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Pathophysiology of elimination (Urinary dysfunction (Signs and symptoms…
Pathophysiology of elimination
Urinary dysfunction
Altered neuromuscular function
Impaired neural transmission
Urinary retention
Urinary incontinence (enuresis)
Caused by drugs (narcotics, analgesics), spinal infection, stroke, trauma, anesthesia
Treatment
Bladder training, intravaginal support devices, pelvic exercises
Surgical options
Anticholinergic drugs for enuresis
Altered perfusion
Inadequate blood supply
Hypoxemia
Necrosis
Polycystic kidney disease
Cysts replace functional tissue
Fewer nutrients reaching kidney
Cysts put pressure on renal arteries
Treatment
Symptomatic care
Lifestyle modifications (healthy weight, healthful diet, limit salt intake, smoking cessation
Palliative care or hospice as disease progresses
Genetic (dominant or recessive) or acquired
Unique symptoms
Cardiac valvular disease, liver/pancreatic cysts, headaches, cerebral aneurysms
Renal artery thrombosis
Thrombolytic drugs
Embolectomy
May be acute or incomplete/chronic
Altered patency
Urolithiasis (kidney stone)
Hypercalciuria, hyperoxaluria, hypocitraturia, or stasis of urine possible causes
CT or ultrasound to diagnose
Pain control, fluids, medications to promote urination or to relax muscles
Extracorporeal shockwave lithotripsy ("blast the stone")
Surgical removal
Diet change depending on type of stone (esp high oxalate foods)
Altered motility
Decreased ureteral peristalsis
Development of casts
Cells trapped in cast indicative of disease
RBCs --> glomerulonephritis WBCs --> polynephritis
Stasis of urine in renal tubules or bladder
Increased risk of infection
Signs and symptoms
Bleeding/ hematuria
Fever
Altered volume of urine excreted
Nausea or vomiting
Pain (in flank or groin or during urination)
Altered characteristics of urine
Altered composition of urine
Bowel dysfunction
Altered neuromuscular function
Impaired neural transmission
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Emotional stress (limbic system, CRF hormone)
Increase in CRF --> diarrhea
Decrease in CRF --> more normal function
Reduced activity or loss of mobility --> reduced stool elimination
Increase activity levels
Functional fecal incontinence
Behavior modification
Scheduled toilet time
Incentives/rewards
Stool softeners
Mental health assistance
Often in children; fear of defecation
No physical abnormalities
Altered patency
Bowel obstruction (complete or partial)
Fecal impaction
Treatment includes figuring out/correcting causes
Enema
Possible causes: lack of water, chronic constipation, overuse of laxatives, sedentary lifestyle
Stool softeners
Tumor/polyp
Risk factors include age; intestinal inflammation; family history; tobacco/alcohol use; obesity; sedentary lifestyle
Cancerous tumors require chemo/radiation
Polyps are not cancerous
At risk of becoming cancerous
Removed during colonoscopy; pathology
Other diagnostic methods: sigmoidoscopy, CT, stool DNA
Diagnosed via colonoscopy
Altered motility
Increase (diarrhea)
Ulcerative colitis
Inflammation of large intestine
Autoimmune disorder?
Epithelial cell atrophy
Friability (tissue easily bleeds)
Necrosis and ulceration
Risk of anemia
Dehydration/malabsorption of water and electrolytes
Treat symptoms: anti-inflammatory, antidiarrheal, and immunosuppressive medications; infusions
Decrease (conspitation)
Diverticulosis
Inner layer of intestine pushes through to outer wall, forming a pocket, most often in colon
Abdominal pain, bloating
Imaging to diagnose(colonoscopy, CT)
Risk of infection in pocket (diverticulitis)
Antibiotics
Surgery/bowel resection
Risk of perforation
Unknown etiology
Treatment includes high fiber intake, increased water consumption, probiotics, healthy lifestyle/weight
Signs and symptoms
Change in stool characteristics
Presence of blood
Change in flatus
Bloating
Altered bowel sounds
Pain, tenderness
Change in bowel habits