1. ELIMINATION
P&A

3. QUICK ANATOMY MOMENT
 Kidneys
 Ureters
 Bladder
 Urethra

4. NORMAL URINE
 Volume – approx 250ml-400ml per void
 - normal production 30ml/hour
-1200-1500cc for average adult per 24 hours
- 500-600 newborns
 Color
light yellow
 Clarity
clear without sediment
 Odor
no odor

5. FACTORS AFFECTING URINATION
 Fluid Intake – influences output and frequency
 Hypovolemia- loss of fluid
 Nutrition – food content, salt, ETOH, caffeine
 Body position – work with gravity
 Cognition – dementia/confusion, stroke

6. FACTORS AFFECTING URINATION
(CONT.)
 Psychological factors – stress, running water,
warm water, privacy
 Obstruction – anatomical, disease process
 Infection – E. coli
 Medications – diuretics

7. ALTERED URINARY FUNCTION
 Dysuria
 Polyuria
 Oliguria
 Urgency
 Frequency

8. ALTERED URINARY FUNCTION
(CONT.)
 Nocturia
 Hematuria
 Pyuria
 Urinary retention

9. INCONTINENCE
 Stress
increased abdominal pressure
 Functional
unable to get to bathroom
 Total
continuous, involuntary

10. DIAGNOSTICS
 Random specimen
- does not need to be sterile
- into container or nun’s cap
 Clean catch
- sterile
- three wipes

11. DIAGNOSTICS (CONT.)
 24 hour
-kidney function
- must include all urine
- timing
 Catheter sample
- sterile
- straight cath or indwelling

12. COLLECTING URINE FROM YOUNG
CHILDREN
 Catheterization not
recommended
 Use of collection bag

13. TESTS
 Specific gravity
- weight or concentration of urine compared to water
- urinometer
- normal adult 1.010 – 1.025
 Reagant strips
- dipped in urine
- measures substances in urine such as
glucose, proteins &
ketones

14. TESTS (CONT)
 Urinalysis
- most common
- 20cc-30cc sample
 Urine C&S
- identify microorganisms
- 24 to 48 hours
- often related to antibiotic use

15. URINARY HEALTH PROMOTION
 Intake
 UTI’s
 Muscle tone

16. URINARY CATHETERS
 Indications
-inability to void, accurate measurement, irrigation,
comfort
 Types
- straight, indwelling (Foley), triple lumen
 Risks
- infection, trauma

17. STRAIGHT CATHETERIZATION
 Wash hands
 Check pt ID
 Explain procedure
 Position patient
 Open kit
 Bottom drape
 Sterile gloves
 Top drape
 Pour betadine on cotton balls
 Open lubricant
 Nondominant vs dominant hands
 Insert and advance
 Sample if needed
 Reposition patient, remove gloves, wash
hands document

18. INDWELLING CATHETERIZATION
 Wash hands
 Check pt ID
 Explain procedure
 Position patient
 Open kit
 Bottom drape
 Sterile gloves
 Top drape
 Test balloon
 Pour betadine on cotton balls
 Open lubricant
 Nondominant vs dominant hands
 Insert, advance & inflate balloon
 Sample if needed
 Reposition patient, strap to leg, remove
gloves, wash hands document

19. INDWELLING CATHETER (FOLEY)

20. NURSING RESPONSIBILITIES
 Placement and removal
 Assessment
 Sample collection
 Troubleshoot
 Irrigate when needed

21. BLADDER IRRIGATION

22. OTHER TYPES OF URINARY
CATHETERS
Suprapubic Nephrostomy tubes
Condom Catheter

23. OTHER RELATED URINARY
COMPONENTS
 Dialysis
Hemodialysis
Peritoneal dialysis
 Bladder scanner

24. BOWEL ELIMINATION

25. FACTORS AFFECTING BOWEL ELIMINATION
 Nutrition
- fiber
- lactose intolerant
- gluten
 Fluid intake
- 75% water
- ↓fluid intake
 Hemorrhoids
- enlarged varicose veins
 Medication
- narcotics
- Fe
- antacids

27. ALTERED BOWEL FUNCTION
 Constipation
- infrequent, painful, hard, dry
 Fecal impaction
- accumulation in rectum
- digital disimpaction
 Diarrhea
- ↑ motility
- medication
 Incontinence
- involuntary
 Distention
- inactivity
 Disease process
- Crohn’s disease, Cystic Fibrosis

28. DIAGNOSTIC TESTS
 Specimen
- stool only
- procedure
 Occult blood
- Guaiac or Hemoccult
- procedure
 Culture
- atypical intestinal
organisms
- procedure, O&P
 Radiologic
- x-ray image of opaque substance
- barium, laxatives, enemas,
NPO
 Endoscopy
- visualization of internal
structures
-EGD (esophagogastro
duodenoscopy)
http://www.youtube.com/watch?v=_qrbzpDA98g&feature=related

29. SPECIMENS

30. CHECKING FOR OCCULT
BLOOD
 http://www.youtube.com/watch?v=Pc3MtqUwFwE

31. COLONOSCOPY
 http://www.youtube.com/watch?v=W0fjO0rsCIw

32. ENEMA
 Purpose – cleansing of large bowel
 Small Volume
- commercially prepared, oil or water, approx. 150cc
 Large Volume
- warm tap water or saline,
- 1000cc for adult, 240cc-350cc for child, 15cc-60cc infant
 Return Flow
- flatus
- 300cc-500cc
- repeat as necessary

33. ENEMA PROCEDURE
 Wash hands
 ID patient and explain procedure
 Fill bag with fluid
 Place patient in left lateral position
 Place chux
 Insert lubricated end of enema tubing 3-4 inches
into rectum
 Hang/hold enema bag 12-18 inches above patient
 Place on bedpan or BSC or eventually bathroom
 Make patient comfortable
 Wash hands
 Document

34. FECAL DIVERSION
 Procedure
 Ostomy
 Ileostomy
 Colostomy
- temporary or permanent
- irrigation
- clothing
- unusual circumstances

35. STOMA

36. TYPES OF COLOSTOMIES
 Ascending  Descending
Sigmoid

37. TYPES OF COLOSTOMIES (CONT.)
 Transverse

38. CARE OF THE COLOSTOMY
 Assessment
- pink, no pain, flush to skin
 Cleaning
- soap and water
 Bag changing
- disposable vs reusable
 Emotional support

39. COVER UP