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elimination, nursing

The document discusses normal and altered urinary and bowel elimination, including the anatomy and physiology related to waste excretion, common problems that can disrupt normal elimination, and nursing responsibilities in assessing and promoting normal elimination or treating disrupted patterns. Nursing goals are maintaining or restoring normal elimination, preventing risks like skin breakdown, and managing conditions like incontinence, constipation, or the use of ostomies through various interventions.

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NURSING FUNDAMENTALS FOCUS IX Elimination Needs
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
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.
BLADDER AND BOWEL FUNCTION 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
Structures and Functions Related To Bowel Elimination STRUCTURES AND FUNCTIONS RELATED TO BOWEL ELIMINATION DIGESTION HTTP://WWW.MEDTROPOLIS.COM/VBODY.ASP
STRUCTURES AND FUNCTIONS RELATED 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
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
 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
FACTORS AFFECTING BOWEL ELIMINATION  Lifestyle  Personal habits  Nutrition and fluid intake  Physical activity  Culture  Norms of western culture  Age  Infancy  Elders
FACTORS AFFECTING BOWEL ELIMINATION  Physiological factors  Pregnancy  Motor and or sensory disturbance  Intestinal pathology  Medications  Surgery and anesthesia  Psychosocial factors  Anxiety  Depression
CHARACTERISTICS OF NORMAL STOOL  Color  Odor  Consistency  Frequency  Amount  Shape  Constituents
SELECTED FECAL ELIMINATION PROBLEMS Constipation Diarrhea Bowel incontinence Flatulence
CONSTIPATION  A symptom not 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
FECAL IMPACTION  Mass or 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
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
FECAL INCONTINENCE  Loss of 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
FLATUENCE  Excessive flatus in intestines  Leads to stretching and inflation of intestines  Can occur from variety of causes: Foods Abdominal surgery Narcotics
ASSESSMENT OF BOWEL FUNCTION  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
ASSESSMENT OF BOWEL FUNCTION  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
ABDOMINAL QUADRANTS AND ORGANS
ABDOMINAL QUADRANTS AND ORGANS
ABDOMINAL QUADRANTS AND ORGANS
ABDOMEN  Subjective Assessments:  Any abdominal pain?  N/V?  Appetite good?  Last BM?  Stool formed/loose?
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
ABDOMEN – ABNORMAL ASSESSMENTS  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
AIDS TO NORMAL BOWEL ELIMINATION  Fluid intake and fiber:  Adequate fiber  Adequate fluid intake  Upright posture
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
FECAL INCONTINENCE Assessment key factors:  Is the problem correctable or manageable?  What is the timeline or duration of situation?  Any associated symptoms?
NANDA NURSING DIAGNOSIS  Bowel Incontinence  Constipation  Risk for Constipation  Perceived Constipation  Diarrhea
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
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
NURSING CONSIDERATIONS  Promoting regular 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
FECAL ELIMINATION PATTERNS  Privacy  Timing  Nutrition and fluids  Exercise  Positioning
ALTERED MEANS OF BOWEL ELIMINATION
ALTERED MEANS OF BOWEL ELIMINATION Ileostomy
ALTERED MEANS OF BOWEL ELIMINATION Stoma Form- ation
ALTERED MEANS OF BOWEL ELIMINATION Stoma
STOMA CARE FOR CLIENTS 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
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
COMMON TESTS  Fecal specimens  Ova and Parasites  Guaiac testing  Hidden (occult) blood
Urinary Elimination
KIDNEYS http://www.youtube.com/watch?v=chhNaLi9P3E Urine Formation http://www.argosymedical.com/flash/urine_formation/landing.html
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
NORMAL MICTURITION MECHANISM AND RELATED BODY STRUCTURES
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
Aids to Normal Urinary 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
STRUCTURES AND FUNCTIONS RELATED TO FLUID ELIMINATION  Characteristics of normal urine:  Color  Clarity  Odor
ALTERED AMOUNT  Oliguria  Diminished, scanty amount <30cc  Anuria  absence of urine  Polyuria  >1500 cc/24 hours  consider intake  Enuresis
COMMON DISRUPTIONS IN URINARY ELIMINATION  Dysuria  Painful urination:  Frequency  Hesitancy  Urgency
COMMON DISRUPTIONS IN URINARY ELIMINATION  Urinary Tract Infection (UTI)  Can occur anywhere in the urinary tract Cystitis Ureteritis Pyleonephritis More common in women than men
COMMON DISRUPTIONS IN URINARY ELIMINATION Urinary retention:  Inability to pass part of the urine in bladder  Common in older men with benign prostate Hyperplasia
COMMON DISRUPTIONS IN URINARY ELIMINATION Urinary obstruction Urolithiasis - Stones calculi block or partially block kidney, Ureters, or bladder - Obstruction from strictures, tumors, edema
FORMS OF INCONTINENCE Urinary Incontinence: 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:
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
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
LOSS OF URINARY CONTROL 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
ALTERED MEANS OF URINARY ELIMINATION Catheters  urethral  suprapubic  condom
FOLEY CATHETER
FOLEY CATHETERS
FOLEY http://www.youtube.com/watch?v=tynS0E4hBn0
FOLEY
CONDOM/TEXAS CATHETER
BEDSIDE DRAINAGE BAGS
SUPRAPUBIC CATHETER
ALTERED MEANS OF URINARY 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
ILEAL CONDUIT
A NEOBLADDER
NEPHROSTOMY TUBE
THE KOCK POUCH—A CONTINENT URINARY DIVERSION
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
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