Child: Infants and toddlers initially lack control over the sphincters and muscles that control urination and bowel elimination, but control is attained during early childhood as a normal developmental milestone. Pregnant: Pregnancy can affect elimination patterns because the fetus in the abdominal cavity affects both bowel and bladder function. As the fetus grows, increased pressure is placed on the bladder, and frequent urination is required. The woman will have larger volumes of urine because she has a larger blood volume during the gestation. The growing fetus can also interfere with intestinal peristalsis and can cause constipation. The use of prenatal vitamins with iron can also contribute to constipation in the pregnant female Older patients are especially vulnerable to the adverse effects of thiazide diuretics, including renal-electrolyte disturbances, gout, hyperglycemia, and hypotension. What assessment would be performed? Abdominal Assessment Changes in frequency, changes in odor, diet changes, any new medications, difficulties with urinating, burning when urinating, family history, any recent surgery, check fluid intake. Do they have any diversions such as Colostomy or Ileostomy Diversion of the intestines (colon or small intestine) through a stoma on the skin is occasionally needed temporarily or permanently as a result of injured or diseased intestine, colon, or rectum. Ileum is used. Ileum conduit. Look up foods to stop diarrhea in children. Fluid Intake: not taking enough it will cause constipation and if you are taking enough it will help with the passage of stool. Disease/Health Conditions: Older people who has other disease conditions it will affect elimination pattern- such as kidney’s being affected by renal calculi, other conditions include Diabetes, Ulcerative Colitis all can affect. Medications: certain medications that can help with constipation and cause diarrhea. Medications such as antidiuretics can cause you to urinate more than you are used to. Opioid can affect both bowel elimination and urine elimination – Look it up. Antibiotics and bowel elimination can cause C-Difficle – look it up. Even brief exposure to any single antibiotic can cause C difficile colitis. A prolonged antibiotic course or the use of 2 or more antibiotics increases the risk of disease. Antibiotics: Given for infection and Antibiotics may also be used prophylactically with urinary retention or recurrent urinary tract infection. Antispasmodics - to relieve spasms with UTI, Imodium, Cholinergics: increase muscle tone and function are often used to relieve smooth muscle spasms in the bowel or bladder Analgesics: to relieve pain caused by elimination – Pyridium Analgesic It can relieve symptoms caused by urinary tract infections and other urinary problems. – if patient is on it as a nurse you will have to tell them that the orange color is normal Prostate Surgery – A prostatectomy is a surgical procedure for the partial or complete removal of the prostate. Bladder Surgery - Cystectomy (sis-TEK-tuh-me) is a surgery to remove the urinary bladder. In men, removing the entire bladder (radical cystectomy) typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy also involves removal of the uterus, ovaries and part of the vagina. Urinary Diversions: Stoma and it is due to they cannot urinate the normal way via the bladder and it is placed through the ileum conduit for urine and colonostomy is for the colon. Surgery to Urinary Calculi: to remove the calculi or stones and the stones are too large to pass through when you urinate and it is done when the stone is more than 5mm to 7mm it is usually last resort. Stents: Allow easier passage of the stone if they are trapped in the ureter or urethra and can help relieve elimination. They break the stones up and stent is placed in to allow easier passage of the stone. Nurse will have to educate the patient that they will see blood in the urine during the recovery period Risk for Urinary Calculi: Low fluids, high protein diet, too much calcium/sodium, too much juice, too much acid in your diet. Can also be genetic, climate – too hot or warm environments causes dehydration, increases with age. Past history of renal calculi or UTI, lifestyle obesity and occupation for sedentary lifestyle. Clinical Manifestation: pH is low color is dark and smoky Famotidine is decreasing acid and can result in urine pH being off. The odor Protein shakes numbness in his legs back pain in the flank area and this is an excruciating pain nausea and vomiting may be present He has kidney stones, and it is apparent due to the sudden flank pain, he was unable to urinate at first and Elevated RBC’s, the color of the urine was dark and smoky. CBC to check for infection , CT Scan and Intravenous Pylogram. IVP will identify the site and confirm the presence of the stone. What is an intravenous pyelogram (IVP)? An IVP is an imaging test used to look at the kidneys and ureters. The ureters are the narrow tubes that carry urine from the kidneys to the bladder. During the test, the radiologist injects a contrast dye into one of your veins. Risk for Developing Renal Calculus: He is training for a marathon, his environment is warm so he is susceptible to dehydration, he is drinking protein shakes and not necessarily water. He is a male, dehydration running in the heat evidence by his difficulty in urination, large in take of protein suppliements, his diet and protein shakes. Collaborative Care: Urologist, nutritionist, nephrologist, radiology, laboratory, pharmacist, MD and nurse Teaching He should receive? Drink plenty fluids Education about normal urine output, smell, and level Pepcid daily can increase calcium and put him at risk for more stones in the future Education on how to treat GERD and works out a lot makes him super hot – he can work out indoors or wait till the temp is cooler to work out. He will have to make dietary changes. Make sure urine is strained so that the calculi’s can be used to analyze the framents. Medication for Pain in kidney stones is that the medication must be provided around the clock You will want to maintain the level of anagelsic to reduce the pain. Lower lights, comfortability in placement of bed, deep breathing exercise, decrease external stimuli. You also want to make sure if they are able to get up in walk they will need to be turned ever so often to prevent skin breakdown – monitor for dehydration and assess for infection, encourage fluids, monitor input and output, education, retest to see what the levels are and if they improved. Patient going for IVP as a nurse you have to prepare the patient in assessing if they have allergy, if they are diabetic and if they are stop metformin prior to the procedure and should be given about 1000 mL of fluid and get the BUN levels before and after. Make sure they are not pregnant. Anyone who develops kidney or bladder stones may experience ammonia-smelling urine. When stones pass through the urinary tract, the risk for UTIs increases and they can cause urine to have an ammonia smell – infection may be present. Prevent stones from forming again. Relieve pain – top priority Understand the disease process and how to prevent reoccurrence Patient will become more comfortable Evaluate if your goals are met. Maintain safety and ensure the patient is ambulating to prevent skin breakdown. He understands proper diet and understanding of the disease process Can cause nephrotoxicity – look it up. Prostate increase UTI in men - look it up.
