Elimination
Basic Principles  <ul><li>Wash Hands & Wear Gloves </li></ul><ul><ul><li>Infection control, your protection & your client’...
Functions of Urinary System <ul><li>Remove wastes from blood to form urine </li></ul><ul><li>Remove nitrogenous waste prod...
Goal of Urinary System <ul><li>To maintain chemical homeostasis of the blood.  </li></ul><ul><ul><li>Filtration by the Nep...
Overview of Urinary System <ul><li>Kidneys </li></ul><ul><ul><li>Bean shaped organs </li></ul></ul><ul><ul><li>Either side...
<ul><li>Ureters </li></ul><ul><ul><li>Connect kidneys to bladder </li></ul></ul><ul><ul><li>10 -12 in length, ½ in diamete...
<ul><li>Bladder </li></ul><ul><ul><li>Distensible, muscular sac </li></ul></ul><ul><ul><li>Reservoir for urine ( approx. c...
<ul><li>Urethra </li></ul><ul><ul><li>Short, muscular tube </li></ul></ul><ul><ul><li>Urine from bladder to meatus and fro...
<ul><li>Meatus </li></ul><ul><ul><li>External opening of the urethra, male & female </li></ul></ul><ul><li>The need to voi...
Life Cycle Changes  <ul><li>Infants & children </li></ul><ul><ul><li>Unable to concentrate urine b/c kidneys are immature ...
<ul><li>Adult </li></ul><ul><ul><li>1500 – 1600 mls urine/24hrs </li></ul></ul><ul><ul><li>Concentrates urine – normal is ...
<ul><li>Elderly </li></ul><ul><ul><li>Micturition impaired </li></ul></ul><ul><ul><li>mobility  </li></ul></ul><ul><ul><li...
Common Problems <ul><li>Urinary Retention </li></ul><ul><ul><li>Accumulation of urine in the bladder </li></ul></ul><ul><u...
<ul><li>Incontinence </li></ul><ul><ul><li>Loss of voluntary control to void </li></ul></ul><ul><ul><ul><li>Infection, ner...
<ul><li>Frequency & Urgency </li></ul><ul><li>Nocturia </li></ul><ul><li>Enuresis – involuntary discharge of urine </li></...
<ul><li>Renal anuria </li></ul><ul><ul><li>cessation of urine production  100mls/24h  </li></ul></ul>
Promoting Healthy Urinary Elimination <ul><li>Urinate as soon as the urge is felt </li></ul><ul><ul><li>Avoids stasis and ...
<ul><li>For people with Nocturia </li></ul><ul><ul><li>fld. Intake in the p.m. </li></ul></ul><ul><ul><li>caffiene and alc...
Client Education <ul><li>S & S of infection </li></ul><ul><li>Fluid intake ( if no restrictions 2-5 L/day ) </li></ul><ul>...
Facilitating Micturition <ul><li>Nursing Measures to promote voiding in people who are having difficulty: </li></ul><ul><u...
<ul><li>Gently stroking inner thighs or pressure to symphysis pubis </li></ul><ul><li>Pain relief </li></ul><ul><li>Warmth...
<ul><li>Promoting complete bladder emptying </li></ul><ul><li>Prevention of infection </li></ul><ul><ul><li>Good perineal ...
Indwelling Catheter Care <ul><li>Goal - prevent infection & maintain unobstructed flow of urine. Monitor for problems. </l...
Catheter Care <ul><li>Fld intake (3L/day ) </li></ul><ul><li>Handwashing and Gloves </li></ul><ul><li>Positioning  </li></...
Bowel Elimination <ul><li>Function - excrete/eliminate waste products of digestion. </li></ul><ul><li>Maintaining normal b...
GI System <ul><li>Small Intestine </li></ul><ul><ul><li>Absorption nutrients & electrolytes </li></ul></ul><ul><ul><li>20 ...
GI <ul><li>Large Intestine </li></ul><ul><ul><li>Absorbs H2O and electrolytes </li></ul></ul><ul><ul><li>Temporarily store...
Patterns through life cycle <ul><li>Babies: 3 – 6 BM’s/day </li></ul><ul><li>Children:  </li></ul><ul><ul><li>Neuromuscula...
<ul><li>Elderly prone to constipation </li></ul><ul><ul><li>Slowing of peristalsis  </li></ul></ul>
Determinants affecting elimination <ul><li>Dietary patterns & fld. Intake </li></ul><ul><ul><li>6 – 8 glasses H2O/day ( 14...
Factors affecting elimination <ul><li>Fiber ( undigestible residue ) provides bulk </li></ul><ul><ul><li>Absorbs fluid </l...
Factors affecting elimination <ul><li>Personal habits </li></ul><ul><ul><li>Busy schedule, postpone BM, constipation </li>...
Factors affecting elimination <ul><li>Emotions </li></ul><ul><ul><li>Anxiety  peristalsis & diarrhea </li></ul></ul><ul><u...
Common Problems <ul><li>Constipation – difficult passage of hard, dry stool; infrequent movements </li></ul><ul><li>Fecal ...
Common Problems <ul><li>Incontinence – inability to control passage of stool </li></ul><ul><li>Hemorrhoids </li></ul><ul><...
<ul><li>Daily BM Not essential. </li></ul><ul><li>   2 / week a concern </li></ul><ul><li>Defecation pattern </li></ul><u...
Promoting Healthy Bowel Elimination <ul><li>Privacy </li></ul><ul><li>Squatting position </li></ul><ul><li>Bedpan position...
<ul><li>Bowel routine </li></ul><ul><ul><li>Daily time clock </li></ul></ul><ul><ul><li>Hot drinks </li></ul></ul><ul><ul>...
Assissting with Elimination  <ul><li>Embarrassing & stressful </li></ul><ul><ul><li>Usually urge to defecate 1hr. Pc </li>...
Procedure <ul><li>Privacy- close door,  </li></ul><ul><li>Side rail as needed </li></ul><ul><li>Recumbent with HOB  </li><...
Procedure <ul><li>Remove pan and cover </li></ul><ul><li>In & Out </li></ul><ul><li>Specimens  </li></ul><ul><li>Clean pan...
Peri - Care <ul><li>Cleaning of genitals , routine part of complete/ partial bed bath </li></ul><ul><li>Incontinence  </li...
Procedure for Peri Care <ul><li>Regular patient </li></ul><ul><ul><li>Simple explanation- layman’s terms </li></ul></ul><u...
Procedure for Peri Care <ul><li>Male – begin penile head move down along shaft, retract foreskin, rinse and dry. </li></ul>
Procedure for Peri Care <ul><li>Catheter –  </li></ul><ul><ul><li>Q 8 hrs. </li></ul></ul><ul><ul><li>Clean perineum & 2in...
<ul><li>Avoid use of baby powder/ cornstarch </li></ul><ul><ul><li>No medicinal purpose  </li></ul></ul><ul><ul><li>Can fo...
Suppository Administration <ul><li>Check physician’s order, protocol </li></ul><ul><li>Left Lateral position </li></ul><ul...
<ul><li>Caution </li></ul><ul><ul><li>Vagus nerve stimulation can cause heart rate to slow – avoid excess manipulation </l...
Enema Administration <ul><li>Main purpose </li></ul><ul><ul><li>Promotion of defecation, stimulate peristalsis </li></ul><...
Types of Enemas
Cleansing Enemas <ul><li>Tap Water </li></ul><ul><ul><li>Hypotonic </li></ul></ul><ul><ul><li>Used only once </li></ul></u...
<ul><li>Normal Saline </li></ul><ul><ul><li>Used when more than one enema is needed </li></ul></ul><ul><ul><li>Safest </li...
<ul><li>Hypertonic Solution </li></ul><ul><ul><li>Smaller volume of fluid </li></ul></ul><ul><ul><li>Draws from surroundin...
<ul><li>Soap suds </li></ul><ul><ul><li>Less common  </li></ul></ul><ul><ul><li>Soap irritates the bowel </li></ul></ul><u...
<ul><li>Oil Retention </li></ul><ul><ul><li>Oil based solution </li></ul></ul><ul><ul><li>Lubricates the rectum and colon ...
<ul><li>Medicated </li></ul><ul><ul><li>Instill meds. </li></ul></ul><ul><ul><li>Rectal mucosa absorption </li></ul></ul><...
Volumes for Enemas <ul><li>Large Volume </li></ul><ul><ul><li>500 – 1000mls.  </li></ul></ul><ul><ul><li>Container 12 – 18...
Volumes for Enemas <ul><li>Pre packaged </li></ul><ul><ul><li>Fleet 150mls </li></ul></ul><ul><ul><li>Microlax 5mls </li><...
<ul><li>Prepackaged used more than large volume because: </li></ul><ul><ul><li>Works  </li></ul></ul><ul><ul><li>Less risk...
<ul><li>Physician’s order reads “ enemas to clear” </li></ul><ul><ul><li>No more than 3 total given </li></ul></ul><ul><ul...
Procedure for Enema Administration <ul><li>Confirm Dr’s order, prepare client, verbal consent, equipment, privacy </li></u...
Procedure for Enema Administration <ul><li>Prime tube </li></ul><ul><li>Lubricate tip </li></ul><ul><li>Glove  </li></ul><...
Procedure for Enema Administration <ul><li>Container at appropriate height </li></ul><ul><ul><li>Lg. = 12 – 18in </li></ul...
Procedure for Enema Administration <ul><li>Assist to bathroom or give bedpan </li></ul><ul><li>Evaluate results </li></ul>...
Ostomy Care
<ul><li>Certain diseases require surgical interventions to create an opening into the abdominal wall for fecal and urinary...
Definitions  <ul><li>Ostomy =  opening made to allow passage of urine or stool  </li></ul><ul><ul><li>Piece of intestine i...
<ul><li>Effluent – drainage from stoma </li></ul><ul><li>Bowel ostomies </li></ul><ul><ul><li>Cancer ( Ca) </li></ul></ul>...
<ul><li>Ileostomy  </li></ul><ul><ul><li>End of small intestine  </li></ul></ul><ul><ul><li>By passes lg. Intestine = freq...
<ul><li>Ostomies may be permanent  </li></ul><ul><ul><li>More common </li></ul></ul><ul><li>temporary </li></ul><ul><ul><l...
Urinary Ostomies <ul><li>Provide drainage of urine that bypasses the bladder = Urinary Diversion </li></ul><ul><li>Uretero...
Ileal Conduit <ul><li>6 – 8 in. ileum </li></ul><ul><li>1 end for external opening </li></ul><ul><li>Other end closed off ...
Concerns <ul><li>Infection  </li></ul><ul><ul><li>Sterile ureters provide opening into system </li></ul></ul><ul><li>Skin ...
Pouching an Enterostomy <ul><li>Effluent ( drainage ) may begin immediately </li></ul><ul><li>Collects all effluent </li><...
Pouch with Skin Barrier <ul><li>Comfortable fit </li></ul><ul><li>Cover skin surrounding stoma </li></ul><ul><li>Good seal...
Types of pouches and skin barriers <ul><li>One Piece Pouching System </li></ul><ul><ul><li>Skin barriers preattached, prec...
Steps to Care for Ostomies <ul><li>Supine position </li></ul><ul><li>Wash hands, glove </li></ul><ul><li>Remove pouch & sk...
Steps to Care for Ostomies <ul><li>Correct sizing </li></ul><ul><li>Cut opening 1/16 – 1/8 larger than stoma </li></ul><ul...
Steps to Care for Ostomies <ul><li>Pouch should point to client’s knees </li></ul><ul><li>Maintain gentle finger pressure ...
Steps to Care for Ostomies <ul><li>Normal stoma oozes blood if rubbed </li></ul><ul><li>Actual bleeding into pouch is abno...
Steps to Care for Ostomies <ul><li>Education </li></ul><ul><li>Counseling  </li></ul><ul><ul><li>Body image </li></ul></ul...
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NurseReview.Org - Elimination Nursing Lecture

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  • good ppt. can I get a copy at kujurmamta@yahoo.co.in
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  • helpful website that help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools . Hope they help


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NurseReview.Org - Elimination Nursing Lecture

  1. 1. Elimination
  2. 2. Basic Principles <ul><li>Wash Hands & Wear Gloves </li></ul><ul><ul><li>Infection control, your protection & your client’s protection </li></ul></ul><ul><li>Privacy </li></ul><ul><ul><li>Embarrassing </li></ul></ul><ul><li>Positions for urination </li></ul><ul><ul><li>Independence </li></ul></ul>
  3. 3. Functions of Urinary System <ul><li>Remove wastes from blood to form urine </li></ul><ul><li>Remove nitrogenous waste products of cellular metabolism </li></ul><ul><li>Regulates fluid and electrolyte balance </li></ul><ul><li>The nephron = functional unit of the kidney and forms the urine </li></ul>
  4. 4. Goal of Urinary System <ul><li>To maintain chemical homeostasis of the blood. </li></ul><ul><ul><li>Filtration by the Nephrons </li></ul></ul><ul><ul><ul><li>H2O, glucose, amino acids, urea, creatinine, major electrolytes </li></ul></ul></ul><ul><ul><ul><li>Not normally large proteins or blood cells </li></ul></ul></ul><ul><ul><ul><ul><li>Proteinuria is a sign of glomerular injury </li></ul></ul></ul></ul><ul><li>Normal adult 24hr output = 1500-1600ml. </li></ul>
  5. 5. Overview of Urinary System <ul><li>Kidneys </li></ul><ul><ul><li>Bean shaped organs </li></ul></ul><ul><ul><li>Either side of vertebral columns T12 – L3 </li></ul></ul><ul><ul><li>Right kidney lower due to liver </li></ul></ul><ul><ul><li>Urine produced with filtration of blood through nephrons </li></ul></ul><ul><ul><li>Major role in fluid & electrolyte balance </li></ul></ul>
  6. 6. <ul><li>Ureters </li></ul><ul><ul><li>Connect kidneys to bladder </li></ul></ul><ul><ul><li>10 -12 in length, ½ in diameter in adult </li></ul></ul><ul><ul><li>Peristaltic waves </li></ul></ul><ul><ul><ul><li>Renal colic </li></ul></ul></ul><ul><li>Micturition </li></ul>
  7. 7. <ul><li>Bladder </li></ul><ul><ul><li>Distensible, muscular sac </li></ul></ul><ul><ul><li>Reservoir for urine ( approx. capacity = 600mls ) </li></ul></ul><ul><ul><li>Organ of excretion ( norm. voiding= 300mls) </li></ul></ul><ul><ul><li>Lies in pelvic cavity behind symphysis pubis </li></ul></ul>
  8. 8. <ul><li>Urethra </li></ul><ul><ul><li>Short, muscular tube </li></ul></ul><ul><ul><li>Urine from bladder to meatus and from the body </li></ul></ul><ul><ul><li>Female 4-6.5cm (1 ½ - 2 ½ in.) length </li></ul></ul><ul><ul><li>Male 20cms ( 8 in.) </li></ul></ul><ul><ul><ul><li>Urinary and reproductive systems </li></ul></ul></ul>
  9. 9. <ul><li>Meatus </li></ul><ul><ul><li>External opening of the urethra, male & female </li></ul></ul><ul><li>The need to void is a conscious awareness </li></ul>
  10. 10. Life Cycle Changes <ul><li>Infants & children </li></ul><ul><ul><li>Unable to concentrate urine b/c kidneys are immature </li></ul></ul><ul><ul><li>Urine is light yellow </li></ul></ul><ul><ul><li>Void frequently </li></ul></ul><ul><ul><li>Voluntary control @ 24mos. when neuromuscular structures develop </li></ul></ul>
  11. 11. <ul><li>Adult </li></ul><ul><ul><li>1500 – 1600 mls urine/24hrs </li></ul></ul><ul><ul><li>Concentrates urine – normal is amber colored </li></ul></ul><ul><ul><li>Nocturia </li></ul></ul><ul><ul><ul><li>Not usually </li></ul></ul></ul><ul><ul><ul><li>Decreased renal blood flow during rest </li></ul></ul></ul><ul><ul><ul><li>Ability to concentrate urine </li></ul></ul></ul>
  12. 12. <ul><li>Elderly </li></ul><ul><ul><li>Micturition impaired </li></ul></ul><ul><ul><li>mobility </li></ul></ul><ul><ul><li>Diseases, alzheimer’s, CVA </li></ul></ul><ul><ul><li>Physiological age related changes </li></ul></ul><ul><ul><ul><li>Bladder loses muscle tone and capacity </li></ul></ul></ul><ul><ul><ul><li>Kidneys lose ability to concentrate urine </li></ul></ul></ul><ul><ul><ul><li>Bladder loses muscle strength </li></ul></ul></ul>
  13. 13. Common Problems <ul><li>Urinary Retention </li></ul><ul><ul><li>Accumulation of urine in the bladder </li></ul></ul><ul><ul><li>Inability to empty </li></ul></ul><ul><ul><li>Pressure, discomfort and tenderness </li></ul></ul><ul><li>Residual Urine = urine retained in the bladder after voiding </li></ul>
  14. 14. <ul><li>Incontinence </li></ul><ul><ul><li>Loss of voluntary control to void </li></ul></ul><ul><ul><ul><li>Infection, nerve damage to bladder or brain, spinal cord injury, or aging process </li></ul></ul></ul><ul><ul><ul><li>Total incontinence = no control </li></ul></ul></ul><ul><ul><ul><li>Stress incontinence = sm. amts. Urine excreted involuntarily with coughing or laughing </li></ul></ul></ul><ul><li>At risk for skin breakdown related to acid urine next to skin. </li></ul><ul><li>Adult Diapers or Attends </li></ul>
  15. 15. <ul><li>Frequency & Urgency </li></ul><ul><li>Nocturia </li></ul><ul><li>Enuresis – involuntary discharge of urine </li></ul><ul><li>Nocturnal Enuresis </li></ul><ul><ul><li>During sleep </li></ul></ul><ul><ul><li>Bed-wetting children 5yrs and older </li></ul></ul><ul><li>Oliguria </li></ul><ul><ul><li>30mls/hr or 720 mls/24hrs </li></ul></ul>
  16. 16. <ul><li>Renal anuria </li></ul><ul><ul><li>cessation of urine production 100mls/24h </li></ul></ul>
  17. 17. Promoting Healthy Urinary Elimination <ul><li>Urinate as soon as the urge is felt </li></ul><ul><ul><li>Avoids stasis and distention </li></ul></ul><ul><ul><li>Prevents urgency, infection, and incontinence </li></ul></ul><ul><li>Drink about 2liters fluid/day </li></ul><ul><li>Limit Na, caffeine, and alcohol </li></ul>
  18. 18. <ul><li>For people with Nocturia </li></ul><ul><ul><li>fld. Intake in the p.m. </li></ul></ul><ul><ul><li>caffiene and alcohol </li></ul></ul><ul><ul><li>Void before bedtime </li></ul></ul><ul><li>For Women </li></ul><ul><ul><li>Wipe perineum front to back </li></ul></ul><ul><ul><li>Void soon after intercourse </li></ul></ul><ul><ul><li>Wash hands </li></ul></ul><ul><ul><li>Pelvic – floor strengthening exercises (Kegel Exercises) </li></ul></ul>
  19. 19. Client Education <ul><li>S & S of infection </li></ul><ul><li>Fluid intake ( if no restrictions 2-5 L/day ) </li></ul><ul><li>Perineal hygiene </li></ul><ul><li>Meds. & side effects on urination, color, and volume </li></ul>
  20. 20. Facilitating Micturition <ul><li>Nursing Measures to promote voiding in people who are having difficulty: </li></ul><ul><ul><li>Privacy and natural position </li></ul></ul><ul><ul><li>Providing commode or bathroom </li></ul></ul><ul><ul><li>Running water </li></ul></ul><ul><ul><li>Warm water to dangle fingers </li></ul></ul><ul><ul><li>Warm water over perineum ( measure if on In/Out ) </li></ul></ul>
  21. 21. <ul><li>Gently stroking inner thighs or pressure to symphysis pubis </li></ul><ul><li>Pain relief </li></ul><ul><li>Warmth to the bladder & perineum relaxes muscles & facilitates voiding. ( Sitz bath or warm tub ) </li></ul><ul><li>If unsuccessful- urinary catheterization may be indicated </li></ul>
  22. 22. <ul><li>Promoting complete bladder emptying </li></ul><ul><li>Prevention of infection </li></ul><ul><ul><li>Good perineal hygiene </li></ul></ul><ul><ul><li>Adequate fld. Intake </li></ul></ul><ul><ul><ul><li>Dilutes urine & flushes urethra </li></ul></ul></ul><ul><ul><li>Acidifying urine ( inhibits microorganisms) </li></ul></ul><ul><ul><ul><li>Cranberry juice, whole grain breads, meats, eggs, prunes and plums. </li></ul></ul></ul>
  23. 23. Indwelling Catheter Care <ul><li>Goal - prevent infection & maintain unobstructed flow of urine. Monitor for problems. </li></ul><ul><li>Perineal hygiene @ least 2x/day and prn </li></ul><ul><li>Do not advance catheter further into urethra during perineal care </li></ul>
  24. 24. Catheter Care <ul><li>Fld intake (3L/day ) </li></ul><ul><li>Handwashing and Gloves </li></ul><ul><li>Positioning </li></ul><ul><ul><li>Urine bag </li></ul></ul><ul><ul><li>Tubing </li></ul></ul>
  25. 25. Bowel Elimination <ul><li>Function - excrete/eliminate waste products of digestion. </li></ul><ul><li>Maintaining normal bowel elimination is essential to health and efficient body functions. </li></ul>
  26. 26. GI System <ul><li>Small Intestine </li></ul><ul><ul><li>Absorption nutrients & electrolytes </li></ul></ul><ul><ul><li>20 ft length, 1 in. diameter </li></ul></ul><ul><ul><li>3 sections </li></ul></ul><ul><ul><ul><li>Duodenum </li></ul></ul></ul><ul><ul><ul><li>Jejunum </li></ul></ul></ul><ul><ul><ul><li>Ileum </li></ul></ul></ul>
  27. 27. GI <ul><li>Large Intestine </li></ul><ul><ul><li>Absorbs H2O and electrolytes </li></ul></ul><ul><ul><li>Temporarily stores waste products </li></ul></ul><ul><ul><li>Main function is elimination </li></ul></ul><ul><ul><li>5 – 6 ft. length, 6 – 7 cm. diameter </li></ul></ul><ul><ul><ul><li>Cecum </li></ul></ul></ul><ul><ul><ul><li>Ascending colon ( Right side ) </li></ul></ul></ul><ul><ul><ul><li>Transverse colon </li></ul></ul></ul><ul><ul><ul><li>Descending colon </li></ul></ul></ul>
  28. 28. Patterns through life cycle <ul><li>Babies: 3 – 6 BM’s/day </li></ul><ul><li>Children: </li></ul><ul><ul><li>Neuromuscular structures not developed until 15 – 18 mos. </li></ul></ul><ul><ul><li>Voluntary control 2 – 3 yrs. </li></ul></ul><ul><li>Pregnant women prone to constipation </li></ul><ul><ul><li>Pressure on abd. Organs </li></ul></ul><ul><ul><li>Iron supplements </li></ul></ul>
  29. 29. <ul><li>Elderly prone to constipation </li></ul><ul><ul><li>Slowing of peristalsis </li></ul></ul>
  30. 30. Determinants affecting elimination <ul><li>Dietary patterns & fld. Intake </li></ul><ul><ul><li>6 – 8 glasses H2O/day ( 1400- 2000mls ) </li></ul></ul><ul><ul><ul><li>fld. Liquifies stool </li></ul></ul></ul><ul><ul><ul><li>Dietary fiber stimulates peristalsis </li></ul></ul></ul><ul><ul><ul><li>Soft stool </li></ul></ul></ul>
  31. 31. Factors affecting elimination <ul><li>Fiber ( undigestible residue ) provides bulk </li></ul><ul><ul><li>Absorbs fluid </li></ul></ul><ul><ul><li>Increases stool mass </li></ul></ul><ul><ul><li>Bowel wall stretches </li></ul></ul><ul><ul><li>Peristalsis stimulated </li></ul></ul><ul><ul><li>Defecation results </li></ul></ul>
  32. 32. Factors affecting elimination <ul><li>Personal habits </li></ul><ul><ul><li>Busy schedule, postpone BM, constipation </li></ul></ul><ul><li>Activity & exercise </li></ul><ul><ul><li>Immobile activity in colon </li></ul></ul><ul><li>Medications </li></ul><ul><ul><li>Laxatives </li></ul></ul><ul><ul><li>Narcotics with codiene </li></ul></ul>
  33. 33. Factors affecting elimination <ul><li>Emotions </li></ul><ul><ul><li>Anxiety peristalsis & diarrhea </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><li>Pain </li></ul><ul><li>Surgery </li></ul><ul><ul><li>Anaesthetic causes temporary cessation of peristalsis </li></ul></ul><ul><ul><li>Direct manipulation of the bowel stops peristalsis </li></ul></ul>
  34. 34. Common Problems <ul><li>Constipation – difficult passage of hard, dry stool; infrequent movements </li></ul><ul><li>Fecal Impaction – unrelieved constipation, feces wedged in rectum, no BM usually 3days, oozing of diarrheal stool develops </li></ul><ul><li>Diarrhea- # liquid stool </li></ul><ul><li>Flatulence – abd. Distention & pain </li></ul>
  35. 35. Common Problems <ul><li>Incontinence – inability to control passage of stool </li></ul><ul><li>Hemorrhoids </li></ul><ul><ul><li>Dilated engorged veins </li></ul></ul><ul><ul><li>Increased pressure when straining </li></ul></ul><ul><ul><li>Internal / external </li></ul></ul><ul><ul><li>Bleeding </li></ul></ul>
  36. 36. <ul><li>Daily BM Not essential. </li></ul><ul><li> 2 / week a concern </li></ul><ul><li>Defecation pattern </li></ul><ul><li>BM, Stool, Feces, Defecate – all mean waste products expelled via the bowel </li></ul>
  37. 37. Promoting Healthy Bowel Elimination <ul><li>Privacy </li></ul><ul><li>Squatting position </li></ul><ul><li>Bedpan position </li></ul><ul><li>Cathartics & laxatives </li></ul><ul><li>Anti- diarrheal agents </li></ul><ul><li>Enemas </li></ul><ul><li>disimpaction </li></ul>
  38. 38. <ul><li>Bowel routine </li></ul><ul><ul><li>Daily time clock </li></ul></ul><ul><ul><li>Hot drinks </li></ul></ul><ul><ul><li>Stool softeners </li></ul></ul><ul><ul><li>Privavy </li></ul></ul><ul><ul><li>Position and abdominal pressure </li></ul></ul><ul><ul><li>Bearing down </li></ul></ul>
  39. 39. Assissting with Elimination <ul><li>Embarrassing & stressful </li></ul><ul><ul><li>Usually urge to defecate 1hr. Pc </li></ul></ul><ul><li>Bedpans </li></ul><ul><ul><li>Metal or plastic </li></ul></ul><ul><ul><li>Regular or fracture pan </li></ul></ul><ul><ul><li>Cleanliness </li></ul></ul><ul><li>Urinals </li></ul><ul><li>Commode </li></ul>
  40. 40. Procedure <ul><li>Privacy- close door, </li></ul><ul><li>Side rail as needed </li></ul><ul><li>Recumbent with HOB </li></ul><ul><li>Tissue </li></ul><ul><li>Call bell </li></ul><ul><li>Leave alone if possible </li></ul><ul><li>Gloves </li></ul><ul><li>Clean genitals </li></ul>
  41. 41. Procedure <ul><li>Remove pan and cover </li></ul><ul><li>In & Out </li></ul><ul><li>Specimens </li></ul><ul><li>Clean pan </li></ul><ul><li>Wash hands yours and client’s </li></ul><ul><li>Lower bed </li></ul><ul><li>Client comfort </li></ul>
  42. 42. Peri - Care <ul><li>Cleaning of genitals , routine part of complete/ partial bed bath </li></ul><ul><li>Incontinence </li></ul>
  43. 43. Procedure for Peri Care <ul><li>Regular patient </li></ul><ul><ul><li>Simple explanation- layman’s terms </li></ul></ul><ul><ul><li>Privacy </li></ul></ul><ul><ul><li>Gloves </li></ul></ul><ul><ul><li>Dorsal recumbent position </li></ul></ul><ul><ul><li>Incontinent pad under buttocks </li></ul></ul><ul><ul><li>Warm soap and water </li></ul></ul><ul><ul><li>Female – separate labia </li></ul></ul>
  44. 44. Procedure for Peri Care <ul><li>Male – begin penile head move down along shaft, retract foreskin, rinse and dry. </li></ul>
  45. 45. Procedure for Peri Care <ul><li>Catheter – </li></ul><ul><ul><li>Q 8 hrs. </li></ul></ul><ul><ul><li>Clean perineum & 2in. Of catheter </li></ul></ul><ul><ul><ul><li>No powders / lotions </li></ul></ul></ul><ul><ul><ul><li>Avoid advancing catheter </li></ul></ul></ul><ul><ul><ul><li>Keep urine drainage bag off floor but below level of bladder </li></ul></ul></ul><ul><ul><ul><li>Empty bag Q8 – 12hrs or when bag is full, remember to mark amt. Emptied on In/Out sheet </li></ul></ul></ul>
  46. 46. <ul><li>Avoid use of baby powder/ cornstarch </li></ul><ul><ul><li>No medicinal purpose </li></ul></ul><ul><ul><li>Can form clumps or will cake in creases </li></ul></ul><ul><ul><li>Use vaseline/ zincoxide as skin barrier for incontinent clients </li></ul></ul>
  47. 47. Suppository Administration <ul><li>Check physician’s order, protocol </li></ul><ul><li>Left Lateral position </li></ul><ul><li>Gloves </li></ul><ul><li>Lubication </li></ul><ul><li>Hold with thumb and index finger </li></ul><ul><li>Insert with index finger (3 – 4”) never force </li></ul><ul><li>Deep breath = relaxes anal sphincter </li></ul>
  48. 48. <ul><li>Caution </li></ul><ul><ul><li>Vagus nerve stimulation can cause heart rate to slow – avoid excess manipulation </li></ul></ul>
  49. 49. Enema Administration <ul><li>Main purpose </li></ul><ul><ul><li>Promotion of defecation, stimulate peristalsis </li></ul></ul><ul><ul><li>The fluid breaks up fecal mass, stretches the rectal wall & initiates the defecation reflex </li></ul></ul>
  50. 50. Types of Enemas
  51. 51. Cleansing Enemas <ul><li>Tap Water </li></ul><ul><ul><li>Hypotonic </li></ul></ul><ul><ul><li>Used only once </li></ul></ul><ul><ul><li>Electrolyte imbalance </li></ul></ul><ul><ul><ul><li>Water toxicity </li></ul></ul></ul><ul><ul><ul><li>Circulatory overload ( concentration gradient) </li></ul></ul></ul>
  52. 52. <ul><li>Normal Saline </li></ul><ul><ul><li>Used when more than one enema is needed </li></ul></ul><ul><ul><li>Safest </li></ul></ul><ul><ul><li>Isotonic </li></ul></ul><ul><ul><li>Large volume to distend bowel </li></ul></ul>
  53. 53. <ul><li>Hypertonic Solution </li></ul><ul><ul><li>Smaller volume of fluid </li></ul></ul><ul><ul><li>Draws from surrounding tissue into bowel to soften stool and stimulate peristalsis </li></ul></ul><ul><ul><li>Fleets – sodium phosphate </li></ul></ul><ul><ul><ul><li>Low volume, concentrated solution </li></ul></ul></ul>
  54. 54. <ul><li>Soap suds </li></ul><ul><ul><li>Less common </li></ul></ul><ul><ul><li>Soap irritates the bowel </li></ul></ul><ul><ul><li>5 – 15 mls. Castile soap in 1000mls warm water </li></ul></ul>
  55. 55. <ul><li>Oil Retention </li></ul><ul><ul><li>Oil based solution </li></ul></ul><ul><ul><li>Lubricates the rectum and colon </li></ul></ul><ul><ul><li>Softens stool, easier to pass </li></ul></ul><ul><ul><li>Retain 1 –2 hrs if possible </li></ul></ul><ul><ul><li>Follow with cleansing enema </li></ul></ul>
  56. 56. <ul><li>Medicated </li></ul><ul><ul><li>Instill meds. </li></ul></ul><ul><ul><li>Rectal mucosa absorption </li></ul></ul><ul><ul><li>Ex. – Kayexalate to K (potassium). Absorbs K from the intestinal tract </li></ul></ul>
  57. 57. Volumes for Enemas <ul><li>Large Volume </li></ul><ul><ul><li>500 – 1000mls. </li></ul></ul><ul><ul><li>Container 12 – 18 in. above the bowel </li></ul></ul><ul><ul><li>Lg. Volume stimulates & causes evacuation of stool </li></ul></ul><ul><li>Small Volume </li></ul><ul><ul><li>500 mls. </li></ul></ul><ul><ul><li>Container 12 in.above bowel </li></ul></ul>
  58. 58. Volumes for Enemas <ul><li>Pre packaged </li></ul><ul><ul><li>Fleet 150mls </li></ul></ul><ul><ul><li>Microlax 5mls </li></ul></ul><ul><ul><li>Hypertonic solution </li></ul></ul><ul><ul><li>User friendly </li></ul></ul><ul><ul><li>Hold for 5min. </li></ul></ul><ul><li>Oral Fleet </li></ul>
  59. 59. <ul><li>Prepackaged used more than large volume because: </li></ul><ul><ul><li>Works </li></ul></ul><ul><ul><li>Less risk for electrolyte imbalance </li></ul></ul><ul><ul><li>Rapid administration </li></ul></ul><ul><ul><li>Less discomfort and distention </li></ul></ul><ul><ul><li>Convenient and quick </li></ul></ul>
  60. 60. <ul><li>Physician’s order reads “ enemas to clear” </li></ul><ul><ul><li>No more than 3 total given </li></ul></ul><ul><ul><li>Return solution will be highly colored but no solid stool </li></ul></ul><ul><ul><li>Isotonic solution (normal saline) </li></ul></ul><ul><li>Excess enema use seriously depletes fluid and electrolytes </li></ul>
  61. 61. Procedure for Enema Administration <ul><li>Confirm Dr’s order, prepare client, verbal consent, equipment, privacy </li></ul><ul><ul><li>Left lateral position ( fld. Flows by gravity) </li></ul></ul><ul><ul><li>Drape, pad under buttocks </li></ul></ul><ul><ul><li>Warm solution- stimulates peristalsis </li></ul></ul><ul><ul><ul><li>Hot sol’n burns mucosa </li></ul></ul></ul><ul><ul><ul><li>Cold sol’n causes cramping </li></ul></ul></ul>
  62. 62. Procedure for Enema Administration <ul><li>Prime tube </li></ul><ul><li>Lubricate tip </li></ul><ul><li>Glove </li></ul><ul><li>Insert 7 – 10 cm.(3-4in) adult </li></ul><ul><ul><li>Do not force </li></ul></ul><ul><ul><li>Deep breath </li></ul></ul><ul><ul><li>Guide toward umbilicus </li></ul></ul>
  63. 63. Procedure for Enema Administration <ul><li>Container at appropriate height </li></ul><ul><ul><li>Lg. = 12 – 18in </li></ul></ul><ul><ul><li>Sm. = 12in </li></ul></ul><ul><ul><li>1000mls takes ~ 10 min to instill </li></ul></ul><ul><ul><li>Higher the bag – greater the pressure </li></ul></ul><ul><ul><ul><li>C/O discomfort, lower bag, slow infusion, stop, then start again </li></ul></ul></ul><ul><ul><li>Remain side lying to retain 5 – 10 min. or as long as possible </li></ul></ul>
  64. 64. Procedure for Enema Administration <ul><li>Assist to bathroom or give bedpan </li></ul><ul><li>Evaluate results </li></ul><ul><li>Document </li></ul><ul><ul><li>Type & volume of enema </li></ul></ul><ul><ul><li>Color, amount, consistency of fecal return </li></ul></ul><ul><ul><li>Hygienic measures for client </li></ul></ul><ul><li>Wash Hands </li></ul>
  65. 65. Ostomy Care
  66. 66. <ul><li>Certain diseases require surgical interventions to create an opening into the abdominal wall for fecal and urinary elimination </li></ul><ul><li>Enterostomy – the surgical procedure performed to produce the artificial stoma. </li></ul>
  67. 67. Definitions <ul><li>Ostomy = opening made to allow passage of urine or stool </li></ul><ul><ul><li>Piece of intestine is brought out onto the client’s abd. </li></ul></ul><ul><ul><li>Lacks nerve endings </li></ul></ul><ul><ul><li>Doesn’t hurt to touch but has other implications </li></ul></ul><ul><li>Stoma = mouth like opening in the abdominal wall to drain urine or stool </li></ul>
  68. 68. <ul><li>Effluent – drainage from stoma </li></ul><ul><li>Bowel ostomies </li></ul><ul><ul><li>Cancer ( Ca) </li></ul></ul><ul><ul><li>Drain fecal material </li></ul></ul><ul><ul><li>Consistency depends on location </li></ul></ul><ul><ul><ul><li>Higher up = more liquid </li></ul></ul></ul><ul><ul><ul><li>Greater risk skin irritation b/c concentration of digestive enzymes </li></ul></ul></ul>
  69. 69. <ul><li>Ileostomy </li></ul><ul><ul><li>End of small intestine </li></ul></ul><ul><ul><li>By passes lg. Intestine = freq. Liquid stools </li></ul></ul><ul><li>Colostomy </li></ul><ul><ul><li>Large intestine </li></ul></ul><ul><ul><li>More solid stool </li></ul></ul>
  70. 70. <ul><li>Ostomies may be permanent </li></ul><ul><ul><li>More common </li></ul></ul><ul><li>temporary </li></ul><ul><ul><li>Rest the bowel </li></ul></ul><ul><ul><li>Crohn’s </li></ul></ul>
  71. 71. Urinary Ostomies <ul><li>Provide drainage of urine that bypasses the bladder = Urinary Diversion </li></ul><ul><li>Ureterostomy </li></ul><ul><ul><li>Ureter to abd. Wall </li></ul></ul><ul><ul><li>Lt., Rt., Bilateral </li></ul></ul>
  72. 72. Ileal Conduit <ul><li>6 – 8 in. ileum </li></ul><ul><li>1 end for external opening </li></ul><ul><li>Other end closed off </li></ul><ul><li>Ureters implanted into this piece of bowel </li></ul><ul><li>Pouch </li></ul><ul><li>Urine will have shred of mucus b/c bowel still produces same </li></ul>
  73. 73. Concerns <ul><li>Infection </li></ul><ul><ul><li>Sterile ureters provide opening into system </li></ul></ul><ul><li>Skin Breakdown </li></ul><ul><ul><li>Continuous drainage </li></ul></ul><ul><ul><li>Moisture on skin </li></ul></ul><ul><li>Replace urinary pouch q 2-3 days </li></ul>
  74. 74. Pouching an Enterostomy <ul><li>Effluent ( drainage ) may begin immediately </li></ul><ul><li>Collects all effluent </li></ul><ul><li>Protects the skin </li></ul><ul><li>Stoma should be moist and reddish pink (same as other mucus membranes) </li></ul><ul><li>Flush to skin or bud-like protrusion </li></ul><ul><li>Black, purple, dry = inadequate circulation </li></ul>
  75. 75. Pouch with Skin Barrier <ul><li>Comfortable fit </li></ul><ul><li>Cover skin surrounding stoma </li></ul><ul><li>Good seal </li></ul><ul><li>Post-op pouch should allow for visibility of stoma </li></ul>
  76. 76. Types of pouches and skin barriers <ul><li>One Piece Pouching System </li></ul><ul><ul><li>Skin barriers preattached, precut, custom fit </li></ul></ul><ul><li>Two Piece System </li></ul><ul><ul><li>Skin barrier with flange ( plastic ring) </li></ul></ul><ul><ul><li>Corresponding size pouch </li></ul></ul><ul><li>Assess stoma </li></ul><ul><ul><li>Measure correct size </li></ul></ul><ul><ul><li>Change q 3-7 days </li></ul></ul><ul><ul><li>Empty 1/3 to ½ full, expel flatus prn </li></ul></ul>
  77. 77. Steps to Care for Ostomies <ul><li>Supine position </li></ul><ul><li>Wash hands, glove </li></ul><ul><li>Remove pouch & skin barrier, push skin away from barrier </li></ul><ul><li>Cleanse peristomal skin gently with warm tap water and clean cloth </li></ul><ul><ul><li>Do not scrub, Avoid soap ( residue- pouch won’t adher) </li></ul></ul>
  78. 78. Steps to Care for Ostomies <ul><li>Correct sizing </li></ul><ul><li>Cut opening 1/16 – 1/8 larger than stoma </li></ul><ul><li>Remove backing </li></ul><ul><li>Ileostomy- apply thin circle barrier paste around opening of pouch and allow to dry (if creases or bumps use barrier paste to even surface for pouch application) </li></ul>
  79. 79. Steps to Care for Ostomies <ul><li>Pouch should point to client’s knees </li></ul><ul><li>Maintain gentle finger pressure around barrier for 1-2 min. </li></ul><ul><li>Picture frame flange with non allergic paper tape </li></ul><ul><li>Ostomy deodorant for pouch </li></ul><ul><li>Tub bath or shower </li></ul>
  80. 80. Steps to Care for Ostomies <ul><li>Normal stoma oozes blood if rubbed </li></ul><ul><li>Actual bleeding into pouch is abnormal </li></ul><ul><li>Pouch covers are available </li></ul><ul><li>The client will be watching the nurse during ostomy care to gage reaction. </li></ul><ul><li>Be conscious of facial expression & nonverbal cues </li></ul>
  81. 81. Steps to Care for Ostomies <ul><li>Education </li></ul><ul><li>Counseling </li></ul><ul><ul><li>Body image </li></ul></ul><ul><ul><li>Self care </li></ul></ul><ul><ul><li>Fear of rejection </li></ul></ul><ul><ul><li>Sexual function </li></ul></ul><ul><ul><li>Powerlessness over bowel regulation </li></ul></ul>

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