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NURSING FUNDAMENTALS FOCUS IX         Elimination Needs
OBJECTIVES:SOLID   Describe the physiology of stool formation and the    elimination process.   List the common problems...
OBJECTIVES:FLUID   Describe the normal micturition process mechanism.   Discuss common conditions /situations responsibl...
BLADDER AND BOWEL FUNCTIONOverview:   The human body eliminates waste of metabolism    through urine and stool.   Normal...
Structures and Functions Related To          Bowel EliminationSTRUCTURES AND FUNCTIONSRELATED TO BOWEL ELIMINATIONDIGESTIO...
STRUCTURES AND FUNCTIONS RELATED TOBOWEL ELIMINATION                                 Bolus with Ptyalin                   ...
Physiology of Defecation Peristalticwaves move the feces into  the sigmoid colon and the rectum Sensory nerves in rectum...
 External  anal sphincter is relaxed  voluntarily if timing is appropriate Expulsion of the feces assisted by  contracti...
FACTORS AFFECTING BOWELELIMINATION    Lifestyle        Personal habits        Nutrition and fluid intake        Physic...
FACTORS AFFECTING BOWEL ELIMINATION   Physiological factors     Pregnancy     Motor  and or sensory disturbance     In...
CHARACTERISTICS OF NORMALSTOOL Color Odor Consistency Frequency Amount Shape Constituents
SELECTED FECAL ELIMINATIONPROBLEMSConstipationDiarrheaBowel  incontinenceFlatulence
CONSTIPATION A symptom not a disease Decreased frequency of defecation Hard, dry, formed stools Straining at stools P...
FECAL IMPACTION Mass or collection of hardened feces in folds  of rectum that cannot be expelled Passage of liquid fecal...
DIARRHEA   Passage of liquid feces and     increased frequency of     defecation   Spasmodic cramps, increased bowel sou...
FECAL INCONTINENCE Loss of voluntary ability to control fecal and  gaseous discharges Generally associated with:     Im...
FLATUENCE Excessive  flatus in intestines Leads to stretching and inflation of  intestines Can occur from variety of ca...
ASSESSMENT OF BOWEL FUNCTION   History of bowel prior patterns       usual time       frequency of stool       past re...
ASSESSMENT OF BOWEL FUNCTION   Infection, trauma, or stress may affect    stool formation   Physical Abdominal Assessmen...
ABDOMINAL QUADRANTS AND ORGANS
ABDOMINAL QUADRANTS AND ORGANS
ABDOMINAL QUADRANTS AND ORGANS
ABDOMEN   Subjective Assessments:     Any abdominal pain?     N/V?     Appetite good?     Last BM?     Stool formed/...
ABDOMEN-OBJECTIVE ASSESSMENT   Normal       soft       non-tender       non-distended       normoactive bowel sounds ...
ABDOMEN – ABNORMAL ASSESSMENTS Distended Rigid Tender Hypoactive bowel sounds (<10/min) Hyperactive bowel sounds (>30...
AIDS TO NORMAL BOWEL ELIMINATION   Fluid intake and fiber:       Adequate fiber       Adequate fluid intake       Upri...
CONSTIPATION    Managing constipation:   Diet       25 -35 G of fiber + WATER!   Medications       Laxatives       ca...
FECAL INCONTINENCEAssessment key factors: Is the problem correctable or manageable? What is the timeline or duration of ...
NANDA NURSING DIAGNOSIS Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea
RELATED NURSING DIAGNOSIS Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity Low Self-esteem Disturbed B...
DESIRED OUTCOMES Maintain  or restore normal bowel  elimination pattern Maintain or regain normal stool  consistency Pr...
NURSING CONSIDERATIONS Promoting regular defecations Teaching about medications Decreasing flatulence Administering en...
FECAL ELIMINATION PATTERNS Privacy Timing Nutrition   and fluids Exercise Positioning
ALTERED MEANS OF BOWEL ELIMINATION
ALTERED MEANS OF BOWEL ELIMINATION Ileostomy
ALTERED MEANS OF BOWELELIMINATIONStomaForm-   ation
ALTERED MEANS OF BOWEL ELIMINATIONStoma
STOMA CARE FOR CLIENTS WITH AN OSTOMY Normal stoma should appear red and may  bleed slightly when touched Assess the per...
COMMON TESTS   Direct Visualization       fiber optic endoscopic instruments introduced through the        mouth or rect...
COMMON TESTS   Fecal specimens     Ova   and Parasites   Guaiac testing     Hidden   (occult) blood
Urinary Elimination
KIDNEYShttp://www.youtube.com/watch?v=chhNaLi9P3EUrine Formationhttp://www.argosymedical.com/flash/urine_formation/landing...
Urinary Elimination Micturition   The process of emptying the bladder   Contraction of detrusor muscle   Increases pre...
NORMAL MICTURITION MECHANISM ANDRELATED BODY STRUCTURES
URINE FORMATION   Nephron   Functional unit of the kidney   Urine is formed here   Glomerulus   Tuft of capillaries s...
Aids to Normal Urinary Elimination   Daily fluid intake       Urine produced = fluid consumed       Need 6 to 8 glasses...
STRUCTURES AND FUNCTIONS RELATEDTO FLUID ELIMINATION   Characteristics of normal urine:     Color     Clarity     Odor
ALTERED AMOUNT   Oliguria       Diminished, scanty amount <30cc   Anuria       absence of urine   Polyuria       >15...
COMMON DISRUPTIONS IN URINARY    ELIMINATION   Dysuria     Painful   urination:     Frequency     Hesitancy     Urgency
COMMON DISRUPTIONS IN URINARY    ELIMINATION   Urinary Tract Infection (UTI)     Can   occur anywhere in the urinary tra...
COMMON DISRUPTIONS IN URINARY    ELIMINATIONUrinary retention:   Inability to pass part    of the urine in bladder   Com...
COMMON DISRUPTIONS IN URINARY     ELIMINATIONUrinary obstruction    Urolithiasis-   Stones calculi block or    partially b...
FORMS OF INCONTINENCEUrinary Incontinence:  Failure of major smooth muscle strength of  Detrusor muscle of the bladder, in...
FORMS OF INCONTINENCE   Urge Incontinence    Urgency following strong sense to void         Decreased bladder capacity  ...
FORMS OF INCONTINENCE   Overflow Incontinence:    Retention   Functional Incontinence:    Intact urinary and nervous sys...
LOSS OF URINARY CONTROLNursing ASSESSMENT of Urinary Incontinence:   Confirm factors related to episodes   Determine cog...
ALTERED MEANS OF URINARYELIMINATION    Catheters     urethral     suprapubic     condom
FOLEY CATHETER
FOLEY CATHETERS
FOLEYhttp://www.youtube.com/watch?v=tynS0E4hBn0
FOLEY
CONDOM/TEXAS CATHETER
BEDSIDE DRAINAGE BAGS
SUPRAPUBIC CATHETER
ALTERED MEANS OF URINARY ELIMINATIONUrinary diversion -             surgical creations Ureterostomy -    (transureterosto...
ILEAL CONDUIT
A NEOBLADDER
NEPHROSTOMY TUBE
THE KOCK POUCH—A CONTINENT URINARYDIVERSION
COMMON TESTS   BUN   http://video.google.com/videoplay?docid=7519331476907982001&q=urinary+system&total=83&start=0&num=1...
COMMON TESTSVisualization procedures KUBAn X-ray showing the kidney, ureter, and bladder. This is in reality a plain abdo...
53 a focus 9 elimination
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Transcript of "53 a focus 9 elimination"

  1. 1. NURSING FUNDAMENTALS FOCUS IX Elimination Needs
  2. 2. OBJECTIVES:SOLID Describe the physiology of stool formation and the elimination process. List the common problems of bowel elimination. Discuss nursing responsibilities involved with each problem. Define and explain some of the basic but important measures to promote normal bowel elimination. Compare and contrast the different types of altered means of bowel elimination. Identify the procedures/technical skills and related nursing responsibilities. Identify the common diagnostic procedures related to the bowel elimination need and the associated nursing responsibilities
  3. 3. OBJECTIVES:FLUID Describe the normal micturition process mechanism. Discuss common conditions /situations responsible for a disruption in the normal micturition process. List the commonly recognizable signs (behaviors) indicating a disruption in urinary elimination. Compare and contrast the altered means of urinary elimination and explain the related procedures and nursing responsibilities. Report the basic but important nursing interventions to promote normal urinary elimination. Examine the common diagnostic procedures related to urinary elimination and the associated nursing responsibilities.
  4. 4. BLADDER AND BOWEL FUNCTIONOverview: The human body eliminates waste of metabolism through urine and stool. Normal function depends on these factors: - anatomic integrity - intact neurologic components for both voluntary and synergistic emptying - a predictable pattern of waste production - physical and mental ability and the psycho-social willingness to carry out toileting related tasks
  5. 5. Structures and Functions Related To Bowel EliminationSTRUCTURES AND FUNCTIONSRELATED TO BOWEL ELIMINATIONDIGESTIONHTTP://WWW.MEDTROPOLIS.COM/VBODY.ASP
  6. 6. STRUCTURES AND FUNCTIONS RELATED TOBOWEL ELIMINATION Bolus with Ptyalin HCL, Pepsin Intrinsic factor Mucus  CHYME Releases bile to Amylase released duodenumAbsorption, secretion, pr Nutrients, electrolytes,otection, elimination vitamins absorbed Defecation process
  7. 7. Physiology of Defecation Peristalticwaves move the feces into the sigmoid colon and the rectum Sensory nerves in rectum are stimulated Individual becomes aware of need to defecate Feces move into the anal canal when the internal and external sphincter relax
  8. 8.  External anal sphincter is relaxed voluntarily if timing is appropriate Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm Moves the feces through the anal canal and expelled through anus Facilitated by thigh flexion and a sitting position
  9. 9. FACTORS AFFECTING BOWELELIMINATION  Lifestyle  Personal habits  Nutrition and fluid intake  Physical activity  Culture  Norms of western culture  Age  Infancy  Elders
  10. 10. FACTORS AFFECTING BOWEL ELIMINATION Physiological factors  Pregnancy  Motor and or sensory disturbance  Intestinal pathology  Medications  Surgery and anesthesia Psychosocial factors  Anxiety  Depression
  11. 11. CHARACTERISTICS OF NORMALSTOOL Color Odor Consistency Frequency Amount Shape Constituents
  12. 12. SELECTED FECAL ELIMINATIONPROBLEMSConstipationDiarrheaBowel incontinenceFlatulence
  13. 13. CONSTIPATION A symptom not a disease Decreased frequency of defecation Hard, dry, formed stools Straining at stools Painful defecation Causes include: Insufficient fiber and fluid intake Insufficient activity Irregular habits
  14. 14. FECAL IMPACTION Mass or collection of hardened feces in folds of rectum that cannot be expelled Passage of liquid fecal seepage and no normal stool Causes usually:  Poor defecation habits  Results from unrelieved constipation Treatment  Removed manually  Must have physician order  Monitor patient for Valsalva reaction
  15. 15. DIARRHEA Passage of liquid feces and increased frequency of defecation Spasmodic cramps, increased bowel sounds Fatigue, weakness, malaise, emaciation A symptom of disorders affecting digestion, absorption, and secretion of the GI tract. Major causes:  Stress, medications, allergies, intolerance of food or fluids, disease of colon
  16. 16. FECAL INCONTINENCE Loss of voluntary ability to control fecal and gaseous discharges Generally associated with:  Impaired functioning of anal sphincter or nerve supply  Neuromuscular diseases  Spinal trauma  Tumor Nursing Considerations  Incontinence can harm a clients body image  Incontinence predisposes the skin to breakdown
  17. 17. FLATUENCE Excessive flatus in intestines Leads to stretching and inflation of intestines Can occur from variety of causes: Foods Abdominal surgery Narcotics
  18. 18. ASSESSMENT OF BOWEL FUNCTION History of bowel prior patterns  usual time  frequency of stool  past reliance on aids Present status and pattern  Time  Characteristics of stool Medications that may affect bowel functioning  sedatives  diuretics  antihistamines
  19. 19. ASSESSMENT OF BOWEL FUNCTION Infection, trauma, or stress may affect stool formation Physical Abdominal Assessment  Inspection  Auscultation  Palpitation  determine abdominal discomfort  palpable obstruction would indicate need for rectal exam
  20. 20. ABDOMINAL QUADRANTS AND ORGANS
  21. 21. ABDOMINAL QUADRANTS AND ORGANS
  22. 22. ABDOMINAL QUADRANTS AND ORGANS
  23. 23. ABDOMEN Subjective Assessments:  Any abdominal pain?  N/V?  Appetite good?  Last BM?  Stool formed/loose?
  24. 24. ABDOMEN-OBJECTIVE ASSESSMENT Normal  soft  non-tender  non-distended  normoactive bowel sounds in all 4 quadrants Normal bowel sounds  2-3 every 15sec or 10-30 every min
  25. 25. ABDOMEN – ABNORMAL ASSESSMENTS Distended Rigid Tender Hypoactive bowel sounds (<10/min) Hyperactive bowel sounds (>30/min) Absence of bowel sounds Presence of mass Ascities Abnormal pulsations Tubes, drains, ostomies
  26. 26. AIDS TO NORMAL BOWEL ELIMINATION Fluid intake and fiber:  Adequate fiber  Adequate fluid intake  Upright posture
  27. 27. CONSTIPATION Managing constipation: Diet  25 -35 G of fiber + WATER! Medications  Laxatives  cathartics Enemas  high – cleanse entire colon  low – cleanse rectum and sigmoid colon  hypotonic and isotonic  – immediate large colonic emptying  hypertonic and mineral - fleets
  28. 28. FECAL INCONTINENCEAssessment key factors: Is the problem correctable or manageable? What is the timeline or duration of situation? Any associated symptoms?
  29. 29. NANDA NURSING DIAGNOSIS Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea
  30. 30. RELATED NURSING DIAGNOSIS Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity Low Self-esteem Disturbed Body Image Deficient Knowledge  Bowel Training  Ostomy Management  Anxiety
  31. 31. DESIRED OUTCOMES Maintain or restore normal bowel elimination pattern Maintain or regain normal stool consistency Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain
  32. 32. NURSING CONSIDERATIONS Promoting regular defecations Teaching about medications Decreasing flatulence Administering enemas Digital removal of a fecal impaction  (if agency policy permits) Instituting bowel training programs Applying a fecal incontinence pouch Ostomy management
  33. 33. FECAL ELIMINATION PATTERNS Privacy Timing Nutrition and fluids Exercise Positioning
  34. 34. ALTERED MEANS OF BOWEL ELIMINATION
  35. 35. ALTERED MEANS OF BOWEL ELIMINATION Ileostomy
  36. 36. ALTERED MEANS OF BOWELELIMINATIONStomaForm- ation
  37. 37. ALTERED MEANS OF BOWEL ELIMINATIONStoma
  38. 38. STOMA CARE FOR CLIENTS WITH AN OSTOMY Normal stoma should appear red and may bleed slightly when touched Assess the peristomal skin for irritation each time the appliance is changed Treat any irritation or skin breakdown immediately Keep skin clean by washing off any excretion and drying thoroughly Protect skin, collect stool, and control odor with an ostomy appliance
  39. 39. COMMON TESTS Direct Visualization  fiber optic endoscopic instruments introduced through the mouth or rectum to inspect integrity of mucosa blood vessels, and organs. UGI Endoscopy Colonoscopyhttp://www.swarminteractive.com/patient_ed_animations.html
  40. 40. COMMON TESTS Fecal specimens  Ova and Parasites Guaiac testing  Hidden (occult) blood
  41. 41. Urinary Elimination
  42. 42. KIDNEYShttp://www.youtube.com/watch?v=chhNaLi9P3EUrine Formationhttp://www.argosymedical.com/flash/urine_formation/landing.html
  43. 43. Urinary Elimination Micturition  The process of emptying the bladder  Contraction of detrusor muscle  Increases pressure on bladder to produce urge to urinate  Pressure overcomes the internal sphincter  Urine enters urethra  Requires relaxation of external sphincter consciously relaxed or contracted
  44. 44. NORMAL MICTURITION MECHANISM ANDRELATED BODY STRUCTURES
  45. 45. URINE FORMATION Nephron Functional unit of the kidney Urine is formed here Glomerulus Tuft of capillaries surrounded by Bowman’s capsule Fluids and solutes move across endothelium of the capillaries into the capsule Bowman’s Capsule Filtrate move from here into the tubule of the nephron
  46. 46. Aids to Normal Urinary Elimination Daily fluid intake  Urine produced = fluid consumed  Need 6 to 8 glasses per day of WATER Activity  External sphincter is part of pelvic floor muscle  Tone needed to maintain voluntary control Personal Habits  Relaxation  Distractions
  47. 47. STRUCTURES AND FUNCTIONS RELATEDTO FLUID ELIMINATION Characteristics of normal urine:  Color  Clarity  Odor
  48. 48. ALTERED AMOUNT Oliguria  Diminished, scanty amount <30cc Anuria  absence of urine Polyuria  >1500 cc/24 hours  consider intake Enuresis
  49. 49. COMMON DISRUPTIONS IN URINARY ELIMINATION Dysuria  Painful urination:  Frequency  Hesitancy  Urgency
  50. 50. COMMON DISRUPTIONS IN URINARY ELIMINATION Urinary Tract Infection (UTI)  Can occur anywhere in the urinary tract Cystitis Ureteritis Pyleonephritis More common in women than men
  51. 51. COMMON DISRUPTIONS IN URINARY ELIMINATIONUrinary retention: Inability to pass part of the urine in bladder Common in older men with benign prostate Hyperplasia
  52. 52. COMMON DISRUPTIONS IN URINARY ELIMINATIONUrinary obstruction Urolithiasis- Stones calculi block or partially block kidney, Ureters, or bladder- Obstruction from strictures, tumors, ed ema
  53. 53. FORMS OF INCONTINENCEUrinary Incontinence: Failure of major smooth muscle strength of Detrusor muscle of the bladder, instability or obstruction. Incontinences divided into 4 types. Pt may have mixed pattern:
  54. 54. FORMS OF INCONTINENCE Urge Incontinence Urgency following strong sense to void  Decreased bladder capacity  Alcohol or caffeine ingestion  infection Stress Incontinence Small amts with laughing, sneezing, coughing  Urgency, frequency
  55. 55. FORMS OF INCONTINENCE Overflow Incontinence: Retention Functional Incontinence: Intact urinary and nervous system  Change in environment  Sensory, cognitive or mobility deficit  Void before reaching bathroom
  56. 56. LOSS OF URINARY CONTROLNursing ASSESSMENT of Urinary Incontinence: Confirm factors related to episodes Determine cognitive function and the ability of patient to participate interventions Make observations during caregiving regarding the amount and frequency of loss of urine and situations surrounding incontinent episodes Assess abdominal and suprapubic palpation for tenderness and fullness Determine hydration status and possibility of constipation Ask specific questions regarding situations that lead to urine loss
  57. 57. ALTERED MEANS OF URINARYELIMINATION Catheters urethral suprapubic condom
  58. 58. FOLEY CATHETER
  59. 59. FOLEY CATHETERS
  60. 60. FOLEYhttp://www.youtube.com/watch?v=tynS0E4hBn0
  61. 61. FOLEY
  62. 62. CONDOM/TEXAS CATHETER
  63. 63. BEDSIDE DRAINAGE BAGS
  64. 64. SUPRAPUBIC CATHETER
  65. 65. ALTERED MEANS OF URINARY ELIMINATIONUrinary diversion - surgical creations Ureterostomy - (transureterostomy) Bring Ureters to abdominal surface Uterosigmoidostomy Ilea conduit or loop Implant ureter into ileum  Form stoma  Form pouch  Need occasional catheterization to empty Kock pouch
  66. 66. ILEAL CONDUIT
  67. 67. A NEOBLADDER
  68. 68. NEPHROSTOMY TUBE
  69. 69. THE KOCK POUCH—A CONTINENT URINARYDIVERSION
  70. 70. COMMON TESTS BUN http://video.google.com/videoplay?docid=7519331476907982001&q=urinary+system&total=83&start=0&num=10&so=0&type =search&plindex=0 Creatinine Clearance Urinalysis
  71. 71. COMMON TESTSVisualization procedures KUBAn X-ray showing the kidney, ureter, and bladder. This is in reality a plain abdominal X-ray andincludes other structures such as the diaphragm above and the pelvis below.http://trismus1.files.wordpress.com/2007/04/eg-kub_2_1withpaint.jpg Retrograde Pyleography CT scan
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