary retention

 

Management of functional urinary incontinence

 

Suggest environmental modifications

Term
Urine Specimen Collection
Definition

Random

 

Clean-voided or midstream

 

Sterile

 

Timed specimens (24 hour collection)

Term
Urine Testing
Definition

Uninalysis

 

Specific Gravity

 

Urine Culture

Term
Nursing Diagnosis
Definition

Incontinence

 

Self-Care deficit

 

Skin Integrity

 

Altered Urinary Elimination

 

Pain

 

Body Image Disturbance

Term
Implementation
Definition

Promoting Normal Micturition

Medications

Catheterization (Indwelling vs. straight)

Catheter Irrigations & Instillations

Routine Catheter Care/Perineal Care

Suprapubic Catheterization – 

External Urinary Cathethers (Condom caths)

Female Urinals

Maintaining Skin Integrity

Preventing Infection

Term
Bowel Elimination
Definition

Continence

 

Structures of the Gastrointestinal Tract 

 

Intestinal Motility and Rectal Accommodation

 

Anal Sphincter Mechanism

Term
Continence
Definition

Consistency of the stool (fecal material)

 

Intestinal motility

 

Compliance and contractility of the rectum 

 

Competence of the anal sphincters

Term
Structures of the Gastrointestinal Tract
Definition

Small intestine

 

Ileocecal valve

 

Large bowel (colon)

 

Ileocecal sphincter

 

Anal sphincter

Term
Intestinal Motility and Rectal Accommodation
Definition

Rectal filling 

 

Rectal contractions

 

Rectal accommodation – from “holding it”

 

Postponement of defecation

 

Constipation

Term
Anal Sphincter Mechanism
Definition

Internal and external sphincters

 

Striated muscle fibers

 

Sensory receptors

Term
Factors Affecting Elimination
Definition

Age

 

Diet

 

Exercise

 

Medications

Term
Bristol Stool Form Scale
Definition

Type 1: Separate hard lumps, like nuts (hard to pass)

Type 2: Sausage-shaped, but lumpy

Type 3: Like a sausage but with cracks on its surface

Type 4: Like a sausage or snake, smooth and soft

Type 5: Soft blobs with clear cut edges (passed easily)

Type 6: Fluffy pieces with ragged edges, a mushy stool

Type 7: Watery, no solid pieces. Entirely liquid

Term
Constipation Factors
Definition

Diverticular disease

Neuropathic conditions

Functional limitations

Irregular defecation habits

Laxative abuse/enema abuse

Psychological stress

Diet

Fluid intake

Age

Disease processes

Term
Complications of Constipation
Definition

Bowel obstruction

 

Vagal Response

 

Fecal impaction

 

Hemorrhoids

Term
Fecal Impaction
Definition

Bolus of hardened stool

 

Further slows colonic transit time and passage of further fecal contents

Term
Primary Causes of Diarrhea
Definition

Malabsorption syndromes

 

Inflammatory bowel disease

 

Short bowel syndrome

 

Side effects of drugs

 

Laxative or enema misuse

 

Infectious diarrhea is caused by a pathogen

Term
Flatulence Treatment
Definition

Decreased amt of swallowed air:

Carbonated beverages, Straws, Gum, Hard candies

 

NGT for decompression of abdomen

Term
Bowel Incontinence
Definition

Dysfunction of the anal sphincter

 

Disorders of the delivery of stool to the rectum

 

Disorders of rectal storage

 

Anatomic defects

Term
Factors affecting GI Elimination
Definition

 

Age, Diet

Fluid Intake

Mobility/Immobility

Psychological Consideration

Life-style Considerations

Medications

Diagnostic Procedures

Anesthesia and Surgery

Pathologic conditions

Irritants

Pain

 

Term
Nursing Process Alterations in Bowel Function
Definition

History

 

Physical Examination

 

Diagnostic and Laboratory Data

Term
Health History
Definition

Elimination habits

 

Type of incontinence

 

Complicating factors

 

Bladder and bowel management strategies used by client

Term
Physical Examination
Definition

Mental status

Mobility and dexterity

Inspection of perineum for skin integrity

Inspection of vaginal vault 

Pelvic support

Perineal sensation

Perianal area, digital rectal exam

Term
Diagnostic and Laboratory Data
Definition

Urinalysis

 

Stool culture

 

Defecography

 

Anorectal ultrasonography

Term
Nursing Diagnoses
Definition

Constipation

 

Perceived Constipation

 

Diarrhea

 

Bowel Incontinence

Term
Other Nursing Diagnoses
Definition

Low Self-Esteem

 

Deficient Knowledge

 

Risk for Infection

 

Risk for Impaired Skin Integrity

 

Toileting Self-Care Deficit

Term
Maintain Elimination Health Implementation
Definition

Fluid intake

 

Diet

Term
Lifestyle and Prevention Implementation
Definition

Alcohol and tobacco use

 

Stress management

 

Weight reduction

 

Elimination habits

 

Positioning

Term
Medication Implementation
Definition

Over the Counter (OTC)

 

Prescription 

Term
Enema Implementation
Definition

Cleanse the lower bowel

 

Assist in evacuation

 

Instill medication

Term
Evaluation
Definition

Client’s level of maintenance or restoration of elimination patterns and return to an appropriate level of independence

 

Prevention of skin breakdown and infection 

 

Client understanding of procedures and self-care

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