53 a focus 9 elimination

53 a focus 9 elimination

• 1.
  NURSING FUNDAMENTALS FOCUSIX Elimination Needs
• 2.
  OBJECTIVES:SOLID  Describe the physiology of stool formation and the elimination process.  List the common problems of bowel elimination.  Discuss nursing responsibilities involved with each problem.  Define and explain some of the basic but important measures to promote normal bowel elimination.  Compare and contrast the different types of altered means of bowel elimination.  Identify the procedures/technical skills and related nursing responsibilities.  Identify the common diagnostic procedures related to the bowel elimination need and the associated nursing responsibilities
• 3.
  OBJECTIVES:FLUID  Describe the normal micturition process mechanism.  Discuss common conditions /situations responsible for a disruption in the normal micturition process.  List the commonly recognizable signs (behaviors) indicating a disruption in urinary elimination.  Compare and contrast the altered means of urinary elimination and explain the related procedures and nursing responsibilities.  Report the basic but important nursing interventions to promote normal urinary elimination.  Examine the common diagnostic procedures related to urinary elimination and the associated nursing responsibilities.
• 4.
  BLADDER AND BOWELFUNCTION Overview:  The human body eliminates waste of metabolism through urine and stool.  Normal function depends on these factors: - anatomic integrity - intact neurologic components for both voluntary and synergistic emptying - a predictable pattern of waste production - physical and mental ability and the psycho-social willingness to carry out toileting related tasks
• 5.
  Structures and FunctionsRelated To Bowel Elimination STRUCTURES AND FUNCTIONS RELATED TO BOWEL ELIMINATION DIGESTION HTTP://WWW.MEDTROPOLIS.COM/VBODY.ASP
• 6.
  STRUCTURES AND FUNCTIONSRELATED TO BOWEL ELIMINATION Bolus with Ptyalin HCL, Pepsin Intrinsic factor Mucus  CHYME Releases bile to Amylase released duodenum Absorption, secretion, pr Nutrients, electrolytes, otection, elimination vitamins absorbed Defecation process
• 7.
  Physiology of Defecation Peristalticwaves move the feces into the sigmoid colon and the rectum  Sensory nerves in rectum are stimulated  Individual becomes aware of need to defecate  Feces move into the anal canal when the internal and external sphincter relax
• 8.
   External anal sphincter is relaxed voluntarily if timing is appropriate  Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm  Moves the feces through the anal canal and expelled through anus  Facilitated by thigh flexion and a sitting position
• 9.
  FACTORS AFFECTING BOWEL ELIMINATION  Lifestyle  Personal habits  Nutrition and fluid intake  Physical activity  Culture  Norms of western culture  Age  Infancy  Elders
• 10.
  FACTORS AFFECTING BOWELELIMINATION  Physiological factors  Pregnancy  Motor and or sensory disturbance  Intestinal pathology  Medications  Surgery and anesthesia  Psychosocial factors  Anxiety  Depression
• 11.
  CHARACTERISTICS OF NORMAL STOOL Color  Odor  Consistency  Frequency  Amount  Shape  Constituents
• 12.
  SELECTED FECAL ELIMINATION PROBLEMS Constipation Diarrhea Bowel incontinence Flatulence
• 13.
  CONSTIPATION  A symptomnot a disease  Decreased frequency of defecation  Hard, dry, formed stools  Straining at stools  Painful defecation  Causes include:  Insufficient fiber and fluid intake  Insufficient activity  Irregular habits
• 14.
  FECAL IMPACTION  Massor collection of hardened feces in folds of rectum that cannot be expelled  Passage of liquid fecal seepage and no normal stool  Causes usually:  Poor defecation habits  Results from unrelieved constipation  Treatment  Removed manually  Must have physician order  Monitor patient for Valsalva reaction
• 15.
  DIARRHEA  Passage of liquid feces and increased frequency of defecation  Spasmodic cramps, increased bowel sounds  Fatigue, weakness, malaise, emaciation  A symptom of disorders affecting digestion, absorption, and secretion of the GI tract.  Major causes:  Stress, medications, allergies, intolerance of food or fluids, disease of colon
• 16.
  FECAL INCONTINENCE  Lossof voluntary ability to control fecal and gaseous discharges  Generally associated with:  Impaired functioning of anal sphincter or nerve supply  Neuromuscular diseases  Spinal trauma  Tumor  Nursing Considerations  Incontinence can harm a clients body image  Incontinence predisposes the skin to breakdown
• 17.
  FLATUENCE  Excessive flatus in intestines  Leads to stretching and inflation of intestines  Can occur from variety of causes: Foods Abdominal surgery Narcotics
• 18.
  ASSESSMENT OF BOWELFUNCTION  History of bowel prior patterns  usual time  frequency of stool  past reliance on aids  Present status and pattern  Time  Characteristics of stool  Medications that may affect bowel functioning  sedatives  diuretics  antihistamines
• 19.
  ASSESSMENT OF BOWELFUNCTION  Infection, trauma, or stress may affect stool formation  Physical Abdominal Assessment  Inspection  Auscultation  Palpitation  determine abdominal discomfort  palpable obstruction would indicate need for rectal exam
• 20.
  ABDOMINAL QUADRANTS ANDORGANS
• 21.
  ABDOMINAL QUADRANTS ANDORGANS
• 22.
  ABDOMINAL QUADRANTS ANDORGANS
• 23.
  ABDOMEN  Subjective Assessments:  Any abdominal pain?  N/V?  Appetite good?  Last BM?  Stool formed/loose?
• 24.
  ABDOMEN-OBJECTIVE ASSESSMENT  Normal  soft  non-tender  non-distended  normoactive bowel sounds in all 4 quadrants  Normal bowel sounds  2-3 every 15sec or 10-30 every min
• 25.
  ABDOMEN – ABNORMALASSESSMENTS  Distended  Rigid  Tender  Hypoactive bowel sounds (<10/min)  Hyperactive bowel sounds (>30/min)  Absence of bowel sounds  Presence of mass  Ascities  Abnormal pulsations  Tubes, drains, ostomies
• 26.
  AIDS TO NORMALBOWEL ELIMINATION  Fluid intake and fiber:  Adequate fiber  Adequate fluid intake  Upright posture
• 27.
  CONSTIPATION Managing constipation:  Diet  25 -35 G of fiber + WATER!  Medications  Laxatives  cathartics  Enemas  high – cleanse entire colon  low – cleanse rectum and sigmoid colon  hypotonic and isotonic  – immediate large colonic emptying  hypertonic and mineral - fleets
• 28.
  FECAL INCONTINENCE Assessment keyfactors:  Is the problem correctable or manageable?  What is the timeline or duration of situation?  Any associated symptoms?
• 29.
  NANDA NURSING DIAGNOSIS Bowel Incontinence  Constipation  Risk for Constipation  Perceived Constipation  Diarrhea
• 30.
  RELATED NURSING DIAGNOSIS Risk for Deficient Fluid Volume  Risk for Impaired Skin Integrity  Low Self-esteem  Disturbed Body Image  Deficient Knowledge  Bowel Training  Ostomy Management  Anxiety
• 31.
  DESIRED OUTCOMES  Maintain or restore normal bowel elimination pattern  Maintain or regain normal stool consistency  Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain
• 32.
  NURSING CONSIDERATIONS  Promotingregular defecations  Teaching about medications  Decreasing flatulence  Administering enemas  Digital removal of a fecal impaction  (if agency policy permits)  Instituting bowel training programs  Applying a fecal incontinence pouch  Ostomy management
• 33.
  FECAL ELIMINATION PATTERNS Privacy  Timing  Nutrition and fluids  Exercise  Positioning
• 34.
  ALTERED MEANS OFBOWEL ELIMINATION
• 35.
  ALTERED MEANS OFBOWEL ELIMINATION Ileostomy
• 36.
  ALTERED MEANS OFBOWEL ELIMINATION Stoma Form- ation
• 37.
  ALTERED MEANS OFBOWEL ELIMINATION Stoma
• 38.
  STOMA CARE FORCLIENTS WITH AN OSTOMY  Normal stoma should appear red and may bleed slightly when touched  Assess the peristomal skin for irritation each time the appliance is changed  Treat any irritation or skin breakdown immediately  Keep skin clean by washing off any excretion and drying thoroughly  Protect skin, collect stool, and control odor with an ostomy appliance
• 39.
  COMMON TESTS  Direct Visualization  fiber optic endoscopic instruments introduced through the mouth or rectum to inspect integrity of mucosa blood vessels, and organs.  UGI Endoscopy  Colonoscopy http://www.swarminteractive.com/patient_ed_animations.html
• 40.
  COMMON TESTS  Fecal specimens  Ova and Parasites  Guaiac testing  Hidden (occult) blood
• 41.
  Urinary Elimination
• 42.
  KIDNEYS http://www.youtube.com/watch?v=chhNaLi9P3E Urine Formation http://www.argosymedical.com/flash/urine_formation/landing.html
• 44.
  Urinary Elimination  Micturition  The process of emptying the bladder  Contraction of detrusor muscle  Increases pressure on bladder to produce urge to urinate  Pressure overcomes the internal sphincter  Urine enters urethra  Requires relaxation of external sphincter consciously relaxed or contracted
• 45.
  NORMAL MICTURITION MECHANISMAND RELATED BODY STRUCTURES
• 46.
  URINE FORMATION  Nephron  Functional unit of the kidney  Urine is formed here  Glomerulus  Tuft of capillaries surrounded by Bowman’s capsule  Fluids and solutes move across endothelium of the capillaries into the capsule  Bowman’s Capsule  Filtrate move from here into the tubule of the nephron
• 47.
  Aids to NormalUrinary Elimination  Daily fluid intake  Urine produced = fluid consumed  Need 6 to 8 glasses per day of WATER  Activity  External sphincter is part of pelvic floor muscle  Tone needed to maintain voluntary control  Personal Habits  Relaxation  Distractions
• 48.
  STRUCTURES AND FUNCTIONSRELATED TO FLUID ELIMINATION  Characteristics of normal urine:  Color  Clarity  Odor
• 49.
  ALTERED AMOUNT  Oliguria  Diminished, scanty amount <30cc  Anuria  absence of urine  Polyuria  >1500 cc/24 hours  consider intake  Enuresis
• 50.
  COMMON DISRUPTIONS INURINARY ELIMINATION  Dysuria  Painful urination:  Frequency  Hesitancy  Urgency
• 51.
  COMMON DISRUPTIONS INURINARY ELIMINATION  Urinary Tract Infection (UTI)  Can occur anywhere in the urinary tract Cystitis Ureteritis Pyleonephritis More common in women than men
• 52.
  COMMON DISRUPTIONS INURINARY ELIMINATION Urinary retention:  Inability to pass part of the urine in bladder  Common in older men with benign prostate Hyperplasia
• 53.
  COMMON DISRUPTIONS INURINARY ELIMINATION Urinary obstruction Urolithiasis - Stones calculi block or partially block kidney, Ureters, or bladder - Obstruction from strictures, tumors, ed ema
• 54.
  FORMS OF INCONTINENCE UrinaryIncontinence: Failure of major smooth muscle strength of Detrusor muscle of the bladder, instability or obstruction. Incontinences divided into 4 types. Pt may have mixed pattern:
• 55.
  FORMS OF INCONTINENCE  Urge Incontinence Urgency following strong sense to void  Decreased bladder capacity  Alcohol or caffeine ingestion  infection  Stress Incontinence Small amts with laughing, sneezing, coughing  Urgency, frequency
• 56.
  FORMS OF INCONTINENCE  Overflow Incontinence: Retention  Functional Incontinence: Intact urinary and nervous system  Change in environment  Sensory, cognitive or mobility deficit  Void before reaching bathroom
• 57.
  LOSS OF URINARYCONTROL Nursing ASSESSMENT of Urinary Incontinence:  Confirm factors related to episodes  Determine cognitive function and the ability of patient to participate interventions  Make observations during caregiving regarding the amount and frequency of loss of urine and situations surrounding incontinent episodes  Assess abdominal and suprapubic palpation for tenderness and fullness  Determine hydration status and possibility of constipation  Ask specific questions regarding situations that lead to urine loss
• 58.
  ALTERED MEANS OFURINARY ELIMINATION Catheters  urethral  suprapubic  condom
• 59.
  FOLEY CATHETER
• 60.
  FOLEY CATHETERS
• 61.
  FOLEY http://www.youtube.com/watch?v=tynS0E4hBn0
• 62.
  FOLEY
• 63.
  CONDOM/TEXAS CATHETER
• 64.
  BEDSIDE DRAINAGE BAGS
• 65.
  SUPRAPUBIC CATHETER
• 66.
  ALTERED MEANS OFURINARY ELIMINATION Urinary diversion - surgical creations  Ureterostomy - (transureterostomy) Bring Ureters to abdominal surface  Uterosigmoidostomy  Ilea conduit or loop Implant ureter into ileum  Form stoma  Form pouch  Need occasional catheterization to empty  Kock pouch
• 67.
  ILEAL CONDUIT
• 68.
  A NEOBLADDER
• 69.
  NEPHROSTOMY TUBE
• 70.
  THE KOCK POUCH—ACONTINENT URINARY DIVERSION
• 71.
  COMMON TESTS  BUN  http://video.google.com/videoplay?docid=7519331476907982001&q=urinary+system&total=83&start=0&num=10&so=0&type =search&plindex=0  Creatinine Clearance  Urinalysis
• 72.
  COMMON TESTS Visualization procedures KUB An X-ray showing the kidney, ureter, and bladder. This is in reality a plain abdominal X-ray and includes other structures such as the diaphragm above and the pelvis below. http://trismus1.files.wordpress.com/2007/04/eg-kub_2_1withpaint.jpg  Retrograde Pyleography  CT scan