Renal System: Urinary Diversions Quiz

Renal System: Urinary Diversions

• Urinary diversions can be temporary or permanent and involve the creation of a stoma using a section of intestine
• Continent diversions include:
  • Continent urinary reservoir: patient must self-catheterize for the rest of their life and has control
  • Orthotopic neobladder: ileal pouch replaces the bladder and the patient voids through the urethra
• Incontinent diversions include:
  • Ureterostomy: requires a collection pouch and the patient has no control
  • Nephrostomy tubes: tubes come out of the back from the kidneys and are used when the ureters are obstructed

Basic GI Anatomy and Function

• Factors that affect bowel elimination in patients include:
  • Age
  • Fluid intake
  • Position during defecation
  • Pregnancy
  • Medications
  • Diet
  • Physical activity
  • Pain
  • Mobility

Bowel Elimination Vocabulary

• Constipation: a symptom characterized by infrequent stools or hard, dry, and small stools
• Impaction: unrelieved constipation resulting in a collection of hardened feces wedged in the rectum
• Diarrhea: an increase in the number of stools or unformed feces
• Incontinence: inability to control feces
• Flatulence: accumulation of gas in the intestines causing the walls to stretch
• Hemorrhoids: dilated veins in the lining of the rectum

Bowel Diversions

• Ileostomy/colostomy: surgical opening of the ileum or colon
• Types of colostomy include:
  • Sigmoid colostomy: more formed stool
  • Transverse colostomy: thick liquid to soft consistency stool
  • End colostomy: usually on the left side, colon is severed and brought to the skin
  • Loop colostomy: reversible stoma, 2 openings
• Antegrade continence enema: enema through a catheter in the abdominal wall (some pediatrics)
• WOCN: Wound Ostomy Continence Nurse

Diagnostic Exams

• Colonoscopy: surgery of the lower GI tract (large intestine, colon, and rectum)
• Endoscopy: surgery of the upper GI tract (esophagus, stomach, and small intestine)
• Barium swallow: examination of the motility of the GI tract
• CT and MRI scans: diagnostic imaging tests
• Fecal specimens: tests for bowel function and disorders

Cathartics, Laxatives, and Antidiarrheals

• Cathartics: stronger and more rapid effect on the intestines than laxatives and suppositories
• Laxatives: empty the bowel (not long-term use)
• Overtaking cathartics and laxatives may cause impaired bowel motility and decreased response to sensory stimulus
• Cathartics and laxatives are used for GI tests, surgery, and constipation
• Antidiarrheals: treat the cause (specific) or symptoms (nonspecific) of diarrhea

Enemas

• Cleansing enemas: promote complete evacuation of feces from the colon
• Types of enemas include:
  • Tap water enema: hypotonic, lower osmotic pressure than fluids
  • Normal saline enema: isotonic, same osmotic pressure as fluids
  • Hypertonic solutions enema: pulls fluid out, beneficial for patients unable to tolerate large volumes of fluid
  • Soap suds enema: causes intestinal irritation to stimulate peristalsis
  • Oil retention enema: lubricates the feces to make it easier to pass
  • Carminative and kayexalate enema: relieves gaseous distension and causes diarrhea to bring potassium down
  • Digital removal of stool: last resort