elimination, nursing
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  • 1. NURSING FUNDAMENTALS FOCUS IX Elimination Needs
  • 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. 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. 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. Structures and Functions Related To Bowel EliminationSTRUCTURES AND FUNCTIONSRELATED TO BOWEL ELIMINATIONDIGESTIONHTTP://WWW.MEDTROPOLIS.COM/VBODY.ASP
  • 6. STRUCTURES AND FUNCTIONS RELATED TOBOWEL ELIMINATION Bolus with Ptyalin HCL, Pepsin Intrinsic factor Mucus  CHYME Releases bile to Amylase released duodenumAbsorption, secretion, Nutrients, electrolytes,protection, elimination vitamins absorbed Defecation process
  • 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.  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. FACTORS AFFECTING BOWELELIMINATION  Lifestyle  Personal habits  Nutrition and fluid intake  Physical activity  Culture  Norms of western culture  Age  Infancy  Elders
  • 10. FACTORS AFFECTING BOWEL ELIMINATION Physiological factors  Pregnancy  Motor and or sensory disturbance  Intestinal pathology  Medications  Surgery and anesthesia Psychosocial factors  Anxiety  Depression
  • 11. CHARACTERISTICS OF NORMALSTOOL Color Odor Consistency Frequency Amount Shape Constituents
  • 12. SELECTED FECAL ELIMINATIONPROBLEMSConstipationDiarrheaBowel incontinenceFlatulence
  • 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. 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. 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. 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. FLATUENCE Excessive flatus in intestines Leads to stretching and inflation of intestines Can occur from variety of causes: Foods Abdominal surgery Narcotics
  • 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. 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. ABDOMINAL QUADRANTS AND ORGANS
  • 21. ABDOMINAL QUADRANTS AND ORGANS
  • 22. ABDOMINAL QUADRANTS AND ORGANS
  • 23. ABDOMEN Subjective Assessments:  Any abdominal pain?  N/V?  Appetite good?  Last BM?  Stool formed/loose?
  • 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. 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. AIDS TO NORMAL BOWEL ELIMINATION Fluid intake and fiber:  Adequate fiber  Adequate fluid intake  Upright posture
  • 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. FECAL INCONTINENCEAssessment key factors: Is the problem correctable or manageable? What is the timeline or duration of situation? Any associated symptoms?
  • 29. NANDA NURSING DIAGNOSIS Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea
  • 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. 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. 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. FECAL ELIMINATION PATTERNS Privacy Timing Nutrition and fluids Exercise Positioning
  • 34. ALTERED MEANS OF BOWEL ELIMINATION
  • 35. ALTERED MEANS OF BOWEL ELIMINATION Ileostomy
  • 36. ALTERED MEANS OF BOWELELIMINATIONStomaForm- ation
  • 37. ALTERED MEANS OF BOWEL ELIMINATIONStoma
  • 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. 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. COMMON TESTS Fecal specimens  Ova and Parasites Guaiac testing  Hidden (occult) blood
  • 41. Urinary Elimination
  • 42. KIDNEYShttp://www.youtube.com/watch?v=chhNaLi9P3EUrine Formationhttp://www.argosymedical.com/flash/urine_formation/landing.html
  • 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. NORMAL MICTURITION MECHANISM ANDRELATED BODY STRUCTURES
  • 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. 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. STRUCTURES AND FUNCTIONS RELATEDTO FLUID ELIMINATION Characteristics of normal urine:  Color  Clarity  Odor
  • 48. ALTERED AMOUNT Oliguria  Diminished, scanty amount <30cc Anuria  absence of urine Polyuria  >1500 cc/24 hours  consider intake Enuresis
  • 49. COMMON DISRUPTIONS IN URINARY ELIMINATION Dysuria  Painful urination:  Frequency  Hesitancy  Urgency
  • 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. COMMON DISRUPTIONS IN URINARY ELIMINATIONUrinary retention: Inability to pass part of the urine in bladder Common in older men with benign prostate Hyperplasia
  • 52. COMMON DISRUPTIONS IN URINARY ELIMINATIONUrinary obstruction Urolithiasis- Stones calculi block or partially block kidney, Ureters, or bladder- Obstruction from strictures, tumors, edema
  • 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. 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. 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. 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. ALTERED MEANS OF URINARYELIMINATION Catheters urethral suprapubic condom
  • 58. FOLEY CATHETER
  • 59. FOLEY CATHETERS
  • 60. FOLEYhttp://www.youtube.com/watch?v=tynS0E4hBn0
  • 61. FOLEY
  • 62. CONDOM/TEXAS CATHETER
  • 63. BEDSIDE DRAINAGE BAGS
  • 64. SUPRAPUBIC CATHETER
  • 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. ILEAL CONDUIT
  • 67. A NEOBLADDER
  • 68. NEPHROSTOMY TUBE
  • 69. THE KOCK POUCH—A CONTINENT URINARYDIVERSION
  • 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. 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