How much urine must collect in the bladder wall to have stretch receptors send a signal to the brain to indicate the need to urinate?
150-200 mL
How much urine must be excreted every hour in order to remove necessary waste products?
30 mL
What are some factors that interfere with urinary elimination?
- stones
- tumors in the abdominal cavity
- trauma to the lower abdomen
- disruption of the bladder by tumor or trauma
- enlarged prostate
- trauma to urethra
- infection of the urinary system
- neurologic damage
What are some measures that we as nurses can provide to help promote urination?
- provide privacy
- educate/assist patient to assume a natural position for urination (sitting for women, standing for men)
- have client maintain an adequate fluid intake
- use stimuli such as running water from a tap to initiate voiding
What is the expected/normal volume range for urine and what is the average volume?
500-3,000 mL/day; 1,200 mL/day
What is the expected/normal specific gravity range for urine?
1.010-1.030
When conducting a serum creatinine and BUN urine test, what is the expected/normal range?
10-20 mg/dL
How can the type of food and drink consumed by a patient alter their urinary patterns?
Foods high in sodium lead to decreased urinary outputs; drinks containing caffeine and alcohol lead to increased urinary outputs
When collecting a routine urine specimen, what is the preferred void to collect?
The first void of the day is the preferred void
When collecting a clean catch specimen, what is a priority instruction for the patient prior to elimination?
To cleanse the external structure through which urine passes (either tip of penis, or labia of vagina)
How would you as a nurse instruct a client to collect a clean catch specimen?
Tell the client to start the urinary stream, and after the first amount has been excreted collect the amounts after, but not all the way to the end. Pretty much collect the middle of the urinary stream
What must you as a nurse do prior to collecting a urine specimen from a catheter?
Clamp the port for 30 minutes and clean the port with an alcohol swab
What is a priority instruction to teach a patient about a 24 hour specimen collection?
To urinate and discard that urine, and then start the 24 hour clock
What is hematuria?
Urine containing blood
What is albuminuria?
Urine containing albumin
What is pyuria?
Urine containing pus
What is proteinuria?
Urine containing plasma proteins
What is glycosuria?
Urine containing glucose
What is ketonuria?
Urine containing ketones
What is anuria
The absence of urine or a volume of 100 mL or less in 24 hours
What is urinary retention?
A disorder where the client produces urine but does not release it from the bladder
What is the main difference between anuria and urinary retention?
While both terms describe the absence of urine, with urinary retention the client is still producing urine but they cannot excrete it, while with anuria the client isn't producing urine at all
What is oliguria?
A urine output of less than 400 mL per 24 hours
What is polyuria?
A greater than normal urinary volume
What is residual urine?
More than 50 mL of urine that remains in the bladder after voiding
What is a complication that can arise from residual urine?
Residual urine can lead to a urinary infection
What is urinary stasis?
The lack of movement of urine from the bladder
What is a complication that can arise from urinary stasis?
Urinary stasis can lead to stone formation in the bladder and ureters
What is nocturia?
Nighttime urination
Why is nocturia abnormal and what could it be a sign of?
Nocturia is abnormal because the rate of urine production is normally reduced at night. The increased rate of urine production and excretion could be a sign of an enlarged prostate in men
What is neurogenic bladder?
A dysfunction of the bladder caused by neurologic damage
What is urinary frequency?
The need to urinate often
What is urinary urgency?
The feeling that urine must be eliminated quickly
What is urinary incontinence?
The inability to control ones bladder
What are characteristics of clients who will likely have to use a fracture pan instead of a bed pan?
- clients who have musculoskeletal disorders and cannot elevate their hips
- A client who has had recent hip, lower extremity, or hip joint surgery
- Elderly clients who have trouble with elevating their hips
What is stress incontinence?
The loss of small amounts of urine when intra-abdominal pressure rises
What are some examples of stress incontinence?
Dribbling of urine associated with sneezing, coughing, lifting, laughing, or rising from a bed or chair
What are some common causes of stress incontinence?
- Loss of perineal and sphincter muscle tone secondary to childbirth
- Menopausal atrophy
- Prolapsed uterus
- Obesity
(I believe that most questions asking about this will make a point to include something about a clients recent or previous childbirths)
What do we do as nurses to help a client with stress incontinence?
- Teach the client pelvic floor muscle exercises (Kegel exercises)
- Instruct the client in ways to reduce their weight
What is urge incontinence?
The need to void perceived frequently, with short lived ability to sustain control of flow
What is an example of urge incontinence?
A client commences voiding while waiting in line to go to the restroom
What are common causes of urge incontinence?
- Bladder irritation secondary to infection
- Loss of bladder tone from recent continuous drainage with an indwelling catheter
What do we do as nurses to help a client with urge incontinence?
- Restrict fluid intake to no more than 2,000 mL/day
- Instruct client to avoid bladder irritants such as caffeine or alcohol
- Administer a diuretic in the morning
What is functional incontinence?
The control over urination is lost due to inaccessibility of a toilet or a compromised ability to use one
What is an example of functional incontinence?
Voiding occurs while a patient is attempting to overcome barriers such as doorways, transferring from a wheelchair, manipulating clothing, acquiring assistance, or making their needs known
What are some common causes of functional incontinence?
- Impaired mobility
- Impaired cognition
- Physical restraints
- Inability to communicate
(most patients who will suffer from functional incontinence will be elderly or will have a altered state of consciousness)
What can we as nurses do to help a client with functional incontinence?
- Modify their clothing
- Provide better access to a commode or urinal
- Make a planned toileting schedule
What is total incontinence?
The loss of urine without any identifiable pattern or warning
What is an example of total incontinence?
The patient passes urine without any ability or effort to control it
What are some common causes of total incontinence?
- Altered consciousness secondary to a head injury
- Loss of sphincter tone secondary to prostatectomy
- Anatomic leak through a urethral/vaginal fistula
What can we as nurses do to help a client with total incontinence?
- Provide absorbent undergarments
- Apply an external catheter
- Insert an indwelling catheter
What is overflow incontinence?
Urine leakage due to the bladder not completely emptying after voiding
What are some examples of overflow incontinence?
- The person voids small amounts frequently
- When urine leaks around a catheter
What are some common causes of overflow incontinence?
- Overstretched bladder or weakened muscle tone secondary to obstruction with a catheter
- An enlarged prostate
- A distended bowel
- Postoperative bowel spasms
What can we as nurses do to help clients with overflow incontinence?
- Provide adequate hydration
- Keep catheter patent and free of debris
- Teach the Crede's maneuver
What is Crede's maneuver?
The act of bending over forward and applying hand pressure over the bladder in order to help the elimination of urine
What is cutaneous triggering and what clients can benefit most from it?
Cutaneous triggering is the act of lightly tapping the skin above the pubic area and paralyzed clients who have retained a voiding reflex will benefit most from it
What are some common reasons for catheter use?
- Keeping incontinent clients dry
- Relieving bladder distention when clients cannot void
- Assessing fluid balance accurately
- Keeping the bladder from becoming distended during procedures such as surgery
- Measuring residual urine
- Obtaining sterile s
What is an example of a external catheter and which clients benefit most from them?
An example of a external catheter is a condom catheter, and clients who are receiving home care benefit most from them due to the ease of application
What is a straight catheter and why is it used?
A straight catheter is a catheter that is inserted into the bladder but not left there, and it is mainly used for patients that need their bladder drained but lack the ability to do so (ex: clients with neurogenic bladder)
What are three main problems associated with external catheters?
- The sheath may be applied to tightly restricting blood flow to the skin and tissues of the penis
- Moisture tends to accumulate beneath the sheath, leading to skin breakdown
- They frequently leak
What is a retention/indwelling catheter?
A catheter that is inserted and left in place for a period of time; it is secured with a balloon that is inflated once inside the bladder and they come in different diameters based on the French system (14F, 16F, 18F)
What is a priority action when setting up a closed drainage system?
Always position the drainage system and associated tubing lower than the bladder to avoid back flow
What are some measures that reduce the risk of patients contracting a UTI due to catheter use?
- advocate against inappropriate short term catheter use
- secure the catheter appropriately
- keep the drainage bad below the level of the bladder at all times
- keep the catheter and drainage tube from kinking
- maintain a closed drainage system
- prefo
What is open system irrigation and why is it dangerous?
Open system irrigation is the process of separating a retention catheter from its drainage tubing to irrigate the catheter. It is very dangerous because it creates a much higher potential for infection due to the exposure of the catheter to the outside
What is closed system irrigation?
The process of irrigating a catheter without removing the catheter from its drainage tubing
How would a nurse preform a closed system irrigation.
The nurse would use a sterile solution and pinch or clamp off the tubing beneath the self sealing port, then the nurse would instill the solution, finally the nurse would release the tubing for drainage
What is continuous irrigation and why is it commonly used?
Continuous irrigation is the ongoing instillation of solution using a 3 way catheter. It is most commonly used after prostate or other urologic surgery in order to keep the catheter patent from blood clots and tissue debris
What is a priority action of the nurse prior to connecting a 3 way catheter to the associated tubing for a continuous irrigation?
The nurse must make sure that all air is purged from the tubing
What is a urostomy?
A urinary diversion that discharges urine from an opening on the abdomen
What is a major complication that can arise from urostomys?
Since urine drains continuously, there is an increased risk for skin breakdown
What is the valsalva maneuver?
The act of increasing abdominal muscle pressure to facilitate defecation
______ moves chyme and gas through the intestines causing bowel sounds
Peristalsis
What are some common factors that affect bowel elimination
- Types of food consumed
- Fluid intake
- Medications
- Emotions
- Neuromuscular activity
- Abdominal muscle tone
- Opportunity for defecation
What is transit time?
The time between when a person eats food and eliminates stool
What is constipation?
A bowel pattern of difficult and infrequent evacuation of hard, dry feces
What are signs and symptoms associated with constipation?
- Complaints of abdominal fullness or bloating
- Abdominal distention
- Complaints of rectal fullness or pressure
- Pain on defecation
- Decreased frequency of bowel movements
- Inability to pass stool
- Changes in stool characteristics such as oozing, li
What is primary constipation?
simple constipation". Constipation that results from lifestyle factors such as inactivity, inadequate intake of fiber, insufficient fluid intake, and ignoring the urge to defecate
What is secondary constipation?
Constipation that is a consequence of a pathologic condition such as bowel obstruction
What is iatrogenic constipation?
Constipation that is a consequence of other medical treatments
What is the most common cause of iatrogenic constipation?
Prolonged narcotic use
What is pseudoconstipation?
A "perceived" constipation in people who are extremely concerned about having a bowel movement every day
Clients who have pseudoconstipation often try to treat this in what ways?
Clients often overuse or abuse laxatives, suppositories, and enemas
What does the overuse of laxatives, suppositories, and enemas result in?
This chronic purging weakens the bowel tone; consequently bowel elimination is less likely unless it is artificially stimulated
What is a fecal impaction?
A fecal impaction is a large, hardened mass of stool that interferes with defecation, making it impossible for the client to pass feces voluntarily
What are some common causes for fecal impactions?
- Unrelieved constipation
- Retained barium from an intestinal X-ray
- Dehydration
- Weakness of abdominal muscles
What is flatulence/flatus?
An excessive accumulation of intestinal gas
What are some foods commonly known to produce gas?
Vegetables such as cabbage, cucumbers, and onions and beans
When a client is extremely uncomfortable and ambulating does not eliminate flatus, what is one way to help clients eliminate flatus?
Inserting a rectal tube
What is diarrhea?
The urgent passage of watery stool
Why is diarrhea commonly had?
Usually diarrhea is a means of eliminating an irritating substance such as tainted food or intestinal pathogens
How might a nurse help a client relieve diarrhea?
The nurse can instruct the client to rest the bowel temporarily by only consuming clear liquids for 12 to 24 hours, and when eating is resumed begin by eating bland and low residue foods such as bananas, applesauce, and cottage cheese
What is fecal incontinence?
The inability to control the elimination of stool
What are some common causes of fecal incontinence?
- Neurologic changes that impair muscle activity, sensation, or thought processes
- Fecal impaction may be an underlying cause
- When a client cannot reach a toilet in time to eliminate, such as after taking a harsh laxative
What does a hypoactive bowel indicate and what does it usually result in?
A hypoactive bowel indicates a decreased in peristalsis and usually results in constipation
What are some common causes of a hypoactive bowel?
- Immobility
- Advanced age
- Inadequate fluid and/or fiber intake
- Injury to the bowel
- Frequent use of laxatives
- Surgery
- Pregnancy
What is the recommended amount of fluid and fiber intake?
2,000-3,000 mL of fluid and 25-30 grams of fiber a day
What are some drugs that may contribute to constipation?
- Narcotic analgesics
- General anesthetics
- Diuretics
- Sedatives
- Anticholinergics
- Calcium channel blockers
What are some drugs used to help treat constipation
- Bulk forming laxatives
- Stool softeners
- Irritant/stimulant laxatives
- Saline laxatives
What does a hyperactive bowel indicate and what does it usually result in?
A hyperactive bowel indicates an increase in peristalsis and usually results in diarrhea
What are some causes of a hyperactive bowel?
- Inflammation of the GI tract
- Infectious diseases
- Antibiotics
How should patients who experience diarrhea from antibiotics replace normal flora?
By eating yogurt, drinking buttermilk, and taking acidophilus
What is a suppository and what is it commonly used for?
A suppository is an oval or cone shaped mass that melts at body temperature that is inserted into a body cavity such as a rectum. It is commonly used to deliver a drug that will promote the expulsion of feces
What are some common reasons to administer an enema?
- Cleanse the lower bowel
- Soften feces
- Expel flatus
- Soothe irritated mucous membranes
- Outline the colon during diagnostic X-rays
- Treat worm and parasite infections
What are the 5 types of enemas and what are they used for?
- retention enema: softens stool as oil is absorbed
- cleansing enema: stimulates peristalsis through distention and irritation of colon and rectum
- distention reduction enema: relieves discomfort from flatus causing distention
- medicated enema: solutio
What are the four types of cleansing enemas?
Tap water (hypotonic), normal saline, soap solution, hypertonic
What is the purpose for each type of cleansing enema?
- Tap water: used prior to rectal examinations to cleanse bowel
- Normal saline: used prior to rectal examinations to cleanse bowel
- Soap solution: acts as an irritant to promote bowel peristalsis
- Hypertonic: draws fluid from body tissues into the bowe
What is a considerations when administering a tap water enema?
Because water is hypotonic, if several enemas are administered fluid and electrolyte imbalances may occur
When providing peristomal care, what kind of solution should be used to was the surrounding areas?
A solution of mild soap and water
How long should an ostomy faceplate stay in place before changing it?
3-5 days or immediately if it becomes loose or causes skin discomfort
How often must a continent ileostomy be drained?
Every 4-6 hours
What are some reasons to irrigate a colostomy?
- To remove formed stool
- To regulate the timing of bowel movements
What does a fecal occult blood test test for?
The test detects heme, an iron compound in blood
When should patients start having colonoscopies and how often should they be done again?
Patients should start getting colonoscopies at the age of 50, and then every 10 years after that unless they have a positive family history
Test taking tip #1
READ THE QUESTION CAREFULLY. Ask yourself what is the question really asking, are there any key words
Test taking tip #2
CAREFULLY READ ANSWERS
Ask yourself does your answer fully answer the question asked, are there any other answers similar to mine and why are they wrong
Test taking tip #3
To go along with reading the question, YOU MUST IDENTIFY THE KEY WORDS
Every question has a key word or words and these words set the pace of the question, be aware of them and know exactly what they want from you. Nursing is very rarely absolute so avoid
Test taking tip #4
DONT ASSUME ANYTHING
Many questions are asked in a very specific way with very specific limitations. Before answering anything determine exactly what the question wants from you, for example if the question asks how a nurse would effect a clients behavior
Test taking tip #5
ELIMINATE CLEARLY WRONG OR INCORRECT ANSWERS
Almost every question has at least one answer that is just wrong, don't bother looking at that answer and try to narrow down your choices
Test taking tip #6
IDENTIFY SIMILAR OPTIONS
Many questions will have answers that are similar in meaning, this means that either they are both correct or both incorrect. If they are both correct look for the answer that includes both of them, for example, if a question asks
Test taking tip #7
WATCH FOR GRAMMATICAL INCONSISTENCIES
So not every question is worded perfectly, but sometimes you can single out a wrong answer because it just doesn't flow correctly with the sentence. When deciding on an answer read the entire question out loud to your
Test taking tip #8
THE SMARTEST ANSWER MAY NOT BE THE RIGHT ONE
Many times there are questions that are asked and an answer that you read that makes perfect sense to you. Sometimes the answer is blatantly better than the others. But keep in mind that is your perception, the