Objectives: Describe the nursing implications of common diagnostic tests of the urinary system.

. (1,2,3,4) Compare and contrast common alteration in urinary elimination. (1,2)

Organs of the Urinary System

Influences of Urination-- Cerebral Cortex, thalamus, hypothalamus, and brainstem

Reflexive Incontinence Overflow incontinence

Factors Influencing Urination:

Disease

Prerenal Renal Postrenal

Sociocultural Psychological Fluid balance Surgical procedures Medications

End Stage Renal Disease (ESRD)

Uremic Syndrome
Renal Replacement Therapies

Increased nitrogenous

wastes in blood and fluid. Leads to electrolyte abnormalities, nausea, vomiting, headache comma convulsions.

Dialysis Peritoneal
Hemodialysis

Organ transplant

Alterations in Urinary Elimination:

Urinary Retention
Urinary Track Infections Urinary incontinence

Urinary diversions

Urinary Elimination: Nursing Process

Assessment:
Through the patients eyes Identify urinary alterations. History Physical Assessment Assessment of urine Diagnostic Examinations

Urinary Tests:
Urinalysis Urine Culture Specific gravity

Diagnostic:
Social isolation Impaired skin integrity Impaired urinary

Disturbed body image

Urinary incontinence Pain Risk of infection

elimination Constipation Urinary retention

Toileting self-care deficit

 Planning:

Goals and outcomes

Priorities Teamwork and Collaboration

 Implementation:

Health promotion Acute Care

 Evaluation

Through the patients eyes Patient outcomes

Testing What We Know

A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is:
Cystitis 2. Hematuria 3. Pyelonephritis 4. Dysuria
1.

Testing What We Know

A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is:
1. Cystitis

2. Hematuria
3. Pyelonephritis 4. Dysuria

Testing What We Know

The nurse notes that the patients Foley catheter bag has been empty for 4 hours. The priority action would be to:
Irrigate the Foley. 2. Check for kinks in the tubing 3. Notify the health care provider 4. Assess the patient's intake
1.

Testing What We Know

The nurse notes that the patients Foley catheter bag has been empty for 4 hours. The priority action would be to:
Irrigate the Foley. 2. Check for kinks in the tubing 3. Notify the health care provider 4. Assess the patient's intake
1.

Testing What We Know

A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is a risk for: (Select all that apply.)
Infection 2. Retention 3. Stagnant urine 4. Reflux of urine
1.

Testing What We Know

A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is a risk for: (Select all that apply.)
1. Infection 2. Retention 3. Stagnant urine 4. Reflux of urine

Discuss the role of gastrointestinal organs in digestion and elimination. (1) Describe three functions of the large intestines. (1,2) List interventions that promote normal elimination. (1,2,4)

Bowel Elimination
Gastrointestinal Organs:
Small Intestine Duodenum Jejunum Ileum Mouth Esophagus Stomach Large Intestine Cecum Colon Rectum

Anus

Bowel Elimination
Nursing Knowledge

Base:
age diet fluid intake physical Activity psychological factors personal habits

position during

defecation pain pregnancy surgery and anesthesia medication diagnostic tests

Common Problems:

Constipation Impaction Diarrhea Incontinence Flatulence Hemorrhoids

Bowel Diversions:
Ostomies:
Loop colostomy End colostomy Double-barrel colostomy Alternatives: Ileoanal pouch anastomosis Kock continent ileostomy Macedo-Malone antegrade continence enema

Bowel Elimination: Critical Thinking

Continue to think about:
Patients response to changes Patients past history Culture Psychosocial Concerns Resources of the Patient and the health care team

Assessment:
Through the patients eyes History

Physical assessment
Laboratory Tests Diagnostic examinations

Diagnostic

Diagnosis:
Bowel incontinence Constipation

Risk for constipation

Perceived constipation Diarrhea

Toileting self-care deficit

Planning:
Goals Priorities

Teamwork and Collaboration

Implementation:
Health Promotion Acute Care

Evaluation:
Through the patients eyes Patient outcomes

Testing What We Know

Number the steps to irrigating a nasogastric tube (NG) in the correct order: 1. Slowly aspirate the syringe 2. Reconnect the NG tube to suction 3. Clamp and disconnect the NG tube 4. Perform hand hygiene and apply clean gloves 5. Insert tip of syringe into NG tube and slowly inject 30ml saline

Testing What We Know

Number the steps to irrigating a nasogastric tube (NG) in the correct order: 1. Perform hand hygiene and apply clean gloves 2. Clamp and disconnect the NG tube 3. Insert tip of syringe into NG tube and slowly inject 30ml saline 4. Slowly aspirate the syringe 5. Reconnect the NG tube to suction

Testing What We Know

The patient is admitted for lower gastrointestinal bleeding. What color of stool does the nurse anticipate the patient to have? 1. Red 2. Black 3. Green 4. Orange

Testing What We Know

The patient is admitted for lower gastrointestinal bleeding. What color of stool does the nurse anticipate the patient to have? 1. Red 2. Black 3. Green 4. Orange

Testing What We Know

Which of the following medications listed in a patients medication history possibly causes gastrointestinal bleeding? (Select all that apply) 1. Aspirin 2. Cathartics 3. Antidiarrheal opiate agents 4. Non-steroidal anti-inflammatory drugs (NSAIDS)

Testing What We Know

Which of the following medications listed in a patients medication history possibly causes gastrointestinal bleeding? (Select all that apply) 1. Aspirin 2. Cathartics 3. Antidiarrheal opiate agents 4. Non-steroidal anti-inflammatory drugs (NSAIDS)