SLO: Urinary Elimination
Questions 2, 5, 8
- Describe the process of urination.
- Identify factors that commonly influence urinary elimination.
- Growth and development – children cannot voluntarily control voiding until 18-24 months, older adults may experience a decrease in bladder capacity
- Sociocultural factors – cultural and gender norms vary north Americans expect private bathrooms some cultures accept communal toilet facilities, social expectations can interfere with timely voiding
- Fluid intake – increased fluid increases urine production when electrolytes are balanced, alcohol decrease antidiuretic hormone and increases urine production
- Pathological conditions – DM, multiple sclerosis, and stroke can alter bladder contractility and ability to sense bladder filling. Prostatic enlargement can cause obstruction of bladder outlet causing urinary retention
- Medications – diuretics increase urinary output by preventing resorption of water and certain electrolytes, some drugs can change the color of urine. Hypnotics and sedatives may reduce the ability to recognize and act on the urge to void.
- Compare and contrast common alterations in urinary elimination.
- Identify nursing diagnoses appropriate for patients with alterations in urinary elimination.
- Describe characteristics of normal and abnormal urine .
- Normal – ranges from a pale straw color to amber depending on the patient’s fluid intake and urine concentration, urine appears transparent at voiding. Normal urine will appear cloudy if left standing.
- Abnormal – bleeding from the kidneys or ureter can cause dark red urine, some medications and foods can also change the color of urine. A patient with renal disease will have cloudy or foamy urine upon urination. DM or starvation can cause urine to have a sweet or fruity odor from the acetone
- Describe the nursing implications of common diagnostic tests of the urinary system.
- Discuss nursing measures to promote normal micturition and reduce episodes of incontinence.
- Discuss nursing measures to reduce urinary tract infection .
- Using infection control principles help prevent the development and spread of UTS. Following medical asepsis when carrying out procedures involving the urinary tract or external genitalia. Providing perineal hygiene is an essential component of care. Use proper hand hygiene at all times.
Bob Clark is a 70-year-old patient who had a total hip replacement today; he is now on the orthopedic unit in stable condition. Mr. Clark had been having pain in his hip for the past 6 months and took NSAIDs for pain. He has a history of hypertension that is treated with a combination antihypertensive and diuretic drug. He also takes a multivitamin daily. He has been using a walker for the last 2 months to help him ambulate. Mr. Clark has an order for morphine 2 mg IV q4h prn. He had a dose 30 minutes ago. Jared Carr is a student nurse who has been assigned to Mr. Clark. Jared works as a nursing assistant at the organization. Jared assesses Mr. Clark and finds that his pain is now rated a 3 on a scale of 1 to 10. He has an IV running at 100 ml/hr. Jared asks Mr. Clark if he has urinated since he returned from surgery, and Mr. Clark tells him that he has not. Jared asks him if he feels the need to urinate. Mr. Clark tells Jared that he does not.
- What assessment should Jared do to determine whether Mr. Clark has a full bladder?
Jared can use a bladder scanner to see if the bladder contains any fluid assess if the bladder is distended
- Jared finds that Mr. Clark does have a distended bladder and wants to help Mr. Clark urinate. What interventions would be helpful? Select all that apply.
A. Provide privacy.
B. Provide adequate fluid intake.
C. Place a urinal for Mr. Clark.
D. Turn on the water.
- Mr. Clark is still unable to urinate 8 hours after surgery. Jared is now to catheterize Mr. Clark with a straight catheter. What is the most important principle for Jared to apply to the procedure?
Answer: The most important principle to apply is to maintain sterilization at all times and following procedure guidelines to maintain patient safety
- Once Jared has finished with the catheterization procedure, he tells Mr. Clark to report any signs that may indicate a urinary tract infection (UTI). What signs should Jared tell Mr. Clark to report? Select all that apply.
A. Frequency of urination
B. Burning upon urination
C. Cloudy urine
D. Odor to urine
E. Blood in urine
SLO: Bowel Elimination
Questions 5, 8
- Discuss the role of gastrointestinal organs in digestion and elimination.
- Describe three functions of the large intestine.
- Explain the physiological aspects of normal defecation.
- Discuss psychological and physiological factors that influence the elimination process.
- Describe common physiological alterations in elimination.
- Prolonged emotional stress alters the digestive system. During emotional stress the digestive process is accelerated, and peristalsis is increased. Side effects include diarrhea and gaseous distension. Many diseases of the GI tract are exacerbated by stress. If a person becomes depressed the autonomic nervous system may slow impulses that decrease peristalsis resulting in constipation.
- List nursing diagnoses related to alterations in elimination.
- Describe nursing implications for common diagnostic examinations of the gastrointestinal tract.
- List nursing interventions that promote normal elimination.
- Helping patients who have a difficulty sitting, place an elevated seat on the toilet or a bedside commode when patients are unable to lower themselves to a sitting position. Assist patients to a comfortable position on a bedpan, bedpan must be high enough so feces enter it. Using medications to help the patient initiate and facilitate stool passage.
- List nursing interventions included in bowel training.
George Miller, a 68-year-old male who had a stroke 6 months ago, comes to the urgent care clinic complaining of abdominal pain and nausea. He lives alone in an assisted living complex. He was never married, and his only relative is a 70-year-old sister who visits him two to three times a week. She is independent and concerned that Mr. Miller is doing okay. Mr. Miller uses a quad cane to ambulate because of hemiplegia on his left side and eats his meals in the central dining room at the complex. The complex has no licensed health care workers. Sally Schmitt, a nursing student, is assigned to the urgent care clinic. Her assignment is to perform an initial assessment on Mr. Miller with the acute care nurse practitioner (ANP). While Sally takes his history, Mr. Miller tells her that he has not had a bowel movement in 4 days. On physical examination, Mr. Miller’s abdomen is hard and he has hyperactive bowel sounds. The ANP determines that Mr. Miller has constipation and has a fecal impaction.
- Sally is to remove the impaction from Mr. Miller. Sally knows that it is not good for Mr. Miller to strain for a bowel movement. Why could straining cause concern for Mr. Miller?
Answer: straining while having a bowel movement causes the veins in the folds of the intestine to become distended from pressure. This distention results in hemorrhoid formation.
- Mr. Miller is also to have a tap water enema to promote bowel evacuation. After getting her equipment ready, Sally should position Mr. Miller in what position on the table?
A. Right side-lying position with his left knee flexed
B. Right side-lying position with his right knee flexed
C. Left side-lying position with his right knee flexed
D. Left side-lying position with his left knee flexed
- Mr. Miller’s sister has come with him to the urgent care clinic and asks Sally what could have caused Mr. Miller to get so constipated? Sally should explain that constipation can be caused by which factors? Select all that apply.
A. Ignoring urge to defecate
B. Low-fiber diet and low fluid intake
D. Depression or cognitive impairment
F. Lack of regular exercise