This document provides information about urinary and bowel elimination. It begins with anatomy and normal functions of the urinary system. It then discusses factors that can affect urination and signs of altered urinary function. It also covers incontinence, diagnostics, urinary health promotion, and urinary catheters. For bowel elimination, it discusses factors affecting function, signs of alteration, diagnostics including specimens and endoscopy, enemas, and fecal diversion including ostomies and their care.

1. ELIMINATION
P&A

3. QUICK ANATOMY MOMENT
 Kidneys
 Ureters
 Bladder
 Urethra

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

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

27. 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

28. 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

29. SPECIMENS

30. CHECKING FOR OCCULT
BLOOD
 http://www.youtube.com/watch?v=Pc3MtqUwFwE

31. COLONOSCOPY
 http://www.youtube.com/watch?v=W0fjO0rsCIw

32. 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

33. 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

34. FECAL DIVERSION
 Procedure
 Ostomy
 Ileostomy
 Colostomy
- temporary or permanent
- irrigation
- clothing
- unusual circumstances

35. STOMA

36. TYPES OF COLOSTOMIES
 Ascending  Descending
Sigmoid

37. TYPES OF COLOSTOMIES (CONT.)
 Transverse

38. CARE OF THE COLOSTOMY
 Assessment
- pink, no pain, flush to skin
 Cleaning
- soap and water
 Bag changing
- disposable vs reusable
 Emotional support

39. COVER UP