Organs of Urinary and Bowel Elimination
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This document provides information on the anatomy, physiology, and functions of the urinary and bowel elimination systems. It discusses the organs involved in urinary and bowel elimination including the kidneys, ureters, bladder, urethra, small intestine, and rectum. Factors that can affect normal elimination are covered as well as common alterations like incontinence, retention, frequency, and impaction. Nursing assessments, interventions, and potential diagnoses related to promotion of normal urinary and bowel elimination are also summarized.
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Organs of Urinary and Bowel Elimination
- 1. ELIMINATION
- 2. URINARY ELIMINATION • ANATOMY AND PHYSIOLOGY
- 3. ANATOMY • FEMALE STRUCTURES • MALE STRUCTURES
- 4. Scientific Knowledge Base: Organs of Urinary Elimination 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.
- 5. Urinary System Urinary System Organs Renal Nephron
- 6. Additional Kidney Functions • Production of erythropoietin is essential to maintaining a normal red blood cell (RBC) volume. – Erythropoietin stimulates bone marrow to produce RBCs and prolongs the life of mature RBCs. • Production of renin, prostaglandin E2, and prostacyclin affects blood pressure. – Renin starts a chain of events that cause water retention, thereby increasing blood volume. – Prostaglandin E2 and prostacyclin aid vasodilation. • Kidneys affect calcium and phosphate regulation
- 7. Act of Urination • 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.
- 8. URINE • 96% WATER • 4% SOLUTES – ORGANIC SOLUTES • UREA* • AMMONIA • CREATININE • URIC ACID – INORGANIC SOLUTES • SODIUM (Na) • CHLORIDE (Cl) • MAGNESIUM (Mg) • PHOSPHORUS (Phos) • SODIUM CHLORIDE (NaCl)*
- 9. FACTORS AFFECTING URINARY ELIMINATION • Fluid • Diet • Response to urge • Stress • Psychosocial factors • Activity • Pathological conditions • Medications • Developmental level • Medical Diagnosis or Surgery
- 10. Factors Influencing Urination • Disease conditions • Medications and medical procedures • Socioeconomic factors (need for privacy) • Psychological factors (anxiety, stress, privacy) • Fluid balance – Nocturia, polyuria, oliguria, anuria – Diuresis – Fever
- 11. ALTERATIONS IN URINARY ELIMINATION • Urinary Retention • Urinary Incontinence – functional – reflex – stress – total – urge • Enuresis – nocturnal enuresis – diurnal enuresis
- 12. Disease Conditions Affecting Urination • Prerenal, renal, postrenal classification • Conditions of the lower urinary tract • Diabetes mellitus and neuromuscular diseases such as multiple sclerosis • Benign prostatic hyperplasia • Cognitive impairments (e.g., Alzheimer’s) • Diseases that slow or hinder physical activity • Conditions that make it difficult to reach and use toilet facilities • End-stage renal disease, uremic syndrome
- 13. ALTERATIONS CONT. • Nocturia • Frequency • Urgency • Dysuria • Hesitancy • Polyuria • Suppression – anuria – oliguria
- 14. DIAGNOSTIC TEST • Culture and sensitivity • KUB • IVP • Cystoscopy • Blood test – BUN (7-18 mg/dl) – Creatinine (.6-1.2 mg/dl) • Urinalysis (type of specimens)
- 15. ASSESSMENT OF URINATION • frequency • amount • color • odor • character • specific gravity • ph • abnormal constituents • discomfort
- 16. Medical Interventions Affecting Urination • Surgical procedures – Restriction of fluid intake lowers urine output. – Stress causes fluid retention. • Medications – Some cause urinary retention and/or overflow incontinence. – Some cause urgency and incontinence. – Some change the color of urine. • Diagnostic examinations – Restriction of fluid intake lowers urine output. – Direct visualization causes localized trauma and edema; patients may have difficulty voiding.
- 17. Dialysis • Renal Replacement • Two methods – Peritoneal – Hemodialysis 17
- 18. Indications for Dialysis Renal failure that can no longer be controlled by conservative management (Conservative management would include dietary modifications and the administration of medications to correct electrolyte abnormalities.) Worsening of uremic syndrome associated with ESRD, which would include nausea, vomiting, neurological changes, and pericarditis) Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures (These abnormalities would include hyperkalemia and pulmonary edema.) by simpler measures
- 19. NURSING INTERVENTIONS TO PROMOTE U. E. • intake & output • position • hygiene • privacy • sitz • catheterize • medications • kegel’s exercise
- 20. Physical Assessment 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.
- 21. Assessment of Urine • 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
- 22. Urine Tests and Diagnostic Examinations Urinalysis Specific gravity Culture Noninvasive procedures Invasive procedures
- 23. CATHETERIZATION • STRAIGHT • RETENTION OR FOLEY • QUICK CATH • LUMENS – SINGLE-STRAIGHT – DOUBLE-RETENTION – TRIPLE-IRRIGATION
- 25. SIZE OF CATHETERS • RANGE FROM # 8-24 • CHILD # 8-10 • FEMALE # 14-16 • MALE # 16-18 • TURP # 22-24 • BALLOONS 5-30 cc
- 26. Nursing Knowledge Base & Assessment Infection control and hygiene Growth and development Muscle tone Psychosocial considerations Cultural considerations
- 27. Nursing Interventions • Insertion of catheters • Maintenance of caths • Specimens from caths • Removing catheters • Irrigation procedure • Residual urine • Suprapubic catheters
- 28. URINARY DIVERSION • Cutaneous Ureterostomy • Ileal Conduit • Ureterosigmoidostomy • Ureteroileosigmoidostomy • Kock Pouch (Continent Vesicostomy)
- 29. Types of Urinary Diversions
- 31. NURSING DIAGNOSES • ALTERED URINARY ELIMINATION • INCONTINENCE • URINARY RETENTION • PAIN • BODY IMAGE DISTURBANCE
- 32. Evaluation • 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.
- 34. ANATOMY • Small intestine (ileum) • Ileocecal valve • Cecum • Ascending • Transverse • Descending • Sigmoid • Rectum • Anus
- 35. PHYSIOLOGY • Peristalsis • Water absorption • Storage • Secretion of mucus
- 36. DEFECATION • Parasympathetic reflex • Defecation reflex • Assessment of stool – pattern – color – consistency/shape – blood – Odor • Bowel Diversions – Stoma, drainage, skin condition
- 37. FACTORS AFFECTING BE • Age • Diet / Fluids • Exercise • Stress • Schedule • Medications • Environment • Anesthesia/Surgery • Diagnostic Test • Pathology • Irritants • Pain
- 38. ALTERED BE • Constipation • Fecal Impaction • Diarrhea • Incontinence • Flatulence • Hemorrhoids
- 39. DIAGNOSTIC TEST • Guaiac test • Hematest • Hemoccult • Proctoscopy • Proctosignoidoscopy • Colonoscopy
- 40. PHYSICAL ASSESSMENT • Inspection – Four quadrants – Nine regions • Auscultation • Percussion • Palpation
- 41. MEDICATIONS • Cathartics (laxative) – Bulk forming – Lubricant – Wetting agent – Stimulant/irritant – Saline • Suppository • Enema – Cleansing – Hypertonic – Oil – Carminative – Return Flow – Cooling – Medication
- 42. ENEMAADMINISTRATION • PROCEDURE – HIGH VS. LOW – AGE – POSITION • SOLUTIONS – HYPOTONIC – HYPERTONIC – ISOTONIC – VOLUME CONSIDERATION
- 43. BOWEL DIVERSIONS • Ileostomy • Ascending Colostomy • Transverse Colostomy • Descending Colostomy
- 44. TYPES OF CONSTRUCTION • Loop • Double Barrel • End • Temporary • Permanent
- 45. NURSING INTERVENTIONS • Psychological needs • Nutritional needs • Hygiene needs • Maintenance • Teaching
- 46. SPECIMEN COLLECTION • Urine – Midstream – Sterile/Culture – 24 hour – Drug • Stool – Blood/Parasite • Technique • Documentation
- 47. NURSING DIAGNOSES • CONSTIPATION • DIARRHEA • INCONTINENCE • ALTERED ELIMINATION • BODY IMAGE DISTURBANCE
- 48. THE END!!!