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Altered Elimination - Coggle Diagram
Altered Elimination
Urinary Dysfunction — Neuromuscular
Treatment
Neurogenic bladder
Clean intermittent catheterization
Indwelling catheter
Botox injections into bladder muscle to reduce involuntary muscle contractions
CNS or PNS signaling abnormality
Failure of coordinated urination
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Muscle unable to respond appropriately
Failure of uncoordinated urination
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Can be caused by
Spinal cord injury
Neurogenic bladder
Impaired mobility
Peripheral neuropathy
Results in
Urinary retention
Urinary incontinence
Incomplete emptying
Increased risk of infection from retained urine
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Urinary Dysfunction — Motility
Decreased urinary flow
Urine remains in tubules or bladder longer (urinary stasis!)
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#
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Precipitation of urinary components
Casts or crystals form
Obstruction and/or infection
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Treatment
Acute tubular necrosis
Discontinuing nephrotoxins
Such as NSAIDs
IV fluids and blood pressure medications
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Restore adequate perfusion to kidneys
Bladder stasis
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Bacterial growth
UTI
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Infection can ascend
Casts
RBCs
Glomerulonephritis
WBCs
Pyelonephritis
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Epithelial cell
Acute tubular necrosis
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Can develop due to
Low flow rate
Increased sodium concentration
Low pH
Bowel Dysfunction — Patency
Treatment
Surgical removal of obstruction
Restores bowel patency
Allows stool and gas to pass
Relieves pressure
Prevents ischemia and perforation
Tumor blocks intestinal lumen
Stool and gas accumulate proximal to obstruction
Pressure increases
Bowel distends
Blood flow may become impaired
Large bowel obstruction
Can be caused by
Colon cancer
Polyps
Impacted feces
Strictures
Results in
Constipation
Abdominal pain
Distention
N/V
Risk of ischemia, perforation, sepsis
Urinary Dysfunction — Perfusion
Treatment
Ischemic Acute Kidney Injury
Fluid resuscitation
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Vasopressors
Stabilize blood pressure
Improve renal perfusion
Can be caused by
Embolus
Severe vasoconstriction
Hypovolemia
Low cardiac output
Decreased arterial perfusion
Decreased oxygen delivery
Renal ischemia
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#
Tissue necrosis/infarction
Loss of nephron function
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Results in
Pain
Bleeding
Renal dysfunction
Loss of functional tissue
Bowel Dysfunction — Motility
Treatment for constipation
Osmotic laxatives
Draw water into intestinal lumen
Soften stool
Facilitate BM
Decreased intestinal motility
Slower transit of stool through the colon
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More water absorbed from fecal matter
Stool becomes hard and dry
Constipation!
Caused by
Inadequate fiber intake
Dehydration
Opioid use
Sedentary lifestyle
Aging
Results in
Hard stools
Infrequent bowel movements
Straining
Abdominal distention/discomfort
Hemorrhoids
Bowel Dysfunction — Neuromuscular
Treatment for peritonitis
Surgical intervention (resection or ostomy)
IV abx
Aggressive fluid resuscitation
Loss of coordinated neural stimulation of intestinal smooth muscle
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Peristalsis decreases or stops
Intestinal contents cannot move forward
Caused by
Abdominal surgery
Electrolyte abnormalities (hypokalemia)
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Peritonitis
Spinal cord injury
Opioid use
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Results in
Severe constipation
Abdominal distention
N/V
Absent or hypoactive bowel sounds
Gas retention
Urinary Dysfunction — Patency
Treatment of renal failure
Remove or bypass obstruction
Restore urine flow
Electrolyte management
Dialysis in severe cases
Obstruction
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Increased hydrostatic pressure
Dilation of urinary structures
Hydroureter
Hydronephrosis
Decreased GFR
Impaired excretion
Decreased perfusion
1 more item...
Caused by
Kidney stones
Tumors
Scar tissue/adhesions
Inflammation