Health Medical
Harvard University Fundamentals of Nursing Urinary Elimination Discussion

Harvard University

Question Description

I’m working on a Nursing question and need guidance to help me study.

Discussion #1:

1) Case Studies for Bowel Elimination:

Pt is a 72-year-old female who complains of abdominal fullness and pain in her LLQ. She has not had a bowel movement for 6 days, and she states that this is not her normal bowel regimen. She lives in an extended care facility and has a history of hypertension, Parkinson's disease, and arthritis. She is currently taking carbamazipine to control her Parkinson's disease. She is non-ambulatory, however, is able to sit in a Cadillac chair with assistance. She admits to a loss of interest in food and doesn't like the taste of the water provided.

Questions:

A. Identify the risk factors that lead to the development of the problem.

B. Give at least five nursing intervention to promote bowel elimination

2) Describe urinary retention, factors causing retention, complications of urinary retention, signs, and symptoms of urinary retention. Give a nursing assessment and interventions of urinary retention with goals and outcomes of urinary retention.

Discussion #2:

Using Chapter 48 PDF, answer the following questions.

1. Because of the foul-smelling tan-colored drainage from Mrs. Stein's hip incision, the staples were removed by the health care provider, and an order was written for moist saline gauze dressing to the area 3 times a day. When the dressing is removed, which factors are critical to assess?

2. A head-to-toe skin assessment is done per institutional policy each shift or on a daily basis. At the most recent assessment of Mrs. Stein's skin, blistering was noted over the sacral area; on direct examination it was a small area of denuded tissue with redness around the blistered area. The area was found to have minimal depth and a red, moist base. How would you describe the impairment in skin integrity in your charting?

3. What will you include in your plan of care for Mrs. Stein to address the impairment in skin integrity in the sacral area?


Answers must be in complete sentences and in APA format.

Unformatted Attachment Preview

FUNDAMENTALS OF NURSING Reduction of Risk Potential: Urinary & Bowel Elimination Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 1 Chapter 33: Urinary Elimination Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 2 Urinary Elimination  Depends on the function of kidneys, ureters, bladder, and urethra  Organs must be functional for successful of urinary waste  Normal urine production is 1 to 2/L per day  Urine is 95% water and 5% solutes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 3 Organs Kidneys Nephrons remove waste products and regulate water and electrolyte balance Ureters Carry urine to bladder Bladder Reservoir for urine When empty, lie in the pelvic cavity below the symphysis pubis Urethra Urine passes from the bladder through the urethra and passes it outside the body via urinary meatus Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 4 Organs: Female & Male Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 5 Factors Affecting Urinary Elimination  Lifestyle Factors    Nutrition and fluids (sodium encourages retention)   Diuresis: increased formation and excretion of urine o o Drinks with caffeine (coffee, tea, some carbonated drinks) Alcoholic beverages (especially beer)  Psychosocial  Activity and exercise Developmental Factors   Childhood Adolescents and young adults Middle and older adults Physiological Factors    Cognitive impairment Neuromuscular disease Impaired mobility Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 6 Altered Urinary Functioning Terms to Know  Anuria  Incontinence  Dysuria  Nocturia  Enuresis  Oliguria  Frequency  Polyuria  Glycosuria  Pyuria  Hematuria  Retention  Hesitancy  Urgency  Frequency  Proteinuria Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 7 Geriatric Considerations Decreased ability of kidneys to concentrate urine and decreased bladder capacity = nocturia  Decreased muscle tone of bladder = increased frequency  Decreased bladder contractility & stasis = increased frequency of UTI  Changes in cognition and mobility (in some) = increased incontinence issues  Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 8 Common Urinary Elimination Problems Retention Urinary Tract Infection Incontinence Accumulation of urine in bladder 80% of hospitalized acquired UTIs Temporary or permanent loss of control over voiding Bladder unable to partially or completely empty E. coli Bacteriuria Bacteremia Urosepsis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 9 Urinary Diversion Continent Urinary Diversion Incontinent Diversion Continent urinary reservoir Surgery involves connecting the ureters to a section of the ileum and forming a stoma on the abdominal wall Orthotopic neobladder Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 10 Nursing Knowledge Base   Infection control and hygiene  E. coli is the common cause  Use medical and surgical asepsis Developmental considerations   Age related changes can contribute to the development of voiding problems Psychosocial implications  Self-concept, culture, and sexuality are affected with elimination problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 11 Assessment  Nursing History  Patterns of urination  Symptoms of urinary alterations  Factors affecting urination  Medication  Mobility usage status  Environmental  Sensory  Past barriers restrictions illnesses, surgery, urinary diversion  Fluid intake  Age Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 12 Laboratory & Diagnostic Testing  Specimen Collection  Urinalysis  Sterile specimen  24-hour  Urine specimen culture Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 13 DIAGNOSTICS   Noninvasive  Plain film KUB or flat plate of the abdomen  Intravenous pylogram (IVP)  Computerized axial tomography (CAT) scan Invasive  Endoscopy  Urodynamic testing Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 14 Assessment: Lab Results Urinalysis- WBC, RBC, protein, glucose, bacteria = abnormal constituents  BUN (blood urea nitrogen) end product of protein metabolism… 10-20 mg/dL  Increased BUN (azotemia) signifies impaired kidney function… affected by diet (hi protein intake) and fluids (dehydration)  Decreased BUN signifies impaired liver function  Many drugs elevate BUN! (e.g., Antibiotics, Lasix) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 15 Assessment: Lab Results  Serum Creatinine - by product of muscle metabolism…excreted entirely by kidneys… Normal = 0.5-1.2 mg/dL Increased levels signify renal impairment  BUN: Creatinine ratio- 20:1… when both rise together indicates kidney failure or disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 16 Normal vs Abnormal Urine  NORMAL URINALYSIS RESULTS              APPEARANCE: Clear COLOR: Amber yellow ODOR: Slight ammonia pH: 4.6 – 8.0 PROTEIN: 0 – 8mg/dl SPECIFIC GRAVITY: 1.005 – 1.030 LEUKOCYTES: Neg NITRITES: Neg KETONES: Neg CRYSTALS: Neg GLUCOSE: Neg RBC: Neg WBC: Neg Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 17 Normal vs Abnormal Urine  Abnormal Findings  Increased pH  Respiratory  Gastric or metabolic alkalosis suctioning  Vomiting  UTI  Decreased pH  Metabolic acidosis  Diabetes  Diarrhea  Respiratory acidosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 18 Normal vs Abnormal Urine  Increased protein  DM  CHF  Pre-eclampsia  Glomerulonephritis  Polycystic  disease Decreased protein  Lupus  Heavy-metal  Bladder poisoning tumor Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 19 Normal vs Abnormal Urine  Increased Specific Gravity  Dehydration  Glycosuria, proteinuria  Fever  Vomiting  Diarrhea  Decreased Specific Gravity  Over-hydration  Renal failure  Hypothermia  Pyelonephritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 20 Normal vs Abnormal Urine  Increased RBCs  Glomerulonephritis  Acute tubular necrosis  Cystitis  Traumatic  catheterization Increased WBCs  Bacterial infection in the urinary tract  Glomerulonephritis  Acute pyelonephritis  Lupus Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 21 Medications Affecting Color of Urine  Anticoagulants — red color  Diuretics — lighten urine to pale yellow  Pyridium — orange to orange-red urine  Elavil — green or blue-green  Levodopa — brown or black Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 22 Physical Assessment  Skin and Mucosa  Kidneys  Bladder  Urethral Meatus  Intake and Output  Characteristics of Urine  Color  Clarity  Odor Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 23 Diagnosis of Medical Problems  history and physical examination  urinalysis - determines the presence of blood or infection  cystoscopy - determines if abnormalities exist  post void residual - measures amount of urine that remains in the bladder after voiding  stress test - determines if urine leaks after bladder is stressed when coughing, lifting, bearing down Remember the reversible causes of urinary incontinence using the mnemonic D.R.I.P. D elirium R estricted mobility (or Retention [urinary]) I nfection (or Inflammation or Impaction [fecal]) P harmaceuticals (or Polyuric states) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 24 Focused Assessment  For Urinary Incontinence    Defining characteristics For Urinary Retention  Defining characteristics o Stress incontinence o Cannot void, feels full o Urge incontinence o Overflow incontinence o Functional incontinence o Reflex incontinence o Postsurgical clients o Total incontinence o Indwelling catheter recently removed o Obstruction  Related factors Related factors o Muscle function o Bladder infection o Impaired ability to recognize cues o Invasive procedures/ medications o Environmental barriers  For Risk of Infection  Prevent Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 25 Urinary Elimination: Dysfunctions  Urinary Incontinence: involuntary release of urine  Types  Stress Incontinence: sudden increase in intraabdominal pressure, such as sneezing or coughing, causes urine to leak from bladder  Overflow (Reflex) Incontinence: bladder empties incompletely, so urine dribbles constantly  Urge Incontinence: uncontrolled contraction of the bladder results in leakage of urine before one reaches the bathroom  Functional Incontinence: incontinence not due to organic reasons; for instance, altered access to toilet, impaired mobility or dexterity may prevent the client from reaching the bathroom in time Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 26 Nursing Diagnosis  Disturbed body image  Functional urinary incontinence  Reflex, stress or urge urinary incontinence  Risk for infection  Deficient knowledge  Toileting, self-care deficit  Impaired skin integrity  Impaired urinary elimination  Urinary retention Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 27 Planning  Goals and outcomes  Setting priorities  Continuity of care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 28 Implementations are Focused on:  Health Promotion  Maintaining adequate fluid intake  Maintaining elimination habits  Stimulating the micturition reflex  Strengthening pelvic floor muscles  Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 29 Goals/ Outcomes  Promotion of Normal Elimination  Urination  adequate fluid intake  normal urinary output: 50 to 60 mL/hour for adults (1 to 2 mL/kg/hr for infants and children). At least 30 – 50 mL/hr.  alternative methods to promote client voiding such as running water Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 30 INTERVENTIONS  Nursing Interventions  provide appropriate skin care and protective undergarments  establish toileting schedule - provide easy access to bathroom and privacy  teach client Kegel exercises  stop and start urinary stream while voiding  hold contraction of perineal muscles for 10 seconds and relax for 10 seconds  work up to 25 repetitions three times a day Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 31 Interventions to Promote Urinary Continence  Establishing continence    Maintaining dry and intact skin    Pelvic muscle exercises: Kegel exercises Bladder retraining External catheters Managing bowel elimination Cognitively impaired client    Scheduled toileting and prompted voiding Patterned urge response training Environmental modifications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 32 Interventions to Relieve/Prevent Retention   Promoting Urination  Fluid management: daily intake 1500 to 2000 mL  Enhancing stimulus to void o Privacy o Adequate time o Comfort Using Catheters  Catheterization  Managing urethral catheters o Maintaining comfort, patency o Relieving bladder spasms Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 33 Rationale for Interventions    To Irrigate the Bladder  To maintain patency  Closed irrigation system: 3-lumen catheter  Opening the system To Manage a Urinary Diversion  Tracking the urine flow  Observing for signs of peritonitis or hemorrhage, decrease in vital signs To Manage Urinary Tract Infection  Increasing fluid intake  Instructing patient in preventive measures Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 34 TREATMENT  Pharmacologic  Antispasmodics & Anticholinergics- relax and increase capacity of the bladder, e.g. Ditropan, Pro-Banthine  Alpha-Adrenergic Agonists - increase urethral resistance  Antibiotics - work against infection, e.g. Bactrim, Levaquin, Cipro  Diuretics - increase urinary output e.g., Lasix, Diuril  Kegel Exercises - strengthen weak muscles of the pelvic floor  Behavioral Training - client learns different way to control urge to urinate  Bladder Retraining - scheduled periods to empty bladder throughout the day  Surgery - repair of weakened or damaged pelvic muscles or urethra Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 35 General Concepts that will be Discussed:  Types of Different Catheterization Procedures  Catheter Insertion  Routine Catheter Care  Catheter Removal  Preventing Infection  Maintenance of Skin Integrity Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 36 Urinary Catheterization Catheter  This is a flexible tube that can be inserted into a vessel or cavity of the body to withdraw or instill fluids.  Most catheters are made of soft plastic or rubber.  Catheters may be used for treatment or diagnosis.  Catheterization of the bladder involves introducing a urinary catheter through the meatus and urethra and into the urinary bladder. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 37 Urinary Catheterization Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 38 Urinary Catheterization Maintaining Adequate Urinary Drainage  Urinary catheters may be introduced into the bladder, ureter, or kidney.  The type and size of urinary catheter used are determined by the location and cause of the urinary tract problem.  Catheters are measured by the French system (Fr).  Urethral catheters range in size from 14 to 24 Fr for adult patients.  Ureteral catheters are usually 4 to 6 Fr and must be inserted by a physician. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 39 Types of Catheters  Coudé Catheter   Foley Catheter   Used to drain urine from the renal pelvis of the kidney Robinson Catheter   Designed with a balloon near the tip so that the balloon may be inflated after insertion, holding the catheter in the urinary bladder for continuous drainage Malecot, Pezzer, and Mushroom Catheters   Selected for ease of insertion when enlargement of the prostate gland is suspected Has multiple openings in its tip to facilitate intermittent drainage Ureteral Catheter  Are long and slender to pass into the ureter Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 40 Types of Catheters  Whistle-Tip Catheter  Has a slanted, larger orifice at its tip to be used if there is blood in the urine  Cystostomy, Vesicostomy, or Suprapubic Catheters  Introduced through the abdominal wall above the symphysis pubis  Used to divert urine flow from the urethra to treat injury to the bony pelvis, urinary tract, or surrounding organs; strictures; or obstructions  Inserted  via a surgical incision or puncture of the abdomen and bladder walls with a trocar Condom Catheters  This device is not a catheter but a drainage system connected to the external male genitalia.  It is used for the incontinent male to minimize skin irritation from urine. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 41 Types of Catheters (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.) Different types of commonly used catheters. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 42 Urinary Catheterization  Purposes  relieve acute urinary retention  relieve chronic urinary retention  dilate or prevent narrowing of some portions of the urinary tract  drain urine preoperatively, postoperatively, or post procedure  determine amount of post void residual  accurately measure urine output in the critically ill  obtain sterile urine specimen  continuous or intermittent bladder irrigation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 43 Urinary Catherization: General Guidelines Indwelling Urethral Catheter  use a closed drainage syste ...
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Discussion#1
Diet plays a significant role when it comes to bowel elimination from the body as the
patient was not taking fiber-containing foods or fluids leading to constipation hence the
difficulty in bowel elimination. Age also contributes because it affects the elimination
process as it slows it down and the ability to control the process due to weak nerves and
muscles. Lack of exercise is also a factor as the patient is non-ambulatory hence bowel
movement and elimination are slowed down. Lastly, health issues act as a risk to the
development of problems as the patient experiences pains and a disorder in the central
nervous system movement.
The nurse can administer medication to allow easy bowel movement along the track
and its elimination from the body. Encouragement to take more fluids like water could help to
speed up the process. The patient should also be encouraged to take food rich in fibre in their
diet as it absorbs water and adds bulk and softness to stool preventing constipation. Motivate
the patient to do exercises within their health level as it improves the muscle toe, thus
promoting bowel elimination.
Urinary retention is the difficulty experienced when urinating thus emptying the
bladder. The holding of urine intentionally is the primary factor causing urinary retention.
Other factors like weak urinary bladder muscles, failure of the nerve system to allow
communication between the bladder and brain and presence of infections like bladder stones
could highly contribute to the disease. Signs and symptoms may include; inability to feel
when the bladder is full, difficulty in beginning urinating and fully emptying the bladder,
with loss of small portions of urine in between the day. Complications can be experienced if
urinary retention disorder is not early...

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