Concept of Elimination...docx
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This document provides an overview of the concepts of elimination, including definitions, common problems, nursing assessments, and interventions. It discusses the normal functioning of the urinary and gastrointestinal systems and factors that can influence elimination patterns. Common urinary issues covered include urinary tract infections, incontinence, retention, and diversions. For the bowels, constipation, diarrhea, impaction, and incontinence are addressed. Nursing assessments and plans of care for both systems are outlined, along with health promotion strategies and acute and restorative nursing interventions.
Concept of Elimination...docx
- 1. Concept of Elimination By: SHAHINA BANO Objectives At the end of this unit, students will be able to: 1. Define elimination pattern 2. Discuss common problems of elimination. 3. Identify nursing interventions for common problems of fecal elimination. 4. Discuss common problem of Urinary Elimination 5. Identify nursing intervention for common urinary problems 6. Describe factors that can alter urinary function 7. Discuss nursing process for a patient with altered elimination pattern. Elimination Pattern • Elimination patterns are essential to maintain health. • The urinary and gastrointestinal systems together provide the elimination of the body wastes. • The urinary system filters and excretes urine from the body, thereby maintaining fluid, electrolyte and acid base balance. • Normal bowel function provides for the regular elimination of solid wastes. Urinary System • Kidneys Ureters: • Attached to each kidney pelvis,and carries urinary wastes into the bladder. Bladder: • Reservoir for urine
- 2. Urethra: • Urine travels from the bladder through the urethra and passes to the outside of the body through the urethral meatus. Act of urination: • urination, micturation, and voiding are all term for expelling urine from the urinary bladder.A person senses a desire to urinate when the bladder contains only a small amount of urine (150 to 200ml) in an adult and 50-100 ml in a child) Factors Influencing Urination • Disease conditions • Socio-cultural factors • Psychological factors • Muscle tone Factors Influencing Urination (cont'd) • Developmental factor • Fluid balance • Surgical procedures • Medications • Diagnostic examinations Alterations • Urinary retention • Urinary tract infections • Urinary incontinence • Urinary diversions Urinary retention • An accumulation of urine in the bladder because the bladder is unable to partially or complete empty. • The pressure in the bladder builts so that the external urethral meatus is unable to hold back urine. The sphincter opens to allow a small volume of urine to escape, after which the bladder pressure fall enough to allow the sphincter to close.
- 3. • The patient may develop overflow incontinence, means patient may void small amount of urine two or three times an hour with no relief of distention or discomfort Causes • Prostate enlargement • Fecal impaction • Pregnancy (third trimester) • Urethral stricture or edema after child birth/surgery/diagnostic examination • Spinal cord and perineal nerve trauma • Emotional anxiety (alter ability to relax sphincters • Medication (anesthetics and opioid dull bladder sensation Urinary tract infections • Microorganism enter urethra, resulting in bacterial spread, causing inflammation. • Most commonly associated with indwelling urinary catheter use. • Escherichia coli, a bacterium commonly found in the colon is responsible for 75-95% • Poor perineal hygiene, that is, failure to wipe from front to back after voiding or defecating, is common cause of UTI development in women. Causes • Kinked or blocked urethral catheter and urinary retention causes obstruction of urine flow • Poor perineal hygiene, ingredient in bubble bath, improper handled diagnostic instruments, improper sterilized equipments. Urinary incontinence • Temporary or permanent loss of control over voiding. • Incontinence involves incompetent or weakened sphincter and lose of control of voiding. Causes • Multiple child birth • Pelvic organ surgery • Removal of prostate gland weaken sphincter • Mental confusion, sedatives or analgesics, spinal cord injury, bladder spasm, bladder atrophy.
- 4. Types of urinary incontinence • Total • Functional • Stress • Urge • reflex Urinary diversions • any one of several surgical procedures to reroute urine flow from its normal pathway. It may be necessary for diseased or defective ureters, bladder or urethra, either temporarily or permanently. • May be necessary in some patients who have conditions such as bladder cancer, radiation injury to the bladder. Average daily urine output in adult = 1500 ml Terms for altered urine production Polyuria: • The production of abnormally large amount of urine by the kidneyes (more than several liters) Oliuria • Low urine output. (usually less than 500 ml) Anurea • Lack of urine production Altered urinary Elimination Urinary frequency: Voiding at frequent intervels,that is more than 4-6 times per day. Urgency: The sudden strong desire to void. Dysuria: Painful or difficult voiding. Enuresis:
- 5. • Involuntary urination in children beyond the age when voluntary control is normally required. Urinary Incontinence • Involuntary urination, is a symptom, not a disease. • Pelvic muscle exercise or Kegal exercise helps to strengthen pelvic floor muscles and can reduce or eliminate episodes of incontinence. Urinary Retention Empting of the bladder is impaired, urine accumulates and the bladder becomes over distended Neurogenic bladder • Impaired neurogenic function can interfere with the normal mechanism of urine elimination. • Does not percieve bladder fullness and is unable to control the urinary sphincters. Infection Control and Hygiene • Asepsis • Client education • Catheterizationion Assessment of Urinary Elimination • Nursing history – Pattern of urination – Symptoms of alterations – Factors affecting urination Assessment of Urinary Elimination (cont'd) • Physical assessment – Skin and mucous membranes – Kidneys – Bladder – Urethral meatus Assessment of Urinary Elimination (cont'd) • Assessment of urine
- 6. – Intake and output – Characteristics: color, clarity, odor – Urine testing: specimen Nursing Diagnoses • Risk for infection • Toileting self-care deficit • Impaired urinary elimination • Urinary retention Planning • Goals and outcomes – Client will void within 8 hours after catheter removal – Client’s bladder is not distended on palpation • Setting priorities • Continuity of care Implementation: Health Promotion • Client education • Promoting normal micturition: stimulation of reflex, maintenance of habits and fluid intake • Promoting complete bladder emptying • Preventing infection: hygiene and acidifying urine Implementation: Acute Care • Maintaining elimination habits • Medications • Urethral catheterization • Alternatives to urethral catheterization: suprapubic catheters, condom catheters Urethral Catheterization • Types • Insertion
- 7. • Drainage systems • Routine care: hygiene, fluids • Prevention of infection • Irrigations and instillations • Removal Implementation: Restorative Care • Strengthening pelvic floor muscles • Bladder retraining • Habit training • Self-catheterization • Maintenance of skin integrity • Promotion of comfort Evaluation • Client care • Client expectations Home works • List down Points for client teaching: Pelvic Muscle exercise (Kegals) (1300) • List 10 nursing diagnosis for urinary elimination problem Bowel Elimination Gastrointestinal Tract • Mouth • Esophagus • Stomach • Small intestine • Large intestine
- 8. • Anus • Defecation Factors Affecting Bowel Elimination • Age • Diet • Fluid intake • Physical activity • Psychological factors • Position during defecation • Medication Common Problems • Constipation • Impaction • Diarrhea • Incontinence Meconium • the first fecal material passed by the new born, normally up to 24 hours after birth. • Constipation: • Decrease frequency of bowel movement accompanied by prolonged or difficult passage of dry hard stool. • Impaction: • collection of hardened feces in the rectum. • Diarrhea: • Increase in number of stools and the passage of liquid, unformed feces. • Incontinence: • Inability to control bowel movement, causing involuntary loss of feces. Assessment: Nursing History
- 9. • Elimination pattern • Characteristics of stool • Routines • Use of medications or enemas • Changes in appetite • Diet and fluid intake • Exercise patterns • Presence of discomfort Client Assessment • Physical examination • Diagnostic examinations Nursing Diagnoses • Bowel incontinence • Constipation • Diarrhea Planning • Goals and outcomes – Client sets regular defecation habits – Client implements a regular exercise program • Continuity of care Implementation: Health Promotion • Positioning • Privacy Implementation • Maintenance of proper fluid and food intake
- 10. • Promotion of regular exercise • Maintenance of skin integrity Reference • Potter. Perry, Stockert.Hall(2010.Basic Nursing (7th edition) Mosby • Sue C.Delaune,Patrecia K,Fundamental of nursing Standard and Practice, 2nd edition