Urinary Elimination

SLO

Week 9

Spring, 2015

46

SLO: Urinary Elimination

Questions 2, 5, 8

OBJECTIVES

1. Describe the process of urination.
2. Identify factors that commonly influence urinary elimination.
1. Growth and development – children cannot voluntarily control voiding until 18-24 months, older adults may experience a decrease in bladder capacity
2. 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
3. Fluid intake – increased fluid increases urine production when electrolytes are balanced, alcohol decrease antidiuretic hormone and increases urine production
4. 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
5. 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.
3. Compare and contrast common alterations in urinary elimination.
4. Identify nursing diagnoses appropriate for patients with alterations in urinary elimination.
5. 
   Describe characteristics of normal and abnormal urine .
1. 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.
2. 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
6. Describe the nursing implications of common diagnostic tests of the urinary system.
7. Discuss nursing measures to promote normal micturition and reduce episodes of incontinence.
8. Discuss nursing measures to reduce urinary tract infection .
1. 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.

47

SLO: Bowel Elimination

Questions 5, 8

OBJECTIVES

1. Discuss the role of gastrointestinal organs in digestion and elimination.
2. Describe three functions of the large intestine.
3. Explain the physiological aspects of normal defecation.
4. Discuss psychological and physiological factors that influence the elimination process.
5. Describe common physiological alterations in elimination.
1. 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.
6. List nursing diagnoses related to alterations in elimination.
7. Describe nursing implications for common diagnostic examinations of the gastrointestinal tract.
8. List nursing interventions that promote normal elimination.
1. 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.
9. 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.