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elimination, nursing
- 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, Nutrients, electrolytes, protection, 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
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- 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, edema
- 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
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- 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
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- 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