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Urinary & bowel elimination, nurse as educator, spiritual health


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Name the reflex that controls fullness in the rectum
Sacral Cord Reflex
What type of muscles line the internal sphincter?
Longitudinal muscles.
How is the external sphincter controlled?
Consciously by the person in the cerebral cortex
What will happen to the defecation reflex if there is an injury below T12?
The reflex will not occur
What will happen to the defecation reflex if there is an injury above T12?
The defecation reflex will occur
People with an injury below T12 will have to have this to control solid elimination...
Bowel management program
What other function do sacral nerves control?
What gives the color to stool?
bilirubin pigment
What color is stool of a person with gall bladder disease who produces no bile?
What color is the stool of a person with a liver problem (cirrhosis)?
What can be true of a person with bloody stools?
GI Bleeding, colon bleeding
What color is the stool of a person with stomach bleeding?
Tarry black because the blood in the stomach is digested.
What type of stool is characteristic of a person with a superinfection?
Green, liquid.
An stool with excessive mucous indicates...
Inflammation or CDiff infection.
What does it indicate when there are lots of WBC's in the stool?
Sign of infection
What color is stool of a person on antibiotics?
Green/gray color
What color stool will a patient have after a barium test?
What does it indicate when a patient has blood streaks on the outside of stool?
What is the normal stool pattern?
Every 1-3 days
What is the first stool of an infant called?
Muconium - and it's black and tarry looking.
A tube-like connection in the bowel that can be between the bowel and bladder, bowel and skin, or bowel and vagina.
When does a fistula occur?
In malnutrition or inflammation
What is one of the causes of constipation?
High fat diet
A twisting of the intestines that causes the feces to not move along.
Name 4 bowel obstructions
Volvulus (twisting)
Intussusception (telescoping)
Strangulation (through hernia)
What type of medication induces bowel movement?
What type of medication induces a bowel movement and is very potent and fast-acting?
When is a laxative contraindicated?
In undiagnosed abdominal pain, possible inflammatory disorders such as appendicitis, ulcertaive colitis. Use caution in pregnancy and breastfeeding.
What problems do carthartics cause?
Fluid and electrolyte disturbances
Some problems of laxatives in pregnant women.
May initiate labor
Laxatives go into fetus and fetus has diarrhea (fluid & electrolyte imbalance)
Don't give laxatives to a patient with severe anemia because it can cause
further loss of nutrients
Surgery patients can use what type of laxative.
mild laxatives
Never give a fiber laxative in an NG tube because it can
clog the tube
How does a fiber laxative work?
It increases bulk and water in the stool and increases peristalsis
What happens when a laxative is given without enough water?
The stool gets hard and solid.
What do you always assess before giving a laxative?
Bowel sounds.
A laxative coats the inside of the colon and has a demulcent effect - therefore it is good for people with
irritable bowel syndrome (IBS)
A condition whereby a patient has alternating diarrhea and constipation with pain.
Irritable bowel syndrome
What type of laxative is good for a patient with diverticular disease?
Bulk-forming Laxative
Do laxatives cause physical dependence?
What is another name for stool softener?
These specific drugs have an osmotic effect and are used as prep for colonoscopy
saline cathertics
What is the safest type of laxative?
Bulk forming laxative
Metamucil, Naturacil, Cologel, Hydrolose, Mitrolan
What type of laxative works the quickest?
Stimulant cathartics
What type of laxative works in 1-3 hours
Which laxative works in 1-3 days?
Stool softeners
Which type of laxative is used after a myocardial infarction, cataract surgery, pregnancy, stroke patients?
Stool softener
Which type of laxative would you never use in an NG tube?
Bulk-forming laxative
Which type of laxative contains a salt preparation and causes fluid and electrolyte imbalances?
Which laxative would you not use in clients with kidney dysfunction?
How do cathartics work?
Irritate the mucosa to stimulate motility.
Which laxative is used in severe constipation?
Which laxative has side effects of flatulence, cramps, gas, belching?
Lubricant Laxative
Which laxative decreases absorption of fat-soluble vitamins (A,D,E,K)?
Lubricant laxatives
What type of laxative is Metamucil?
Bulk forming laxative
What type of laxative is GoLytely?
Lubricant laxative
What laxative is used before a colonoscopy?
GoLytely, lubricant laxative.
What type of laxative is Colase?
Stool softener
Which type of laxative works in 6-8 hours?
Lubricant laxative
Which laxative is the most potent?
Which laxative can cause pneumonia if aspirated?
Lubricant laxative
Which laxative may cause pruritis?
Lubricant laxative
What is a PEG solution used for?
Bowel cleansing before a colonoscopy.
What type of laxative is Milk of Magnesia?
Saline cathartic
What type of laxative is Fleet?
Saline cathartic
What type of laxatives are Ex-Lax and Correctol?
Stimulant cathartics.
What laxative used to be used commonly and is a stimulant cathartic?
Castor oil
What type of laxative is used to decrease blood ammonia in chronic liver disease?
Lactulose (Lubricant laxative)
What is another name for stool softeners?
emollient or fecal moistening agent
What type of laxative should you avoid taking with milk or antiacids?
Stimulant Cathartic - Dulcolax, Biscodyl
How fast do stimulant cathartic suppositories work?
15-60 minutes
What type of laxative discolors the urine pink, red, violet or brown and comes in a liquid form with an anise flavoring?
Cascara (stimulant cathartic)
How should castor oil be given?
On an empty stomach because it retards emptying of the stomach.
How should a lubricant laxative be given?
The client should be upright. Test swallowing before administering.
How can you make castor oil more tasty?
Mix with baking soda and orange juice.
Which laxative can produce cardiac distress, respiratory distress, and nausea with repeated large doses?
Stimulant cathartics.
Phenolphthalein (Doxidan, Correctol, Ex-Lax)
How much water should be given with Polyethylene glycol solution (PEG)?
240cc q 10 min - total 4 liters
What are some causes of constipation?
irregular bowel habits, low fiber diet, high fat diet, fluid intake less than 1500cc.
What are some types of enemas?
Fleet - hypertonic
Saline - safest
Soap suds
Tap water - never give to children
Oil retention - for impaction
What is a serious complication of diarrhea?
Dicubitis ulcer - can occur in 1 day of diarrhea.
Causes of diarrhea
emotional stress, intestinal infection
food allergies, intolerance to greasy, spicy foods, tube feedings w/ inadequate water, antibiotics, colitis, chron's disease
What antidiarrheal agent causes blue gums?
Pepto bismol (bismuth)
When using synthetic opioids you should monitor for what?
toxic response
What antidiarrheal has an anticoagulent effect?
Pepto bismol - bismuth
What nerve controls micturition?
Sacral nerve
What type of action is the micturition reflex?
What type of action involves relaxation of the external urethral sphincter?
What is the name of the muscles in the bladder that contracts during micturition?
The detrusor muscle
Decreased blood flow to the kidney from intravascular fluid volume deficit results in ...
oliguria or anuria
A dilation of the kidney pelvis & calyces due to obstruction of the pelvic outlet.
Urinary stasis can lead to ...
UT infection
When there is damage to the spinal cord above the sacral region a person can get...
reflex bladder
An injury below T12 in the sacral area can damage the reflex arc and result in ...
Autonomic Bladder
Management of autonomic bladder is managed by ...
intermittent catheterization
Alphaadrenergic blocker
urinary diversion surgery
implantable sphincter stimulator
Alphaadrenergic blockers such as prazosin relax the bladder sphincter by ...
stopping the sympathetic and maximizing the parasympathetic nervous system.
Bladder distention can cause this by compressing the vessels in the bladder...
The normal amount of urine that an adult voids in a day.
1500 ml
A protrusion of the bladder into the vaginal canal resulting in inability to empty bladder completely is called ...
A test that shows the outline of the kidneys, bladder, ureters, urethra. It cannot be given to people who are allergic to iodine and fish.
Intravenous pyelogram (IVP)
Symptoms of urinary retention include...
bladder distentin and small frequent voiding w/o emptying the bladder.
Two drugs that are given as a bladder antispasmodic
Bella Donna & Opium suppository (B&O)
What type of drug is prazosin?
Alphaadernergic (blocks the sympathetic nervous system and maximizes the parasympathetic nervous system.)
Females should wipe from front to back
drink 2000-3000 mL per day
void at least q4h
avoid bubble baths & tub baths
avoid nylon underwear and thongs
void immediately after sex
Things to do to prevent a UTI
A type of drug for the treatment of UTI
Two very common drugs used to treat UTI's
Levofloxacin (Levaquin)
When giving sulfa drugs the top nursing priority to prevent crystals in the urine and to clear the urinary tract of pus is...
2500 - 3000 mL Fluid intake
When taking sulfa drugs, one may get an adverse effect of
serum sickness in 7-10 days with joint pain, uritcaria, leukopenia
A urinary tract analgesic
Pyridium (phenazopyridine) discolors the urine reddish orange.
An infection of the upper urinary system is called
A defining characteristic of pyelonephritis is...
very high fever (along with low back pain, N,V, h/a, weakness, cloudy urine, high WBC's.)
The most important treatment of pyelonephritis is
IV fluids for nausea, vomiting & to flush kidneys of pus
When a patient has urge incontinence this may be prescribed to increase the bladder capacitiy & sphincter tone.
In a teaching plan, the five components to include for each domain.
Client learning outcome (goal)
Teaching strategy (how)
Criteria for evaluation (test)
Documentation (report)
Teaching content (explanation)
What are the 3 domains in a teaching plan?
Cognitive, Affective, Psychomotor
What is the most important teaching strategy?
Praise the client for accomplishments.
Which type of laxative irritates the mucosa of the colon?
stimulant cathartic
Which laxative creates an osmotic effect?
Saline Cathartic
Which laxative lowers the surface tension of the stool
stool softener
Which laxative is an osmotic bowel cleansing?
Saline cathartic
Which laxative relieves straining on defecation?
stool softener
Which laxative decreases the blood ammonia level?
Lactulose (a lubricant laxative)
Which laxative penetrates and coats the stool prevents excessive absorption?
Lubricant laxatives
Which laxative is contraindicated in kidney disease?
Saline cathartics
Which laxative could cause aspiration in a dysphagic client?
Mineral Oil
Which specific laxative results in a bowel obstruction if not mixed with 240cc of water?
Which laxative should be avoided during pregnancy and lactation?
Dulcolax (stimulant cathartic)
Which laxative is preferable to use at bedtime?
Colace because it works in 6-8 hours.
Types of loss
Engel's Model of Grief
Shock and Disbelief
Kubler Ross's Stages of dying
Denial, Anger, Bargaining, Depression
Preparation of body
Bathe dirty areas
close eyes and mouth, towel under mouth
raise head
take tubes out if allowed
tag corpse

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