This document provides information on the urinary and bowel elimination systems and processes. It describes the anatomy involved in urination including the kidneys, ureters, bladder and urethra. It then discusses the processes of urine formation, micturition, characteristics of normal urine, factors affecting urination, and potential issues like incontinence. For bowel elimination it covers similar topics like factors affecting function, diagnostic tests, specimens, and issues like constipation. It also provides details on procedures like catheterization, irrigation, and care of ostomies.

1. ELIMINATION

2. Quick Anatomy Moment
 Kidneys
 Ureters
 Bladder
 Urethra

3. Urinary Elimination
Urine formation
Filtration – filters blood
- does not filter out RBC’s & protein
Reabsorption – as needed
Water, electrolytes, glucose
Secretion
H,K ammonia, creatinine, uric acid
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

4. Characteristics of 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
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 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
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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
Peritoneal dialysis
Dialysis  Bladder scanner
Hemodialysis

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
Lifestyle
 Personal habits
 Nutrition and fluid intake
 Physical activity
 Culture
 Norms of western culture
 Age
 Infancy
 Elders

26. Factors Affecting Bowel Elimination
Physiological factors
 Pregnancy
 Motor and or sensory disturbance
 Intestinal pathology
 Medications
 Surgery and anesthesia
 Psychosocial factors
 Anxiety
 Depression

28. 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

29. 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

30. Specimens

31. Checking for Occult Blood
 The fecal occult blood test (FOBT) is a
lab test used to check stool samples for hidden
(occult) blood. Occult blood in the stool may
indicate colon cancer or polyps in the colon or
rectum — though not all cancers or polyps
bleed.
 http://www.youtube.com/watch?v=Pc3MtqUwFwE

32. Colonoscop
y A colonoscopy is an exam used to detect
changes or abnormalities in the large
intestine (colon) and rectum. During
a colonoscopy, a long, flexible tube
(colonoscope) is inserted into the rectum. A
tiny video camera at the tip of the tube
allows the doctor to view the inside of the
entire colon.
 http://www.youtube.com/watch?v=W0fjO
0rsCIw

33. 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
Is a procedure in which liquid or gas is
injected into the rectum, to expel its contents
or to introduce drugs or permit X-ray imaging.

34. 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

35. Fecal Diversion
 Procedure: refers to the creation of an ileostomy or
colostomy. An ileostomy is an opening between the surface of
the skin and the small intestine, while a colostomy is an
opening between the surface of the skin and the colon.
 Ostomy
 Ileostomy
 Colostomy
- temporary or permanent
- irrigation
- clothing
- unusual circumstances

36. Stoma

37. Types of Colostomies
 Ascending  Descending
Sigmoid

38. Types of Colostomies (cont.)
 Transverse

39. Care of the Colostomy
 Assessment
- pink, no pain, flush to skin
 Cleaning
- soap and water
 Bag changing
- disposable vs reusable
 Emotional support