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Chapter 8
Urinary and Bowel
Elimination
Testing Urine
• The physician can learn many things
about the function of the body from urine
tests
• Protect patients’ dignity and privacy
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Testing Urine
• Reagents are chemicals used for
diagnostic tests
• They come in tablets and strips
• Some are caustic
– Avoid touching or ingesting them
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Testing Urine
• Always use a fresh urine sample
• If a strip containing multiple tests is used,
place it on a paper towel to process
• Holding upright may cause the chemicals
to run together
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Urine Tests
• pH testing
– Measures the acidity or alkalinity of urine,
revealing kidney function
• Urine specific gravity measures how well
the kidneys concentrate urine
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Urine Tests
• Test for sugar and ketones when
hyperglycemia is suspected
• Compare sample to the color chart
• Take reading at the recommended time
– Waiting too long will cause invalid results
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Catheters
• A catheter drains urine from the bladder
– Used only when medically necessary
• Risk of infection is increased
• Use sterile technique for catheter insertion
and care
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Catheters
• Children
– 6, 8, or 10 gauge
• Adult females
– 14 or 16 gauge
• For adult males
– 14, 16, or 18 gauge
• Monitor I&O if a catheter is used
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Caring for a Catheterized
Patient
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Secure catheter with a strap at all times
Attach tubing to the bed
Avoid opening the closed system
Use sterile technique if the catheter must
be disconnected
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Caring for a Catheterized
Patient
• Keep closed drainage system off the floor
• Attach drainage bag to bed frame
• Keep tubing and bag below bladder
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Caring for a Catheterized
Patient
• Make sure urine is draining freely
• Use care when moving patients to avoid
accidentally dislodging inflated catheter
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Caring for a Catheterized
Patient
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Move bag first, then the patient
Avoid stepping on the tubing
Attach bag to frame of chair
Monitor urine in drainage bag
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Disconnecting the Catheter
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Open package containing plug and cap
Leave package open, but don’t touch it
Disconnect the catheter and tubing
Hold both ends in your hand
Insert plug into the catheter
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Disconnecting the Catheter
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Place the cap over the end of the tube
After covering, put both items down
Use drainage bag when patient is in bed
Never put patient to bed with a leg bag
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Suprapubic Catheter
• A suprapubic catheter is inserted surgically
through the abdominal wall directly into the
bladder
• This catheter may be called a cystostomy
tube
• Catheter may be temporary or permanent
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Bladder Irrigation
• Open method of irrigation involves
– Opening drainage system
– Instilling solution
– Allowing it to drain
– Closing system
• In the closed method, a small amount of
irrigant is injected; the system is not
opened
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Bladder Irrigation
• Closed method
– Small amount of irrigant is injected
– System is not opened
– Avoid forcing solution into the bladder
– Inform RN if it does not readily enter
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Nephrostomy Tube
• Nephrostomy tube is surgically inserted
through the skin into the kidney
• Tube drains urine continuously from the
kidney to the outside of the body
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Nephrostomy Tube
• Nephrostomy tube is connected to a
drainage bag
• Make sure it does not kink or bend
– Will cause a backflow of urine into the kidney
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Dialysis
• Cleanses the blood of toxins and
impurities when the kidneys have failed
• Usually a temporary measure while the
patient awaits a kidney transplant
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Dialysis
• Patients receiving dialysis have fluid and
diet restrictions
• Monitor strict I&O
• Weigh the patient daily
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Hemodialysis
• Hemodialysis is done at a dialysis center
using a machine to clean the blood
• Cleaned blood is returned to the body
• Patients have a shunt, graft, or fistula
through which they receive treatment
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Hemodialysis
• After dialysis, patients may be weak
– Monitor ambulation and watch for dizziness
• Take vital signs upon return
– Then every 2 to 4 hours for 8 hours
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Peritoneal Dialysis
• Involves inserting solution through a
cannula into the abdominal cavity
– Wear a mask since this is a sterile procedure
• Solution hangs on an IV pole
– RN clamps tubing to keep fluid in abdomen
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Peritoneal Dialysis
• After a prescribed period of time (5
minutes to 4 hours), the drain clamp is
released
• Fluid drains from the body through another
tube
– Drainage contains toxins and impurities
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Observations for Peritoneal
Dialysis
• Notify the RN promptly if:
– Dialysate is cloudy or bloody
– Dressing becomes wet or soiled
– Patient has a fever, dyspnea, or pain
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Observations for Peritoneal
Dialysis
• Solution stops running, or runs slowly
• Drainage container is almost full
• Patient has hypotension or is dizzy or
weak
• Tubing or catheter is disconnected
• Patient develops twitching or spasticity
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Bowel Elimination
• Affected by illness, injury, immobility, and
certain medications
• Monitoring and recording bowel
elimination is an important nursing
responsibility
• If patients have no BM in 3 days, inform
the RN
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Bowel Elimination
• Constipation is the inability to pass stool
• Fecal impaction is the most serious form
of constipation
• Unrelieved, it can become life-threatening
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Other Rectal Treatments
• Rectal tube is used to reduce and
eliminate flatus
– Used once every 24 hours for no more than
20 minutes
• Monitor the abdomen for the amount of
distention (stretching)
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Other Rectal Treatments
• Rectal suppositories are inserted into the
rectum to stimulate bowel elimination
• Body heat melts the suppository,
stimulating bowel elimination
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Enemas
• Fluid introduced into the bowel to cleanse
the anus, rectum, and colon
• A cleansing enema cleanses the rectum
and bowel, stimulating movement
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Enemas
• Retention enema is oil-based, and it is
used for constipation or fecal impaction
• Enema softens hard stool and gently
stimulates evacuation
• Sims’ position is used for enemas
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Caring for Patients with Ostomy
• An ostomy is a surgically created opening
into the body
– Those described in this chapter are used for
bowel elimination
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Caring for Patients with Ostomy
• Ostomies are done because of:
– Obstruction
– Cancer
– Bowel disease
– Trauma
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Caring for Patients with Ostomy
• Some ostomies are reversible
– Most are permanent
• The opening to the outside of the body is
called a stoma
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