2. 1. Define elimination pattern
2. Discuss common problems of elimination.
3. Identify nursing interventions for common problems
of fecal elimination.
4. Discuss common problem of Urinary Elimination
5. Identify nursing intervention for common urinary
problems
6. Describe factors that can alter urinary function
7. Discuss nursing process for a patient with altered
elimination pattern
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3. Excretion of undigested substances and
waste products from our body is known
as elimination.
3
4. Elimination patterns describe the
regulation, control, and removal of by-
products and wastes in the body. The term
usually refers to the movement of feces or
urine from the body.
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5. Urinary elimination occurs through a group of
organs in the body that collects excess fluid along
with waste products from the bloodstream, and
excretes it out of the body in the form of urine.
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6. Kidneys
Remove waste from
the blood to form
urine
Ureters
Transport urine from
the kidneys to the
bladder
Bladder
Reservoir for urine until
the urge to urinate
develops
Urethra
Urine travels from
the bladder and exits
through the urethral
meatus.
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7. • Urination ( Micturition, voiding) is the process of
emptying the urinary bladder.
• Enuresis is defined as the involuntary passing of
urine.
• Nocturnal enuresis (bed-wetting) is the
involuntary passing of urine during sleep.
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8. Brain structures influence bladder function.
Voiding: Bladder contraction + Urethral sphincter and
pelvic floor muscle relaxation
1. Stretching of bladder wall signals the micturition center in
the sacral spinal cord.
2. Impulses from the micturition center in the brain respond
to or ignore this urge, thus making urination under
voluntary control.
3. When a person is ready to void, the external sphincter
relaxes, the micturition reflex stimulates the detrusor
muscle to contract, and the bladder empties.
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10. Polyuria:
Polyuria (or diuresis) refersto
the production of abnormally
large amounts of urine by the
kidneys, often several litters
more than the client’s usual
daily output.
Oliguria:
Oliguria is low urine
output, usually less than
500 ml a day or 30 ml
an hour for an adult.
Anuria:
Anuria refers to a
lack of urine
production
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12. Urinary frequency
Urinary frequency is
voiding at frequent
intervals, that is, more
than four to six times per
day
Nocturia
Nocturia is voiding
two or more times at
night.
Urgency
Urgency is the sudden,
strong desire to void.
Dysuria
Dysuria means
voiding that is either
painful or difficult.
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14. Urinary Hesitancy
A delay and
difficulty in
initiating voiding
Urinary Retention
When emptying of the bladder
is impaired, urine accumulates
and the bladder becomes over
distended, a condition known
as urinary retention
Urinary diversion
Diversion of urine to
external source
Urinary incontinence (UI), or
involuntary leakage of urine or loss
of bladder control.
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16. 1-Stress urinary incontinence
(SUI) occurs because of weak
pelvic floor muscles causing urine
leakage with such activities as
laughing, coughing, sneezing.
2-Urge Urinary Incontinence is
described as an urgent need to
void and the inability to stop
micturition.
3-Mixed Incontinence is diagnosed
when symptoms of both stress UI
and urgency UI are present.
4-Overflow Incontinence is
“continuous involuntary leakage or
dribbling of urine that occurs with
incomplete bladder emptying”
Types of Urinary incontinence
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19. Assessing
A complete assessment of a client’s urinary function
includes the following:
Nursing history
Physical assessment of the genitourinary system,
hydration status, and examination of the urine
Relating the data obtained to the results of any
diagnostic tests and procedures.
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20. Gather nursing history for the patient’s urination pattern
and symptoms, and factors affecting urination.
Conduct physical assessment of the patient’s body systems
potentially affected by urinary change.
Assess characteristics of urine.
Assess the patient’s perception of urinary problems as it
affects self-concept and sexuality.
Gather relevant laboratory and diagnostic test data.
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21. Skin and mucosal
membranes
Assess hydration.
Kidneys
Flank pain may occur with
infection or inflammation.
Bladder
Distended bladder rises
above symphysis pubis.
Urethral meatus
Observe for discharge,
inflammation, and lesions.
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22. Intake and output
Characteristics of urine
Color
Pale-straw to amber color
Clarity
Transparent unless pathology is present
Odor
Ammonia in nature
Urine testing
Specimen collection
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25. Maintaining Normal Urinary Elimination
promoting adequate fluid intake
maintaining normal voiding habits
assisting with toileting.
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26. Preventing Urinary Tract Infections
Managing Urinary Incontinence
Education of the client and support people.
Bladder retraining
Habit training
Pelvic Floor Muscle Exercises
Pelvic floor muscle (PFM), or Kegel exercises help
to strengthen pelvic floor muscles and can reduce or
eliminate episodes of incontinence.
Maintaining Skin Integrity
Promotion of comfort
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28. Evaluate whether the patient has met outcomes and
goals.
Check how the patient reports progress made.
Help the patient redefine goals if necessary.
Revise nursing interventions as indicated.
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29. Faecal elimination is the expulsion of the residues
of digestion—faeces—from the digestive tract. The
act of expelling faeces is called defecation
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30. Mouth
Digestion begins with
mastication.
Esophagus
Peristalsis moves food into
the stomach.
Stomach
Stores food; mixes food,
liquid, and digestive juices;
moves food into small
intestines
Small intestine
Duodenum, jejunum, and
ileum
Large intestine
The primary organ of bowel
elimination
Anus
Expels feces and flatus
from the rectum
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31. • Development
• Diet
• Fluid Intake and Output
• Activity
• Psychological Factors
• Defecation Habits
• Medications
• Anesthesia and Surgery
• Pathologic Conditions
• Pain
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32. Constipation is defined as
fewer than three bowel
movements per week.
Fecal impaction is a mass or
collection of hardened feces in the
folds of the rectum. Impaction
results from prolonged retention
and accumulation of fecal material
Diarrhea refers to the
passage of liquid feces and an
increased frequency of
defecation.
Hemorrhoids is dilated,
engorged veins in the lining
of the rectum
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34. Bowel Incontinence also
called fecal incontinence,
refers to the loss of voluntary
ability to control fecal and
gaseous discharges through
the anal sphincter
Flatulence is the presence of
excessive flatus in the
intestines and leads to
stretching and inflation of the
intestines (intestinal
distention)
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36. Nursing history
Identifying normal and abnormal patterns,
habits, and the patient’s perception of normal
and abnormal with regard to bowel
elimination allows you to accurately
determine a patient’s problems.
Physical assessment
Mouth, abdomen, and rectum
Laboratory tests
Fecal characteristics
Fecal specimens
Assess bowel sounds
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37. Diagnostic examinations
Radiologic imaging, with or without contrast
Endoscopy
Ultrasound
CT Scan or MRI
Assess for s/s of constipation
Decrease in frequency of bowel movements
Consistency of stool
Anorexia
Abdominal distention and pain
Feeling of fullness or pressure inrectum
Straining during defecation
Assess bowel sounds
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37
40. Encourage fluid intake of at least1500
ml/24hr
Encourage activity: walk pt in hallway 4
times a day
Encourage to defect whenever urge is felt
Assist the pt in high Fowlers for defecation
Provide for privacy
Encourage to drink hot liquids inAM
Administer laxatives or enemas as ordered
Consult with HCP to check for impaction
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