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Concepts of ELIMINATION Urinary Elimination Urinary elimination depends on the functions of the kidneys, ureters, bladder and urethra. Kidneys remove wastes from the blood and urine. Ureters transport urine from kidney to bladder Bladder holds urine until urge to urinate ANATOMY FEMALE STRUCTURES MALE STRUCTURES KIDNEY Bean shaped organ On either side of the vertebral column Against deep muscles of back Functioning unit is the nephron High blood flow represents appro, 25% of the C.O. Kidney is very vascular Kidney cont. Kidneys responsible for maintaining a normal RBC volume by producing erthropoietin (which stimulates RBC production in bone marrow) Decreased kidney function leads to ddecrease RBCs leads to decreased HGB Bladder Hollow muscular organ If empty lies in pelvic cavity behind symphysis pubis. Shape changes when filled with urine. Normal bladder can hold about 600ml. URINE 96% WATER 4% SOLUTES ORGANIC SOLUTES UREA* AMMONIA CREATININE URIC ACID INORGANIC SOLUTES SODIUM (Na) CHLORIDE (Cl) MAGNESIUM (Mg) PHOSPHORUS (Phos) SODIUM CHLORIDE (NaCl)* Urine The normal range of urine production is 1-2 liters per day. Urine which is sterile moves in peristaltic waves to bladder. Bladder normally holds approx. 600 ml Protein does not normally filter through glomerulus, Therefore protein in urine (proteinuria) is not a normal finding Factors influencing URINARY ELIMINATION Growth and Development Sociocultural Factor Psychological Factors Personal Habits Muscle Tone Fluid intake Pathological conditions Surgical Procedures Medications Diagnostic Examinations Common Urinary Elimination Problems Urinary Retention Urinary Tract Infection Residual urine Urinary Incontinence Urosepsis/Sepsis (bacteria in the blood stream very serious) Types of incontinence Total Functional Stress Urge Reflex Nursing Knowledge Base Infection control and hygiene E. coli is a common source of UTI. Use medical and surgical asepsis. Developmental considerations Age-related changes can contribute to the development of voiding problems. Psychosocial implications Self-concept, culture, and sexuality influences Cultural Focus Female/Female Male/Male Privacy Family members present Assessments Nursing history Pattern of urination Symptoms of urinary alterations Factors affecting urination Alterations in Urinary Eliminations. Nocturia Frequency Urgency Dysuria Hesitancy Polyuria Oliguria scant < 500ml/d Dribbling Hematuria Retention Residual urine FACTORS AFFECTING URINARY ELIMINATION Medications Activity Environmental barriers Sensory restrictions Past illness Major surgery Urinary diversions Personal habits Fluid Diet Age Assessment of Urine Intake and output Color Pale straw to amber, depends on concentration Clarity Transparent unless problems occurs Odor Ammonia in nature Specimen Collection Urinalysis Clean voided or midstream, sterile, 24 hour Specific gravity Measures concentration of dissolved substances Urine culture 72 hours to determine bacterial growth Diagnostic Examinations KUB, flat plate, or plain film Intravenous pyelogram (IVP) Renal scan Computerized axial tomography (CAT) Renal ultrasound Endoscopy/cystoscope Angiogram Urodynamic testing Assisting Normal Urination Maintenance of elimination habits Patient comfort Maintaining adequate fluid intake Promotion of bladder emptying Strengthening pelvic floor muscles Manual bladder compression Drug therapy ASSESSMENT OF URINATION I&O frequency amount color odor character specific gravity ph abnormal constituents Discomfort Intake and Output NURSING INTERVENTIONS TO PROMOTE U. E. intake & output position hygiene privacy sitz catheterize medications kegel’s exercise Routine Urinalysis Does not require sterile specimen. Screening test for renal function, metabolic disorders, lower urinary tract alteration in fluid imbalances Urinalysis Values Clean- Voided or Midstream Specimen Instruct how to clean meatus front to back (only once per wipe) Give sterile cup Start stream and discard, then collect next stream. Must be in lab within one hours of collection Sterile Specimen Collection of a urine specimen by catheterizing client Obtain from indwelling foley bag. 24 Hour Urine Specimen Urine is collected for 24 hours First voiding is discarded begin time from this voiding. If a specimen is missed test must be restarted. Brown contained with special acid in it not to be touched directly by patient. NURSING DIAGNOSES ALTERED URINARY ELIMINATION INCONTINENCE URINARY RETENTION PAIN acute/chronic BODY IMAGE DISTURBANCE Risk for infection Knowledge deficient Skin integrity, risk for impaired Health Promotion/Restoration Adequate Hydration Micturition Habits Personal Hygiene Emptying bladder completely Infection prevention Skin integrity Tips for preventing Infection in Catheterized Clients Nursing Interventions Insertion of catheters Maintenance of caths Specimens from caths Removing catheters Irrigation procedure Residual urine Suprapubic catheters NSG Interventions Cont. Encourage fluids Increase in fluids prevents stasis of urination and decreases irriatation Decreased fluids contributes to UTI Elderly think they should decrease fluids to help bladder control, will not help will increase UTI I&O every 12 hours unless critical then every hour BOWEL ELIMINATION Bowel Elimination Essential for health, Rids waste Feces is 75% water and 25% solid Alterations in bowel habits are often early s/s of problems in either the GI system or other body systems. Gastrointestinal Tract Is a series of hollow mucous membrane lined muscular organs that begin at the mouth and end at the anal orifice. FUNCTION To prepare food products for use by the body’s cells Promote the absorption of fluid and nutrients ANATOMY Mouth Esophagus Stomach Small intestine (ileum) Ileocecal valve Cecum Ascending Transverse Descending Sigmoid Rectum Anus PHYSIOLOGY Peristalsis Water absorption Storage Secretion of mucus DEFECATION Parasympathetic reflex Defecation reflex Valsalva maneuver Assessment of stool pattern color consistency/shape blood Odor Bowel Diversions Stoma, drainage, skin condition FACTORS AFFECTING BE Age Diet / Fluids Exercise/Activities Stress Schedule Medications Environment Personal Habits Anesthesia/Surgery Diagnostic Test Pathology Irritants Pain Position ALTERED BOWEL ELIMINATION Constipation Fecal Impaction Diarrhea Incontinence Flatulence Hemorrhoids Constipation CONSTIPATION R/T Decreased intestinal motility, altered pattern or schedule Slowed motility in colon, causing prolongd exposure of fecal mass to the intesitnal wall Causes diet changes, meds inflamation, environmental factors, and lack of reg bowel habits. **Lack of Water in diet**** Laxative abuse, change in diet, <bulk,<fluids, Medications (narcotics), <exercise, age,disease=bowel obstruction. Nursing Interventions >bulk, fluids, exercise, schedule, privacy Meds.(Cathartics) 2 types-laxative and purgative Metamucil(Bulk) Minerol oil(softener) Castor Oil (chemical irrit) Colace (wetting agent) MOM(saline-draws water) Suppositories (stimulate flatus and peristalsis) Enemas FECAL IMPACTION Caused from unrelieved constipation, collection of hardened feces, localized in rectum FECAL IMPACTION (seepage of watery stool around hard stool, N&V, abdominal distention, may palpate with digital exam) • Remove impaction • 2.Oil retention enema followed by cleansing enema •DIARRHEA 3.Caution with heart patient, vagal nerve stimulation decrease heart rate • • • • • Increased freq. In loose stools. Fluid and electrolyte imbalance can result DIARRHEA (watery stool, inc. peristalsis, dangerous children and elderly. Caused by diet, irritants, spices, infection, stress, drugs, disease (Crohn’s, Celiacs, ulcerative colitis) Replace fluids as ordered, rectal care, antispasmotics, antidiarrhea (Lomotil) INCONTINENCE Involuntary passage of stool INCONTINENCE Any condition that impairs function or control of the anal sphincter may cause fecal incontinence (spinal cord injury) NSG DX :Alt in Skin Integrity See Hand Out FLATULENCE • • FLATULENCE (excessive flatus caused by air, constipation, meds, anxiety, diet, surgery Nursing Interventions: Correct diet, increase mobility, rectal tube, NG tube HEMORROIDS • • • HEMORROIDS-Distended veins in rectum, internal and external Caused by straining, pregnancy, obesity, increased rectal pressure Treatment-astringents-Witch Hazel soaks to decrease swelling, Anesthetics for pain DIAGNOSTIC TEST Guaiac test Hematest Hemoccult Proctoscopy Proctosignoidoscopy Colonoscopy PHYSICAL ASSESSMENT Inspection Four quadrants Nine regions Auscultation Percussion Palpation Health history Freq Description of usual stool (color, hard/soft, consist.) Appetite Routines to promote normal elimination ( hot liq., laxatives, spec. foods) artificial aids (enemas, laxatives) Artificial orifices (ostomy) Diet history HEALTH HISTORY cont. Daily fluid intake History of surgeries or illness effecting GI tract Medications Emotional state/ social state History of exercise History of pain or discomfort MEDICATIONS Cathartics (laxative) Bulk forming Lubricant Wetting agent Stimulant/irritant Saline Suppository Enema Cleansing Hypertonic Oil Carminative Return Flow Cooling Medication ENEMAS Instillation of a preparation into the rectum and sigmoid colon. Promote defecation by stimulating peristalsis. Cleansing enemas promote complete evacuation of feces from the colon. ENEMA ADMINISTRATION PROCEDURE HIGH VS. LOW AGE POSITION SOLUTIONS HYPOTONIC HYPERTONIC ISOTONIC VOLUME CONSIDERATION NURSING INTERVENTIONS Psychological needs Nutritional needs Hygiene needs Maintenance Teaching SPECIMEN COLLECTION Stool Blood/Parasite Technique Documentation NURSING DIAGNOSES CONSTIPATION DIARRHEA INCONTINENCE ALTERED ELIMINATION BODY IMAGE DISTURBANCE DISCREASED SOCIALIZATION THE END!!!
