Bs.Nursing - FON-II

1. CONCEPT OF
ELIMINATION
By:Aasan Das
Student: ICoN&M - DUHS

2. Objectives:
At the end of this unit, learners will be able to:
Define elimination pattern
Discuss common problems of elimination.
Identify nursing interventions for common problems of fecal
elimination.
Discuss the common problem of Urinary Elimination
Identify nursing intervention for common urinary problem.
Describe factors that can alter the urinary function
Discuss the nursing process for a patient with an altered elimination
pattern.

3. Elimination
It refers to the excretion of waste and nondigested
products of the metabolic processes.
Urinary Elimination
Bowel elimination
Importance:
In balance of fluids, electrolytes and nutrition.
Interrelated functioning:
GIS,US,NUS, SKIN.

4. Urinary Elimination
Desire to void (250‐450 ml)
Stimulation of voiding reflex centre
Inhibition of voiding reflex centre
and pudent nerve.
Relaxation of external sphincter
and contraction of urinary bladder.
Voiding

5. Bowel Elimination
Receiving of chyme
⬇
Movement of chyme
⬇
Gastrocolic reflex
⬇
Duodenocolic reflex
⬇
Defecation reflex
⬇
Defecation

6. PROBLEMS OF ELIMINATION
Diarrhea
Diarrhea is loose, watery stools (bowel movements). You have
diarrhea if you have loose stools three or more times in one
day.
What causes diarrhea?
Bacteria
Viruses
Parasites
Medicines
Food intolerance
Diseases and problem with bowel.

7. Sign and symptoms
Cramps or pain in the abdomen
An urgent need to use the bathroom
Loss of bowel control
If a virus or bacteria is the cause of your diarrhea, you
may also have a fever, chills, and bloody stools.
Constipation:
Having fewer than three bowel movements a week is,
technically, the definition of constipation. However, how
often you “go” varies widely from

8. Sign and symptoms
Your stools are dry and hard.
Your bowel movement is painful and stools are difficult to pass.
You have a feeling that you have not fully emptied your bowels.
Causes
Eating foods low in fiber.
Not drinking enough water (dehydration).
Not getting enough exercise.
Changes in your regular routine, such as traveling or eating or
going to bed at different times.
Eating large amounts of milk or cheese.
Stress.
Resisting the urge to have a bowel movement.
Medications

9. Impaction
Fecal impaction is a severe bowel condition in which a
hard, dry mass of stool becomes stuck in the colon or
rectum. This immobile mass will block the passage and
cause a buildup of waste, which a person will be unable to
pass.
Sign and symptoms:
Liquid stool leaking from the rectum
Pain or discomfort in the abdomen
Abdominal bloating
Nausea or vomiting
Unintentional weight loss

10. Causes
Untreated constipation
Arorectal surgery
Immobility
Medications
Overuse of laxatives

11. Hemorrhoids
Hemorrhoids, also called piles, are swollen vein in your anus
and lower rectum , similar to various veins . Hemorrhoids can
develop inside the rectum (internal hemorrhoids) or under the
skin around the anus (external hemorrhoids).
Causes of hemorrhoids:
Straining during bowel movements .
Having chronic diarrhea or constipation
Being obese
Eating a low fiber diet
Being pregnant
Regular heavy lifting

12. Signs and symptoms:
External hemorrhoids
Itching or irritation in your anal region
Pain or discomfort
Swelling around your anus
Internal Hemorrhoids:
Painless bleeding during bowel movements . You
might notice small amount of bright red blood.
A hemorrhoid to push through the and opening
(prolapsed or protruding hemorrhoid) resulting in
pain and irritation.

13. Flatulence
Gas accumulation in the lumen of intestine
Commonly known as farting, passing wind or having gas.
Flatulence occurs when gas collects inside the digestive
system.
Causes of Flatulence:
Swallowing air:
Smoking
Drinking carbonated drinks
Eating too quickly
Dietary choices:
Beans
Cabbage
Broccoli

14. Signs and symptoms:
Foul smelling gas
Abdominal pain
Cramping
Incontinence:
Inability to control passage of feces and gas from the anus.
The severity ranges from occasionally leaking urine when
you cough or sneeze to having an urge to urinate that’s so
sudden and strong.

15. Causes of Incontinence:
Urinary incontinence can be caused by every
day habits. Underlying medical conditions or
physical problems
Alcohol
Carbonated drinks and sparking water.
Heart and blood pressure medication ,
sedatives and muscle relaxants.
Urinary incontinence can also be caused by
physical problems or changes:
Pregnancy
Child birth
Menopause

16. Sign and symptoms:
Experience frequent or constant dribbling of urine
due to a bladder that does not empty completely .
Lose small to moderate amounts of urine more
frequently.
Urine leaks when you exert pressure by sneezing ,
coughing , laughing , exercising or lifting something
heavy.

17. Nursing Interventions for problems of
fecal elimination
Interventions (for Diarrhea)
Weigh patient daily and
note decreased weight.
Give antidiarrheal drugs
as ordered.
Rationales
An accurate daily weight is
an important indicator of
fluid balance in the body.
Most antidiarrheal drugs
suppress gastrointestinal
motility, thus allowing for
more fluid absorption.
Supplements of beneficial
bacteria (“probiotics”) or
yogurt may reduce
symptoms by reestablishing
normal flora in the intestine.

18. Interventions(for Constipation)
Encourage the patient to
take in fluid 2000 to 3000
mL/day, if not
contraindicated medically.
Assist patient to take at
least 20 g of dietary fiber
(e.g., raw fruits, fresh
vegetable, whole grains)
per day.
Rationales
Sufficient fluid is needed to
keep the fecal mass soft.
But take note of some
patients or older patients
having cardiovascular
limitations requiring less
fluid intake.
Fiber adds bulk to the stool
and makes defecation
easier because it passes
through the intestine
essentially unchanged.

19. Interventions
Urge patient for some
physical activity and
exercise. Consider
isometric abdominal and
gluteal exercises.
Encourage a regular
period for elimination.
Rationales
Movement promotes peristalsis.
Abdominal exercises strengthen
abdominal muscles that facilitate
defecation.
Most people defecate following the
first daily meal or coffee, as a
result of the gastrocolic reflex.

20. Interventions(for Incontinence)
Digitally eliminate the
fecal impaction.
Warm sitz bath
Rationales
Stool that remains in the rectum for
long periods becomes dry and
hard; debilitated patients,
especially older patients, may not
be able to pass these stools
without manual assistance.
The warmth of the water relaxes
muscles before defecation
attempts.

21. Interventions
Unless contraindicated,
encourage the patient to
use the bathroom. For
bedridden patients; assist
the patient in assuming a
high-Fowler’s position with
knees flexed.
Using the heel of the hand
or a tennis ball, apply and
release pressure firmly but
gently around the abdomen
in a clockwise direction.
Rationales
A sitting position with
knees flexed straightens
the rectum, enhances
the use of abdominal
muscles, and facilitates
defecation.
Abdominal massage has
been known to be helpful in
neurogenic bowel disorder
but not for constipation in
older adults.

22. Interventions(for Hemorrhoids)
Administer
topical medication as
ordered.
Administer stool softeners
as ordered.
Rationales
Reduces swelling, pain,
and/or itching in order to
make the patient more
comfortable.
Helps prevent straining and
increases the pressure that
may cause clotted vessels
to rupture or cause further
hemorrhoids to develop.
Helps relieve pain by
avoiding passage of hard
fecal material.

23. Interventions
Assist with procedures for
the treatment of
hemorrhoids.
Instruct patient and/or
family in dietary
management.
Rationales
Laser surgery may be performed
but symptomatic relief is not
obtained immediately.
Increasing bulk, fiber, fluids, and
eating fruits and vegetables can
help by maintaining soft stools to
avoid straining at bowel
movements.

24. Common problems of Urinary
Elimination
Urinary elimination:
Urinary elimination is defined as the passage of urine through
the urinary tract by means of the urinary sphincter and urethra
Normal conditions: an average person eliminates
approximately 1500-3000 ml of urine each day
Need to urinate becomes apparent when the bladder distends
with approximately 150-300 ml of urine.
Pattern of urinary elimination:
Physiologic
Emotional
Social
Examples: Amount of food consumed, volume of
fluid intake, and the amount of fluid losses.

25. Alternation in Urinary
Elimination:
Polyuria
Oliguria
Anyria
Dysuria
Frequency
Nacturia
Pallakuria
Urigency
Hesitancy
Inconvenience

26. Polyuria: Increase Urination
 More than 100cc/hour
 Above 2500cc/day.
Oliguria: Decrease urine output.
 Less than 30cc/hour
 100-500cc/day
Anuria or Enuresis: Passage of less than 50 mL of urine per
day.
Dysuria: Painful or difficult urination.
Frequency: Abnormally frequent urination

27. Nocturia: Excessive urination at night.
Pollakuria: Excessive urination at day.
Urigency: Is an abrupt, strong, often overwhelming need
to urinate.
Hesitancy: When a person has trouble starting or
maintaining a urine stream.
Incontinence: Involuntary passage of urine due to the loss
of bladder control psychologically or physiologically.

28. Urinary Tract Infection
Urinary tract infection is caused by pathogenic
microorganisms in the urinary tract.
Stay hydrated, drinking water regularly may help you to
treat UTI
Urinate when the need arises.
Drink cranberry juice.
Get enough vitamin C: Large amount of vitamin C limit the
growth of some bacteria by acidifying the urine.
Practice good sexual hygiene.

29. Nursing Interventions for Common
Urinary Problems
Provide privacy (Privacy aids relaxation of
urinary sphincters).
Encourage adequate fluid intake.
Avoiding caffeine and smoking.
Maintain drainage of catheters.

30. Allow the patient to listen the sound of
running water, or dip hands in warm water or
pour water over perineum
Offer fluid before voiding
Encourage patient to void at least every
four hours

31. Encourage regular intake of cranberry juice.
Place the patient in upright position to
facilitate successful voiding.
Promote continuous mobility.
Teach patient about perineum hygiene.

32. Decompress bladder moderately.
Teach the patient about surgical treatment
as needed.
Suggest sitz bath.

33. Factors that can Alter Urinary Function
Abnormal findings of urine:
Hematuria: Presence of blood in the urine.
Pyuria: Presence of pus in the urine.
Albuminuria: Presence of albumin in urine.
Glycosuria: Presence of blood sugar in urine.
Casts: Presence of coagulated protein from the kidney
tubule.
Dark urine: Means the urine is concentrated.

34. Factors that can Alter Urinary Function
Fluid intake.
Bladder capacity
Intake of drugs
Psychological factors.

35. Pathologic conditions.
Physical activities.
Blood pressure.
Obstruction.
Hormonal influence.

36. Nursing Interventions: Health Promotion
Measures to Promote Voiding
Privacy, unhurried, offer assistance at patient’s usual
voiding times, encourage voiding every 4 hours, relieve
anxiety and discomfort, assist into physiologic positioning.
Promote Adequate Fluid Intake.
Prevent UTI:
Void every 4 hours; female void immediately after
intercourse; avoid bubble baths and harsh soapa; teach
symptoms of UTI.
Promote optimal muscle tone: Kegel exercises.

37. Nursing Interventions for Altered
Functioning
Behavioral Interventions
Adequate fluid intake
Scheduled voiding:
Timed voiding every 2 hours
Bladder retraining: void every 2 hours and suppress urge:
gradually increase to 4 hours
Strengthening pelvic floor muscles (kegels)
External catheters and absorbent products Perineal
hygiene of incontinent patient

38. Drug therapy:
Increase emptying (in rentention): Urecholine
(Bethanocol)
Decrease hyperactivity of bladder (in urge incontinence),
Tolterodine (Detrol), Oxybutinin (Ditropan)
Care of Indwelling Catheters:
Monitor urine output: should be at least 30cc/hr
If less; check placement, bladder scan
If still no improvement call MD; could be clogged or could
indicate serious condition
Monitor color, clarity, odor of urine and mental status
At high risk for developing UTI

39. Prevent CAUTI
Good handwashing; empty through outlet port at least every
8 hours; affix to body to prevent trauma; keep below level of
bladder; cleanse perineal area at least daily and after every
bowel movement.
Once Foley catheter is removed: void within 6-8 hours
No void in 6-8 hrs requires urgent assessments/interventions
for urinary retention.
Interventions (Cont…)
Suprapubic catheters
Intermittent catheterization
Nephrostomy tubes (never clamp)
Legs bags
Renal dialysis