Bladder And Bowel Elimination .pdf

Bladder and bowel elimination  Bladder Bowel Stretch receptors simulated at Not a specific Normal it can Normal 250-400 mL ⑪ depend on the pers...

Bladder and bowel elimination  Bladder Bowel Stretch receptors simulated at Not a specific Normal it can Normal 250-400 mL ⑪ depend on the person/ elimination Voluntary control and dictated should be soft and Hard 8 by intact nerve conduction Diet should include fiber Irregular eating patterns Fluid and food intake ↳ Spicy foods in high sugars can Muscle tone lead to diarrhea Factors Surgical and diagnostic procedures Activity affecting Medication Pain Medication‘s Age, arteriosclerosis, Age Risk factors chronic conditions, Sex surgery, genetics Chronic illness Immobility Polyuria: production of abnormally, large Diarrhea: the passage of liquid feces with amounts of urine ⑪ increased frequency, results in loss of fluid can Polydipsia: compulsive intake of excessive lead to dehydration * amounts of fluid & Flatulence: presence of excess gas leading to Alterations Anuria: less than 100 mL a day (no urine) ⑪ inflation and bloating 3 Oliguria: less than 400 mL a day ( low urine Diverticulitis: results form inflamed diverticula can obstruct bowel output) & Bowel obstruction: occurs when the contents Frequency: urinating often & of the intestine are unable to move through Urgency: got to go & "got to go" ⑧ the intestine Nocturia: 2 or more times a night & G Dysuria: trouble urinating & S Hesitancy: hesitate to urinate I Neurogenic bladder: can’t sense the feeling & to urinate hesitate to void - Neurogenic Bladder - & disruptide (can't sense) We want 30 m/hr nI continence is 3-/m)/kg/hr · 0. void at least 6 hours a day * never normal or 4-10 times a day D U Regent 10 , 10, 15 G  Observation and Patient Interview Look for: Anxiety, odor, and absorbent items Voiding Pattern _______? Description of urine? Urinary Elimination problems? Investigate other factors influencing urinary elimination Physical Examination Palpation of abdomen Flank Pain Skin Turgor Inspection of any urine or fecal material Genitalia Diagnostic Tests Urine Studies _______ Bladder ____: scan Evaluates bladder emptying Radiologic Examinations such as retrograde pyelography Cystoscopy: Allows for direct visualization of bladder wall Imaging: KUB radiograph, CT, MRI, US, etc. Kidney Biopsy Independent Nursing Interventions Monitoring Intake & Output Catheter Care Incontinence Care Urine Specimen Collection Patient Teaching Collaborative Therapies Treatment team can consist of many members Referrals may need to be made Pharmacologic therapy can be initiated ______ can also be used for severe injury or disease dialysis progression  Anticholinergics Cholinergics (Muscarinic Agonists) (Muscarinic Antagonists) Examples: oxybutynin Examples: bethanechol MOA: blocks receptors in the detrusor muscle MOA: Stimulate bladder contraction and of the bladder, preventing contractions and assist with voiding via relaxation of the urge to avoid trigone & sphincter muscles Adverse Effects: Blurred vision, constipation, Adverse Effects: cramping and other GI dry mouth, anhidrosis, photophobia, dry symptoms, diaphoresis, headache, eyes, tachycardia, hallucinations, nausea, bradycardia, hypotension, confusion,… bronchoconstriction,… –Mnemonic: Can’t See, Can’t Pee, Can’t Spit, Nursing Considerations: Do not give if Can’t… poop patient has GI or urinary tract Nursing Considerations: Contraindicated if obstruction, asthma, bradycardia, patient has urinary retention, gastrointestinal hypotension, or Parkinson Disease. problems, and with uncontrolled narrow- –Can alter liver panel. angle glaucoma. –Take on empty stomach. –Avoid use in older adults. –Can interact with antihistamines, –Increase dietary fiber and consume 2-3 L/day tricyclic antidepressants, and of fluid from beverage/food sources phenothiazines Dialysis A semipermeable membrane is used to filter blood by osmosis per patient schedule Hemodialysis: Blood flows through external machine –Be careful with limb restriction! Peritoneal: Solution is instilled into abdomen and rests there while molecules exchange and then it is drained Newborns Lower glomerular filtration rate (GFR) Smaller structures Improves at 3 months Pregnant Women Void within 24 hours Varies across trimesters Initial void may be cloudy Glycosuria may be present Toddlers and Preschoolers Postpartum risks too ____ years old –Esp considering increased UO Control between 2-5 Day control first Accidents happen Older Adults Front to back! Declining renal function –Inability to concentrate urine School-Age Blood flow to kidneys decreases Maturity Impaired excretion of drugs Diurnal enuresis Structural Changes –5-6 yo Nocturnal enuresis –7 yo  Bowel Elimination Formation and expulsion of _____ Seces Complex, retains nutrients and removes waste Bowel elimination patterns are highly individualized Alterations can have a large amount of variability in severity - I Factors Affecting Bowel Factors Affecting Elimination Bowel Elimination dief should contain bulk/fiber _____ _____ intake of 2,000-3,000 Low-residue foods move slowly mL/daily through alimentary canal The body will reabsorb fluid Irregular eating schedules can alter even if intake is low –Hard feces will result patterns Spicy foods and high sugar foods can If there is an excess in lead to diarrhea chyme, stool will be softer or more watery Other Factors Affecting Bowel Elimination Activity _______ Defecation Habits Alterations and Manifestations Psychologic Factors _______ diarrhea is the passage of liquid feces with increased Medications frequency Diagnostic Procedures There is a rapid passage of chyme and a loss of fluid & Anesthesia and surgical procedures electrolytes Pathologic conditions Control maybe difficult & skin breakdown may result Pain Electrolyte imbalances can be dangerous - Alterations and Alterations and Manifestations Manifestations Flatulence is the presence of excess ________ gas leading to inflation & stretching Diverticula_______ ________ disease Alterations and results from of intestines Most gas absorbed through intestinal inflammation of Manifestations bowel ________occurs _______ obstruction capillaries diverticula Excess most often caused by food, when the contents of the Most patients with intestine are unable to surgery, or narcotics diverticula are If it cannot be expelled through anus, move through the intestine patient may need rectal tube asymptomatic Obstructions can be Inflamed diverticula can mechanical or functional compress arteries, Paralytic ileus can result from surgery or medication obstruct the bowel, Obstructed bowels distend perforate, and bleeding and necrosis or perforation can result can result  Nursing Assessment Risk Factors Observation and Patient History Age –Demeanor and clothing Sex –Defecation pattern –Description of feces/changes illness Chronic ________ –Problems Immobility –Factors influencing defecation Aids, diet, fluid, exercise, medications, stress Modifiable Risk Factors –Ostomy? Healthy Weight Physical Examination Exercise Ausculate palpate, percuss –Inspect, _________, Good toileting habits –Be very careful with pressure during palpation Avoid tobacco Diagnostic tests Adequate fluid intake –Blood & fecal tests, endoscopy, biopsy, and imaging Hygiene care Food Preparation Screening ___________! endoscopy Be thorough with patient interview Antidiarrheal Examples: loperamide Newborns and Infants MOA: blocks action of acetylcholine, Meconium slowing motility of the intestines Immature intestine Adverse Effects: Electrolyte imbalance No blood with prolonged use Toddlers Nursing Considerations: Avoid using in Control begins at _______ patients with severe dehydration, liver/ School-Age Children/ renal disorders, or glaucoma Adolescents –Patients should seek care if diarrhea doesn’t improve within 2 days, fever develops, or dehydration occurs Pregnant Women Prokinetic Agents Progesterone Examples: metoclopramide Enlarging Uterus Gastric Reflux MOA: Augments acetylcholine, Hemorrhoids increasing upper GI motility and Sluggish postpartum peristalsis Adverse Effects: Tardive dyskinesia, Older Adults extrapyramidal symptoms, Almost ____ experience constipation! restlessness, anxiety, sedation, Poor intake, reduced activity, and medications diarrhea, increased seizure risk Nursing Considerations: Use cautiously with older adults and children –Don’t use with bowel obstruction, perforation, hemorrhage  Stool Softeners/Surfactant Stimulant Laxatives Laxatives (Cathartics) Examples: docusate sodium Examples: bisacodyl, senna MOA: Lowers surface tension of stool so that water MOA: Stimulates intestinal can penetrate, soften, and allow for easier passing peristalsis and increases the Adverse Effects: Electrolyte imbalance with volume of water and prolonged use electrolytes in intestine Nursing Considerations: Bowel movement should Adverse Effects: Stomach occur within 3 days discomfort, nausea, diarrhea, –Don’t use with bowel obstruction cramps, and fluid & electrolyte loss Nursing Considerations: Bowel Osmotic Laxatives movement should occur within Examples: magnesium hydroxide, lactulose 12 hours MOA: Draws water into intestine to increase –Don’t take within 1 hour of milk mass of stool and stretching of musculature or antacid (causing peristalsis) –Avoid with bowel obstruction Adverse Effects: Abdominal cramping, diarrhea, fluid & electrolyte imbalance, Bulk-Forming dehydration Laxatives Nursing Considerations: Bowel movement Examples: psyllium should occur within 3 days. May interact with MOA: Supplemental fiber to soften some antibiotics. fecal mass and increase bulk –Don’t use if pregnant or breastfeeding Adverse Effects: Increased –Don’t use with bowel obstruction bloating, abdominal pain, obstruction (esophageal as well!) Nursing Considerations: Try to Opioid Antagonists take 2 hours before or after other Examples: naloxegol meds MOA: Blocks the opioid mu –Sufficient water (8 oz at least)! receptors in GI tract Adverse Effects: abdominal pain, nausea, vomiting, diarrhea, and flatulence Nursing Considerations: Slight chance for opioid withdrawal symptoms/poorer pain control