Download FUNDAMENTALS OF NURSING

FUNDAMENTALS OF NURSING
LESSON #15 ASSISTING PATIENTS WITH ELIMINIATION
LECTURE OUTLINE
REFERENCE: E, P, P CH. 9, FON PG. 573-605.
I & O= Intake (po, iv fluids, irrigations, liquids, jello) and Output (urine, feces, drainage,
emesis, wet diapers)
Terms describing bladder emptying—micturition, urination, voiding
II. FACTORS THAT ALTER NORMAL VOIDING.
A. Normal elimination patterns
1. Assess normal patterns
 Often disturbed by physical or psychological factors
 To promote—determine normal pattern, attempt to copy.
 Normal urinary output is 30cc/hr
 Normal healthy adult—body responds to decreased urine output by
triggering the thirst mechanism.
 The purpose of increasing urine acidity through diet is to decrease
microbial/bacterial growth.
2. Accommodation
 Offer often to avoid accidental soiling
 Privacy—insuring privacy helps decrease the reluctance to use assistive
devices (bedpans, urinals, etc)
 Position concerns—assisting male patients to as upright position as
possible helps them urinate easier.
 Sights, sounds, odors—may be embarrassing for patient.
B. Emotional Stressors
Anxiety can result in urinary frequency and urgency, or urinary retention.
1. Increased peristalsis—diarrhea can result from anxiety,
fear, anger, stress
2. Decreased peristalsis—constipation can result from
depression, narcotics, or bedrest
C. Urinary Incontinence
1. Defined—loss of control over voiding. Characterized by
urine flow at unpredictable times requiring disposable
underpads/garments (primary management)
2. Constant or intermittent—common in elderly but not
normal.
3. Interventions to assist
a. Bladder training—schedule, train, may involve
clamping off foley. Involves developing the use of
perineal muscles to increase voluntary control.
b. Pelvic muscle exercises (Kegels)—to strengthen
pelvic floor muscles especially if inconsistent
bladder control (i.e. stress incontinence)
D. Aging Concerns
Incontinence is not an expected result of the aging process
1. Mobility restriction
 Increased risk of constipation
 Increased risk of leaking, slower to toilet
2. Decreased sphincter muscle control
 Requires immediate response to take to toilet, offer
bedpan or urinal
3. Diuretics
 Many of the elderly are on due to CHF
 Increases urinary frequency
 Possible risk of constipation
4. Loss of bladder tone (associated with Foley catheter as
well)
 Increased stress incontinence
E. Immobility
Decreased mobility slows peristalsis of intestines. This increases risk for
UTI and Constipation or Impaction
F. Fluid Loss
Decreased intake, diuretics, diarrhea, sweating
Assess occupation—heavy labor
G. Fecal Incontinence
Ask client what is normal BM pattern at home.
Usually will see either little or no BM with liquid fecal seepage.
1. Transient incontinence—associated with diarrhea
2. Chronic incontinence—loss of sphincter control, decreased
senses, or decreased mental status.
With incontinent patients regardless if urine, bowel, or both—assess skin and if redness
noted keep clean, can expose to air every shift, protect skin (moisture barrier q attends
change)
III. DESCRIBE DEVICES USED TO PROMOTE URINARY DRAINAGE.
Provide as much privacy when patient uses the bedpan, commode, or urinal. It helps to
decrease reluctance for use.
A. Bedpan—2 types metal or plastic, regular or fracture Raise head of bed
after bedpan placed under buttocks—provides comfort and assists in efficient
use. Will learn skill of placement in skills lab.
B. Urinal—to facilitate use, assist patient to as upright position as possible.
C. Foley catheter bag—indwelling, placed using sterile technique. Keep bag
below level of bladder to facilitate drainage and prevent UTI. If no output,
check for kinks in tubing. Most common type of nosocomial infection. Teach
patient clean technique to use at home, Sterile technique is used in hospital.
D. External catheter—also called condom catheter or Texas catheter. Least
invasive urinary drainage.
Undesired outcome is that the skin under catheter appears bluish because it is too small or
too tight. Avoid trauma to urethra by catheter being pulled out.
Hematuria—blood in the urine.
Abnormal fecal color may indicate disease process:
Black, tarry—upper GI bleeding
Clay colored—Bile obstruction
Frank bleeding—hemorrhoid or lower GI bleeding
IV.
METHODS TO RELIEVE CONSTIPATION AND IMPACTION.
A. NUTRITIONAL—assess for intake, high fiber foods, raw fruit, whole
grains, beans, green leafy vegetables. High fiber foods—increase bulk,
which increases fluid content in stool.
B. EXERCISE—increases peristalsis and regularity (work, occupation)
C. MEDICATIONS—diuretics alter output, some medications cause
constipation (narcotics), Kayexalate—given to decrease potassium. Stool
softeners and laxatives.
D. EMEMAS—given to promote defecation. Watch for vagal stimulation.
Soap suds to cleanse. Best position is lateral sims. If complaints of
abdominal cramping, lower the height of the enema container.
 hypertonic—purpose is to pull fluid from circulation into bowel.
Contraindicated if patient is dehydrated
 oil retention—given to soften stool and lubricate the rectum
 cleansing—purpose is to completely evacuate the colon.
“enemas till clear”—usually 3 consecutive. Expelled solution until
clear with fecal particles.
 Medicated—medication administered into colon. sterile precolon prep
 Carminative(Harris, Return flow)—purpose is to relieve
accumulated flatus
E. Manual Removal—Watch for vagal stimulation. Fecal impaction—
indicated by liquid stool seepage with complaint of constipation. No BM
for 3-4 days.
V.
DISCUSS PATIENT/FAMILY TEACHING THAT WOULD ASSIST WITH
PATIENT ELIMINATION.
 Teach about diet changes that can assist with normal bowel
pattern.
 Teach that increased exercise can assist with regularity by
increasing peristalsis.
 Teach about medications that are prescribed for patient.